[Antinuclear antibodies: analysis of images and classification of immunofluorescence aspects on nuclei isolated from rat hepatocytes]. / Anticorps anti-noyaux: analyse d'images et classification des aspects d'immunofluorescence, sur noyaux isolés d'hépatocytes de rat.

Image analysis and Fourier transformation of the various nuclear immunofluorescence patterns observed while detecting antinuclear antibodies allow an objective and quantitative definition of the fluorescence. They also point out various IF types hidden by the main pattern, without having to dilute the test serum. They make obvious the difference between speckled and reticular patterns, and reveal the existence of intermediate states. The usual nuclear IF patterns (homogeneous, ring, nucleolar, reticulated, speckled and diffuse) may be grouped, according to their photo emission, into nuclear and subnuclear patterns. The first group includes homogeneous, annular and passive nucleolar IF. The second group is composed of speckled, reticulated, mixed, and active nucleolar IF. Alternatively, these aspects may be grouped into three types: homogeneous nuclear IF (homogeneous and ring), heterogeneous nuclear IF (speckled, reticulated and mixed) and nucleolar IF (active or passive). Diffusion can affect or not these aspects and does not apply to a special type or pattern. Image analysis and the study of the image spatial spectrum lead to automated recognition of the IF types, and later on, to the discrimination of antinuclear antibodies.

Erythrocyte sedimentation rate of healthy subjects--chronological aspects.

Thanks to an elaborated mathematical approach, based on statistics and signal processing, the chronological changes of the Erythrocyte Sedimentation Rate (ESR) of young healthy subjects, considered from a collective point of view, have been discriminated into genuine and well-defined rhythms. These rhythms are tied up either to natural (year, season) or 'social' (month, week, holidays) cycles, or to some other causes, still unknown and possibly intrinsic (such is probably the case of a 26.5-day strongly marked period). The solar induced time variation strictly obeys a frequency modulation law, the relative amplitude of which is 10 per cent. Two axes of symmetry are found, centered on 8 August and 8 February. The rhythm is roughly in accordance with seasons. The modulation frequency is maximum at summer time. Oscillations of the ESR are observed during the week and the month. Fridays and the last fortnight of each month appear to be low ESR time.

Chronorhythms of the circulating erythrocytes and leukocytes--correlation with the E.S.R. cycles.

2750 healthy and fasting subjects, 20-30 years old, were studied over a half-year period in 1980. Considering the mean day value as a basic piece of information for statistics, the Erythrocyte Sedimentation Rate (E.S.R.) and the blood counts (erythrocytes, leukocytes, polymorphonuclears, lymphocytes, monocytes and eosinophils) were compared. The timeless relation between E.S.R. and each cell type number or percentage is rectilinear. The stronger slope and relation apply to the polymorphonuclears (PMN) or to the overall leukocytes. The chronological normalized variations of the E.S.R. and of the PMN or leukocyte number or percentage are highly correlated. E.S.R. is less correlated with monocytes, eosinophils and Lymphocytes. Contrary to what could have been expected, the erythrocyte situation is but an intermediate one. The spectra derived from the time variations show that all the cell types, whatever they are, are to be taken into account to explain the E.S.R. value and variation with time, even if, for a given cell type, the correlation and timeless relation were but faint ones. Each cell type has a specific spectrum. Erythrocytes are subject to low frequency variations (316-158 days). PMNs oscillate with time within the medium frequency range (90 days). Lymphocytes, monocytes and eosinophils fluctuate more quickly (53 days).

Quantitation of renal function with 99Tcm-DMSA. A comparison with creatinine clearance in children with single kidney.

To study the accuracy of renal function quantification with 99Tcm-DMSA we compared DMSA renal uptake and creatinine clearance in 16 cases of children with single kidney. The age of the patients ranged from two months to fourteen years. Creatinine clearance was normalized to 1.73 m2. DMSA uptake was measured 7 h after intravenous injection. Background subtraction was used and soft tissue attenuation was taken into account. The uptake was normalized in percentage of the injected activity. A significant correlation was found between creatinine clearance and DMSA uptake (rt = 0.866, p less than 0.01). Normal creatinine clearance range in children (80 to 120 ml min-1/1.73 m2) allowed determination of normal uptake range (36 to 60%). This study indicates that in case of asymmetrical renal impairment renal uptake will reflect split renal creatinine clearance. Since the former is much easier to measure, DMSA should play an important role in the evaluation of differential renal function.

Usefulness of radionuclide ventriculography during transesophageal atrial pacing in the diagnosis of coronary artery disease.

Radionuclide ventriculography before, during, and after atrial transesophageal pacing was carried out in 15 patients with suspected coronary artery disease (CAD) and without myocardial infarction. All patients underwent coronary angiography. Ten patients (group 1) had a coronary lesion > 50% on at least one of the main coronary arteries. Five patients (group 2) had normal coronary arteries. Radionuclide left ventricular ejection fraction (LVEF) before pacing was 56 +/- 3% in group 1 and 59 +/- 3% in group 2 (NS). Radionuclide ventriculography during pacing was 45 +/- 4% in group 1 (P < 0.0001 vs basal in group 1) and 45 +/- 6% in group 2 (P < 0.01 vs basal in group 2, NS vs group 1 during pacing). Immediate postpacing ejection fraction did not differ in the two groups and was identical to the prepacing value. A quantitative regional wall motion analysis was performed in 105 segments. Regional radionuclide ventriculography was calculated in each segment as follows: end-diastolic counts-end-systolic counts/end-diastolic counts. The relative decrease in regional LVEF during pacing was more important in the 39 segments related to a narrowed vessel than in the 66 segments related to normal coronary artery (32 +/- 13% vs 13 +/- 10%, P < 0.0001). A more than 20% relative decrease in at least one segment during pacing occurred in 10 patients in group 1 (sensitivity 100%) and in 2 patients in group 2 (specificity 60%). In conclusion, global radionuclide ventriculography during transesophageal atrial pacing decreases in patients with and without CAD.(ABSTRACT TRUNCATED AT 250 WORDS)

[Radioisotope measurement of coronary flow with atrial stimulation in the normal subject and in patients with coronary disease]. / Mesure radio-isotopique du débit coronaire avec stimulation auriculaire chez le sujet normal et le coronarien

The induction of atrial systole by stimulation is a means of demonstrating insufficiency of myocardial perfusion, even where there is a normal coronary flow under basal conditions in a genuine case of coronary atherosclerosis. The method, which entailed the use of radiocardiography with potassium 42, was first checked for reproducibility. The coronary flow was then measured under basal conditions, and subsequently during or after atrial stimulation at 150/min. in a group of 50 controls and coronary patients. Under atrial stimulation, the value increases by an average of 15 per cent in the controls, and decreases by an average of 32 per cent in cardiac patients with vessels which are patent on coronary angiography. The coronary moiety of the cardiac output increases by an average of 27 per cent in the controls, but does not change significantly in the coronary group. After aorto-coronary by-pass, the coronary moiety of the cardiac output is increased significantly during stimulation when the by-pass is patent.

[Measurement by isotope study of the cardiac output in the elderly]. / Mesure par étude isotopique du débit cardiaque chez le vieillard.

Cardiac output and haemodynamic volumetric values (stroke volume, stroke index, left ventricular end-diastolic volume, blood volume, mean corpuscular volume and packed red cell volume) were measured in a population of 69 very old subjects (80 to 102 years) whose heart was regarded as normal on the basis of criteria determined, by radiocardiography and radionuclide ventriculography. These harmless and non-invasive techniques provided reference values in subjects of a seldom explored age group. Altogether, these values were lower than those of younger adults, and they decreased with age. Their reliability is due to the fact that they were obtained by true measurement and not by extrapolation of results observed in adults.

[Study of coronary perfusion by radioisotopes]. / Etude de la perfusion coronarienne par les radio-isotopes.

The study of coronary blood flow by radio isotpopes may determine the casual relationship between coronary artery narrowing and myocardial ischemia. Total coronary flow is measured without cardiac catheterisation by double counter technique using 84 Rb and by radionuclide angiography using 42 K and 113m in fixed on siderophilin. This is an easier method, which is very reproductible and which may be sensitised by atrial pacing. The measurement of regional coronary flow gives a better estimation of the physiological effects of coronary artery disease. Two indicators are used; radioactive gases (113 Xe and more recently 81 m Kr) and microspheres tracers. Selective coronary injection of biodegradable microspheres labelled with 99m Tc and 113m In may be used to assess the hyperemic reaction in the coronary arteriolar territory to the triiodide contrast media used in coronary angiography, and to estimate the reserve coronary blood flow. The transmural perfusion may be studied in animal experiments with non-biodegradable microspheres. Tomographic techniques should allow quantification of myocardial perfusion in man.

[Induced coronary spasm: immediate revascularization by the opposite coronary artery. Use of myocardial scintigraphy]. / Spasme coronaire provoqué revascularisation immédiate par suppléance hétérocoronarienne. Apport de la scintigraphie myocardique.

The case reported analyses the instantaneous revascularisation distal to a coronary spasm by electrocardiography and thallium scintigraphy. The patient, a 48 year old man, had an 18 months history of spontaneous anginal chest pain sensitive to trinitrin. No electrocardiogrammes had been recorded during an attack. Coronary angiography was normal apart from a slight reduction in calibre of a dominant right coronary artery. Injection of 0.4 mg methylergometrine provoked an occlusive spasm of this artery after 4 minutes. At the same time the patient experienced angina and 4,5 mm depression of the ST segment, without ST changes in D3 and AVF, was observed. Opacification of the left coronary artery during spasme of the right showed retrograde revascularisation of the posterior interventricular artery which was reversed when the coronary spasm was terminated with trinitrin. Thallium scintigraphy was performed during another spasm provocation test four days later which gave identical clinical and electrical changes. A zone of hypofixation with blurred limits over the inferior myocardial wall was demonstrated. In the absence of ST elevation and of lacuna on myocardial scanning, the myocardial ischaemia induced by this occlusive spasm could not be considered to be total. Therefore the immediate revascularisation of the coronary artery in spasm seemed to have played the role of an effective collateral circulation.

[Postinfarction segmental asynergy: correction after angioplasty. Predictive value of exercise thallium scintigraphy]. / Asynergie segmentaire postinfarctus: correction après angioplastie. Valeur prédictive de la scintigraphie au thallium d'effort.

The aim of this study was twofold: to evaluate the frequency of reversibility of segmental post-subendocardial infarction asynergy after coronary angioplasty, and to test the predictive value of the redistribution phenomenon during stress Thallium scintigraphy with respect to the reversibility of segmental asynergy. The inclusion criteria for this study were: previous postsubendocardial myocardial ischaemia with residual resting or effort ischaemia documented with or without the Thallium test, segmented asynergy documented by quantitative analysis of the ventriculography, complete correction of coronary angioplasty of stenotic single or double vessel disease, a balanced coronary distribution or dominant left coronary in cases of lesion of the circumflex artery. Out of 254 consecutive angioplasty procedures 39 patients met these inclusion criteria. The location of the subendocardial infarct (SEI) was anterior in 17 cases and inferior in 22 cases. The study protocol included a Thallium scintigraphy from the 10th day after SEI, ventriculography 24 hours later, angioplasty and control ventriculography 24 hours after angioplasty. Comparison of the two ventriculographies opposed Group A (reversible asynergy) and Group B (irreversible asynergy) according to criteria defined in 15 normal subjects whose average regional ejection fraction (REF) was 0.53 +/- 0.11. This result enables definition of normal segmental motion if the REF greater than 0.30 (mean--2 SD); hypokinetic if the REF greater than 0.30 or akinetic if the REF less than 0.10 (mean--4 SD). An increase of REF of 0.15 (50% of the minimal normal value) allowed definition of reversibility of asynergy. By these criteria, 19 patients (48.7%) had reversible asynergy after PTCA; 20 had definitive asynergy (51.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Tolerance of amlodipine in left ventricular dysfunction of ischemic origin]. / Tolérance de l'amlodipine dans la dysfonction ventriculaire gauche modérée d'origine ischémique.

The aim of this study was to assess the effects of amlodipine on left ventricular function at rest and on effort, at least 30 days after myocardial infarction. The 30 patients included in the study had resting isotopic ejection fractions of 40 to 60%. At inclusion and after 15 days treatment with 10 mg of amlodipine, the patients underwent exercise stress testing with a standard Bruce protocol and resting and exercise isotopic left ventricular ejection fractions were measured. The association of betablockers was allowed but vasodilator therapy was prohibited. During the second exercise stress test, the duration of exercise increased (437 +/- 167 to 518 +/- 154 s; p < 0.002) and the work level rose from 140 +/- 56 to 169 +/- 60 Watts; p < 0.04. The number of electrically positive tests did not change significantly (33 vs 26.7%; NS). The resting ejection fraction did not increase after 15 days treatment with amlodipine (47.4 +/- 6.7 vs 48.3 +/- 8.9%; NS). Similar results were observed with respect to the exercise ejection fraction (51.4 +/- 10.4 vs 52.6 +/- 8.6%; NS). These patients may however be divided into two subgroups. In the first subgroup of 10 patients, the resting ejection fraction rose by more than 5% with amlodipine whereas the exercise ejection fraction remained unchanged (54.4 +/- 7.7% vs 54.5 +/- 7.5% with amlodipine). In the second subgroup of 20 patients, the resting ejection fraction decreased slightly with amlodipine (48 +/- 6.9% vs 45.3 +/- 8%; p = 0.04) but increased significantly on exercise (45.3 +/- 8% vs 51.7 +/- 9.1%; p < 0.0002). Therefore, amlodipine, a new generation calcium antagonist, does not induce any deleterious effect after myocardial infarction with mild left ventricular dysfunction.

[Measurement of mean pulmonary pressures and right systolic ventricular pressure by radiocardiography]. / Mesure des pressions pulmonaires moyennes et de la pression ventriculaire droite systolique par radiocardiographie

Computer exploitation of some parameters of the radiocardiogram and of the pressures measured by catheterization in a series of 678 subjects, studied both in Paris and in Prague, has made it possible to establish regression equations providing the rates of mean pulmonary arterial and wedge pressures together with the systolic right ventricular pressure on the basis of the radiocardiogram data. The latter was obtained by the conventional technique of the isotope dilution curves or by gamma-angiocardiography. Easy repetition of radiocardiography makes it an interesting investigation for the haemodynamic follow-up of the patients with heart disease.

[Dynamic study of the coronary vascular bed by selective coronary scanning using hyperaemia]. / Exploration dynamique du lit artériolaire coronaire par scintigraphie coronarienne sélective sous hyperhémie.

Advantage may be taken of the hyperaemic response to the iodine contained in the contrast medium injected during coronary angiography to assess the functional value of the coronary tree using radioactive microspheres. This series comprises 73 selective coronary scans performed in the resting state (113 m In marked microspheres) and during the hyperaemic phase (99 m TC marked microspheres) in 70 patients. A positive hyperaemic response distal to severe truncular stenosis indicates a good distal arteriolar bed and collateral circulation for aorto-coronary bypass grafting. After aorto-coronary bypass (23 cases), the hyperaemic response gives an indication of the functional value of the revascularised myocardium. In 71% cases, the results correlate well with the measurement of the peroperative blood flow through the graft. It is usually positive when the bypass graft is implanted with good distal arterial run off.

[Value of hemodynamic surveillance by radiocardiography in human heart transplants]. / Intérêt de la surveillance hémodynamique par radiocardiographie dans les transplantations cardiaques humaines.

Eighteen cases of cardiac transplantation have been carried out for 16 recipients since October 1973, there being 8 survivors at present. The importance of screening in such a treatment is vital. It is a simple method, easy to control, can be carried out at the bedside, is reproducible, reliable, and completely harmless, and by allowing the haemodynamic function of the graft to be seen at all times, helps in the marching of the donor and the recipient, in following the function of the graft in the immediate post-operative period, and in discovering rejection crises, and evaluating the long-term fate of the transplant.

[Selective coronary scintigraphy using labelled microspheres]. / Scintigraphie coronarienne sélective au moyen de microsphères marquées

Selective intracoronary injection of microspheres labelled with radioactive substances which emit gamma rays with different energy levels (Indium 113 m and Technetium 99 m) allows us to explore by scintigraphic methods the areas of distribution of the two coronary arteries. Having been carefully calibrated, the particles are injected in limited numbers, and block the precapillary arterioles, where they gradually diminish in number. Scintigraphic examination is carried out in various projections (anteroposterior, left anterior oblique and right anterior oblique) immediately after coronary arteriography. Coronary scintigraphy allows us to establish the integrity of the distribution network of a coronary trunk which appears normal on coronary arteriography, to visualise the diminution of flow caused by a stenosed but patent trunk, and to visualise the extent of the collateral circulation and the quality of revascularisation achieved by an aorto-coronary bypass operation.

[Radioisotope measurement of left ventricular ejection fraction. Comparison with results of cineangiocardiography]. / Mesure radioisotopique de la fraction d'éjection ventriculaire gauche. Comparaison avec les résultats de la cinéangiocardiographie

The combination of radiocardiography with scintigraphy of the cavities of the heart allows us to calculate the effective systemic ejection fraction. The systolic volume effectively ejected into the systemic circulation is obtained from radiocardiography using Stewart-Hamilton's principle. It is correlated with the left ventricular end-diastolic volume as calculated by planimetry on the scintigraphic record of the cavities of the heart, making due allowance for the geometrical axis of the heart. The ejection fraction measured by this isotope method has been compared with the ejection fraction measured by selective left ventricular cineangiography, both measurements being carried out at an interval of less than 48 hours in 100 patients without valvular disease. The results show an excellent correlation between the two methods (r = 0.94). In the 15 cases where the haemodynamic status of the ventricule appeared to be normal, the ejection fraction meastured by the two techniques was 0.65 +/- 0.04 and 0.66 +/- 0.04 respectively. In those patients with valve disorders with incompetence, the effective systemic ejection fraction is always lower than the total ejection fraction given by cineangiography. The difference corresponds with the fraction of the blood volume which is regurgitated.

[Criteria of detection and treatment of rejection crises following human cardiac transplantation in a series of 10 cases]. / Critères de détection et traitement des crises de rejet après transplantation cardiaque humaine sur une série de 10 cas

Analysis of a series of 10 cardiac transplantations confirmed that the reject phenomena have a paroxysmal course, the diagnosis of which is different according to the time occurence of the reject crises, whether early (acute early rejection) or late (late acute rejection or chronic rejection). Because of the early diagnosis based on the follow-up of the electrocardiogram, of coagulation, of the graft flow, overcome eight rejection crises on the 3 patients with middle-term survival.

[Evaluation of post-infarction disorders of left ventricular contraction by echocardiography and scintigraphy of the cardiac cavities]. / Evaluation des troubles de contraction ventriculaire gauche post-infarctus par l'échocardiographie et la scintigraphie des cavités cardiaques.

The comparison in 36 patients of two-dimensional echocardiography and scintigraphy of the cardiac cavities in the steady state with left cineventriculography selective for the evaluation of anomalies in left ventricular contraction post infarction shows good agreement between these techniques for the detection of major segmental anomalies, a higher sensitivity being found for echocardiography in dyskinesis. The overall rejection fraction calculated by two-dimensional echocardiography is correlated with the ejection fraction calculated in left cineventriculography (r = 0.57; p less than 0.001). The same is true of the overall ejection fraction obtained by cavitary scintigraphy (r = 0.62; p less than 0.01). The indices of residual myocardium in the anterior wall (IRM ant) and the posterior wall (IRM post) calculated in apical echographic section for the two cavities and in left cineventriculography (oblique anterior right) are also well correlated (IRM ant: r = 0.70 and p less than 0.001; IRM post: r = 0.46 and p less than 0.01). The determination of these parameters as well as the percentage of shortening of the left ventricular small axis measured by echocardiography TM, to the smallest value, permits a valid assessment of ventricular function and makes it possible to avoid coronaroventriculography when this function is too impaired.