[The "tako-tsubo" syndrome: report of two cases]. / Le syndrome de "tako-tsubo": à propos de deux cas.

The "tako-tsubo" syndrome, initially described by Japanese authors is an apical akinesis of the left ventricule without significant coronary artery disease, with a moderate elevation of troponine I. We report 2 cases of women (with an average age of 68 years). They were refered for suspected acute coronary syndrome including on admission chest pain and ST segment elevation. Cardiac ultrasonography shew an apical akinesis. Coronary angiography didn't show significant coronary lesion. A moderate elevation of troponine was noted but no significant elevation of CPK. The prognosis has been excellent for these 2 patients. We observed a ventricular tachycardia due to QT lengthening in 1 case treated anteriorly by Flecaïn which spontaneously resolved. The first month, the electrocardiogram and cardiac ultrasonography anomalies disappeared totally. The treatment is based on beta-blockers, aspirin, statines, ACE. In the two cases, we didn't find arguments for myocarditis, recanalized thrombosis, coronary spasm, pheochromocytomas, but a risk factor is inboth: emotional stress. Maybe the diagnosis could be easier with the submillimeter cardiac computed tomography.

[Treatment of acute coronary syndrome in a small volume center: "survival rate in hospital and at 2 years of follow up"]. / Prise en charge de syndrome coronarien aigu dans un centre de petit volume: "Survie hospitalière et suivi à deux ans"

UNLABELLED: We report our experience of the treatment of the coronary syndrome ST+ in a small volume center. PATIENTS AND METHODS: For a period of 1 year (September 2004 to September 2005), 110 patients were treated by emergency coronarography at the hospital in Vichy (France). These patients were followed up for a period of 2 years. RESULTS: This population was relatively elderly: 43.6% of the patients were above 75 years of age. One hundred patients (91%) were treated by emergency angioplasty with a success rate of 88%. The average waiting time for treatment in the coronarography ward is 55 minutes and 35 seconds. Mortality in hospital is 6.36% for the totally of the population. It should be noted that 10.9% of these patients were admitted in a state of cardiogenic shock (12 patients), 3 of whom (25%) have died. 3 of these received a CPIA. At the end of an average follow-up of 21.44 months the survival rate is 83.6%, including and incident-free survival rate of 61.8%. CONCLUSION: These results, comparable with what has been published in the literature, confirm the effectiveness of emergency coronary angioplasty as a method of revascularization even in a small volume center, in respect both of the survival rate in hospital and also of incident-free survival at 2 years.

[Management of antiplatelet therapy: a case report]. / Gestion des anti-agrégants plaquettaires en préopératoire: à propos d'un cas.

We report a personal case of myocardial infarction with flurbiprofen used instead of clopidogrel before an operation. We re-examined the literature concerning the management of the antiagregant treatment of the patient with angioplasty and/or stent who needs surgery. This management proves to be delicate and all the questions that it raises have not so far been answered in particular with regard to the problem of resistance to aspirin. Anyway this personal observation supports our view that contrary to certain recomendations flurbiprofène is not a satisfactory alternative to aspirin either with or without thiénopyridine.

[Results of percutaneous coronary intervention in a hospital with a low case load]. / Angioplastie coronaire dans un centre de petit volume.

Since efficacy of small volume centers performing coronary and angioplasty is questioned, we present our data for 2003. In 2003, 669 coronary examinations were performed in our unit (average age 68 years, 67% men) with 215 angioplasties. We take charge essentially Acute Coronary Syndrome (99%), with 37% ACS ST +. The radical approach was taken in 15% of cases. We used anti GP IIb/IIIa in 67% of cases (only abciximab), the rate of stenting was 84% with 43.6% of Direct Stenting. The primary angiographic results were good in 98% of cases. The rate of Restenosis was 6%. The hospital mortality was 2.8%. So we think that coronary and angioplasty in a small volume center can be performed with safety and a level of success in accordance with the data of the literature.

Methyl alcohol poisoning III. Ocular toxicity.

The ocular toxicity of methyl alcohol has been investigated in six rhesus monkeys. All the animals developed fundus changes within 43 to 171 hours after its ingestion. The only fundus lesion seen was optic disc edema and associated changes, usually of a marked degree. Fluorescein fundus angiography confirmed the findings. The retinal and choroidal circulations, including the retinal capillary bed, were normal. Ophthalmoscopically and angiographically, optic disc edema in methyl alcohol poisoning was indistinguishable from that seen in raised intracranial pressure, except that no increased intracranial pressure was observed. It is postulated that optic disc edema in methyl alcohol poisoning is due to an axoplasmic flow stasis.

Methyl alcohol poisoning. IV. Alterations of the morphological findings of the retina and optic nerve.

The ocular morphological findings of three methyl alcohol-intoxicated rhesus monkeys with optic disc swelling was investigated with light and electron microscopy in conjunction with intravascular horse radish peroxidase. Alterations observed in the optic nerve head were confined to the axons and consisted of swelling and clustering of the mitochondria, disruption of the neurotubules, the formation of vesicles, and enlargement of the axon segments in the prelaminar region. Swelling of the oligodendroglial cytoplasm in contact with the axons and of the astrocytes was seen in the retrolaminar optic nerve and the intraorbital optic nerve. Alterations were not observed in the retina. It is hypothesized that the alterations in the axons are the result of disrupted axoplasmic flow. Possible mechanisms relating methyl alcohol intoxication to disruption of axoplasmic flow are discussed.

Methyl alcohol poisoning. II. Development of a model for ocular toxicity in methyl alcohol poisoning using the rhesus monkey.

Rhesus monkeys were intoxicated with methyl alcohol, using an initial dose of 2 gm/kg and subsequent doses were administered in order to maintain an attenuated and prolonged state of intoxication. Arterial blood samples were drawn for methyl alcohol, formate, PO2, PCO2, and pH, which were monitored periodically throughout the course of the experiment. With the use of these procedures monkeys developed metabolic acidosis with the accumulation of formic acid in the blood and a corresponding decrease in blood bicarbonate. These animals served as models, which allowed for ocular evaluation for early signs related to methyl alcohol poisoning. A mechanism to explain toxicity is proposed and discussed.

The ependymal surface of the fourth ventricle of the rat: a combined scanning and transmission electron microscopic study.

The morphological features of the ependymal surface and supraependymal elements of the fourth ventricle of the rat were examined by scanning electron microscopy (SEM) and by the transmission electron microscopy (TEM). The results confirm the following aspects: 1) The presence of supraependymal elements and microvilli in the ependymal territories, including the sites where the cilia completely cover the ependymal surface; 2) The existence of cilia with oval or spherical thickenings together with supraependymal bulbs similar in size to those of the larger ciliary swellings; 3) Identification of the long supraependymal fibres with intermittent fusiform dilations observed under the SEM with the nerve fibres seen under the TEM; 4) The existence of intraventricular axodendritic synapses.

[Spontaneous course towards pulmonary atresia of Fallot's tetralogy. Theoretical and practical aspects]. / Evolution spontanée vers l'atrésie pulmonaire d'une tétralogie de Fallot

A case of severe Fallot's tetralogy is presented; there was angiographic evidence of progression towards pulmonary atresia. The relationship between Fallot's tetralogy and pulmonary atresia with open septum is discussed, as is the variability of the pulmonary circulation found in cases of pulmonary atresia with septal defect, and the treatment is also discussed.

[Comparative results of the use of Greenfields' filter, an umbrella filter, and a caval clip for vena cava interruption]. / Notre expérience du filtre de Greenfield. A propos de 40 observations comparées à 40 filtres-ombrelles et 40 clips.

Results of interruption of the vena cava for thromboembolic complications are reported. Greenfields filter was used in 40 cases, its introduction appearing to be a more delicate procedure than when other materials (caval clip in 40 cases and Mobin-Uddin's filter in 40 cases) were used. Results with regard to recurrence of emboli were comparable for the different materials, but Greenfield's filter becomes thrombosed less often and provokes fewer major sequelae.

[Myocardial diverticulum of the left ventricle. Review of the literature apropos of a case]. / Diverticule myocardique du ventricule gauche. Revue de la littérature à propos d'un cas.

Left ventricular myocardial diverticular rare, as they represent 0.05% of all forms of diagnosed congenital heart disease. The circumstances of diagnosis are as variable as the multiplicity of symptoms with which they are associated. Consequently, treatments (or very often conservative management) are also varied and a standardized procedure has not been defined in this field, apart from a common sense approach.

[Spontaneous dissection of coronary arteries. Apropos of 2 new cases with favourable course]. / Dissections spontanées des artères coronaires. A propos de deux nouveaux cas avec évolution favorable.

The authors report two new cases of spontaneous coronary dissection and discuss the real frequency of this disease as well as their generally reported poor prognosis. One case was a 32-year-old female migraine-sufferer treated by beta-blockers, who developed a rudimentary anterior myocardial infarction. The other case was a 43-year-old man who presented with a threatened anterior myocardial infarction without myolysis documented by cardiac enzymes. Both patients were smokers and both had an excellent outcome, clinically and on stress tests, with a follow-up on medical treatment alone of thirty months for the first case and fourteen months for the second case. These two new cases had a good prognosis, in contrast with the majority of cases published.

[Spatial distribution of Cordyceps spp. (Ascomycotina: Clavicipitaceae) and its impact on the ants in forests of Amazonian Colombian foothill]. / Distribución espacial de Cordyceps spp. (Ascomycotina: Clavicipitaceae) y su impacto sobre las hormigas en selvas del piedemonte amazónico de Colombia.

Entomopathogenic fungi of the genus Cordyceps were sampled in the foothills of the Colombian Amazon region (450-600 msnm altitude. January and May, 1998, i.e. dry and wet seasons, respectively). Healthy and Cordyceps-parasitized ants from a nearly pristine, a naturally disturbed and a human-disturbed forests were collected on 100 quadrants (1 m2) per forest. Litter, shrubs and trunks were explored as substrates, and samples were gathered in vertical strata from 50 cm to 2 m high. Azteca was the predominant ant genus in near pristine forest whereas Camponotus, Pheidole and Crematogaster were dominant in disturbed forests. In the naturally disturbed forest we found 759 individuals of Cordyceps unilateralis and 69 of C. lloydii var. binata parasitizing Camponotus spp. (Formicidae: Formicinae), whereas C. kniphofioides var. ponerinarum and C. australis were found only in six cases infecting the ants Paraponera clavata and Pachycondila crassinoda (Formicidae: Ponerinae). In the human disturbed forest it were found 34 individuals of C. unilateralis on Camponotus. In the near pristine forest we did not find parasitized ants. The Camponotus spp. ants parasitized by C. unilateralis and C. lloydii var. binata were found predominantly in the substratum foliage up to 1 m. It was concluded that the incidence of Cordyceps-ant interactions is not influenced by the conservation status of the forest. Instead, relative humidity and presence/absence of host ants appear to be key factors. Also, the microspatial distribution of the interactions seems to follow a definite pattern. This work observations support the hypothesis on coevolution of dispersion mechanisms in Cordyceps and ant pheromonal codes.

[Tako-Tsubo syndrome during normal human immunoglobolin perfusion]. / Syndrome Tako-tsubo au décours d'une perfusion d'immunoglobuline humaine normale (Tégeline(®)).

This is a case of an 82 year old female patient with myasthenia gravis, who following treatment with Human Normal Immunoglobulin (Tegeline(®)), developed dyspnoea, chest pain without cardiac insufficiency, inverted T wave on ECG with slight increase in Troponine T 0.43ng/mL (<0.2ng/mL normal value in our hospital) and marked increase in Pro-BNP 4900 (Nl≤450pg/mL for an age greater than 65 years old). Her coronary angiogram showed hypokinesia of apical area but was otherwise normal. Also, MRI ruled out inflammatory and ischemic cardiac diseases. The most likely diagnosis for us was Tako-Tsubo syndrome in relation with injection of Human Normal Immunoglobulin (Tegeline(®)) according to the Mayo clinic criteria.

[Pseudo-aneurysm of mitro-aortic continuity: a rare complication after aortic valve replacement]. / Le pseudo-anévrisme du trigone fibreux aorto-mitral : une complication rare du remplacement valvulaire aortique chirurgical.

Pseudo-aneurysm of the fibrous continuity zone between the aortic and mitral valves, the so-called "mitral-aortic intervalvular fibrosa" is a rare complication of acute infective endocarditis, rarely after an aortic valve replacement. We report the case of a large pseudo-aneurysm occurred in a 70-year-old man, who had a history of surgical aortic valve replacement 3 years before. There were no biological or clinical evidence for infective acute endocarditis. The originality of this observation can be summarized in three points: the late onset after surgery, the absence of any infectious context and the chronic nature of pseudo-aneurysm, without any complication during a follow-up of 12 months. Transesophageal echocardiography remains the best diagnostic tool.

[Management of patients with ST-elevation myocardial infarction in the French General Hospitals in 2008--reperfusion strategies--additives treatments (2008 study on the practices of General Hospitals)]. / Prise en charge de l'infarctus du myocarde dans les CHG français en 2008--stratégies de reperfusion--traitements adjuvants (enquête 2008 sur les pratiques des hôpitaux généraux). Étude SCA ST+ 2008--CHG.

We have performed a retrospective survey on the management of ACS ST+ in French general hospitals in 2008. The aim was to assess adherence to recommendations of various scientific societies. Sixty-six hospitals responded. The total number of patients was 4741, 63% supported by mobile emergency resuscitation service and 37% by emergencies. The treatment of reperfusion and adjuvants are detailed, the heterogeneity of regimens is emphasized. The median treatment of reperfusion is 107, the median rate of reperfusion was 91% with 72% of primary angioplasty. In general, centers with interventional cardiology use less fibrinolysis and are the only ones to use anti-G2B3A.

[Myocardial infarction after voluntary intoxication by drug interaction between dipyridamole and aspirin]. / Infarctus du myocarde après intoxication volontaire par l'association acide acétylsalicylique et dipyridamole.

A 60-year-old male presented a myocardial infarction after a voluntary overdose of Asasantine(®) started after strokes. He took chronically this association and some psychotropic drugs with vasodilator effects. After an intake of 40 tablets, he presented a cardiogenic shock with a myocardial infarction confirmed by biological samples, EKG, echocardiography and angiocoronarographie. No recent change of his treatment was found and symptoms regressed when dipyridamole was stopped while other vasodilators drugs were continued. Chronological analysis of events led us to suspect dipyridamole as a starter of the myocardial infarction secondary to a coronary artery steal reinforced by the vasodilator effect of combined treatments, in a patient at risk of ischemia. This case shows that, in such particular conditions, a change in dipyridamole dosage can induce a myocardial infarction even if its blood level remains in the therapeutic range.

[Diagnostic schelf: a case of pulmonary embolism with ST elevation]. / Embolie pulmonaire massive et sus décalage du segment ST dans les dérivations antérieures : piège diagnostic.

Some pulmonary embolism may present electrocardiogram changes, which suggest the diagnosis of myocardial infarction. We report the case of a patient with such a confounding presentation. In this patient, the wrong diagnosis of myocardial infarction led to a primary coronarography which was normal and finally, echocardiogram gave us the key leading to a fibrinolitic treatment which improved the patient.