[Microalbuminuria and urinary albumin excretion: French guidelines]. / Microalbuminurie et excrétion urinaire d'albumine: recommandations pour la pratique clinique.

UNLABELLED: Measurement of urinary albumin excretion (UAE) may be done on a morning urinary sample or on a 24 hour-urine sample. Values defining microalbuminuria are: - 24-hour urine sample: 30-300 mg/24 hours - Morning urine sample: 20-200 mg/mL or 30-300 mg/g creatinine or 2.5-25 mg/mmol creatinine (men) or 3.5-35 mg/mol (women). - Timed urine sample: 20-200 mug/min. The optimal use of semi-quantitative urine test-strip is not clearly defined. It is generally believed that microalbuminuria reflects a generalized impairment of the endothelium; however, no definite proof has been shown in humans. In diabetic subjects, microalbuminuria is a marker of increased risk of cardiovascular (CV) and renal morbidity and mortality in type 1 and type 2 diabetic subjects. The increase in UAE during follow-up is also a marker of CV and renal risk in type 1 and type 2 diabetic subjects; its decrease during follow-up is associated with lower risks. In non-diabetic subjects, microalbuminuria is a marker of increased risk for diabetes mellitus, deterioration of the renal function, CV morbidity and all-cause mortality. It is a marker of increased risk for the development of hypertension in normotensive subjects, and is associated with unfavorable outcome in patients with cancer and lymphoma. Persistence or elevation of UAE overtime is associated with deleterious outcome in some hypertensive subjects. Measurement of UAE may be recommended in hypertensive subjects with 1 or 2 CV risk factors in whom CV risk remains difficult to assess, and in those with refractory hypertension: microalbuminuria indicates a high CV risk and must lead to strict control of arterial pressure. Studies focused on microalbuminuria in non-diabetic, non-hypertensive subjects are limited; most of them suggest that microalbuminuria predicts CV complications and deleterious outcome as it is in diabetic or hypertensive subjects. Subjects with a history of CV or cerebrovascular disease have an even greater CV risk if microalbuminuria is present than if it is not; however, in all cases, therapeutic intervention must be aggressive regardless of whether microalbuminuria is present or not. It is not recommended to measure UAE in non-diabetic non-hypertensive subjects in the absence of history of renal disease. Monitoring of renal function (UAE, serum creatinine and estimation of GFR) is annually recommended in all subjects with microalbuminuria. MANAGEMENT: in patients with microalbuminuria, weight reduction, sodium restriction (< 6 g/day), smoking cessation, strict glucose control in diabetic subjects, strict arterial pressure control are necessary; in diabetic subjects: use of maximal doses of ACEI or ARB are recommended; ACEI/ARB and thiazides have synergistic actions on arterial pressure and reduction of UAE; in non-diabetic subjects, any of the five classes of anti-hypertensive medications (ACEI, ARB, thiazides, calcium channel blockers or beta-blockers) can be used.

Oxidative stress implication in a new phenotype of amyotrophic quadricipital syndrome with cardiac involvement due to lamin A/C mutation.

This study aimed at evaluating OS in an amyotrophic quadricipital syndrome with cardiac impairment in a family of 80 members with a mutation in lamin A/C gene. Twelve patients had cardiac involvement (5 cardiac and skeletal muscles impairment). OS was evaluated in blood samples (thiobarbituric acid-reactive substances (TBARS), carbonylated proteins (PCO)) 6 "affected patients" with phenotypic and genotypic abnormalities without heart failure and 3 "healthy carrier" patients. OS was higher in affected patients than in healthy, as shown by the higher TBARS and PCO values. Patients with cardiac and peripheral myopathy exhibited a higher OS than patients with only cardiac disease (TBARS: 1.73 +/- 0.05 vs. 1.51 +/- 0.04 mmol/l (p = 0.051), PCO: 2.73 +/- 0.34 vs. 0.90 +/- 0.10 nmol/mg protein (p = 0.47)), and with healthy carriers patients (TBARS: 1.73 +/- 0.05 vs. 1.16 +/- 0.14 mmol/l (p = 0.05), PCO: 2.73 +/- 0.34 vs. 0.90 +/- 0.20 nmol/mg protein (p = 0.47)). OS may thus contribute to the degenerative process of this laminopathy. ROS production occurs, prior to heart failure symptoms. We suggest that the extent activation may also promote the variable phenotypic expression of the disease.

Microalbuminuria and urinary albumin excretion: French clinical practice guidelines.

Urinary albumin excretion (UAE) may be assayed on a morning urinary sample or a 24 h-urine sample. Values defining microalbuminuria are: 1) 24-h urine sample: 30-300 mg/24 h; 2) morning urine sample: 20-200 mg/ml or 30-300 mg/g creatinine or 2.5-25 mg/mmol creatinine (men) or 3.5-35 mg/mmol (women); 3) timed urine sample: 20-200 mug/min. The optimal use of semi-quantitative urine test-strip is not clearly defined. It is generally believed that microalbuminuria reflects a generalized impairment of the endothelium; however, no definite proof has been obtained in humans. IN DIABETIC SUBJECTS: Microalbuminuria is a marker of increased risk of cardiovascular (CV) and renal morbidity and mortality in type 1 and type 2 diabetic subjects. The increase in UAE during follow-up is associated with greater CV and renal risks in type 1 and type 2 diabetic subjects; its decrease during follow-up is associated with lower risks. IN NON-DIABETIC SUBJECTS: Microalbuminuria is a marker of increased risk for diabetes mellitus, deterioration of renal function, CV morbidity and all-cause mortality. It is a marker of increased risk for the development of hypertension in normotensive subjects, and is associated with unfavorable outcome in patients with cancer and lymphoma. Persistence of elevated UAE during follow-up is associated with poor outcome in some hypertensive subjects. Measurement of UAE may be recommended in hypertensive medium-risk subjects with 1 or 2 CV risk factors in whom CV risk remains difficult to assess, and in those with refractory hypertension: microalbuminuria indicates a high CV risk and must lead to strict control of arterial pressure. Studies focused on microalbuminuria in non-diabetic non-hypertensive subjects are limited; most of them suggest that microalbuminuria predicts CV complications and deleterious outcome. Subjects with a history of CV or cerebrovascular disease have an even greater CV risk if microalbuminuria is present than if it is not; however, in all cases, therapeutic intervention must be aggressive regardless of whether microalbuminuria is present or not. It is not recommended to measure UAE in non-diabetic non-hypertensive subjects in the absence of history of renal disease. Monitoring of renal function (UAE, serum creatinine and estimation of GFR) is recommended annually in all subjects with microalbuminuria. MANAGEMENT: In patients with microalbuminuria, weight reduction, sodium restriction (<6 g per day), smoking cessation, strict glucose control in diabetic subjects, strict arterial pressure control are necessary; in diabetic subjects: use of maximal doses of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) are recommended; ACEI/ARB and thiazides have synergistic actions on arterial pressure and reduction of UAE; in non-diabetic subjects, any of the five classes of anti-hypertensive medications (ACEI, ARB, thiazides, calcium channel blockers or beta-blockers) can be used.

Heart failure with preserved systolic function: a diagnostic algorithm for a pragmatic definition.

Heart failure is a major health problem which often concerns the elderly. Prevalence of heart failure with preserved systolic function is increasing and varies from 40 to 50%. In the literature, and in the large epidemiological studies, it is commonly designed with the term of "diastolic heart failure", even if a precise analysis of diastolic function is not performed. A diagnostic algorithm is proposed in order to better define the concept of heart failure with preserved systolic function. It consists of seven steps from symptoms and clinical signs to the echocardiographic analysis of diastolic function, in order to confirm the definition of heart failure with preserved systolic function.

[Neurological aspects of Fabry's disease]. / Manifestations neurologiques de la maladie de Fabry.

Fabry disease is a rare X-linked disorder caused by deficient activity of the lysosomal enzyme alpha-galactosidase A. Progressive accumulation in lysosomes of the undegraded glycosphingolipids leads to a multi-system disease with dermatological, ocular, renal, cardiac, and neurological manifestations. Peripheral nerve involvement, neuropathic pain and chronic acroparesthesiae, are frequent and early-onset signs revealing the disease. They are due to the involvement of small nerve fiber, thus explaining the normality of electroneuromyography. Cochleo-vestibular and autonomic nervous system involvement is frequent. Besides rare aseptic meningitis, central nervous system involvement is essentially represented by cerebrovascular events (stroke, transient ischemic attack). Affecting essentially the posterior circulation, their etiologies have to be clarified: progressive stenosis of small vessels with globotriasocylceramide deposits, arterial remodeling, endothelial dysfunction, pro-thrombotic state, cerebral hypoperfusion consecutive to dysautonaumy, cardiac embolism. MRI shows numerous silent lesions, increasing with age, mainly in small perforant arteries (periventricular white matter, brainstem, cerebellum, basal ganglia). Pulvinar calcifications, due to an increase in cerebral hyperperfusion, could be specific of Fabry disease. Positon tomography analysis shows a reduced cerebral flow velocity and impaired cerebral autoregulation, secondary to the glycosphingolipid storage in vascular endothelial cells. Enzyme replacement therapy has to be carefully monitored.

Comparative efficacy and safety of enalapril and sustained-release nifedipine in patients with mild to moderate hypertension. The Enalapril vs Nifedipine French Study Group.

The long acting angiotensin-converting enzyme inhibitor enalapril was compared with the calcium channel blocker nifedipine as sustained-release formulation in 136 patients with mild to moderate hypertension. This multicentre study was carried out in a double-blind, double-dummy fashion by 28 cardiologists in private practice. After a 2-week placebo period, patients were randomly allocated to 2 treatment groups; the first group received enalapril 20 mg daily (n = 68), and the second group received sustained-release nifedipine 20 mg twice daily (n = 68). The duration of treatment was 12 weeks. In both groups, hydrochlorothiazide 25 mg was added at week 4 if diastolic blood pressure remained greater than 90 mm Hg. At week 8, if the target diastolic pressure of less than 90 mm Hg was not achieved, the dosage of hydrochlorothiazide was increased to 50mg. The clinical characteristics of the patients in each group were comparable. After 4 weeks of treatment, the reduction in supine diastolic blood pressure was similar in both groups (12.1 mm Hg in the enalapril group vs 10.3 mm Hg in the nifedipine group). Moreover, although the difference between the groups was more noticeable after 12 weeks of treatment (16.3 vs 13.9 mm Hg, respectively), it did not reach significance. The number of patients experiencing clinical adverse effects was significantly greater in the nifedipine group than in the enalapril group [33 (48.5%) vs 18 (26.5%), respectively]. The most common complaints of patients administered nifedipine included swollen ankles, flushing and headaches, whereas complaints in the enalapril group included cough, asthenia, and epigastralgia. Three patients were withdrawn from the study because of side effects in the enalapril group and 10 were withdrawn from the nifedipine group. These results indicate that enalapril and sustained-release nifedipine are equally effective in controlling mild to moderate hypertension. However, enalapril was much better tolerated in this study.

[Oxygen free radicals in cardiology]. / Les radicaux libres oxygénés en cardiologie.

Oxygen free radicals are extremely toxic chemical entities derived from oxygen metabolism. This is a physiological process which explains a great deal of the phenomenon of phagocytosis. Under normal conditions, the body's natural defense mechanism neutralise the oxygen-free radicals as they are produced. In certain pathological situations, a disequilibrium is observed between the free radical aggression and the defense systems which creates an oxidative stress and organ damage. In cardiology, the oxidative stress occurs essentially in the phenomenon of reperfusion ischaemia. It is partially responsible for the reperfusion arrhythmias and myocardial stunning. An irreversible myocardial disease such as myocardial infarction, the responsibility of the oxidative stress is more uncertain. In myocardial protection during cardiac surgery the radical-induced damage occurs without it being possible to demonstrate the phenomenon in irreversible myocardial disease. The role of oxidative stress is unquestionable in myocardial reperfusion ischaemia. The detection of sensitive biological markers and a better understanding of the physiopathology should increase our knowledge of oxygen free radicals and enable effective treatment of their complications.

[Economic implications of the various treatment methods in myocardial ischemia]. / Les implications économiques des divers traitements de l'ischémie myocardique.

Modern treatments of myocardial ischaemia are effective. Surgical coronary revascularization involves high immediate expenditures, but these are tempered by a subsequent reduction in medical consumption and costs. Coronary angioplasty is a more comfortable revascularization procedure than bypass surgery which it increasingly tends to supersede. The overall health expenditures involved are about 20% lower than those of surgery. Treatment of incipient infarction has recently been introduced. Its generalization implies a reorganization of medical care and a major increase in expenditures. To what extent this increase will be upset by the benefits of avoided or limited infarction can only be determined by detailed and accurate evaluation.

[Mobitz type II suprahisian atrioventricular block : block in the subnodal-suprahisian (NH) zone?]. / Bloc auriculo-ventriculaire suprahisien de type Möbitz II : bloc dans la zone NH?

The electrophysiological properties of the atrioventricular node differ from those of the His bundle. Nodal conduction is always decremential; this is its principal physiological characteristic, and accounts for the fact that almost the only form of block found at this level is Wenckebach block. The His bundle is characterised by an all-or-nothing response and usually blocks in the Mobitz II mode. Wenckebach phenomena have been described in the His Purkinje system, but Mobitz II block has not been reported in the atrioventricular node. Similarly, phase IV paradoxical block is found in the His Purkinje system but has not been described in the atrioventricular node in the absence of vagal phenomena. In addition, the atrioventricular node is very sensitive to the influence of the autonomic nervous system, the His bundle much less so. The first patient had a normal resting electrocardiogram showing sinus rhythm; second degree atrioventricular block was observed when the atrial rhythm was increased by exercise, atropine or atrial pacing. His bundle recordings showed the block to be suprahisian; the blocked atrial potentials were not followed by a His potential, whilst the conducted atrial activity was followed by a normal His potential and a normal HV interval. However, this atrioventricular block was of the Mobitz II and not the expected Mobitz I type, conduction to the ventricles suddenly blocking (with a 3/2 or 2/1 response) when the atrial rate was increased, without obvious lengthening of the PR or AH intervals before the blocked atria.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prehospital fibrinolysis with rt-PA in acute myocardial infarction]. / Fibrinolyse préhospitalière par rt-PA dans l'infarctus aigu du myocarde.

Thrombolytic therapy has been shown to be very effective in the acute phase of myocardial infarction and the benefits are greater if the treatment is initiated as soon as possible. In France, early treatment in the prehospital phase is possible through the SAMU, an emergency ambulance and care unit organisation. Between December 1987 and November 1988, 80 patients (73 men and 7 women) with an average age of 55 +/- 9 years were treated by rt-PA (100 mg i.v. in 90 minutes) for acute myocardial infarction within three and a half hours of the onset of symptoms. The average delay between the onset of pain and the administration of rt-PA was 126 +/- 43 minutes, which represents an estimated average time gain of 55 minutes compared with thrombolysis started after hospital admission. No haemorrhagic or allergic complications occurred during hospital transfer and there was no mortality. There were, however, two diagnostic errors. Thrombolysis was estimated to be effective on clinical, electrocardiographic and enzymatic criteria in 60 p. 100 of cases. Thirty early coronary angiographies (within 48 hours) showed that 83 p. 100 of the arteries thought to be responsible for the infarct were patent. Haemorrhage was a rare complication during the hospital phase and had a favourable outcome. Hospital mortality was 6 per cent. The low morbidity and the reliability of diagnosis indicate that prehospital thrombolysis is feasible in the acute phase of myocardial infarction.

[Contribution of nuclear magnetic resonance in right atrial angiosarcoma. Apropos of a case]. / Apport de l'exploration par résonance magnétique nucléaire dans l'angiosarcome auriculaire droit. A propos d'une observation.

A 25-year old female patient was admitted to hospital for respiratory failure with pulmonary miliary. Subsequently, clinical signs of pericardial tamponade developed. Echocardiography showed a tumour of the right atrium. Malignancy of the tumour was strongly suspected on the basis of magnetic resonance findings. At surgery, the tumour could not be removed and multiple biopsies showed that it was an angiosarcoma with metastases in the lymph nodes and the lungs, the latter presenting as carcinomatous miliary. This case is of interest because of the unusual way the tumour was discovered with a possible alternative diagnosis of cardiac tuberculoma, and because of the usefulness of magnetic resonance imaging to diagnose cardiac tumours and evaluate the extension of those which are malignant.

[Antioxidative treatment in myocardial reperfusion ischemia]. / Le traitement antioxydant dans l'ischémie reperfusion myocardique.

Perfusion-induced myocardial ischaemia is observed in several situations: chronic coronary insufficiency, unstable angina, myocardial infarction, and during coronary angioplasty or bypass surgery. Oxygen-derived free radicals are liberated in large quantities during myocardial reperfusion ischaemia. Though very toxic in experimental studies, the responsibility of these free radicals in myocardial injury remains to be demonstrated clinically. Oxidant stress, characterised by an imbalance between the free radical attack and insufficient cellular defense seems partially responsible for reperfusion arrhythmias and post-ischemic stunning. On the other hand, its role is less evident in prolonged myocardial ischaemia causing irreversible myocardial lesions such as infarction. Antioxidant therapy is under evaluation in clinical trials. There are several options: some prevent the formation of free radicals by inhibiting the biochemical reactions which may produce them or by limiting the intervention of the neutrophils--the "fulcrum" of free radicals formations. Other antioxidant therapies inactivate free radicals as they are formed by promoting their degradation or their neutralisation. Experimental data is profuse and discordant. The models are very different. The first clinical trials are under way using either specific antioxidant molecules or molecules having other beneficial effects: in the latter case, the benefit of the antioxidant action is more difficult to demonstrate. Antioxidant therapy could play a role in surgical myocardial protection, especially of transplant organs, in very early forms of ischaemia. It could also prevent the pejorative hemodynamic consequences of myocardial stunning of the border zones of infarction, so enabling patients to survive a difficult period. The results of on-going studies should clarify the role of antioxidant therapy in reperfusion-induced myocardial ischaemia.

[Treatment by redilatation and thrombolysis of occlusion occurring during percutaneous coronary angioplasty]. / Traitement par redilatation et thrombolyse des occlusions survenant lors des angioplasties coronaires percutanées.

In patients who develop acute coronary occlusion during or after percutaneous coronary angioplasty, surgery is not mandatory, and other treatments may be considered, namely redilatation and/or thrombolysis. Between June, 1984 and January, 1988 we performed 500 dilatations of coronary arteries, not counting the attempts made in the acute phase of myocardial infarction. Acute coronary occlusion without angiographic image of occlusive dissection occurred in 31 patients (6.2%) and was treated by attempted redilatation and intracoronary thrombolysis. In 10 patients (group A) either the occlusion could not be removed and emergency surgery was tried (5 cases with 2 infarctions and 1 death), or the occlusion was removed but myocardial infarction took place (5 cases). In 21 patients (group B), the occlusion was removed and the outcome was favourable without myocardial infarction. Altogether, myocardial infarction or death occurred in only 8 cases, or 26% of acute occlusions. The clinical and angiographic features of the two groups before and after angioplasty were compared; two of them differentiated group A from group B: (1) unstable angina, 7/10 in group A, 4/21 in group B (p less than 0.01), and (2) degree of stenosis, 93.1% in group A, 78% in group B (p less than 0.01). When coronary occlusion occurs during or after coronary angioplasty and is poorly tolerated with fall in blood pressure, surgery must be contemplated at once, even after recanalization of the vessel and subsidence of ischaemia. In all other cases, treatment with both redilatation and thrombolysis should restore the benefits of angioplasty without myocardial infarction.

[Value of antimyosin monoclonal antibody scintigraphy in the diagnosis of acute myocardial infarction]. / Intérêt de la scintigraphie aux anticorps monoclonaux antimyosine dans le diagnostic d'infarctus du myocarde rudimentaire.

A 53 year old woman developed chest pain with transient anterior subepicardial ischaemic ECG changes and a mild increase in serum myocardial enzyme concentrations. She was admitted to hospital some time later but there were no electrocardiographic signs of infarction. Echocardiography was considered to be normal. Coronary angiography showed no significant stenosis and there were no segmental wall motion abnormalities on left ventriculography. The diagnosis of a non-Q wave infarct was confirmed by myocardial scintigraphy using antimyosin monoclonal antibodies labelled with Indium 111. The site and size of the necrosis were also determined by this non-invasive investigation.

[Has the obligation to inform patients changed our mode of practice?]. / L'information du patient a-t-elle modifié notre comportement?

From January 2000, the Council of State has harmonised the jurisprudence with the Court of Appeal, changing the responsibility of medical practitioners by requiring them to provide proof that information was both given and understood by their patients. This obligation to inform patients raises several questions: who should give the information? to whom should the information be addressed? how can proof of this information be provided? what should the information be? The authors sent a questionnaire to practicing cardiologists by the internet site of the French Society of Cardiology from the 1st December 2002 to 15th January 2003. Three hundred and thirty-two replies were received of which 305 could be exploited. The activities of the cardiologists who replied were mainly in public hospitals (51.8%), private (18.2%) or mixed (30%). Patient information was mainly performed before invasive procedures, especially coronary angiography (90%) or cardiac pacing (77.3%). On the other hand, it was less commonly undertaken before exercise stress tests (63.2%) or transoesophageal echocardiography (61.4%), although these percentages are much higher than those recorded during previous enquiries in 2000 and 2001. The information given was, in the large majority of cases, that proposed by the French Society of Cardiology and it was usually the practitioner who ordered the investigation who informed the patient (45.4%). In 2002, the role of the nurse was much greater as the nurse informed the patient in 27.2% of cases. The patient was generally given the information the day before the procedure was carried out (74.1%) with complementary information (90.7%), and less than 1% of patients declined the investigation under these conditions. In order to provide proof of patient information, the practitioner usually required the patient's signature (58.3% of cases); less commonly, the referring physician was informed by letter (13.9% of cases) or a note was made in the patient's file (33.9% of cases). The new requirements for patient information have changed medical practice in nearly 53.5% of cases. Finally, although patient information is considered to be part of the normal patient-doctor relationship in most cases (42.7%), doctors thought that patients interpreted this procedure as a cover for the medical team in 18.2% of cases. The information bases most commonly used to determine the methods of informing patients and the nature of the information to be provided were medical reviews (38.9%) or the internet (30.5%). The authors conclude that patient information is carried out before complementary cardiological investigations. The new laws of the Code of Public Health are not well known. Finally, the proof of patient information is not easily provided and the majority of cardiologists request written patient consent, which is not a legal requirement.

[Medical treatment of sustained ventricular tachycardia. Retrospective study of 85 patients]. / Traitement médical des tachycardies ventriculaires soutenues. Etude rétrospective de 85 patients.

In this retrospective study the antiarrhythmic of 85 patients suffering from sustained and recurrent attacks of ventricular tachycardia is analysed. Among these patients, 48 had ischaemic heart disease, 18 had right ventricular arrhythmogenic dysplasia, 9 had dilated cardiomyopathy and 2 had complex heart disease; in 8 patients the tachycardia was idiopathic. Two hundred and seventy-two antiarrhythmic treatments administered orally alone or in combination were studied. Their effectiveness was evaluated on the clinical course of the disease, on the résults of Holter recordings and, in some cases, on electrophysiological exploration. The mean follow-up period was 50 months. Each patient received 3.2 antiarrhythmic treatments on average. The effectiveness and side-effects of these treatments are analysed retrospectively, but the relative effectiveness of a treatment compared to another cannot be extrapolated to a new patient. Prescription in this field is purely empirical. The recent amiodarone-flecainide combination has been the most frequently used antiarrhythmic treatment in recent years. It was given to 33 patients in this series and proved effective in 21 patients followed up for 22 months.

[Infected false aneurysm at the level of an aortotomy cicatrix 5 years after mechanical replacement of the aortic valve]. / Faux anévrysme infecté au niveau d'une cicatrice d'aortotomie cinq ans après remplacement valvulaire aortique mécanique.

The authors report the case of Streptococcus Bovis Infection of a pseudoaneurysm which developed in the aortotomy suture line five years after aortic valve replacement with a Bjork-Shiley prosthesis. This was an isolated lesion without involvement of the prosthesis or aortic ring and was an operative finding.

[Mitral valvuloplasty during the 4th month of pregnancy. Fetal protection with a lead mantle]. / Valvuloplastie mitrale au quatrième mois de grossesse. Protection foetale par un manteau de plomb.

A 27 year old woman who had undergone closed heart surgical commissurotomy 10 years previously, underwent percutaneous mitral valvuloplasty during the fourth month of her pregnancy. Despite significant valvular thickening with calcification, the balloon dilatation led to an increase in valve surface area from 1.1 to 2 cm2 with no complications and with relief of the pulmonary hypertension. Foetal protection against ionising radiation was assured by a lead mantle completely surrounding the patient's abdomen. This protection reduced irradiation of the pelvic region to 0.5 milliSievert which corresponds to 1/100 of the permitted irradiation of pregnant women professionally exposed to ionising radiation.

[Patient information. First evaluation]. / L'information au patient. Premier bilan.

The recent harmonisation of the jurisprudence between the Court of Appeal and State Council has affected medical responsibility because it is now the physician's obligation to prove that the information to the patient has been properly given: it is, therefore, a current issue. A first evaluation was undertaken to determine the modalities of patient information in cardiology by an enquiry of cardiologists working in the public and private sectors. The results show that information to patients was given concerning complementary investigations such as exercise stress testing, transoesophageal echocardiography, coronary angiography and cardiac pacing; the information was more often given for invasive procedures. In the great majority of cases (92%), it is the prescribing or operating physician who gives this information, usually the day before the procedure, with complementary oral explanations in about 90% of cases. Patient information, therefore, seems to be well done by cardiologists. However, the proof of information is not always easy, written consent, signed by the patient, not being compulsory at present.

[Patient information and the cardiologist]. / L'information du patient et le cardiologue.

AIM OF THE STUDY: The patient's information prior to paraclinical testings is a part of the medical deontology and takes on increasing legal importance since new laws. METHODS: From December 2001 to January 2002, we administered to cardiologists through the website of the French Society of Cardiology a questionnaire in order to determine the way the information is dispensed to patients and to compare the results to the survey performed in 2000. RESULTS: Among the 293 answers obtained, 243 were utilizable. The answers were obtained from cardiologists working on private medicine (27.5%), public medicine (52.8%) or mixed (19.7%). Information was more frequently dispensed for invasive procedures: coronary angiography (92.2%), cardiac pacing (76.8%) than non invasive assessments: transesophageal echocardiography (47.6%) and treadmill test (44.7%). The most frequent information document given to patients was the one edited by the French Society of Cardiology (71.6%). In the great majority of cases, there is the prescribing cardiologist (35.9%) and/or the one performing the assessment who dispenses the information, generally the day prior the examination (73.5%) with additive explanations (91.4%). Few patients refuse the examination after information. The situation where the assessment is performed on a patient without the faculty of understanding modalities and the necessity of that examination is in emergency (45%). In 63.4% of cases, the cardiologist requires the patients signature on the information document. CONCLUSION: Information dispensation prior to an examination is generally well done by cardiologists. The evidence of the information's dispensation is not at ease and most of cardiologists require written document from their patients, which is not legally necessary.