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Ambulatory 24 hour electrocardiography by the Holter method was carried out in 134 normal subjects (59 men, 75 women, mean age: 42.5 +/- 14 years). The average heart rate over 24 hours was 75 +/- 9 bpm, 82 +/- 10 bpm during the daytime and 64 +/- 8 bpm at night. Maximal and minimal momentary variations (over 5 minutes) were small during the night (+23% and -7%) and greater during the daytime (+47% and -16%). The heart rate slowed progressively over a two hour period before going to bed an increased progressively over a three hour period, reaching a peak and then slightly falling before getting up. The average heart rates of women were faster than in men (+5 bpm). The average heart rate fell with age from 30 years onwards (-0.4 bpm per year). Tobacco consumption did not seem to affect the heart rate. Supraventricular extrasystoles were observed in 68% of subjects during the day, and in 50% during the night; ventricular extrasystoles occurred in 42% of subjects by day and in 23% by night. Only 22% of subjects had no extrasystolic activity. Tobacco consumption and sex were unrelated to the incidence and frequency of extrasystoles. On the other hand, the incidence and frequency of extrasystoles were very significantly related to age.
Arch Mal Coeur Vaiss 1986 Mar
PMID:[Physiological limits of variations in heart rate measured by the Holter method in 134 normal subjects]. 242 96

The exaggerated natriuretic response to extracellular fluid volume expansion (VE) observed in essential hypertension (EH) is related directly to blood pressure (BP) and indirectly to plasma renin activity (PRA). In order to evaluate the precise role of different hormonal parameters, the response to acute VE (isotonic saline, 1,800 ml IV over 3 hours) was assessed in 14 patients with primary aldosteronism (PA, surgically proven adrenal adenoma) and 18 clinically matched EH. At the time of the maneuver, BP and sodium intake were similar in the two groups, but serum potassium (2.89 +/- 0.13 vs 3.69 +/- 0.09 mmol/l), PRA (0.9 +/- 0.2 vs 3.5 +/- 0.9 ng/ml/h) and plasma aldosterone concentration (PAC, 25.9 +/- 3.8 vs 12.6 +/- 1.6 ng/dl) were significantly different. During VE, sodium excretion (UNaV) increased more in PA than in EH (98.1 +/- 15.2 vs 63.5 +/- 7.9 mmol/3 h); moreover, the slope of the regression line relating UNAVVE to UNaVcontrol was significantly steeper in PA. By contrast, the change in BP and indices of VE (hematocrit and plasma protein concentration) as well as the decrease in PRA (-45 +/- 9 vs -43 +/- 5 p. 100) and the increase in ANP (+ 65 +/- 16 vs + 69 +/- 28 p. 100) were similar in the two groups. VE left PAC unchanged in PA, whilst it decreased PAC in EH. We conclude that the natriuretic response to volume expansion is more marked in primary aldosteronism than in essential hypertension, a difference which is not explained by variations in the renin-angiotensin system or atrial natriuretic peptide.
Arch Mal Coeur Vaiss 1989 Jul
PMID:[Renal response to acute volume expansion in primary hyperaldosteronism]. 251 Jun 53

Acute extracellular volume expansion (VE) by isotonic saline is associated with variable change in mean arterial pressure (MAP) in normotensive subjects (NT). Following VE by 1,800 ml isotonic saline in 3 h, two patterns of MAP response were observed in NT: either an increase by more than 10% (SS: sodium or VE sensitive, n = 12) or no change (NSS: non-sodium or VE sensitive, n = 14). We assessed in all subjects the response to VE of glomerular filtration rate (GFR), urinary sodium (UNaV) and kallikrein (UKalV) excretion rate, plasma renin activity (PRA) and aldosterone concentration (PAC). Family history of blood pressure was not different between the groups. In response to VE, MAP increased (88 +/- 3 to 102 +/- 4 mmHg) in group SS and did not change in group NSS (83 +/- 3 to 85 +/- 3 mmHg). Whilst UNaV measured during the hour prior to VE was similar in both groups, the total amount of sodium excreted during VE was higher in group SS than in group NSS (52 +/- 9 vs 32 +/- 3 mmol/3 h, p less than 0.05). Control GFR as well as changes in GFR associated with VE were similar in both groups. A similar decrease in PRA and PAC was observed in both groups and pre-VE values were identical. UKalV was lower in SS than NSS subjects during the pre-VE control jour (0.42 +/- 0.09 vs 0.74 nKat/h; p less than 0.05) and during VE (1.14 +/- 0.16 vs 2.5 vs 0.47 nKat/3 h; p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
Arch Mal Coeur Vaiss 1986 Jun
PMID:[Urinary excretion of kallikrein and sensitivity of blood pressure to acute sodium loading in healthy subjects]. 309 97

The lack of effect of treatment of mild hypertension on the coronary heart disease has motivated researches for a better diagnosis of hypertension. One of the approaches presently under study uses the recording of ambulatory blood pressure using semi-automatic devices. The usefulness of these apparatus is however restricted by the lack of reference values recorded in normotensive control patients. We have recorded ambulatory blood pressure (PAA) in 24 normotensives, 22 untreated hypertensives and 45 treated hypertensive patients, and compared the data obtained to the blood pressure recorded during medical examination (PAC). If a good correlation is usually observed between PAA and PAC, very large and unpredictable discordances are frequently observed. No correlation is found between the difference PAA-PAC and the variability of PAA. This variability does not fully explain the difference observed between PAA and PAC. This variability expressed in mmHg increases with age and the level of BP. Ambulatory BP appears to be a very reproducible value which may allow to improve the definition of hypertension and there-fore the cardiovascular risk.
Arch Mal Coeur Vaiss 1988 Jun
PMID:[Does ambulatory blood pressure measurement allow a better definition of arterial hypertension?]. 314 11

To obtain information on the cardiac rhythm characteristics of subjects without heart disease during their daily work, we examined the continuous 24-hour electrocardiographic recordings of 400 workers from 4 factories in Eastern France presenting with criteria of cardiac normality. Sex, age and socio-professional category were taken into account. Supraventricular extrasystoles were extremely common, being observed in 52 p. 100 of men and 39 p. 100 of women. In men, the frequency of these extrasystoles increased with age (p less than 0.001), and their number was less than 20 per 24 hours in 90 p. 100 of the cases. Ventricular extrasystoles were detected in 40 p. 100 of men and 32 p. 100 of women. They too were age-related, though not significantly. Their number was less than 10 per 24 hours in 68 p. 100 of the cases and 10 to 50 per 24 hours in 28 p. 100. These ventricular extrasystoles usually were monomorphous, regularly coupled (92 p. 100) and isolated. However, 2 attacks of tachycardia were discovered. Episodes of bradyarrhythmia (RR superior or equal to 1500 ms) were present in 25 p. 100 of men and 19 p. 100 of women. They occurred more frequently before the age of 35 than later (p less than 0.001) and the recordings confirmed that they were predominantly nocturnal. Recordings without "disorders of rhythm" were relatively rare (20 p. 100 of men, 28.5 p. 100 of women). Finally, there was no clear-cut correlation between the prevalence or characteristics of these various "rhythmic abnormalities" and the type of professional activity.
Arch Mal Coeur Vaiss 1988 Nov
PMID:[Cardiac arrhythmia observed in 400 workers without obvious heart disease by Holter monitoring]. 314 28

Continuous 24 hour electrocardiography (Holter method) was carried out during work time in 64 workers. They were divided into two groups: the first group comprised 34 subjects with either organic heart disease (coronary artery disease, valvular heart disease, operated coarctation, hypertrophic cardiomyopathy) or a documented arrhythmia without proven underlying cardiac disease; the second group comprised 30 subjects without known cardiac disease but complaining of symptoms suspected to be of cardiac origin or with isolated electrocardiographic abnormalities. At the end of the study we concluded that Holter monitoring is possible in subjects performing physical occupations even in difficult conditions. The trends of heart rate, especially mean heart rate calculated over 10 minute periods, confirmed the relationship between heart rate and the intensity of the physical activity. Atrial extrasystoles and episodes of supraventricular tachycardia were as common in the first as in the second group (20% and 18% respectively). This did not apply to ventricular extrasystoles: they were observed in both groups but were significantly more common in the first group (55% compared to 33%); ventricular extrasystoles, usually of a single configuration and isolated, were more common in the first group, especially amongst the coronary patients. Sinus node dysfunction was only observed in the second group (12.5%), in young subjects, and this occurred with only one exception at night. These findings support previous reports in the literature. However, the interpretation of these results is difficult because of the absence of well established normal values.
Arch Mal Coeur Vaiss 1984 Feb
PMID:[Continuous electrocardiographic registration in occupational medicine]. 642 4

A 58 year old man who died of metastatic carcinoma had undergone electrophysiological investigation 4 years previously for a Wolff-Parkinson-White syndrome (Rosenbaum Type A, Frank and Boineau Type IV) associated with supraventricular tachycardia (SVT) at 180/mn, atrial fibrillation and flutter and slow junctional (or low atrial) rhythm at 70-80/mn. Atrial extrasystoles or appropriate atrial stimulation not only induced and terminated the SVT but also the junctional rhythm and allowed passage from one arrhythmia to another. These studies showed the presence of a left lateral Kent bundle responsible for orthodromic SVT with retrograde conduction through the accessory pathway, and suggested that the junctional rhythm might be due to longitudinal dissociation of the AV node. Autopsy findings confirmed the presence of the left posterolateral Kent bundle in an almost horizontal position, parallel to the mitral annulus (it might therefore have escaped eventual surgical section) and the longitudinal dissociation of the AV node.
Arch Mal Coeur Vaiss 1981 Jul
PMID:[Wolff-Parkinson-White syndrome and longitudinal dissociation of the atrioventricular node. Anatomical and electrophysiological correlates]. 679 2

Between February 1989 and June 1994 193 cases of acute community acquired pneumonia (PAC) which were of intermediate or great severity were admitted to two hospitals in the South West of France. These patients were explored using bronchofibroscopy (FB) with a protected brush (BP) and alveolar microlavage (MLBA) and quantitative cultures were performed, also there were other specimens taken in a regular fashion. The percentage of positive examinations was 60% for brushings (BP), 59% for MLBA and 21% for blood cultures and 16% for serological tests. An aetiology was determined in 137 cases (70.9%). The organisms recovered were Streptococcus pneumoniae (49.6%), gram negative bacilli (17.4%), Haemophilus influenzae (11.7%), Mycoplasma pneumoniae (4.4%), Mycobacterium tuberculosis (4.4%), Staphylococcus aureus (3.6%), Chlamydia pneumoniae (2.2%), Legionella pneumophila (0.7%), and various 5.8%. The overall mortality was 15% despite immediate antibiotics based on the likely organism in 88% of cases. The study of prognostic factors confirmed the Fine score system (determined a posteriori) which constitutes a useful and practical index determining the management of PAC. On the other hand the role of bacteriological documentation in improving the vital prognosis remains to be confirmed. If bronchofibroscopy has appeared to us as a safe and useful means of investigation, the management of these disease remains to specified. We suggest that its use is reserved for subjects with life threatening disease (a Fine score equal to or greater than 3) or for those patients who are likely to have unusual germs: failure of previous antibiotics, diabetes, malnourishment, cancer, airflow obstruction and inhalation.
Rev Mal Respir 1996
PMID:[Acute community-acquired pneumonia of moderate and grave severity investigated by bronchoscopy. Analysis of 193 cases hospitalized in a general hospital]. 871 Dec 37

Venous valves are more frequent in distal veins and venulae, providing a protecting action against blood skin reflux. Structurally simple, collagen and endothelium, they allow a cavity to be formed by distension, when occlusion occurs. Venous angioscopy can distinguish bicuspid floating valves, reinforced, reinforcing valves with free edges and seat valves as well as the presence of apertures of small collateral vessels in the sinus, of which they play a role in the filling up. Valves are inefficient in supine and in standing among 20% of the adult population. Sinuses allow vortices to be created, low recirculating zones, where blood flow move slowly in niches, at a low shear rate, independently from the main stream. A deep vortex is located in sinus, usually empty, but likely to receive red cell aggregates and leukocytes in the condition of stasis and hyperviscosity. Such a vortex is hypoxic, cause of endothelial activation. In such areas fibrin-leucocytic nidus are created, histologically recognized, of which sub-endothelium has become thick and thrombogenic. Two stages characterized its progression: stage I: a few alteration in the valves, little thrombin generation, taken over by the coagulation inhibitors: AT III, APC and TFPI. Stage II: damaged valves, local consumption of the inhibitors and extended generation of thrombin over the platelets, through factor IXa. Hereditary inhibitor deficits increase the risk (frequent factor Leyden V). When the coagulation cascade is considered, VIIa-tissue factor complex appears to be the thrombotic pathway, leading first to wall linked thrombin, uneasily reached by AT III and facteur IXa non inhibited by TFPI, therefore explaining the platelet extension. Monocytes, which can bear tissue factor, may be "lodged" inside the niches. Besides this important role in deep venous thrombosis, incompetent venous valves are responsible for the skin venous hypertension, a subsequent ground for ulcers. Their role in chronic venous insufficiency is uncertain. In the near future, venous angioscopy will bring about new findings about the pathophysiology of venous valves.
J Mal Vasc 1997 May
PMID:[Venous valves in the legs: hemodynamic and biological problems and relationship to physiopathology]. 948 Mar 31