M Brochier

University of Tours , Tours, Centre, France

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Publications (181)73.51 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: Intravenous thrombolysis during the acute phase of myocardial infarction is successful in restoring perfusion in 60 to 80% of cases. When it is unsuccessful, there is disagreement about the best approach to adopt. The article reports the results obtained in 40 consecutive patients treated by angioplasty after thrombolysis had been unsuccessful. Reperfusion was achieved in 92.5% of cases, with a hospital mortality rate of 7.5% (2.5% if patients admitted in a stage of cardiogenic shock are excluded). There was no mortality related to the procedure itself and an emergency aorto-coronary by-pass was not required in any case. Since it is accepted that the subsequent prognosis depends on coronary patency, coronary artery assessment after thrombolysis, followed by angioplasty if the occlusion persists seems to be a logical strategy if the myocardial territory is compromised.
    Annales de Cardiologie et d Angéiologie 02/1992; 41(1):1-6. · 0.30 Impact Factor
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    ABSTRACT: In order to develop a technique which allows the detection of Pattern A (PA) we present in this paper a series of steps for constructing an observation gril (ethogram) which allows for the quantification of behavior in situation of structured interview. The behavioral units making up the final ethogram are derived from inter-item correlations taken from a population of 48 subjects who had suffered heart attacks. The observations on this population permit an inclusion score in the PA. These observations also confirm that the PA present a risk factor which is independent of classical risk factors. A significative positive correlation with work stress has been found showing, in accordance with the view of Friedman and Rosenman that the PA corresponds to a particular behavioral pattern which is dependent on the work environment.
    Annales de Cardiologie et d Angéiologie 10/1990; 39(7):397-402. · 0.30 Impact Factor
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    ABSTRACT: Ambulatory blood pressure measurements in 20 hypertensive patients with uni- or bilateral renal artery stenosis were compared with those in 20 essential hypertensive patients. Analysis of the 24 hour blood pressure curve of the renal artery stenosis group shows a tendency to equalization of blood pressure throughout the day. The nocturnal decrease of systolic or diastolic blood pressure was not significantly different between the two groups (9.2 vs. 15.3 mmHg). The blunted curve seems to be related more to the severity of hypertension than to its aetiology, but further studies are required to elucidate this point.
    Journal of Human Hypertension 09/1990; 4(4):390-2. · 2.82 Impact Factor
  • Cardiovascular Drugs and Therapy 09/1990; 4 Suppl 4:824-5. · 2.67 Impact Factor
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    ABSTRACT: In order to develop a technique which allows the detection of Pattern A (P.A.) we present in this paper a series of steps for constructing an observation grill (ethogram) which allows for the quantification of behavior in situation of structured interview. The behavioral units making up the final ethogram are derived from inter-item correlations taken from a population of 48 subjects who had suffered heart attacks. The observations on this population permit an inclusion score in the P.A. These observations also confirm that the P.A. present a risk factor which is independent of classical risk factors. A significative positive correlation with work stress has been found showing, in accordance with the view of Friedman and Rosenman that the P.A. corresponds to a particular behavioral pattern which is dependent on the work environment.
    Annales Médico-psychologiques revue psychiatrique 06/1990; 148(5):471-82. · 0.20 Impact Factor
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    ABSTRACT: The study of two cases of young patients with renal transplants who, successively and a few months after the procedure, presented a thrombophlebitis of the lower extremities (with or without pulmonary embolism), then an acute coronary insufficiency, without any encouraging or triggering factor, raises the hypothesis that this is not a mere coincidence. In fact, in the literature, numerous cardiovascular risk factors) inherent in complicated chronic renal failure, dialysis, steroid therapy and immuno-suppressive treatment (Azathioprime, under these circumstances) were demonstrated. In addition, abnormalities of the platelets aggregation, hemostasis and fibrinolysis, were at the origin of thrombo-embolic accidents. Besides any specific cardiovascular risk factor or any obvious biological anomaly, there is still a predisposition of patients with renal transplants, to arterial as well as venous thrombo-embolic accidents.
    Annales de Cardiologie et d Angéiologie 07/1989; 38(6):309-12. · 0.30 Impact Factor
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    ABSTRACT: The authors report a case of total anomalous pulmonary venous return (TAPVR) draining into the innominate (brachiocephalic) vein, discovered in a 40-year old male patient and successfully treated by surgery. This type of cardiopathy is usually suspected in the neonatal period, being badly tolerated, and such a prolonged survival is quite exceptional. Survival is conditioned by the site of the TAPVR, by the size of the atrial septal defect and also by the presence or absence of an obstacle to the pulmonary venous return and of pulmonary arterial hypertension. In the absence of pulmonary vascular disease, surgical correction is mandatory and results in regression of the symptoms and of the pulmonary arterial hypertension.
    Archives des maladies du coeur et des vaisseaux 06/1989; 82(5):815-7. · 0.40 Impact Factor
  • C Monpere, G Francois, M Brochier
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    ABSTRACT: The aim of the study was to assess the effects of rehabilitation in 46 consecutive three-vessel coronary disease patients who were considered to have no possibility of revascularization; there were 45 males and one female (mean age 58) sent in the third week after acute myocardial infarction (N = 31) or after unstable angina (N = 15). Left ventricular ejection fraction (EF) was normal in 50% of the patients, but 15% had an EF less than or equal to 0.30. Three patients could not begin their rehabilitation because of unstable angina (N = 2) or severe pulmonary oedema (N = 1). After a 4-week rehabilitation programme, the comparison of stress tests revealed an increase in functional capacities (maximal work-load = 103.6 +/- 27 W before rehabilitation, 126.4 +/- 31 W after rehabilitation, P less than 0.001), and an improvement of the ischaemic threshold [82 +/- 32 W before rehabilitation, 91 +/- 31 W after rehabilitation, P less than 0.05]. During long-term follow up [20.8 months], four patients died of cardiac events [8.7%]; all of them had an EF less than 0.45. Among the 42 living patients 61.9% were asymptomatic, 28.7% had exertional angina, and 9.4% had cardiac complications, and coronary surgery was performed in two cases with good results. The level of return to work was 85% with the mean delay of 1.7 months after rehabilitation. So, rehabilitation in three-vessel coronary disease patients is safe under medical control; improvements in exertional capacities are obvious and give the patients a better self confidence as assessed by the good score of return to work after rehabilitation.
    European Heart Journal 12/1988; 9 Suppl M:28-31. · 14.10 Impact Factor
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    ABSTRACT: BRL 26921 (Eminase registered trade mark in Belgium, Germany and The Netherlands) is the p-anisoyl derivative of the primary (human) lys plasminogen-streptokinase activator complex (APSAC). The acyl-enzyme has the theoretical advantage of causing fibrinolysis in situ in the presence of fibrin clotbound plasminogen. It was administered to 34 patients with severe pulmonary embolism (PE) in an open multicentre study. PE was suspected on clinical, blood gas, ECG, and radiographic data. Pulmonary angiograms performed pre- and post-treatment confirmed the diagnosis and were assessed using the Miller Index (MI). Fibrinogen, plasminogen, alpha-2-antiplasmin, fibrinogen degradation products (FDP), activated partial thromboplastin time (APTT), partial thromboplastin time (PTT) were closely monitored before and after each administration of APSAC. Median angiographic improvement was 50% (range 0-94%). The following adverse events were reported: bleeding at puncture sites (n = 12), haematuria (n = 1), epistaxis (n = 3), fever (n = 2). A blood transfusion was given in one patient with an inguinal haematoma. Systemic fibrinogenolysis occurred in 20/28 patients.
    European Respiratory Journal 09/1988; 1(8):721-5. · 6.36 Impact Factor
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    ABSTRACT: Two cases of MIBG (metaiodobenzylguanidine) scintigraphy are reported: the first case concerns a female patient hospitalized for high blood pressure (HBP) with symptoms evocative of pheochromocytoma. Urinary titration of catecholamines metabolites, which are usually abnormally high, and tomodensitometry permit the visualization of a left adrenal tumor. On the contrary, the MIBG scintigraphy does not show any abnormal fixation. After resection, the pathological examination confirms the diagnosis of pheochromocytoma. The second case concerns a female patient hospitalized for HBP with, on the chest X-Ray, a left postero-inferior density. Serum and urinary catecholamine levels are normal. Tomodensitometry confirms the tumor of the posterior mediastinum and the MIBG scintigraphy demonstrates a focus of thoracic opposite the tumor. After resection, the pathological examination shows an ectopic supernumerary bronchial bud. These two cases illustrate the limitations of MIBG scintigraphy to locate pheochromocytomas. There are false negative (10%) which may be explained by an insufficient uptake of the tracer by the tumor, by an insufficient image formation or by medication interferences. On the contrary, there may be false positives because of histochemical similarities between the chromaffin tissues and certain glandular or neural tumors. Nevertheless, in spite of serious limitations, which we must be aware of, MIBG scintigraphy remains the best primary examination for the location of pheochromocytomas.
    Annales de Cardiologie et d Angéiologie 04/1988; 37(3):147-51. · 0.30 Impact Factor
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    ABSTRACT: Arterial hypertension is frequently and at an early stage complicated by left ventricular hypertrophy, i.e. an increase in muscular mass due to the proliferation of myofibrillae. This in fact is a physiological mechanism aimed at maintaining systolic function and systemic blood flow rate. Left ventricular hypertrophy may be associated with myocardial alterations, such as increase of collagen, abnormalities of diastolic function, reduced contractility, increased cell excitability and disorders of coronary perfusion. It is responsible for a higher risk of cardiovascular mortality. Antihypertensive treatments, therefore, must not only bring blood pressure down to normal values, but also reduce the myocardial mass. In order to avoid a detrimental effect on coronary reserve, it is highly desirable that arterial hypertension and left ventricular hypertrophy regress simultaneously. Regression of the myocardial hypertrophy associated with arterial hypertension is observed with most antihypertensive drugs, except vasodilators that act directly on the vascular smooth muscle, probably due to stimulation of the sympathetic system. Diuretics also have an inconstant beneficial effect on left ventricular hypertrophy. When a choice has to be made between two drugs that have the same antihypertensive activity, it is the one that also brings about an early and lasting regression of myocardial hypertrophy which must be prescribed.
    La Presse Médicale 03/1988; 17(7):333-8. · 0.87 Impact Factor
  • B Charbonnier, M Lang, M Brochier
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    ABSTRACT: Fibrinolysis is a physiological process which aims at dissolving intravascular thrombi and is mediated by activation of plasminogen to plasmin. Streptokinase (SK) and urokinase (UK) are non-specific plasminogen activators. They have proved effective as thrombolytic agents, but their use is limited by the risk of haemorrhages due to systemic fibrinogenolysis. More fibrin-specific drugs have recently been developed. One is a tissue plasminogen activator (t-PA), the other is a urokinase precursor (pro-UK), also called single chain urokinase plasminogen activator (scu-PA). Genetic engineering techniques have resulted in the large-scale production of a "recombinant t-PA" (rt-PA) and a "recombinant scu-PA" (r scu-PA) for therapeutic use, notably in acute myocardial infarction. In vitro, these two drugs exhibit a thrombolytic activity that is equal to, or greater than that of SK or UK. In vivo, their fibrinogenolytic effect is less pronounced, and their thrombolytic effect greater than those of SK or UK. "Acyl-enzymes" have more recently emerged. These are inactive acylated SK-plasminogen complexes which progressively become effective in plasma after deacylation. So far, the most extensively studied of these complexes is BRL 26921 (anisoylated plasminogen streptokinase activator complex, or APSAC) which is administered by bolus intravenous injection. It is more thrombolytic than SK but produces systemic fibrinogenolysis to an equivalent degree. Injected intravenously (by infusion or bolus) during the first hours of a coronary infarction these three new thrombolytic agents have proved effective in promoting coronary reperfusion, with an early coronary patency rate of 70-75%.(ABSTRACT TRUNCATED AT 250 WORDS)
    Archives des maladies du coeur et des vaisseaux 12/1987; 80(12):1785-91. · 0.40 Impact Factor
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    ABSTRACT: Primary hyperaldosteronism (HA1) represent a rare etiology of arterial hypertension (less than 1%). It concerns, most of the time, aldosterone-producing adenomas or bilateral adrenal hyperplasias although intermediate forms have been reported. The diagnosis of HA1 is based on simple examinations, especially systematic measurement of kaliemia in every hypertensive patient with a normal sodium diet before treatment. The elevation of aldosterone blood levels associated with a low plasma renin activity confirms the autonomous nature of the hormonal secretion which is dissociated from the renin-angiotensin system. Study of the ratio aldosterone blood level/ARP and the captopril test are particularly useful in borderline cases. Once the diagnosis of HA1 is made, a topographic analysis may be undertaken; tomodensitometry and adrenal scintigraphy are currently the examinations of choice in the diagnosis of adrenal tumors. Due to biological, morphological and topographic factors, aldosterone-producing adenomas may be identified with a great deal of certainty: surgical excision ensures a cure in a large majority of cases. The treatment of bilateral hyperplasias remains medical.
    Annales de Cardiologie et d Angéiologie 12/1987; 36(9):495-501. · 0.30 Impact Factor
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    ABSTRACT: The authors report 3 cases of acromegaly diagnosed while the patients were in hospital for cardiovascular disease: arterial hypertension in two and hypertrophic myocardiopathy in all three. Coronary arteriography was normal in the 3 patients. The exercise-induced dyspnoea observed in these 3 cases was unexplained by right and left cardiac catheterization results (normal pressures, normal or increased cardiac index). It was most probably related to the myocardial hypertrophy and to abnormalities in diastolic function demonstrated by radioisotopic methods in patients 2 and 3. The degree of myocardial hypertrophy present in these 3 patients seemed to correlate with the size of the pituitary adenoma and the plasma level of growth hormone rather than with the duration or degree of arterial hypertension. After excision of the pituitary adenoma hypertension persisted in 1 case, due to associated adrenal gland hyperplasia, and subsided in the other cases. Abnormalities of diastolic function and dyspnoea are gradually regressing but left ventricular hypertrophy has not significantly decreased after 6 post-operative months.
    Archives des maladies du coeur et des vaisseaux 11/1987; 80(11):1643-50. · 0.40 Impact Factor
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    ABSTRACT: A case of leiomyosarcoma of the pulmonary artery in a 64-year old man without previous cardiovascular disease is reported. The clinical picture, which comprised episodes of paroxysmal dyspnoea associated with acute cor pulmonale, suggested pulmonary embolism. Radioisotope perfusion study and pulmonary angiography seemed to confirm this diagnosis, but no improvement was obtained with a prolonged thrombolytic treatment. The presence of a median mass at CT led to exploratory thoracotomy and to the finding of a tumour in the pulmonary artery, which turned out to be a leiomyosarcoma. The disease rapidly took an unfavourable course. Comparison of this case with data from the literature showed that primary tumours of the pulmonary artery are extremely rare, that they are diagnosed with difficulty and often at a late stage and that their prognosis is usually very sombre.
    Archives des maladies du coeur et des vaisseaux 09/1987; 80(9):1417-21. · 0.40 Impact Factor
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    ABSTRACT: From 1982 to 1984 included, 31 patients under 70 years of age were admitted during the first three hours of a primary myocardial infarction (MI) and are the subject of a randomized prospective study. 16 patients are treated with 5,000 U of heparin given in intravenous bolus, followed with 150,000 IU of urokinase (UK) in intravenous bolus, then 12,000 IU of UK/min for 90 min or a total dose of 1,230,000 IU. 15 patients are treated with heparin alone (intravenous bolus of 5,000 U). Repeated titrations of creatine phosphokinase (CPK) and the coagulation parameters are performed during the first 24 hours. A coronary angiography with ventriculography (RAO 30 degrees) is performed on the 1st day (D1) and the 3rd week (W3). Study of the left ventricular kinetics (LV) is carried out according to the Stanford method. At D1, the rate of coronary patency is 56 p cent (n = 9) in the UK (A) group and 53 p. cent (n = 8) in the control group B (heparin alone). The percentage of late re-thrombosis is 0 p. cent in group A and 12.5 p. cent in group B (heparin alone). 1 patient died in each group. The CPK peak is less high in case of coronary patency in group A than in case of thrombosis (1,444 +/- 413 vs 1,710 +/- 120 U -heparin alone) and occurs earlier (16 +/- 2 h vs 21 +/- 1 h). In group A a significant decrease of fibrinogen (p. 0.01) as well as plasminogen and alpha-2-antiplasmins (p less than 0.001), is noted. No severe haemorrhagic complications nor sustained rhythm disorders are noted.(ABSTRACT TRUNCATED AT 250 WORDS)
    Annales de Cardiologie et d Angéiologie 07/1987; 36(6):313-7. · 0.30 Impact Factor
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    ABSTRACT: The prourokinase-urokinase system physiologically contributes to fibrinolysis activation. It is therefore rational to envisage the use of urokinase in thrombotic diseases, and notably in the acute phase of myocardial infarction (MI) where coronary thrombosis is virtually constant. The main studies on this subject were published in 1975 and in 1985, thus reflecting the changes in therapeutic concepts that have occurred during these 10 years. The older studies concerned patients who were admitted within the first 12 hours of MI and had no early angiographic examination; the results were evaluated indirectly on clinical and enzymatic criteria and on the regression of electrical signs of myocardial suffering. The more recent studies concern patients who are treated at an early stage, often within the first 3 hours of the accident, on the basis of experimental data which favoured early coronary reperfusion as a means of protecting the myocardium; in these studies coronary arteriography is performed immediately after the thrombolytic treatment; computer-assisted studies of the left ventricular function are also carried out, so that the results of thrombolysis are expressed in terms of coronary patency and improvement in segmental kinetics. The results of these different sets of studies have proved to be similar with time. Urokinase, notably when injected intravenously, has a beneficial effect in the acute phase of MI when compared to the conventional treatment. The coronary reperfusion obtained with urokinase is favourable to the myocardium, and the sooner it occurs the better. This benefit is demonstrated by clinical, electrical, enzymatic and angiographic data. Thus, despite its cost, urokinase remains useful in the treatment of MI, notably because it is well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)
    Archives des maladies du coeur et des vaisseaux 06/1987; 80(5):591-7. · 0.40 Impact Factor
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    ABSTRACT: Seldom mentioned as a possible etiology of false positive stress tests (ST), the right atrial hypertrophy (RAH) may cause electrocardiographic aspects evocative of myocardial ischemia in the lower areas. The retrospective study concerns STs in 4 patients, staying in a cardiac rehabilitation center, following (D14) surgery for isolated type II IAC, Fallot's trilogy (n = 1), or dual valvular disease (tricuspid insufficiency and mitral stenosis, n = 1), and presenting all on basal ECG a RAH (group I). These STs are compared to that of a reference group operated (D14) from a IAC type II (isolated n = 3, associated to RVPA n = 1), but without signs of RAH on the rest ECG (group II). All other possible causes of electrically positive STs were eliminated from this study. In patients with RAH, the stress test is positive in the lower area (ST = -1.27 +/- 0.25 mm). In four other patients without HAD, the STest is negative in 3 cases and uncertain in one. These results do not seem to be linked to pre-operative hemodynamic data, nor to sonocardiographic data. Atrial repolarization alone seems to be the cause of these ECG alterations during stress, as demonstrated, in one patient, by sudden variations of the ST segment during a change from an atrial rhythm (AR) (with retrograde atrial depolarization) to a sinus rhythm (SR). These observations suggest the role of atrial repolarization in the origin of false positive stress tests in patients with RAH.
    Annales de Cardiologie et d Angéiologie 06/1987; 36(5):249-53. · 0.30 Impact Factor
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    ABSTRACT: The authors report a case of massive haemolytic anaemia with acute mitral valve regurgitation and left cardiac failure, which occurred one year after surgical reconstruction of the mitral valve for rupture of smaller leaflet chordae. Anaemia, mitral regurgitation and cardiac failure disappeared after mitral valve replacement, using a Carpentier Edwards No. 29 valve. Haemolytic anaemia following mitral valve reconstruction is exceptional. It seems to be due to the suture material lying in a turbulent regurgitation stream when mitral incompetence develops again.
    Archives des maladies du coeur et des vaisseaux 04/1987; 80(3):367-70. · 0.40 Impact Factor
  • Medecine Et Maladies Infectieuses - MED MAL INFEC. 01/1987; 17:361-361.