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Affiliation(s)
- A Labbé
- Unité de réanimation pédiatrique et des maladies respiratoires de l'enfant, Hôtel-Dieu, CHU de Clermont-Ferrand, boulevard Léon-Malfreyt, 63038 Clermont-Ferrand, France.
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Echemann M, Alla F, Briançon S, Juillière Y, Virion JM, Mertès PM, Villemot JP, Zannad F, Aliot E, Breton C, KhalifE K, Neimann JL, Allam S, Admant P, Baille N, Bellanger P, D'Hôtel R, Dambrine P, Dodet JF, Graille M, Kessler M, Rebeix G, Saulnier JP, Thisse JY, Trutt B, Vidal P, Vuillemin MC, Ducimetière P, Fagnani F, Guize L. Antithrombotic therapy is associated with better survival in patients with severe heart failure and left ventricular systolic dysfunction (EPICAL study). Eur J Heart Fail 2002; 4:647-54. [PMID: 12413509 DOI: 10.1016/s1388-9842(02)00028-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In patients with congestive heart failure (CHF), clinical trials have demonstrated the benefit of a number of drugs on morbidity and mortality. Nevertheless so far, there is no published controlled study of long-term antithrombotic therapy in patients with CHF. The aim of this work was to identify the relationship between cardiovascular drug use, especially antithrombotic therapy, and survival of CHF patients in current clinical practice, using an observational, population-based database. METHODS The EPICAL study (Epidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine) has identified prospectively all patients with severe CHF in the community of Lorraine. Inclusion criteria were age 20-80 years in 1994, at least one hospitalisation for cardiac decompensation, NYHA III/IV HF, ventricular ejection fraction < or =30% or cardiothoracic index > or =60% and arterial hypotension or peripheral and/or pulmonary oedema. A total of 417 consecutive patients surviving at hospital discharge were included in the database. The average follow-up period was 5 years. Univariate Cox models were used to test the relationship of baseline biological and clinical factors to survival. Cardiovascular drug prescriptions were tested in a multivariate Cox model adjusted by other known predictive factors. RESULTS Duration of disease >1 year, renal failure, serum sodium > or =138 mmol/l, old age, serious comorbidity, previous decompensation, high doses of furosemide and vasodilators use were independently associated with poor prognosis at 1 and 5 years. Oral anticoagulants, aspirin, lipid lowering drugs and beta-blockers use were associated with better survival. There was no interaction between aspirin and angiotensin converting enzyme inhibitor use on survival. CONCLUSION Antithrombotic therapy was associated with a better long-term survival in our study population of severe CHF. These results together with other previously published circumstantial evidence urge for a prospective, controlled and randomised trial specifically designed to evaluate optimal oral anticoagulants and aspirin in patients with congestive heart failure.
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Affiliation(s)
- M Echemann
- Service d'Epidémiologie et d'Evaluation cliniques, Hôpital Marin, CHU Nancy, France
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Abstract
UNLABELLED Staghorn lithiases in the infant are rare. We report a staghorn lithiasis related to high calcium intake due to the exclusive use of the mineral water Hépar. CASE REPORT In an eight-month-old infant, an abdominal film performed for repeated urinary symptoms showed a right-sided staghorn lithiasis. Past history revealed that his diet had contained as high as four times the recommended daily intake for calcium (1,750 mg) related to the exclusive use of Hépar mineral water. The latter had been discontinued one month prior to admission. Excessive doses of vitamin D (1,480 U/day) were given at this time. Blood tests were normal. Treatment combined surgical removal of the stone by right pyelolithotomy, and three extracorporeal lithotrity courses. A postoperative infection had a simple course after antibiotics. CONCLUSION This staghorn lithiasis is the second case report to complications associated with long-term exclusive intake of Hépar mineral water in an infant. It has been likely favored by excessive doses of vitamin D. It emphasizes the danger of the exclusive use of high-calcium mineral water.
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Affiliation(s)
- J P Saulnier
- Service de pédiatrie, hôpital Jean-Bernard, CHU, BP 577, 86021 Poitiers, France
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Chalumeau M, Saulnier JP, Ainaud P, Lebever H, Stephanazzi J, Lecoadou A, Carsin H. Initial general management and surgery of six extensively burned children treated with cultured epidermal autografts. J Pediatr Surg 1999; 34:602-5. [PMID: 10235332 DOI: 10.1016/s0022-3468(99)90083-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to document the surgical and intensive care methods used in six extensively burned children (EBC), ie, total body surface area (TBSA) burned over 70% or TBSA with deep burns over 60%, treated with cultured epidermal autografts (CEA). METHODS Six EBC, with a mean age of 7.5 years (range, 2.5 to 12) received CEA. Their mean TBSA burned was 82% (range, 70-94) with 74% (range, 60-90) of TBSA with deep burns. All sustained flame burns and inhalation injuries. RESULTS The survival rate was six of six. The average initial and final engraftment rates of CEA were, respectively, 79% (range, 70 to 95) and 84% (range, 72 to 100). CEA definitively covered 45% (range, 18 to 57) of TBSA for a mean cost per child of $80,000 (range, 55,000 to 110,000). CONCLUSION Even if CEA are expensive, such engraftment rates and survival ratio results make them an excellent alternative wound covering method for EBC when donor sites for widely meshed autografts are exhausted.
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Affiliation(s)
- M Chalumeau
- Burn Center, Percy Military Hospital, France
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Vuillerme V, Fohr JP, Saulnier JP, Oriot D, Saulnier JB, Blay D. Convective heat transfer around an infant head. Ann N Y Acad Sci 1998; 858:310-7. [PMID: 9917827 DOI: 10.1111/j.1749-6632.1998.tb10165.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Knowledge of heat and mass transfer between an infant and his environment is necessary to control hospital care conditions, or understand a pathology as Sudden Infant Death Syndrome (SIDS). This paper precises the particular importance of the heat transfer over the head and quantifies the influence of various parameters on natural convection heat transfer.
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Affiliation(s)
- V Vuillerme
- Laboratoire d'Etudes Thermiques (UMR-CNRS 6608), Futuroscope, France
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Oriot D, Berthier M, Saulnier JP, Blay D, Fohr JP, Vuillerme V, Saulnier JB. Prone position may increase temperature around the head of the infant. Acta Paediatr 1998; 87:1005-7. [PMID: 9764899 DOI: 10.1080/080352598750031707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Recommendations to adopt the supine position were followed by a dramatic decrease of SIDS. But no explanation has been given for the association between SIDS and the prone position nor for its decrease in the supine position. We report data on an infant and a mannequin demonstrating an increase in temperature around the head in the prone position. A 4-month-old boy presented an acute life-threatening event related to temperature after febrile otitis despite treatment: 40.5 degrees C, heart rate 280 bpm with circulatory failure and cardiorespiratory arrest requiring resuscitation. There were no seizures. Blood and CSF cultures were negative. The course under antibiotics was favourable. On d 3, we measured temperature at several sites on and around the heat. Temperatures were higher in the prone than in the supine position in pericephalic areas: +1 degrees C (supracephalic), +2.5 degrees C (peritemporal), and +3.5 degrees C (submandibular). In a thermoregulated room, we used a mechanically ventilated mannequin of an infant. The prone position was also associated with an increase in temperature around the head: +3.3 degrees C (supracephalic), +1.8 degrees C (peritemporal), and +1.1 degrees C (submandibular). Changing from the supine to prone position thus increased temperature around the head (infant and mannequin). To our knowledge, this has not been reported before. SIDS is related to factors modifying temperature status and environment. Furthermore, evacuation of heat is mandatory for an infant. We think the increase in temperature around the head in the prone position is due to the absence of convective fluxes, and speculate it could impair thermolysis.
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Affiliation(s)
- D Oriot
- Paediatric Department, University Hospital, Poitiers, France
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Saulnier JP, Nassimi A, Cardona J, Gambert C, Barret D, Berthier M, Levard G, Oriot D. [Bacteroides fragilis meningitis revealing a meningorectal fistula]. Arch Pediatr 1998; 5:641-3. [PMID: 9759210 DOI: 10.1016/s0929-693x(98)80171-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Cases of meningitis due to Bacteroides fragilis are rare; we report a case revealing a meningorectal fistula. CASE REPORT A 2-month-old infant developed a severe sepsis syndrome following a rectosigmoidoscopy for rectal bleeding. Lumbar puncture diagnosed bacterial meningitis. Cerebrospinal fluid (CSF) culture evidenced B fragilis with betalactamase. The initial antibiotherapy was changed for imipenem-metronidazole, which is at present the recommended antibiotherapy. Malformation including pre-spinal tumor and meningorectal fistula was evoked on magnetic resonance imaging (MRI) and confirmed by surgery. The outcome was favorable after surgery and antibiotherapy. CONCLUSION B fragilis meningitis are usually associated with sepsis, whose origin is obvious. In our case, meningitis was isolated, revealing a meningorectal fistula.
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Zannad F, Aliot E, Florentin J, Saulnier JP, Gilgenkrantz JM. Hemodynamic and electrophysiologic effects of a new alpha 2-adrenoceptor agonist, rilmenidine, for systemic hypertension. Am J Cardiol 1988; 61:67D-71D. [PMID: 2894162 DOI: 10.1016/0002-9149(88)90468-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The hemodynamic and electrophysiologic effects of rilmenidine were examined after single oral administration to hypertensive patients. In 8 untreated hypertensive patients, cardiac output, pulmonary pressure and blood pressure were measured before and for 10 hours after the administration of 25 micrograms/kg of rilmenidine (1.3 to 2.4 mg, mean 1.88). In addition, electrophysiologic investigations were performed before and 2 hours after administration. Hemodynamics were repeated in 8 other hypertensive patients receiving 50 micrograms/kg rilmenidine (3.0 to 4.8 mg, mean 3.85 mg). The electrophysiologic study was repeated in 8 other hypertensive patients receiving 50 micrograms/kg of rilmenidine (3.2 to 4.4 mg, mean 3.90). In contrast to the results obtained at the dose of 50 micrograms/kg, there was no significant variation in pulmonary arterial pressure, cardiac index or stroke index after administration of 25 micrograms/kg. No significant variation was observed in heart rate, sinus function, conduction parameters or atrial, nodal and ventricular refractory periods after administration of 25 and 50 micrograms/kg. Rilmenidine, after single oral administration at the 25 micrograms/kg dose, led to a significant reduction in blood pressure and peripheral resistance without any significant change in cardiac output; the 25- and 50-micrograms/kg doses led to no alteration in heart rate and cardiac electrophysiology.
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Affiliation(s)
- F Zannad
- Departement de pharmacologie clinique, Faculté de Médecine, Nancy, France
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Aliot E, Saulnier JP, Bruntz JF, Chevrier J, Gregoire P, Gilgenkrantz JM. [Bidirectional ventricular tachycardia (arguments in favor of reentry)]. Arch Mal Coeur Vaiss 1982; 75:513-9. [PMID: 6180691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Bidirectional ventricular tachycardia, defined as the rapid alternation of the QRS complexes with successive opposing axial deviation, is a rare arrhythmia. In the rare cases which have undergone endocavitary investigations, an infrahisian origin has generally been proved. However, the mechanism of these tachycardias remains poorly understood and is discussed with respect to a new case. Bidirectional tachycardia occurred in a 79 year old woman with previous diaphragmatic and anterior wall infarction. It was a wide QRS tachycardia at 180/min with a succession of ventriculogrammes of opposing axis in the frontal plane and permanent right bundle branch block over the right precordium. The two types of tachycardia were observed, monomorphic type A or Type B or a combination of the two realising an A-B bidirectional tachycardia. The origin of these episodes, which occurred on a background of atrial tachycardia at about 100/min, was ventricular as shown by the absence of a His potential before the ventricular complexes in tachycardia. The presence of ventricular extrasystoles with relatively fixed coupling intervals, and the results of endocavitary investigation were suggestive of a reentry phenomenon ventricular extrastimuli were capable of transforming the bidirectional into monomorphic tachycardia and vice versa; this suggests that A was at times the origin of a reentry B, but protected by A, tachycardia B could be sustained. In the light of previously reported cases with documented endocavitary investigation and this new case, it seems possible to talk in terms of true "bidirectional ventricular tachycardia", a tachycardia whose mechanism is obscure but certainly not univocal.
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Saulnier JP, Nouviaire R, Aliot E, Mariot J, Celotto W, Gilgenkrantz JM. [Reentry tachycardia with complete atrioventricular dissociation probably connected with the right Mahaïm bundle]. Arch Mal Coeur Vaiss 1979; 72:1259-66. [PMID: 121531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A case of reentrant tachycardia with narrow and wide ventricular complexes without appearances of preexcitation is reported. Electrophysiological investigation showed complete retrograde atrioventricular block during tachycardia; left bundle branch block did not show the tachycardia rate. The reentry loop probably comprised: the His bundle, the right bundle branch, a right Mahaïm bundle and possibly a myocardial bridge. Possible intra-hisian reentry is discussed. The initiation of the tachycardia is analysed together with the possible consequences of permanent cardiac pacing.
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Gilgenkrantz JM, Perrot B, Saulnier JP, Aliot E. [The incidence of concealed accessory atrioventricular pathways in paroxysmal junctional tachycardias]. Arch Mal Coeur Vaiss 1979; 72:697-705. [PMID: 117767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Forty patients with normal resting ECGs and a history of paroxysmal junctional tachycardia underwent endocavitory electrocardiography. Accessory atrioventricular pathways were demonstrated in 34 patients (82.5%), 14 of whom (35%) had Kent bundles. The ventriculo-atrial conduction time during ventricular stimulation was constantin 85% of the 40 patients but increased after injection of striadyne (ATP). This may suggest a reentry circuit partially bypassing the atrioventricular node.
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Ducloux G, Faivre G, Perrin A, Raynaud R, Canicave JC, Fauchier JP, Groussin P, Loire R, Saulnier JP. [Use of intravenous disopyramide in 126 cases of cardiac rhythm disorders (author's transl)]. Ann Cardiol Angeiol (Paris) 1978; 27:297-302. [PMID: 80150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Gilgenkrantz JM, Mathieu P, Neimann JL, Saulnier JP, Paquis M, Tenette C, Aliot E. [Postinfarction false aneurysm caused by ventriculo-pericardial communication. Surgical treatment]. Arch Mal Coeur Vaiss 1977; 70:285-90. [PMID: 404986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Dodinot B, Saulnier JP, Massin N. [Electrical treatment for ventricular tachycardia (author's transl)]. Ann Cardiol Angeiol (Paris) 1976; 25:361-5. [PMID: 984721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Gilgenkrantz JM, Saulnier JP, Aliot E, Groussin P. [The physiological mechanisms involved in ventricular tachycardia (author's transl)]. Ann Cardiol Angeiol (Paris) 1976; 25:329-34. [PMID: 984717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Gilgenkrantz JM, Groussin P, Witz F, Cherrier F, Saulnier JP, Dodinot B. [Hemocynamic role of atrial contraction in the acute phase of myocardial infarct]. Arch Mal Coeur Vaiss 1975; 68:1021-8. [PMID: 816267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The authors have studied the haemodynamic role of atrial systole in patients in the acute stage of a myocardial infarction, usually with left ventricular failure. Their main comparison is between the results obtained with stimulation of the right ventricle at a fixed rate and those obtained with bifocal stimulation, thus restoring the atrio-ventricular sequence. The authors discuss their results, and especially their findings of improvement in cardiac output and systemic arterial blood pressure. They raise the question of synchronous stimulation in cases of infarction with heartblock complicated by left ventricular failure, and also of re-establishing sinus rhythm in cases of arrhythmia of supraventricular origin.
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Gilgenkrantz JM, Mentre B, Saulnier JP. [Conduction disorders in the acute stage of myocardial infarction. Anatomo-physiological generalities]. Ann Cardiol Angeiol (Paris) 1974; 23:87-93. [PMID: 4441007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Dodinot B, Saulnier JP, Neimann JL, Sestier F, Mentre B, Faivre G. [Hazards of demand pacemaking during the acute stage of myocardial infarct]. Arch Mal Coeur Vaiss 1972; 65:1423-32. [PMID: 4197115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Lamy P, Anthoine D, Rebeix G, David M, Saulnier JP. [Bronchial cancers and leukemoid reactions]. Ann Med Nancy 1965; 4:589-603. [PMID: 5839666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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