[Right bundle branch block: electrocardiographic and prognostic features]. / Bloc de branche droit: aspects electrocardiographiques et pronostiques.

The electrocardiographic appearances and the significance of right bundle branch block were described at the beginning of the 20th century. Typical appearances include prolongation > 0.12 s of the QRS complex, RR' or rR' or Rr' appearances in V1 and widened S waves in the leads exploring the left ventricle (SI, aVL, V5 and V6). A delay in the appearance of the intrinsic deflection > 0.08 s may also be observed in the right precordial leads and negative T waves with ST depression may be seen in V1 and sometimes in V2. Left axis deviation of the QRS complex greater than - 45 degrees suggests associated left anterior hemiblock. Right axis deviation beyond + 120 degrees is equivocal. The principal differential ECG diagnosis is the Brugada syndrome, a familial arrhythmogenic autosomal dominant cardiomyopathy of variable penetration. This diagnosis is suggested when ECG abnormalities are observed in patients with a personal or family history of sudden death. Right bundle branch block only seems to have haemodynamic consequences in cardiac failure with associated asynchrony of the left ventricle or in certain cases of right ventricular dilatation encountered in congenital heart disease. The prognosis of right bundle branch block in the absence of underlying cardiac disease is good but it may be poor in other cases, particularly coronary artery disease. Moreover, the prognosis of right bundle branch block to complete atrioventricular block is rare in the absence of associated cardiac disease.

[The heart and aerobatics]. / Coeur et voltige aérienne.

Aerobatics is an aerial sport which has many physiological constraints, principally cardiovascular, with a risk if not adapted of sudden mid-air incapacity which could jeopardise aviation safety, and thus justifies the selection and surveillance of pilots. The aeronautical constraints during flight are multiple, related to the environment traversed, how the aircraft functions and its movements. Those which cause accelerations (+G in particular) pose the problem of haemodynamic tolerance because they can induce loss of consciousness due to cerebral hypoxia. Tolerance of acceleration varies among individuals; it can be improved with training, certain protective manoeuvres, and is reduced by hypoxia, certain medications, dehydration and heat. Moreover, in aerobatics certain tricks require manoeuvres which reduce this tolerance to +G accelerations. This is the "push-pull" effect (_G acceleration immediately followed by +G acceleration). This leads to a risk of sudden loss of consciousness with a load factor much lower than that which the pilot knows he is capable of tolerating. Besides the haemodynamic effects, the existence of an actual acceleration cardiomyopathy has been suggested but has not been proven in man. Finally, while changes in cardiac rhythm during accelerations are usual and relate to changes in vaso-sympathetic balance, ventricular and supra-ventricular rhythm disturbances are rare and are related to the intensity and duration of the acceleration.

[Multislice computed tomography to detect coronary stenosis among asymptomatic patients with cardiovascular risk factors and equivocal prior stress test: preliminary study]. / Apport du scanner multicoupes dans le dépistage des lésions coronaires chez des patients asymptomatiques à risque: étude préliminaire.

UNLABELLED: Multislice computed tomography (MSCT) is a non-invasive and validated technique to detect coronary stenoses. Some questions remain about its accuracy to detect coronary stenoses (CS), especially for asymptomatic patients (P) when a prior stress test isn't conclusive. METHODS: MSCT was performed among 45 asymptomatic men (mean age: 58,3 +/- 16), with a high ten year risk of fatal cardiovascular disease (SCORE 2003 data for low-risk regions of Europe), without any previous coronary history and with previous non conclusive exercise testing. When significant (> 50%) CS was suspected at MSCT, an angiocoronarography (AC) was done. RESULTS: Eighteen MSCT were normal, unsignificant CS (< 50%) were detected on 14 MSCT and significant coronary stenoses (SCS) for 13 P. Among this 13 P, 19 SCS were identified: 2 SCS of left main coronary artery (CA), 9 of the left descending CA, 6 of the right CA and 2 of the left circumflex CA. 13 CS were confirmed at AC. Finally, because of critical angiographic lesions +/- ischemia at nuclear tomoscintigraphy (NT), 9 P had coronary revascularization (7 catheter based, 2 surgical bypass), 4 P had medical treatment. DISCUSSION: Benefits of this preliminary study are obvious: 9 coronary revascularization/45 P. However, the place of MSCT for the screening of CS is uncertain, but may be usefull as a complement for the screening of coronary arterial disease.

[Venous thromboembolic risk during repatriation for medical reasons]. / Risque veineux thromboembolique et sa prévention lors d'un rapatriement sanitaire.

In France, approximately 3000 people are repatriated every year, either in a civil situation by insurers. Repatriation also concerns French army soldiers. The literature is scarce on the topic of venous thromboembolic risk and its prevention during repatriation for medical reasons, a common situation. Most studies have focused on the association between venous thrombosis and travel, a relationship recognized more than 60 years ago but still subject to debate. Examining the degree of venous thromboembolic risk during repatriation for medical reasons must take into account several parameters, related to the patient, to comorbid conditions and to repatriation modalities. Appropriate prevention must be determined on an individual basis.

[Treatment specifics for spontaneous pneumothorax in flight personnel]. / Spécificités de la prise en charge du pneumothorax spontané chez le personnel navigant.

Spontaneous pneumothorax is one cause of aeronautical unfitness in flight personnel, because of the risk of recurrence in flight, making it an issue of flight safety. Specific treatment is required for fighter pilots, pilots flying single-pilot and pilots in professional training: surgical synthesis via video-thoracoscopy is obligatory from the first episode. Considering the exposure to an accumulation of aeronautical factors that are likely to encourage pneumothorax recurrence in flight, it is apical pleurectomy together with abrasion of the remaining pleura and resection of bullae/blebs that is required for fighter pilots to allow them to recover aeronautical fitness unrestrictedly. For all other categories of flight personnel, treatment is no different from that of the common patient. Knowledge of these treatment specifics is essential, to avoid unnecessary systematic surgical indication for all flight personnel, or jeopardise professional fitness in some of them due to inappropriate treatment.