[Chronic leg artery syndrome of exceptional aetiology: regarding 2 cases].
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
X Chanudet
Publications and source records attributed to X Chanudet.
Home blood pressure monitoring in diabetic population.
Normalization of blood pressure is today as necessary as an optimal blood glucose control. These targets aim at reducing the negative consequences of hypertension which is particularly frequent and of poor prognosis for these patients. Nevertheless, the definition of the real blood pressure of these patients is uneasy because of the lack of precision of clinical blood pressure measurement. New methods have been developed to address this insufficiency. Home blood pressure monitoring is characterised by good compliance and accuracy, but patient education needs a special training and validated automated devices. This method has to be proposed to the diabetic population as soon as hypertension may be a problem. These patients will contribute to monitor their own blood pressure as they do it with blood glucose control.
Blood Glucose↗
[Importance of transesophageal echocardiography and computed tomography in the differential diagnosis of a case of papillary fibroelastoma revealed by a neurologic accident].
In the light of a new case revealed by a stroke, the authors confirm the importance of transesophagal echocardiography (TEE), and show that multislide computered tomography can be used as a new efficient tool for the diagnosis of cardiac papillary fibroelastoma (CPF). These benign tumours of endocardium are rare and case reports have been published sporadically. Stroke is an usual clinical complication and the most frequent symptom associated with CPF. Transesophageal echocardiography is the reference for diagnosis of CPF when transthoracic echocardiography is normal. When TEE is contraindicated or technically impossible, multislide computered tomography appears as an interesting alternate solution for diagnosis because of its fast acquisition and high spatial resolution. Symptomatology may be connected to either tumoral embolisation or cruoric emboli. Surgery is required for any symptomatic tumour.
Aged↗
Antihypertensive efficacy and tolerability of low-dose perindopril/indapamide combination compared with losartan in the treatment of essential hypertension.
The aim of the study was to evaluate the antihypertensive efficacy and tolerability of the low-dose combination of the angiotensin-converting enzyme inhibitor perindopril 2 mg plus the diuretic indapamide 0.625 mg (P/I) compared with the angiotensin II antagonist losartan 50 mg (L50) in the treatment of essential hypertension. Patients (n = 277) were randomised, double-blind and allocated to receive either P/I or L50 once daily for a period of 12 weeks. Responder and normalisation rates in the two groups were compared by a chi 2 test. Ambulatory blood pressure monitoring results were compared using the one-tailed Student's t-test. Normalisation rates were significantly greater in the P/I group (76.0%) than in the L50 group (60.0%) (p = 0.009). Responder rates were significantly higher in the P/I group (91.7%) than in the L50 group (81.8%) (p = 0.025). The average blood pressure reductions were: in sSBP (P/I-L50 = -2.4 mmHg; CI: 6.2; 1.3) and sDBP (P/I-L50 = -2.0 mmHg; CI: -4.2; 0.2). The average night-time SBP decrease (ABPM) was significantly greater in the P/I group (p = 0.041). The tolerability was comparable between the two groups in terms of emergent adverse events related to treatment (12.4% for P/I patients and 8.4% for L50 patients). Laboratory evaluations did not show any significant variations. It was concluded the low-dose P/I combination had significantly higher responder and normalisation rates than L50. This study also confirmed the good tolerability of both treatments.
Antihypertensive Agents↗
User procedure for self-measurement of blood pressure. First International Consensus Conference on Self Blood Pressure Measurement.
OBJECTIVE: To review the medical literature regarding the methodology of self-measurement of blood pressure and to provide some practical recommendations regarding protocol and procedure for measurement, documentation and analysis of data, choice and provision of devices and education of patients and physicians. PROCEDURE AND PROTOCOL FOR MEASUREMENTS: Technical recommendations regarding measurement of blood pressure do not differ from usual guidelines. Frequency of measurement remains a matter of discussion. At the beginning of the self-measurements of blood pressure and during the titration phase, there should be a 7-day measurement period with two measurement of blood pressure each morning and two measurements in the evening at pre-stipulated times. For long-term observation, a minimum measurement period of 1 week per quarter is required. The minimum number of measurements performed during each period should be a total of 12 readings recorded within seven working days. Depending on individual needs (e.g. poor compliance) or for pharmacologic studies, a higher frequency of readings could be used. DOCUMENTATION AND ANALYSIS OF DATA: Owing to the lack of reliability of patients' diaries, the use of printer-equipped or memory-equipped devices is advocated. All the recorded data, except those obtained on the first day, must be used for analysis. CHOICE AND PROVISION OF DEVICES: Self-measurement of blood pressure should be performed with validated fully automated devices using a brachial cuff. The preference should be given to apparatus offering the possibility of storing and transmitting measurements. Wrist apparatus should be used with caution due to the risk of measurement errors if it is used inappropriately. A manual device should be considered for patients suffering from irregular cardiac rhythms and patients with large or small arm circumferences, since automated devices have not been validated for use in these situations. Reimbursement of hypertensive patients using validated devices should be considered, so long as they are adequately trained and supervised. EDUCATION OF PATIENTS: In a therapeutic perspective, self-measurement of blood pressure should be performed by trained patients under the supervision of their practitioner. Teaching must be performed by skilled staff in hypertension centers and ultimately in general practice. Self-measurement of blood pressure is to be recommended for any hypertensive patient who is sufficiently motivated to participate in the treatment of his own hypertension. Patients with physical problems or mental disabilities that make them unable to perform or to understand the measuring technique represent the limits of the method. Education of patients must encompass information about hypertension and cardiovascular risk, blood-pressure-measurement procedures, advice on items of equipment and their proper use, protocols, and interpretation of data. A patient's proficiency must be checked before he or she should be considered competent at performing the procedure. Annual reevaluation is required.
Blood Pressure Determination↗
[Leiomyosarcoma of the right ventricle].
A 58-year-old woman has dyspnea and palpitations which reveal a leiomyosarcoma of the right ventricle. The medical imaging shows a lobulated sessile tumor attached to the ventricular septum and the tricuspid valve extending into the pulmonary artery trunk. The resection is performed with a tricuspid valvoplasty. In spite of chemotherapy (epirubicin-cyclophosphamide), relapse is observed with pulmonary metastases 17 months after the surgery. The death becomes on 18 months in congestive heart failure. From this case, the authors make a review of the literature about this exceptional tumour, and talk over the low possibilities of treatment, despite the capacities of the new ways of diagnosis.
Dyspnea↗
[Importance of the blood pressure exercise graph in the diabetic].
The evaluation of the real blood pressure in the diabetic population has a major interest. Arterial blood pressure measure during standardised exercise test could be a supplementary aid in this field of research. This retrospective work is based on 134 diabetic patients compared with age, sex and body mass index matched controls. All of them were tested with a standardised protocol of bicycle ergometer. In the diabetic group, 62 patients present a microalbuminuria over 30 mg/day. The heart rate and arterial pressure do not differ between diabetics and controls before, during, and after the exercise. The registered parameters at the top of the effort are exactly the same for the pulse the systolic and the diastolic blood pressure. Systolic blood pressure gradient during effort is not different between the two groups. The presence of microalbuminuria into the diabetic group do not provoke any modification of cardiac frequency or pressure during the effort. Nevertheless a decrease in systolic blood pressure gradient is noted into the microalbuminuria group despite their older age is in favour of an increase in this parameter. Exercise test has a main place to track down coronary disease and the field of interest is the same that non diabetic patients to find white coat hypertension, to value arterial pressure reactivity during effort of hypertensive athletes or border line hypertensives. The signification and interest of the modification of systolic blood pressure gradient should to be evaluated by other works.
Blood Pressure↗
[Can ambulatory arterial blood pressure monitoring taken in the 4th month of pregnancy in normotensive primaparas predict the appearance of a fetomaternal event? Results of a French multicenter study. Report of 170 cases].
OBJECTIVE: To evaluate in a primigravid normotensive population the predictive value of outcome of the ambulatory blood pressure monitoring (ABPM) at the 4th month of pregnancy. DESIGN AND METHODS: A longitudinal observational study was carried out in 174 primigravid normotensives free from proteinuria and glycosuria during the first trimester. These women underwent an ABPM (Spacelabs 90207) at 17 +/- 3 weeks gestation and were then followed up throughout pregnancy for the identification of outcome: gestational hypertension (blood pressure > or = 140/80), proteinuria, hyperuricemia, preterm delivery, birth weight < 10th percentile, need for admission to the special care neonatal unit (SCNU). STATISTICS: Non parametric tests, ROC curves. RESULTS: Of the 174 women, 170 had sufficient readings to be considered for analysis. Pre-eclampsia occurred in 5 cases (3%), gestational hypertension in 27 (16%), proteinuria in 20 (12%), hyperuricemia in 2 (1%), preterm delivery in 11 (6%), low birth weight in 9 (5%) and admission to SCNU in 16 (9%). Women with gestational hypertension already exhibited at the 4th month, both ambulatory and clinical blood pressure (BP) higher than did normotensive women (respectively: 117 +/- 7/70 +/- 5 vs 110 +/- 7/65 +/- 6 mmHg, p < 0.0001 for 24-hour ABPM, and 124 +/- 8/76 +/- 7 vs 117 +/- 10/70 +/- 9 mmHg, p < 0.005 for clinical BP). There was a non significative trend for both ambulatory and clinical values to be slightly higher in the setting of preterm delivery, proteinuria and admission to SCNU and in contrast to be slightly lower in case of low birth weight. The occurrence of one outcome or more (49 outcomes, low birth weight excepted), was associated with significantly higher ambulatory and clinical BP levels (114 +/- 7/68 +/- 6 vs 111 +/- 7/65 +/- 5 mmHg, p < 0.009 for ABPM, and 121 +/- 9/74 +/- 8 vs 117 +/- 9/70 +/- 8 mmHg, p < 0.007 for clinical BP). Positive and negative predictive values for the outcome of gestational hypertension were respectively for systolic ambulatory BP of 28% and 95% using a cut off value of 115 mmHg and for systolic clinical BP of 26% and 97% using a cut-off value of 120 mmHg. CONCLUSION: ABPM in a normotensive primigravid population at 17 weeks of gestation is not a better predictor of outcome, even of gestational hypertension, than clinical measurement.
Adult↗
Relationship between diabetic autonomic dysfunction and heart rate variability assessed by recurrence plot.
Beat-to-beat heart rate (HR) and blood pressure were measured by the Finapres system in 44 healthy and 64 diabetic subjects in the at-rest condition. Autonomic control in diabetic subjects was assessed by the Ewing test. HR variability was explored by both linear and nonlinear methods. Linear methods used HR standard deviation and power spectrum. The percentage of the spectrum in the low frequencies was used to assess the sympathetic tone of the autonomic control. The nonlinear method used the "recurrence plot." This method explored long parallel subsequences in the HR time series. These sequences characterize the dependence of the HR dynamics on initial values. The HR standard deviation was reduced in the diabetic subjects compared with the healthy subjects (2.80 +/- 1.17 vs. 3.64 +/- 1.45 beats/min; P < 0.001). In the diabetic subjects, the HR standard deviation and the percentage of the spectrum in the low frequencies showed no correlations with the Ewing score (P > 0.10). In contrast, the longest length index was very strongly correlated to the Ewing score (r = -0.60; P < 0.0001). The results suggest that nonlinear methods might be powerful to explore the autonomic dysfunction in diabetic subjects.
Adult↗
The trough: peak ratio and the normalization of blood pressure profiles.
Experts from the Food and Drug Administration (FDA) of the USA have assumed that hypertensive patients are likely to achieve greatest benefit from therapy in which the antihypertensive effects do not vary excessively during the course of the day. They suggested that the ratio of the minimal (trough) effect to the maximal (peak) effect of the drug should be no lower than 0.5. The concept of the trough: peak ratio (TPR) raises many practical problems. Using actual data, the effect of a drug often shows erratic fluctuations with several local minima and maxima. Mean blood pressure levels for several hours have been used to estimate the trough and peak effects. Blood pressure averages over 4 h may e a good choice, because blood pressures measured 4 h apart are not correlated. The statistical distribution of the TPR is not Gaussian. Negative and very low or positive and very high individual ratios are frequently observed. Therefore, the individual TPR is of questionable clinical value, except when the ratio is applied for responders only. The TPR can be calculated for a sample. In that case, the bootstrap method can be used to estimate the error of the TPR. Most important is the question of why the TPR should be higher than 0.5. We introduced the concept of 'normalization of the blood pressure profile', namely 'reducing the blood pressure profiles in hypertensives to match those profiles in normotensives'. This concept leads very naturally to the TPR and justifies the lower limit of 0.5 for the TPR.
Journal Article↗
[Circadian variations of blood pressure].
Blood pressure (BP) exhibit diurnal variations with low level during night time and high level during daytime. There is little evidence of an endogenous mechanism of BP variations whereas a lot of clues show the contribution of external factors such as activity, mood, postures. Different pathophysiological conditions may alter the pattern of BP circadian variations. This is the case of severe hypertension, hypertension in the elderly and some secondary forms of the disease. Other pathological conditions concerned by BP rhythm alterations are dysautonomia, complicated diabetes, Cushing syndrome, organ transplantations. Methods currently in use to handle data are reviewed.
Aged↗
[Evaluation of the degree of diabetic dysautonomy with the analysis of heart rate measured at rest with the FINAPRES system].
In this work, we developped the ERK (Eckmann, Ruelle and Khamporst) method of recurrent plots to analyse Heart Rate Variability (HRV), measured by the FINAPRES system in diabetic subjects. Our aim was to search some indices that might characterize the degree of dysautonomy detected in diabetic subjects, using the Ewing tests. The idea was to analyze the recurrences of the HR to previously observed values. When a value of HR, xi measured at the j-th beat come back to an already observed value, we compare the distances between the following measures (xi + 1 to xj + 1), (xj + 2 to xj + 2)... If the distances are under a given criteria during k beats, xi is deterministic of order k. Let n1 be the number of recurrent points and nk the number of k-order deterministic points, with k = 2, 3, 4... We defined the index of determinism nk + 1/nk and the Shannon entropy of the Nk = nk-nk + 1. These indices will be correlated to the total score of the 5 Ewing tests, which represent the standard measure to evaluate the diabetic dysautonomy. Blood pressure (BP) and HR were measured during about 30 minutes using the FINAPRES system in 44 healthy subjects and 60 non-hypertensive diabetic subjects. In the diabetic subjects, the age, the body weight and systolic and diastolic BP were 56 +/- 13 years (mean +/- standard-deviation), 79 +/- 14 kg, 80 +/- 10 mmHg and 137 +/- 20 mmHg. HR was weakly correlated to age (r = 0.29; p = 0.02) and the Ewing score (r = 0.31; p = 0.01). Its standard-deviation is also weakly correlated to age (r = 0.32; p = 0.01) and to the Ewing score (r = 0.34; p = 0.01). Using the ERK method, we obtained indices which are much more correlated to the Ewing score. In particular, the ratio n2/n1 and Shannon entropy were correlated to the Ewing score with r = 0.51 and r = 0.53, respectively (p < 0.0001 in both cases). These indices are also correlated to age (r = 0.40; p = 0.003) in both cases. The ERK method give some indices which are easy to obtain (measurement of HR during a rest period) and easy to interpret. These indices are strongly linked to the dysautonomy score which required a good cooperation of the patient and a great vigilance during its execution. This method could be applied to BP to explore BP regulation in hypertensive subjects.
Adult↗
[Comparison of the efficacy of enalapril + hydrochlorothiazide and captopril + hydrochlorothiazide combinations in mild-to-moderate arterial hypertension by ambulatory measurement of blood pressure].
This two-centre trial compared the efficacy of combinations of enalapril + hydrochlorothiazide (E + H) and captopril + hydrochlorothiazide (C + H) on mild-to-moderate hypertension, after a two-week placebo period, in 26 patients with mild-to-moderate HT (DBP between 95 and 114 mmHg) not controlled by previous treatment, randomized under double-blind conditions into two groups for two 4-week crossover treatment periods separated by a 4-week wash-out period. One group received E + H (20 mg/12.5 mg) followed by C + H (50 mg/25 mg) and the other group received C + H (50/25) followed E + H (20/12.5), once a day. The efficacy of the two treatments was evaluated by 24-hour ambulatory blood pressure monitoring (ABPM) at the start of the study and after each treatment period. Plasma renin activity, aldosterone and angiotensin converting enzyme were assayed under the same conditions. Analysis was based on 26 cases, as none of the patients were withdrawn from the trial. No difference was observed between the two groups in terms of the main biometric and laboratory characteristics. Blood pressure evaluated by ABPM and intermittently was not significantly different between the two groups at the time of inclusion in the study. On intermittent Bp determinations, E + H and C + H decreased diastolic and systolic blood pressure, with no significant difference between the two treatments. On ABPM, the two treatments significantly decreased mean systolic, diastolic and mean blood pressure during the diurnal, nocturnal and circadian periods.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Chronic compartment syndrome].
Among causes of leg pains, a usual disability in athletes, chronic exertional compartment syndrome is far from being uncommon. To the opposite, descriptions concerning the others compartments such as the forearm or thigh are still scarce and poorly documented. A variety of techniques have been described for the measurement of intramuscular pressure. Intramuscular pressure measurement is a valuable and essential tool for diagnosing a compartment syndrome, but it is somewhat controversial when the deep posterior compartment is concerned. Conservative treatment is unsuccessful, whereas surgical decompression yield favorable results; two procedures are performed subcutaneous fasciotomy or open fasciotomy.
Chronic Disease↗
[Primary lymphoma of the adrenal glands].
Explore the source record for details and available documents.
Adrenal Gland Neoplasms↗
[Pseudo-thalassemia in the course of Basedow disease].
Explore the source record for details and available documents.
Female↗
Use of runs test to assess cardiovascular autonomic function in diabetic subjects.
OBJECTIVE: We suggest a simple, noninvasive method to assess the autonomic function in diabetic subjects. The method requires only a monitoring of heart rate (HR) with subjects in the sitting position. RESEARCH DESIGN AND METHODS: Sixty diabetic subjects, 44 men and 16 women, between 20-80 years of age, were recruited, chronologically, for this study. Subjects treated for high blood pressure were not included. Their autonomic function was assessed by the total score of five classical cardiovascular function tests. In the same subjects and in 44 healthy subjects, blood pressure and HR were determined from beat to beat by the Finapres system with subjects in the sitting position. We examined the randomness of the HR changes by calculating the zeta statistic of the runs test on 1,000 successive HR readings (the zeta value is low if the HR changes are random). When the HR changes are random, we consider that the autonomic control of HR is impaired. RESULTS: The zeta values of HR changes were significantly lower in diabetic subjects compared with normal subjects (2.98 +/- 0.97 vs. 3.54 +/- 0.97, P < 0.004). In diabetic subjects, the zeta value was closely correlated to the total score of disautonomy (r = -0.66, P < 0.0001, after correction for age effect) and to the office systolic blood pressure (r = -0.43, P < 0.001). CONCLUSIONS: The zeta value of HR changes might be a marker of the autonomic function in diabetic subjects.
Adult↗
Ambulatory blood pressure in diabetic subjects.
Ambulatory blood pressure (ABP) was measured every 15 min for 24 h in 82 diabetic subjects aged 35 to 79 years and in 66 healthy controls having the same age and office blood pressure. The autonomic control in diabetic subjects was evaluated by the total score of five cardiovascular function tests (a high score means an autonomic neuropathy). The diurnal cycle of BP was assessed by the difference of BP between daytime and nighttime (delta BP = BP in the day - BP in the night). The variability of BP was evaluated by the standard deviations of the readings. Compared with control subjects, diabetic subjects had the same 24-h mean level of BP, a smaller delta BP, and an increased variability during the daytime; however, the differences were in the limit of statistical significance. Clearcut results were obtained in diabetic subjects with autonomic neuropathy. In the latter, the score of autonomic neuropathy was (1) negatively correlated to delta SBP (systolic) and delta DBP (diastolic) (r = 0.44, P = .0004 and r = 0.46, P = .0004, respectively) and (2) positively correlated to the variability of SBP and DBP during the daytime (r = 0.46, P .0004 and r = 0.29, P = .03, respectively). In diabetic subjects, mean level and variability of ABP were positively correlated to urinary microalbumin. The relationships were the most significant when one relates microalbuminuria to the level of SBP in the night (r = 0.42, P < .0003) and to the variability of SBP in the day (r = 0.32, P = .008).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗