[Gamma heavy chain disease associated with aggressive B lymphoma in the context of myelodysplastic syndrome]. / Maladie des chaînes lourdes de type gamma associée à un lymphome B diffus à grandes cellules dans un contexte de myélodysplasie.

INTRODUCTION: Heavy chain disease is a rare entity characterized by the production of incomplete immunoglobulin heavy chain without associated light chain. It is a B-cell lymphoproliferation, categorized according to the immunoglobulin involved. It is often associated with lymphomas but also with autoimmune diseases. OBSERVATION: We report the case of a 70-year-old patient who presented a gamma-type heavy chain disease, associated with a diffuse large B-cell lymphoma in the context of myelodysplastic syndrome. CONCLUSION: This is the first case of diffuse large B-cell lymphoma associated gamma heavy chain disease described in the context of myelodysplastic syndrome.

[Diagnostic value of ST depression corrected for heart rate in the post-exercise recovery period]. / Apport diagnostique du sous-décalage du segment ST rapporté à la fréquence cardiaque en récupération post-effort.

This study assessed the diagnostic value of two new electrocardiographic criteria of coronary artery disease: the ST/HR index and the slope of the linear relationship between ST segment changes and the heart rate during the first three minutes of the post-exercise recovery period. These two criteria were compared to the standard criteria (> or = 1 mm horizontal or descending ST depression or > or = 2 mm ascending ST depression) to Detrano's ST/HR exercise index (> 1.6 microV/bpm in coronary patient), the exercise ST/HR slope (> or = 2.4 microV/bpm in coronary patients) and the exercise recovery loop (clockwise in normal and anticlockwise in coronary patients) in 88 subjects investigated for suspected coronary artery disease who underwent a computerised exercise stress test and coronary angiography (25 single vessel, 21 double vessel, 20 triple vessel disease; 22 with no significant coronary disease). The ROC identified thresholds of abnormality of the ST/HR recovery index at > or = 2.1 microV/bpm and of the ST/HR recovery slope at > or = 2.52 microV/bpm. Global comparison of the areas under the ROC showed the diagnostic superiority of the exercise ST/HR indices (0.96) over the standard criteria (0.92) and recovery indices (0.86) but without statistically significant values (p = 0.65 and p = 0.15 respectively). The ST/HR index and slope during recovery identify coronary disease with a diagnostic accuracy of 80% and 77% respectively which is similar to that (84%) of the standard ST criteria. The exercise-recovery loop was less accurate (64%).

[Value of echocardiography-dobutamine in the study of reserve myocardial contractility in aortic stenosis with alteration of left ventricular function. Apropos of a case]. / Intérêt de l'échocardiographie-dobutamine dans l'étude de la réserve de contractilité myocardique du rétrécissement aortique avec altération de la fonction ventriculaire gauche. A propos d'un cas.

The authors report a case of tight aortic stenosis, without coronary artery disease, presenting with heart failure, alteration of global left ventricular contractility and a low gradient. Increasing-dose dobutamine echocardiography demonstrated an improvement of myocardial contractility and an accentuation of the transvalvular gradient. The place of this examination in the therapeutic strategy and follow-up of the disease is discussed in the light of the current data of the literature.