[Cardiovascular effects linked to the use of chloroquine]. / Les effets cardiovasculaires liés à l'utilisation de la chloroquine.

The chloroquine is the mainly and most frequently drug used as antimalaric in the world, in spite of the extension of resistance phenomena. Besides, the chloroquine is also commonly indicated in rheumatology and dermatology as a chronic treatment of some connective tissue disease. The chloroquine has three main cardiovascular effect: membrane stabilizer, direct negative inotropic effect and direct arterial vasodilator. Thus, these cardiovascular iatrogenic effects of the chloroquine are important both through their potential frequency and seriousness. Personal clinical cases and medical review enables to identify the main effects, observed either with prophylactic, or curative, or even toxic dosages. The more often, there are some rhythm and conductance disorders, myocardiopathy, even sometimes vasoplegic shocks. A list of the commercial patent medicine including chloroquine enables to be aware, to prevent and to take into account the cardiovascular risks of a treatment newly set or carried on for long years.

[Acute post-traumatic aortic insufficiency: transesophageal echocardiography in the diagnosis and therapy of the lesions]. / Insuffisance aortique valvulaire aiguë post-traumatique: apport de l'échocardiographie transoesophagienne pour le diagnostic lésionnel et le traitement.

A 58-year-old car driver suffered a road accident responsible for severe blunt thoraco-abdominal trauma. Transoephageal echocardiography, performed following the secondary development of a diastolic murmur, confirmed the presence of aortic incompetence due to commissural avulsion and guided the surgical treatment, which consisted of commissural suspension under cardiopulmonary bypass via a mini transverse trans-sternal incision. The rarity of acute aortic valve incompetence following non-penetrating thoracic trauma is illustrated by the data of the literature. This lesion is due to either avulsion of a sigmoid cusp or commissure, or laceration of the valvular tissue. Transthoracic echocardiography confirms the reality of aortic incompetence suggested clinically by appearance of a diastolic murmur, but confirmation of the mechanism of the lesions is based on transoesophageal echocardiography which allows perfectly safe and rapid visualization of the mechanism of the valvular lesion, investigation of associated lesions and guidance of therapeutic management.

[Incidental CT discovery of an isolated thrombus in the aortic arch]. / Découverte scanographique fortuite d'un thrombus isolé de l'arche aortique.

The authors report a case of isolated thrombus of the aortic arch discovered incidentally during thoracic CT angiography, complicated by clinical features of embolic renal infarction despite introduction of anticoagulant treatment. This case confirms the value of transoesophageal echocardiography to diagnose and follow these lesions and illustrates the therapeutic approach following discovery of aortic thrombi.

[Effort-induced macroscopic hematuria revealing segmental and congenital absence of inferior vena cava]. / Hématurie macroscopique d'effort révélant une absence segmentaire et congénitale de la veine cave inférieure.

Absence of inferior vena cava (IVC) is an uncommon congenital abnormality with few clinical repercussions. We report the case of a 39 year old man with chronic pelvic pain, in whom a macroscopic hematuria episode occurring during exercise led to the discovery of an echographic pelvic venous stasis syndrome. Abdominal and pelvic computed tomography scanning then magnetic resonance imaging of inferior vena cava revealed absence of the postrenal segment of IVC with azygos continuation and considerable collateral venous derivations, leading to pelvic cavernoma.

Prospective evaluation of high-dose or low-dose isoproterenol upright tilt protocol for unexplained syncope in young adults.

The sensitivity of the passive head-up tilt test (HUT) in the evaluation of unexplained short-lasting syncope in young adults remains insufficient. The infusion of isoproterenol was proposed to improve the benefit. To evaluate the sensitivity-specificity relationship during isoproterenol dosing, we studied 76 young adults (aged 20.9 +/- 1.7 years) (group S) with recurrent (mean 3.8 +/- 1.6) losses of consciousness that remained unexplained after clinical and noninvasive assessment and 35 young healthy volunteers (aged 22.6 +/- 2.7 years) (group V). Subjects underwent either passive HUT (45 min, 60 degrees without drug dosing for 48 subjects in group S (S1) and 17 in group V (V1), or HUT with isoproterenol infusion at progressive doses (2 then 5 micrograms/min) after 30 minutes of passive tilting for 28 patients in group S (S2) and 18 in group V (V2). During passive HUT, the test was positive (asystole, bradycardia, or fall in systolic blood pressure) in 2 of 17 (11.8%) patients in group V1 and in 7 of 48 (14.6%) in group S1 before 30 minutes, and in 3 of 17 (17.6%) in group V1 compared with 10 of 48 (20.8%) in group S1 at the end of the 45-minute infusion, with no difference in delay before the appearance of a positive result. During HUT with isoproterenol dosing, the test was positive in 2 of 18 (11.1%) patients in group V2 and in 18 of 28 (64.2%) in group S2 before 45 minutes (2 micrograms/min; p < 0.01) in 7 of 18 (38.8%) in group V2 compared with 24 of 28 (85.7%) in group S2 before 60 min (5 micrograms/min; p < 0.01). In both cases the mean delay in evoking a positive response was significantly shorter. No asystolic response was observed in the volunteers regardless of the protocol used. The most characteristic response to isoproterenol injection was the appearance of a junctional escape rate with a fall in systolic blood pressure (61.5% of subjects in group S2). The infusion of isoproterenol considerably improves the sensitivity of the HUT with satisfactory specificity if low doses are used (< 3 micrograms/min). These results support the use of HUT with isoproterenol in the evaluation of unexplained syncope in young adults.

[Risk factors for transmissible cardiovascular diseases]. / Les facteurs de risque cardiovasculaire transmissibles.

Atherosclerosis is a multi-factor disease representing a real plague for developed countries, and spreading at an increasing rate in third world nations. In industrialized countries, coronary pathology occupied the first place in terms of morbidity and cardiovascular mortality, affecting more and more frequently younger people, thus constituting a serious problem of public health. Therefore, it seems absolutely necessary to carry out systematic screening for atherosclerosis amongst all high cardiovascular risk families groups, from infancy onwards. Lacking knowledge about the exact cause of atheroma, we had to determine what are commonly called the factors of cardiovascular risk. Among these, some are transmissible. Transmission may be direct: genetic and hereditary factors (sex, race, antecedents, dyslipemia, high blood pressure, diabetes) but it may also concern the transmission of a way of life. To prevent ischaemic heart disease, it is necessary to bring out change in behaviour from infancy onwards to detect high risk subjects and to correct every factor of cardiovascular risk upon which an action is possible.

[Delayed relapses of hepatic amoebiasis initially cured by metronidazole: 2 cases (author's transl)]. / Rechutes tardives d'amibiases hépatiques initialement guéries par le métronidazole: 2 cas.

Two cases of hepatic amoebic abscesses are reported as having relapsed--one three times, the other twice--after from several weeks to several months of apparent cure by mitronidazole, without recontamination. The following hypothesis can be eliminated: resistance of E. histolytica to metronidazole, poor absorption or faulty diffusion of the drug, its possible inactivation. The persistance of amoebae in the digestive tract, even if they are not detected, seems probable however: either because they are situated in such a way as to be inaccessible to the active metabolities of the metronidazole or because the intra-luminal concentration of these metabolites is not sufficient. The fact that the intestinal parasitism repeatedly leads to the constitution of successive hepatic abscesses in the same person presupposes the privileged anatomic situation of a colonic ulceration which brings about reiterated dissemination through the portal veinous system.

[The cost of alcoholism in a hospital medical department (author's transl)]. / Le coût de l'alcoolisme dans un service de pathologie interne.

The authors evaluated the costs involved when alcoholic patients were admitted to a hospital medical department. Costs which were identical for all patients, such as basic services and hospitalization fees, were discounted, and only those for individual investigations and treatment were calculated. These costs were then compared with the average daily costs for non-alcoholic patients in the same department over the same period. The results are discussed in relation to other similar studies.