[Fever, acute colitis and renal insufficiency in a 44-year-old woman].
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Acute Disease↗
Biomedical subjects
J Fourcade
Publications and source records attributed to J Fourcade.
Lack of haemodynamic effects of nitric oxide on post-capillary pulmonary hypertension induced by acute sino-aortic denervation.
1. The aims of the present experiments were to define a new experimental model of pulmonary hypertension induced by a post-capillary mechanism and to assess the haemodynamic effects of nitric oxide on post-capillary pulmonary hypertension. 2. Cardiopulmonary variables of 28 male beagle dogs, anaesthetized with chloralose, 16 spontaneous breathing and 12 with assisted ventilation, were studied before and after sino-aortic denervation (SAD). The haemodynamic effects of inhaled nitric oxide (25 p.p.m., 10 min). N(omega)-nitro-L-arginine methyl ester (20 mg kg-1, i.v.), urapidil (0.5 mg kg-1-, i.v.) and propranolol (300 micrograms kg-1, i.v.) were studied after SAD. 3. SAD induced an acute and transient pulmonary hypertension, more marked in spontaneous breathing dogs. This pulmonary hypertension involved a post-capillary mechanism, secondary to the left ventricular haemodynamic effects of the acute increase of left ventricular after-load induced by systemic hypertension. In fact, the increase of mean pulmonary arterial pressure after SAD and the decrease of this parameter after urapidil or propranolol were strongly correlated with the variations of pulmonary capillary wedge pressure. Furthermore, no significant change in pulmonary vascular resistance was found after SAD or administration of alpha or beta-adrenoceptor antagonists. 4. Inhaled nitric oxide did not reverse pulmonary hypertension induced by SAD. N(omega)-nitro-L-arginine methyl ester had no significant haemodynamic effect of pulmonary circulation. 5. In conclusion, the lack of effect of inhaled nitric oxide and nitric synthase inhibitor on pulmonary circulation parameters SAD suggest that endothelium-derived oxide is not involved in the mechanisms leading to post-capillary pulmonary hypertension.
Adrenergic beta-Antagonists↗
Continuous administration of intravenous iron during haemodialysis.
A simple, safe and potentially cost effective method of giving intravenous iron to patients receiving regular haemodialysis therapy is described. The heparin and iron are mixed in normal saline and given as a continuous infusion via the syringe pump present on the modern dialysis machine. No pharmacological incompatibility was observed between iron polymaltose and Heparin Choay or Heparin Roche. No adverse reactions attributable to i.v. iron were observed in over 400 patients and more than 30,000 dialyses.
Anaphylaxis↗
Prognostic value of arrhythmogenic markers in systemic hypertension.
OBJECTIVE: To evaluate the prognostic value of arrhythmogenic markers in hypertensive patients. DESIGN: Two hundred and fourteen hypertensive patients without symptomatic coronary disease, systolic dysfunction, electrolyte disturbances or anti-arrhythmic therapy were included. Recordings were made of 12-lead standard ECGs with calculations of QT interval dispersion, 24 h Holter ECGs (204 patients), echocardiography (187 patients) and signal-averaged ECGs (125 patients). RESULTS BASELINE DATA: echocardiographic left ventricular hypertrophy was found in 63 patients (33.7%), non-sustained ventricular tachycardia (Lown class IV b) in 33 patients (16.2%), ventricular late potentials in 27 patients (21.6%). Mortality: after a mean follow-up of 42.4 +/- 26.8 months, global mortality was 11.2% (24 patients), cardiac mortality 7.9% (17 patients), sudden death 4.2% (nine patients). Univariate analysis: predictors of global, cardiac and sudden death were age > or = 65 years, ECG strain pattern, Lown class IV b and QT interval dispersion > 80 ms (P < or = 0.01). Left ventricular mass index was closely related to cardiac mortality (P = 0.002). Multivariate analysis: only Lown class IV b was an independent predictor of global (RR 2.6, 95% CI 1.2-6.0) and cardiac mortality (RR 3.5, 95% CI 1.2-9.7). CONCLUSION: In hypertensive patients, non-sustained ventricular tachycardia has a prognostic value.
Aged↗
Prognostic value of ventricular arrhythmias in systemic hypertension.
OBJECTIVE: Hypertensive left ventricular hypertrophy is associated with an increased risk of arrhythmias and mortality. However, no clinical study has demonstrated a significant relationship between ventricular arrhythmias and mortality in systemic hypertension. DESIGN AND METHODS: To evaluate the prognostic value of arrhythmogenic markers, we included, prospectively, 214 hypertensive patients aged (mean+/-SD) 59.1+/-12.8 years, without symptomatic coronary disease, myocardial infarction, systolic dysfunction or electrolyte disturbances. At inclusion, a 12-lead electrocardiogram (ECG) with QT dispersion calculation, a 24 h Holter ECG (204 patients) with Lown classification of ventricular arrhythmias, echocardiography (reliable in 187 patients) and a signal-averaged ECG (125 patients) with ventricular late potentials were recorded. RESULTS: At baseline, echocardiographic left ventricular hypertrophy was found in 63 patients (33.7%). Non-sustained ventricular tachycardia (Lown class IVb) was recorded in 33 patients (16.2%) and late potentials in 27 patients (21.6%). After a mean follow-up of 42.4+/-26.8 months, all-cause mortality was 11.2% (24 patients); 17 patients died of cardiac causes (7.9%); of these, nine (4.2%) died suddenly. In univariate analysis, age, Lown class IVb and a QT dispersion > 80 ms were significantly related to global, cardiac and sudden death (P < 0.01). The left ventricular mass index was related to cardiac mortality (P= 0.002). In multivariate analysis, only Lown class IVb was an independent predictor of global and cardiac mortality, increasing the risk of global death 2.6-fold (95% confidence interval 1.2-6.0) and cardiac death 3.5-fold (95% confidence interval 1.2-9.7). CONCLUSION: In hypertensive patients the presence of non-sustained ventricular tachycardia has prognostic value.
Echocardiography↗
[Epiphyseal pain from cyclosporine in renal transplants].
In patients with renal transplant, cyclosporin has been implicated in the occurrence of osteoarticular pain. This syndrome, which we illustrate by two of our observations, is fairly stereo-typed. Osteoarticular pain begins around the second month post-transplant and in a symmetrical pattern involves, knees, ankles, tarsi, less frequently hips, and almost never upper limbs. Pain arises on standing and walking, which is severely impeded. Clinical examination is usually normal. Radiographs show patchy, subchondral osteopenia. Bone scintiscan documents numerous foci of increased uptake and MRI multiple areas of T1-weighted low signal intensity and T2-weighted high signal intensity. Pain disappears in three to six months. Ethiopathogeny is still a matter of discussion with frequent reference to reflex sympathetic dystrophy. The syndrome could also be related to a cyclosporin-induced increase in bone remodelling. Steroids could contribute, as could the healing of pre-transplant, renal osteodystrophy. Microfractures are common but it is not known whether they are causative through an ensuing reflex sympathetic dystrophy or whether they are simply but a consequence of increased bone remodelling.
Arthralgia↗
[Left ventricular repercussion of obesity-induced arterial hypertension in the dog].
UNLABELLED: Obesity and hypertension are frequently associated. The aim of our study was to assess the effects of high fat diet on weight, blood pressure and left ventricule in dogs. We studied 6 male Beagle dogs before and after 7 weeks of hypercaloric hyperlipidic diet. Echocardiography was used to measure left ventricular wall thickness, volumes, ejection fraction and mass. Results are expressed as % of variation of initial values. After 20 weeks, dogs presented abdominal obesity with increased body weight (11.9 +/- 2.3 to 15.2 +/- 2 kg; p < 0.03) associated with an increasing of systolic (196.5 +/- 14.6 to 260.1 +/- 17.5 mmHg; p < 0.03), diastolic (76.6 +/- 9 to 110.6 +/- 10.2; p < 0.004) and mean blood pressure (128.8 +/- 7 to 152.7 +/- 7.6 mmHg; p < 0.004). There were non significant changes concerning diastolic thickness of septum and posterior wall. Left ventricular volumes increased in diastole (41.1 +/- 4.5 to 48.9 +/- 10.3 cm3; p < 0.03) and systole (12.2 +/- 1.7 to 14.9 +/- 3.2 cm3; p < 0.03). So, despite any changes in wall thickness, we observed an increased of ventricular mass (67 +/- 15 to 80 +/- 24.3 g; p < 0.03). Ejection fraction remained unchanged. CONCLUSION: it appears that hight fat diet induces obesity and hypertension in dogs; changes in left ventricule suggest a volodependent hypertension.
Animals↗
[Prognostic value of ventricular arrhythmia in hypertensive patients].
OBJECTIVE: Hypertensive left ventricular hypertrophy (LVH) is associated with increased risk of arrhythmias and mortality. However, no clinical study demonstrated a significant relation between ventricular arrhythmias and mortality in systemic hypertension. DESIGN AND METHODS: To evaluate the prognostic value of arrhythmogenic markers in systemic hypertension, we included between 1987 and 1993. 214 hypertensive patients, 59.1 +/- 12.8 years old, without symptomatic coronary disease, myocardial infarction, systolic dysfunction, electrolyte disturbances or antiarrhythmic therapy. At inclusion, an ECG, a 24 h Holter ECG (204 patients) with Lown classification of ventricular arrhythmias, an echocardiography (reliable in 187 patients) with left ventricular mass index and ejection fraction calculation, a SAECG (125 patients, enrolled after 1988) with ventricular late potentials (LP) were recorded. QT interval dispersion (QTd) was calculated on 12 leads standard ECG and LVH was appreciated. RESULTS: At baseline echocardiographic LVH was recorded in 63 patients (33.7%) with normal ejection fraction (75 +/- 7.4%). Non-sustained ventricular tachycardia (Lown IVb) was found in 33 pts (16.2%) and LP in 27 patients (21.6%). After a mean follow up of 42.4 +/- 26.8 months, all-cause mortality was 11.2% (24 patients); 17 patients died of cardiac causes (7.9%); of these 9 patients (4.2%) died suddenly. In univariate analysis, age, strain pattern of LVH, advanced Lown classes and abnormal QT dispersion (> 80 ms) were significantly related to global, cardiac and sudden death (p < or = 0.01). Left ventricular mass index was closely related to cardiac mortality (p = 0.002). LP failed to predict mortality. In multivariate analysis, only Lown class IVb was an independent predictor of global and cardiac mortality, increasing the risk of global death 2.6 fold [1.2-6.0] (CI 95%) and the risk of cardiac death 3.5 fold [1.2-9.7] (CI 95%). CONCLUSIONS: In hypertensive patients the presence of non-sustained ventricular tachycardia on 24 h Holter has a prognostic value.
Aged↗
[Autonomic nervous system abnormalities in the initial phase of insulin resistance syndrome. Value of the study of variability of cardiac rate and blood pressure on a model of nutritional obesity].
Changes in the activity of the sympathetic activity are often involved in the development of human insulin-resistance syndrome. However, the nature of changes in both the parasympathetic and orthosympathetic components are still controversial. We have recently developed an experimental model reproducing in dog this morbid triptyque (obesity, hypertension and hyperinsulinism), obtained by hypercaloric hyperlipidic diet. The aim of the present study was to characterize the changes in autonomic nervous system and spontaneous baroreflex in the initial period of obesity-hypertension syndrome. Ten male Beagle-Harrier dogs were used in this study. We investigated before and during 20 weeks after the beginning of the hypercaloric diet, plasma insulin, noradrenaline levels, spontaneous baroreflex efficiency (using the sequence method), arterial blood pressure, heart rate and their spectral analysis (fast Fourier Transformation) in both low (LF: 50-150 mHz, reflecting sympathetic activity) and high (HF: respiratory rate +/- 50 mHz, reflecting parasympathetic activity) frequency bands. Body weight (+20%), systolic (SBP: +23%) and diastolic (+16%) blood pressure and heart rate (+19%) increased during 6 weeks and then remained stable. Concomitantly, high frequency of HR (22.01 +/- 1.9 vs 14.15 +/- 1.04% at 7th week) and BF of systolic blood pressure (15.6 +/- 1.1 vs 19.2 +/- 1.2% at 4th week); p < 0.07, showed a rapid decrease in parasympathetic tone and a early increase in sympathetic activity. Nevertheless, in steady state of this syndrome, parasympathetic tone returned to initial values (18.43 +/- 3.25% at 20th week). Insulinemia significantly increased from the 4th week (14.2 +/- 0.9 vs 25.3 +/- 2.2 microUI/mL at 20th week), but noradrenaline remained not modify (400 +/- 85 vs 312 +/- 45 pg/mL at 20th week). Spontaneous baroreflex efficiency also decreased from the 2nd week (35.5 +/- 5.5 vs 16.7 +/- 4.9 mmHg/ms at 20th week). This study shows that an hyperlipidic hypercaloric diet induces a decrease in both parasympathetic tone and spontaneous baroreflex efficiency, which could be the physiopathological link between obesity, hypertension and hyperinsulinism.
Animals↗
Identification of coronary thrombus after myocardial infarction by intracoronary ultrasound compared with histology of tissues sampled by atherectomy.
This study compares the ability of intracoronary ultrasound (ICUS) to identify thrombus by means of actual criteria, with the histologic studies of tissues removed by directional atherectomy in patients treated previously with thrombolytic therapy. Coronary angiography and intravascular ultrasound imaging were performed before atherectomy in 34 patients who had received intravenous thrombolytic therapy for acute myocardial infarction a mean of 6 days before. The lesion morphology and the percentage of stenosis were defined on the angiogram. The ultrasound characteristics of the narrowing were described as intraluminal thrombus, mural thrombus, mixed plaque, and dense plaque. Thirty patients were studied. Thrombus was suspected in 8 patients on angiography. By ICUS, the presence of thrombus was predicted in 21 patients. Histologic studies of excised tissues found thrombus in 20 of the 30 patients. When ICUS was compared with histology, the true-positive rate was 80% and the false-positive rate was 50%; the true-negative rate was 50% and the false-negative rate was 20%. The correlation between observers was high. These observations suggest that ICUS may be useful in identifying fresh thrombus. The findings of this study help to confirm the criteria for diagnosing intraluminal thrombus by ICUS imaging.
Adult↗
Prognostic value of late potentials in patients with congestive heart failure.
To investigate whether detection of ventricular late potentials could provide prognostic information in patients with congestive heart failure with or without bundle branch block, we prospectively obtained a signal-averaged ECG from 151 patients with congestive heart failure, using specific criteria in 57 patients with bundle branch block. Late potentials were detected in 49 patients (32.5%); their incidence was not significantly different in patients without (31%; 29 patients) or with bundle branch block (35%; 20 patients). Late potentials were present in 25 of 73 patients (34%) with idiopathic dilated cardiomyopathy, in 20 of 57 patients (35%) with ischaemic cardiomyopathy and in four of 21 patients (19%) with hypertensive heart disease (ns). Age, NYHA class, ejection fraction and use of amiodarone were not statistically different among patients with or without late potentials. In contrast, patients with late potentials had more past episodes of sustained ventricular tachycardia (8.2%; four patients) than those without late potentials (1.9%; two patients). Twenty four hour ambulatory ECGs were obtained in 135 patients (89%). Non-sustained ventricular tachycardia was not correlated with the presence of late potentials found in 45 of 88 patients (51%) without late potentials and in 29 of 47 patients (62%) with late potentials (ns). The mean follow-up was 27 +/- 12 months; 51 patients died, 31 from progressive congestive heart failure and 13 suddenly; seven prospectively had sustained ventricular tachycardia. The total mortality rate, the cardiac mortality rate and sudden death risk were not significantly related to the presence of late potentials; their incidence were respectively 35% (36 patients), 32% (33 patients) and 10% (10 patients) in patients without late potentials and 31% (15 patients), 23% (11 patients) and 6% (three patients) in those without late potentials. The incidence of sustained ventricular tachycardia during follow-up was 2% (two patients) in patients without late potentials and 10% (five patients) in those with late potentials. The incidence of sustained ventricular tachycardia experienced by the patients before the study or seen during follow-up was significantly increased in the presence of late potentials: 18% (nine patients) vs 2% (two patients) in the absence of late potentials (P < 0.001). Removal from the study of data from patients with bundle branch block, patients with severe congestive heart failure (NYHA 3 or 4) or patients taking amiodarone did not alter these results. Thus, signal-averaged ECG results only improved risk stratification for sustained ventricular tachycardia in patients with congestive heart failure and failed to identify patients at high risk for sudden death.
Action Potentials↗
[Representations, discourses and practices about drug substitution with opiates. Apropos of a survey conducted in cooperation with 97 French physicians].
In order to analyse the various factors which determine physician's position on the use of opiates in a substitution treatment--as a harm-reducting and heroin dependence treatment tool-, 97 French physicians (i.e. 47 general practioners, 36 psychiatrists, 10 internists, 4 emergency care practioners) answered anonymously 103 closed questions, in presence of a single investigator. Among these 97 physicians, 40 were choosed at random from a list of addiction treatment's practioners, 19 were choosed nominatively for their explicit point of view toward substitution, and 38 were choosed at random from the Herault physicians register. In this latter sample, the survey showed a majority of physicians took an ambivalent position towards substitution, or were favourable without being prescriptors themselves--even though meeting drug users-. General practioners were more favourable to drug substitutes than specialists (50% vs 22%). This practice appeared as legitimate for 70% of physicians; AIDS helped justify this attitude for 26% of the specialists and 5% of the general practioners. Individual or socio-professional factors, the representations of the drug-addict and of his suffering, the perceptions of AIDS contamination risk and the standards of knowledge on the substitution treatments did not differ significatively (p < 0.02) between the groups, determinated according to the expressed practioners point of view toward substitution. Using a method exploring opinion structuration, no description of the typical doctor can be drawn from his position towards substitution. Militant discourses were rare; the main disagreements concerned the status, the negotiation around "the product ... or the medicament" within the drug addict-physician relationship should have. Substitution was considered by some as a mere shift from one object of dependence to another; and to others, as a means of setting up a therapeutic relationship. Ambivalent opinions frequently noticed in the physician's point of view towards substitution appears as a multifactorial phenomenon. Not only does it reveal the physician's difficultie in adapting previous patterns of treatment which are not longer adequate to a critical situation, but it also questions the foundations of the very relationship between the practioner and the drug addict.
Attitude↗
[Correlation between QT interval dispersion and ventricular arrhythmia in hypertension].
OBJECTIVE: To evaluate the correlation between QT interval dispersion (QTd) and ventricular arrhythmias in hypertensive patients (pts) with or without left ventricular hypertrophy (LVH). A secondary aim was to investigate correlations of QTd with other markers of arrythmogenic propensity: ventricular late potentials (LP) and heart rate variability (HRV). METHODS: We retrospectively measured the QTd on the 12 standard surface ECG leads in 230 hypertensive pts (94F, 136M; 59.6 +/- 12.7 years old). A 24 hours ECG Holter recording was performed in 218 pts and ventricular arrhythmias were appreciated using the Lown classification. Left ventricular mass was determined by echocardiography (LVM-Devereux formula) and left ventricular mass index (LVMI) were determined in 202 subjects. LP (122 pts) and HRV (55 pts) were investigated. RESULTS: The QTd varied between 20 and 160 msec (57.8 +/- 32.7 msec). The distribution of pts classified using Lown criteria was: 29 pts (13.3%) class O; 106 pts (48.6%) class I; 8 pts (3.6%) class II; 13 pts (6%) class III; 29 pts (13.3%) class IVa; 33 pts (15.1%) class IVb; 116 pts (69.5%) had LVH determined by echocardiography. The QTd was strongly correlated with the Lown classes (p < 0.0001). The QTd was significantly broader in Lown classes III, IVa and IVb compared to classes O, I and II cumulated (p < 0.002); there was no difference concerning QTd between Lown classes III, IVa and IVb. The QTd was also correlated with the absolute number of premature ventricular depolarizations/24 hours (p = 0.02; r = 0.16). The 75 pts with an increased LVMI had significantly elevated QTd compared to pts without it (p < 0.0001). Qtd was correlated with LVMI (r = 0.37; p < 0.0001). There was no correlation between QTd and the existence of LP (which were correlated with the Lown classes; p < 0.03) and HRV parameters. CONCLUSION: Elevated QT interval dispersion is associated with more severe ventricular arrhythmias in hypertensive subjects with LVH. The mechanism of an increased inhomogeneity of repolarisation is probably related to the anatomic modifications induced by LVH. No significant correlation between QTd, LP and HRV was observed.
Aged↗
[Value of the study of latent atrial vulnerability in unexplained ischemic cerebrovascular accident of young subjects].
This study searched for abnormalities of the atrial electrophysiological substrate in young subjects with unexplained ischaemic cerebrovascular accidents. Thirty-seven patients (18 to 45 years) underwent programmed atrial stimulation at 2 sites in the right atrium after an unexplained ischaemic cerebrovascular accident. Seventeen of them underwent repeat study at 6 months. The following parameters were analysed: indices of atrioventricular conduction and sinus node automaticity; indices related to atrial hyperexcitability: effective refractory period; adaptation of the refractory periods to heart rate, intraatrial conduction and the index of latent vulnerability; the inducibility test by the extrastimulus technique. The following results were obtained: 54% of patients had an inducible atrial arrhythmia; the effective refractory periods and index of latent vulnerability were lower (204 +/- 21 ms and 2.25 +/- 0.7) in the inducible patients than in the non-inducible patients (232 +/- 28 ms and 3.4 +/- 1.1) (p < 0.001 and p < 0.002 respectively); 76% of patients had latent atrial vulnerability indicating and underlying arrhythmogenic substrate; this substrate was still present 6 months later in 80% of these cases; in patients with an abnormality of the interatrial septum, there was an abnormality of the electrophysiological investigation in 85% of cases compared with 65% in those with normal transoesophageal echocardiography. These results confirm the presence of an arrhythmogenic substrate similar to that of patients with paroxysmal atrial fibrillation in over two thirds of cases. Programmed atrial stimulation is a reproducible technique. The relationship between latent atrial vulnerability and abnormalities of the interatrial septum requires confirmation in a series with a larger numbers of patients.
Adolescent↗
Subcutaneous erythropoietin administration in predialysis patients: a single centre prospective study.
Since 1991 we have used subcutaneous administration of recombinant human erythropoietin (rHuEpo) in predialysis patients selected on the basis of chronic anaemia [haemoglobin (Hb) < 7.5 g%] without any extrarenal cause and chronic renal failure with a creatinine clearance of less than 10 ml/min. rHuEpo was given to 16 predialysis patients with nephropathy, due to chronic glomerulonephritis in all 12 of the cases. The sex ratio was 1:1 and mean age was 65 +/- 9 years (range 43-87). Hb was 7 +/- 0.4 g%. rHuEpo was injected subcutaneously thrice weekly while iron was given orally systematically before rHuEpo administration. Follow-up was performed monthly until dialysis (mean 9 months). Anaemia was corrected in all cases (Hb 11 +/- 0.5 g%). Mean Epo dose was 53 +/- 26 IU/kg/week in males and 47 +/- 11 IU/kg/week in females. Iron was systematically added (Fe2+ 8.2 mg/kg/week). Every patient had improved physical and intellectual ability after rHuEpo within the first month. No adverse side effects were noted but all patients were under antihypertensive therapy (one to three drugs). Serum potassium was unchanged. Mean creatinine before treatment was 507 mumol/l, and was 820 mumol/l after the treatment. Progression of renal failure was only affected by rHuEpo in one patient. In this case renal failure progression decreased. There was no significant alteration in the slope of the creatinine curve from 12 months before to after rHuEpo. Ten patients underwent dialysis (five CAPD, five haemodialysis), while six remained dialysis free. From January 1991 to December 1993 rHuEpo was given to 12.3% of the end-stage renal failure patients on dialysis.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[Coronary artery disease in octogenarians: contribution of coronary angiography and evaluation of therapeutic possibilities].
An increasing number of octogenarians is being referred for coronary angiography with a view to myocardial revascularisation. Based on a retrospective study of 168 octogenarians undergoing coronary angiography between January 1987 and December 1992, the authors reviewed the indications, the risks and therapeutic decisions taken in those patients with significant coronary artery disease. The population studied had acute myocardial ischaemia in 88.7% of cases, a low incidence of previous myocardial infarction and severe extracardiac pathology. Significant coronary lesions were observed in 90% of patients (151) with multiple vessel diseases in 57.8% of cases. The mortality attributed to coronary angioplasty was 0.59% (1 case) and the morbidity was 4.7%. The number of disease vessels did not influence the decision as 75.5% of single vessel, 75% of double vessel and 77.3% of triple vessel disease patients were referred for coronary surgery or angioplasty. Of the patients undergoing a revascularisation procedure (n = 108), those referred for surgery (n = 22) had more severe coronary disease than those referred for angioplasty (p < 0.05). The hospital mortality was high about 8%, irrespective of the therapeutic decision. The 3 year actuarial survival was 70% in the group undergoing myocardial revascularisation (whether by angioplasty or coronary surgery) and 53.6% in subjects treated medically. These results show that coronary angiography in a selected elderly population is possible although the mortality and morbidity should not be underestimated. A high proportion of these patients (72%) is referred for myocardial revascularisation.
Aged↗
[Atrial insertion of accessory pathways in permanent reciprocating junctional tachycardia].
Permanent reciprocating junctional tachycardia (PRJT) is an uncommon type of Tachycardia, usually associated with a retrogradely conducting accessory pathway situated near to the ostium of the coronary sinus. This study reports the localisation of the site of atrial insertion of the accessory pathway, confirmed by the efficacy of intracardiac catheter ablation. Five patients (4 men), aged 14 to 45, experienced PRTJT at rates of 120 to 150/mn over a period of 2 to 15 years. 4 patients were normal, expected in 2 patients in whom they were 16 and 20%. One of these suffered a thromboembolic complication after pharmacological interruption of the tachycardia. The presence of an accessory pathway with decremential retrograde conduction was confirmed in all cases. Catheter ablation was successful in the medio-septal (2 cases), posteroseptal (1 case), lateral (1 case) and anteroseptal (1 case) regions. Six to 30 applications of 20 to 30 watts of radiofrequency energy were used in the 5 cases. In one case (right lateral accessory pathway), a fulguration procedure was necessary with a cathodic shock of 160 Joules. The AV conduction was preserved and retrograde conduction was normalised in all cases. All patients remained asymptomatic for a period of 10 to 43 months without antiarrhythmic therapy. The ejection fractions of the two patients with left ventricular dysfunction returned to normal. The authors conclude that the accessory pathways of PRJT may be situated in different regions of the right atrium. The efficacy of catheter ablation was 100 % in this form of tachycardia.
Adolescent↗
Increased cardiovascular risk factors and features of endothelial activation and dysfunction in dialyzed uremic patients.
Due to the incidence of symptomatic atherosclerosis in uremic patients, hemostasis-derived cardiovascular risk factors, basal plasma concentrations of some endothelial-derived glycoproteins and desmopressin-induced variations of endothelial-derived proteins were studied in 22 uremic patients on prolonged maintenance hemodialysis with no cardiovascular antecedent. Compared to control subjects, patients had increased predialysis hemostasis-related cardiovascular risk factors: high fibrinogen, proconvertin, and type 1 plasminogen activator inhibitor plasma concentrations; low albumin values; generally low antithrombin III values but sometimes high. They had high predialysis plasma concentrations of endothelium-derived glycoproteins: von Willebrand factor, tissue-type plasminogen activator and urokinase-type plasminogen activator, which are secreted by endothelial cells, but also soluble thrombomodulin, a marker of endothelial cell injury. The desmopressin-induced release of tissue-type plasminogen activator and of von Willebrand factor were lower than in controls. High fibrinogen, type 1 plasminogen activator inhibitor and low albumin plasma concentrations may be linked to repeated acute phase reactions associated with hemodialysis. Data concerning endothelium-related proteins are concordant with the co-existence of a chronic in vivo endothelial activation and endothelial injury in uremia. This could be linked to the initiation and progression of atherosclerosis.
Adolescent↗