[Similarities and differences between pathological gambling and substance dependance: A clarification]. / Similitudes et différences entre le jeu pathologique et la dépendance aux substances : qu'en est-il ?

UNLABELLED: Similarities and differences between pathological gambling and substance dependence: a clarification. A critical analysis of a French review of the international literature on gambling. INTRODUCTION: The integration of pathological gambling in the spectrum of addictive disorders modeled by substance dependence is currently discussed. OBJECTIVE: To perform a systematic review of the similarities and differences between pathological gambling and substance dependence, and to classify and analyze them, based on the data collected by a previously published French systematic analysis of the international literature on pathological gambling. METHOD: We established a checklist of each comparison of pathological gambling with substance dependence within the report. Then, every entry was classified as similarity or difference, analyzed and discussed. RESULTS: Similarities retrieved were epidemiological characteristics (gender, age, socio-demographic characteristics of subjects), diagnostic criteria from DSM-IV (five criteria in common), frequent co-occurrence of pathological gambling and substance dependence, neurobiological and genetic characteristics, cases of spontaneous recovery, and similarities of therapeutic care. Differences retrieved were a more elevated prevalence of mood disorders and suicide among pathological gamblers, intrinsic risk factors related to gambling activity (delay between bid and result, gambling device, big win), cognitive distortion of pathological gamblers (notably chasing), specificities of cognitive behavioral therapies focused on these cognitive distortions, and specificities of social care of pathological gamblers. DISCUSSION: Pathological gambling shared many similarities with substance dependence, but also some differences. However, our critical analysis of these elements, reported to be specific to pathological gambling, showed significant commonalities with substance dependence. Also, the existence of key symptoms of substance dependence such as craving and loss of control in pathological gambling was not discussed in the review, although other data suggest a common ground. These could be key elements to group together pathological gambling and substance dependence within the addictive disorders.

Synthesis of 2'-C-methyl-4'-thio ribonucleosides.

Starting from 2-C-methyl-ribonolactone, 1,2,3,5-tetra-O-acetyl-2-C-methyl-4-thioribofuranose was synthesized and condensed with heterocyclic bases to afford 2-C-methyl-4'-thioribonucleosides.

Synthesis of 5-aza-7-deazaguanine nucleoside derivatives as potential anti-flavivirus agents.

Coupling suitable sugars (D- or L-ribofuranose, 2' or 3-deoxysugar, branched sugars) with 2-aminoimidazo[1,2-a]-s-triazin-4-one was carried out using the different reaction conditions: 1) condensation in the presence of sodium hydride; or 2) condensation using Vorbrüggen's methods. The 5-aza- 7-deazaguanine nucleoside analogues obtained were evaluated in cell culture experiments for the inhibition of the replication of a number of RNA viruses, including BVDV, YFV, and WNV.

[Post-radiation coronary diseases. Presentation of 7 cases and review of the literature]. / Les coronaropathies post-radiques. Présentation de 7 cas et revue de la littérature.

Coronary lesions are one of the complications of mediastinal radiotherapy; they are more uncommon, at least in their clinical expression, than the involvement of the pericardium, but they are interesting by their gravity and occurrence in young patients (35 years old, in an average). We are reporting 7 cases in addition to the 53 already recorded in the literature. The neoplasm which led to the radiation treatment is, in 85 p. cent of the cases Hodgkin's disease and in 10 per cent of the cases a breast cancer. The time of occurrence of the clinical signs is of 5 years, in an average. The revealing symptom is an initial necrosis or an angor, most often unstable (45 p. cent of the cases, for each of them), more exceptionnally it is a sudden death or a pericarditis. The coronary risk factors have been determined in 37 patients; 45 p. cent had none. In half of the cases, the coronary involvement is monotruncular and frequently proximal (the anterior interventricular trunk is affected twice as often as the right coronary); in the other half, there is an equal distribution between bi-troncular and tri-truncular involvement. There are various pathological lesions: typical with isolated fibrosis of the intima and aventitia, pure atherosclerotic lesions or association of the two. The prognosis of these coronary lesions is severe (43 p. cent of deaths), but the patients who underwent revascularization procedures (by-pass or more seldom transluminal angioplasty) have in 80 p. cent of the cases a favorable evolution.(ABSTRACT TRUNCATED AT 250 WORDS)

[Malignant pheochromocytoma. Apropos of a case report]. / Phéochromocytome malin. A propos d'une observation.

Pheochromocytoma was diagnosed in a male of 38 on the basis of severe and progressive hypertension associated with marked increases in urinary catecholamines and vanilmandelic acid. Left extra-adrenal topography was examined by tomography and confirmed by surgical treatment involving exeresis of the primary tumor and the metastatic latero-aortic lymph nodes, thus corroborating the diagnosis of malignancy. Complementary post-operative radiotherapy was performed on the abdomen. Eighty months later the patient is making good progress.

[Multiple congenital coronaro-left ventricular fistulas. Apropos of 7 cases]. / Les fistules congénitales multiples coronaro-ventriculaires gauches. A propos de 7 observations.

Multiple congenital coronary-left ventricular fistulae (CLVF) are rare (4.5% of all coronaro-cardiac fistulae, the same incidence as isolated CLVF); data obtained from 7 personal and 25 previously reported cases, showed that this anomaly, is diagnosed at coronary angiography performed for anginal chest pains in 2 out of 3 cases; cardiac auscultation was usually normal but the basal ECG was pathological in 3 out of 4 cases; the electrical changes suggested myocardial ischaemia in 20 out of 24 cases. However, exercise stress testing was negative in 47% of cases. Multiple CLVF usually arose from the same artery (59%); the commonest artery involved was the left anterior descending (84% of the single artery fistulae and 100% in cases of multiple CLVF arising from more than one artery). The angiographic appearances of multiple CLVF were constant: images of "intracavitary rain". Associated ventriculographic abnormalities were uncommon but coronary atherosclerosis was observed in 15% of cases. The main differential diagnosis is that of CLVF secondary to intra-left ventricular thrombosis due to the development of neovascularisation of the thrombus from the underlying endocardium. The value of non-invasive investigations (2D echocardiography alone or coupled with pulsed Doppler) has not been shown in this type of coronaro-cardiac fistulae. Surgical correction was attempted in 3 cases, 2 of which had associated cardiac pathology justifying surgery. The presence of unequivocal coronary insufficiency due to CLVF was not demonstrated despite some suggestive clinical and paraclinical indicators.

[Proximal and peripheral coronaro-pulmonary fistulae. Apropos of 10 cases]. / Fistules coronaro-pulmonaires proximales et périphériques. A propos de 10 observations.

Coronaro-pulmonary fistula (CPF) is a rare congenital malformation comprising about 17 p. 100 of coronaro-cardiac fistulae. The authors report a series of 10 cases of CPF diagnosed in over 6 000 coronary angiographic studies. This material includes 7 cases of "proximal" CPF in which the receiving vessel was the main pulmonary artery (MPA), there were two cases of fistula between the coronary and distal pulmonary arteries ("distal" fistulae), one of which had an associated proximal CPF; finally one case showed abnormal vascularisation of part of the lung by a branch of the left circumflex artery. The left coronary artery was involved in all 8 cases of proximal CPF, confirming previously published data. The communication comprised a single pedicle or a plexus arising from the initial segment of the coronary artery and draining into the MPA in all cases. Coronary angiography was performed in the 5 men and 3 women (average age 53 years) for chest pain (2 cases) acute ischaemia in the territory of the left anterior descending artery (1 case), residual post-infarction angina and assessment after infarction (2 cases), mitral valve disease (2 cases) and for a continuous murmur (1 case). The ECG was normal in 2 cases; 5 patients had ST abnormalities; left ventricular hypertrophy was observed in 2 cases but these patients had associated mitral valve disease. Radiological cardiomegaly was present in 2 cases. Finally, no significant left-to-right shunt could be detected on cardiac catheterisation. The outcome was favourable in 7 patients (resection of fistula and eventual coronary bypass surgery in 3 cases; surgical abstention in the remainder).(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects of lidocaine at the plasma concentrations obtained by peridural injection on atrioventricular conduction disorders]. / Effets de la lidocaïne aux concentrations plasmatiques obtenues par voie péridurale sur les troubles de la conduction auriculo-ventriculaire.

The aim of this study was to measure plasma concentrations obtained during lidocaine extradural blocks, and to determine whether these concentrations were able to induce high degree AV blocks in patients with impaired AV conduction. In a preliminary study, 12 patients were given an extradural block with an initial bolus of 3.4 mg . kg-1 lidocaine. After repeat injections, the mean total dose was 4.7 mg . kg-1. Plasma lidocaine concentrations were determined over an 8 h period after the first injection. The study itself was carried out in 14 patients with conduction disturbances undergoing His-bundle exploration. After informed consent had been obtained, the patients received an intravenous bolus of lidocaine (1.6 mg . kg-1 over 30 s). After baseline values had been measured. His conduction and lidocaine plasma concentrations were recorded 2, 5, 10, 30 and 60 min after lidocaine injection. In the preliminary study, the peak plasma lidocaine concentration was obtained at the 15th min (1.22 +/- 0.81 microgram . ml-1). In the second series, no clinical disturbance was seen after the i.v. injection of lidocaine. The peak plasma lidocaine concentration was obtained at the 2nd min (3.05 +/- 1.44 micrograms . ml-1). No significant alteration of conduction occurred after intravenous lidocaine. It is therefore possible to conclude that bifascicular AV disturbances do not constitute a contraindication to extradural anaesthesia with lidocaine.

[Subacute ischemia of the lower leg caused by a popliteal synovial cyst. Apropos of a case]. / Ischémie subaiguë du membre inférieur par kyste synovial poplité. A propos d'une observation.

Based on the observation of a cyst compressing the popiteal artery, the authors discuss the characteristic clinical picture and radiology of this benign neoformation. They emphasize two possible causes: cystic degeneration of the arterial median or a cyst of articular derivation. Histological data from this observation supports the second hypothesis.

[Topographic diagnosis of pheochromocytoma. Value of computerized axial tomography]. / Diagnostic topographique de phéochromocytome. Intérêt de la tomodensitométrie.

The localisation of a pheochromocytoma is difficult and sometimes hazardous. There are many radiological techniques of varying sensitivity and the risks of hypertensive crises or of cardiovascular collapse are not negligeable (especially during arteriography and venography). Abdominal computerised axial tomography (CAT) would appear to be of considerable value. It gives a very precise localisation without any risk. Three personal cases confirm this opinion. The first case was of a 38 year old man with an extra-adrenal pheochromocytoma localised in the pelvis of the left kidney by CAT (after negative intravenous urography); the second case was of a 54 year old man with a left adrenal pheochromocytoma confirmed on CAT (after 2 negative aortic arteriogrammes and adrenal venography); the third case was of a 39 year old woman with a para aortic pheochromocytoma, diagnosed on CAT (after negative intravenous urography). These three cases bring to 43 the total number of reports of pheochromocytoma localised by abdominal CAT. When this method is compared with intravenous urography and aortic arteriography, abdominal CAT is over three times more sensitive than intravenous urography (90% compared to 26%) and also more sensitive than arteriography (90% compared to 76%). The false negative results on CAT usually involve small tumours (diameter less than 30 mm). The new generation of CAT should reduce these errors. The great advantage of this investigation should change the order of the radiological examinations in the localisation of pheochromocytoma. It would seem logical to carry out an abdominal CAT as soon as biological confirmation of the hypersecretion of catecholamines had been obtained. The other radiological investigations (especially aortic arteriography) should be reserved for cases with negative abdominal CAT.

[Automatic activity of the pre-excitation pathways]. / Activité automatique des voies de préexcitation.

The possibility of preexcitation pathways exhibiting automatic activity was demonstrated in 3 cases: in two cases electrophysiological studies supported this diagnosis which was confirmed in the third case by histological examination of the preexcitation pathway. During sinus node dysfunction, spontaneous or induced (by rapid right atrial pacing or by a reciprocating tachycardia), the substitute rhythm arose from the Kent Bundle either transiently or for a longer period: rhythms arising from the Kent Bundle can only be diagnosed after eliminating the possibility of an atrioventricular junctional rhythm conducted to the ventricles by Mahaïm fibres.

[Congenital arteriopathies and Leo Buerger's disease]. / Artériopathies congénitales et maladie de Leo Buerger.

A homogenous series of 7 consecutive cases of Buerger's disease were investigated and the congenital malformations of the upper and lower limb arterial trunks were classified. These malformations constitute the anatomical basis of Buerger's disease and define an autonomous disease entity. Total supra-malleolar interruption of the main lower limb arteries either by triple vessel agenesis or, more rarely, by femoro-popliteal or popliteal and tibio-peronal agenesis was observed. The appearances of the collateral circulation, already established in utero, are characteristic with long axial spiral-shaped arteries and dependant arterioles maintaining a precarious supply to the distal tissues which may be adequate for many years. The nautral history of the disease is directly related to the malformation of the congenital arterial system of the limbs. Proximal arterial malformative occlusion is the cause of early, inevitable trophic lesions; the spiral-shaped arteries and distal arterioles, which represent the maximal embryonic collateral circulation, limit the area of necrosis and favour healing.

[Congenital defects of the aortic system]. / Artériopathies congénitales du système aortique.

The authors give a basic embriological classification of congenital arterial defects. Congenital abnormalities of the arterial system (arising in an embryo of 12 to 30 mm) affect the primary segments, and comprise excessive involution of the antibrachial trunk, of the popliteal artery, of the tibio-peroneal trunk and peroneal artery, abnormal or persistence of the interosseus artery, of the artery of sciatic nerve, and of the peroneal artery, a high axillary origin of the radial or antecubital artery, renal polar arteries arising directly from the aorta, and agenesis of the palmar or plantar arches. In the second generation arteries, they comprise agenesis or hypogenesis of the radial, antecubital or tibial arteries, and gross hypogenesis of the trunk of the renal artery with an immature kidney. Arrested or mal-development in the foetus can give rise to coarctation and stenosis of the thoracic aorta and large vessels, to segmental agenesis with huge collaterals, to imperforate osita, especially in the mesenteric arteries, to sudden variations in diameter of the renal arteries, and to parietal dyplasia and aneurysms in vessels in the residual undifferentiated mesenchymatous tissue, and diffuse dilatation or stenosis. The authors give their experience for a cardiological clinic, adding arterial hypertension and arterioparenchymatous dysplasia of the kidneys, Raynaud's, Takayasbu's and Burger's disease, and intermittent claudication of the lower limbs; they indicate the areas which they are currently studying.

[Arterial malformations and Takayashu disease]. / Malformations artérielles et maladie de Takayashu.

The authors report a recent series of 5 cases with Takayashu's disease and discuss the common pathological presentation of malformations of the arterial trunk, caused by disorderd development of the arterial system or by later segmental arrested development of the large trunks. The disease, which presents in the young adult as a diffuse inflammatory process, is probably auto-immune, but has its foundations in embryonic and foetal development.