The effect of month and breed on plasma adrenocorticotropic hormone concentrations in equids.

Use of plasma adrenocorticotropic hormone (ACTH) concentrations for the diagnosis of PPID in equids requires awareness of other factors that might influence ACTH concentrations, including breed and time of year. This study was designed to investigate effects of breed on plasma ACTH concentrations and potential interactions between breed and time of year. Ten breeds were selected from a laboratory database containing data on plasma ACTH concentrations. Breeds represented were Arabians, Cobs, Connemara ponies, donkeys, Irish Sports horses, New Forest ponies, Shetland ponies, Thoroughbreds, Warmbloods and Welsh breeds. Multivariable analysis was used to determine the effects of month and breed on plasma ACTH concentrations. A circannual pattern of ACTH concentration was documented, with a nadir in April and a peak in September. Arabian horses and donkeys had significantly higher ACTH concentrations than some other breeds, primarily from May to November, whereas in Shetland ponies and Welsh breeds, relatively higher ACTH concentrations only occurred from July to November. The annual increase in plasma ACTH appeared to commence in late April/early May in response to increasing daylight and decreased again promptly after the late September equinox as daylength fell below 12 h per day. Inter-breed differences in plasma ACTH were substantial and indicated that breed and time of year should be considered when interpreting plasma ACTH concentrations in equids suspected for PPID.

[Leptospirosis in a paperless migrant living in Brussels]. / Leptospirose sévère chez un migrant sans-papier résidant à Bruxelles.

We report the clinical history of a paperless migrant living in Belgium who contracted Weil's disease. This historical term refers to the severe form of leptospirosis, an ever more frequent tropical disease in Europe due to the growing globalization background. However, leptospirosis remains underdiagnosed. Actually, common clinical forms are neglected in outpatient medicine and the performance of available diagnostic tests is limited, especially when they are performed in severe, potentially life-threatening forms. In these cases of sepsis or even septic shock, the antibiotic treatment is most often empirical although fortunately adapted thanks to the large sensitivity of the spirochete.

Nous rapportons l'histoire clinique d'un sans-papier séjournant en Belgique atteint de maladie de Weil. Ce terme historique désigne la forme sévère de la leptospirose, une maladie tropicale dont l'incidence augmente en Europe, sur fond de mondialisation en essor. La leptospirose reste toutefois sous-diagnostiquée. En effet, les formes cliniques courantes sont négligées en médecine ambulatoire et la performance des tests diagnostiques disponibles est limitée, lorsqu'ils sont demandés face aux formes sévères, potentiellement mortelles. Dans ces cas de sepsis, voire de choc septique, le traitement antibiotique est donc le plus souvent empirique, tout en demeurant, heureusement, adapté de par la multisensibilité du spirochète.

[Temporomandibular joint (TMJ): Condyle hyperplasia and condylectomy]. / Articulation temporomandibulaire (ATM) : hypercondylie et condylectomie.

The mandibular condyle is a special structure. Its embryology and physiology provide to the TMJ a particular behavior that explains the occurrence of specific diseases. Condyle hyperplasia is one of these disorders. It can be explained by a dysregulation of the prechondroblast cell layer within the cartilage cap providing an increase in volume first of the condyle, then of the ramus and finally of the entire affected hemiface. Mandible deformation affects the basal bone, leading to dento-alveolar deformations related to compensation attempts. Controversies, condylectomy is performed by many surgeons. This procedure allows for the correction of some of the dento-alveolar compensations. In some cases, an additional orthognathic surgery will be required to achieve a perfect result.

[Temporomandibular joint disc surgery]. / Chirurgie discale de l'articulation temporo-mandibulaire.

Temporomandibular joint (TMJ) disorders are a common disease and may be responsible for major functional and painful repercussions. Treatment is not consensual. The literature highlights the role of conservative treatments (physiotherapy, analgesics, splints) in a first attempt. Minimally invasive surgical techniques (arthroscopy, arthrocentesis) have developed rapidly in recent decades. They have proven effective and reliable, especially in patients suffering from irreducible or reducible anterior disc dislocation or presenting with arthopathies. The goal of our work was to make an update about disk surgery.

Thermoresponsive self-assembled cyclodextrin-end-decorated PNIPAM for aqueous catalysis.

The catalytic performance of thermoresponsive poly(N-isopropylacrylamide) (PNIPAM) functionalized at the terminal position with randomly methylated ß-cyclodextrin was demonstrated by the aqueous Rh-catalysed hydroformylation of higher olefins.

Genetic diversity within Pisum sativum using protein- and PCR-based markers.

A collection of 148 Pisum accessions, mostly from Western Europe, and including both primitive germplasm and cultivated types, was structured using 121 protein- and PCR-based markers. This molecular marker-based classification allowed us to trace back major lineages of pea breeding in Western Europe over the last decades, and to follow the main breeding objectives: increase of seed weight, introduction of the afila foliage type and white flowers, and improvement of frost tolerance for winter-sown peas. The classification was largely consistent with the available pedigree data, and clearly resolved the different main varietal types according to their end-uses (fodder, food and feed peas) from exotic types and wild forms. Fodder types were further separated into two sub-groups. Feed peas, corresponding to either spring-sown or winter-sown types, were also separated, with two apparently different gene pools for winter-sown peas. The garden pea group was the most difficult to structure, probably due to a continuum in breeding of feed peas from garden types. The classification also stressed the paradox between the narrowness of the genetic basis of recent cultivars and the very large diversity available within P. sativum. A sub-collection of 43 accessions representing 96% of the whole allelic variability is proposed as a starting point for the construction of a core collection.

[Association of D-dimer and helicoidal thoracic scanner for diagnosis of pulmonary embolism. Prospective study of 106 ambulatory patients]. / Association D-dimères et scanner thoracique hélicoïdal pour le diagnostic d'embolie pulmonaire. Etude prospective chez 106 patients ambulatoires.

OBJECTIVE: Ventilation/perfusion pulmonary scintigraphy (PS), the current mainspring in the diagnosis of pulmonary oedema (PE), is frequently non-conclusive. The objective of this study was to determine, prospectively, the diagnostic value of the association of D-dimers and helicoidal thoracic scanner (HTS) in a continuous series of ambulatory adults with suspected PE and admitted to a cardiologic emergency unit. METHODS: Exclusion criteria were as follows: symptoms or clinical signs of seventy, contraindication for HTS and/or on pulmonary angiography, curative anticoagulant therapy for more than 48 hours, history of PE less than 3 months before or the impossibility of conducting all the examinations with 48 hours. All the patients underwent determination of D-dimers by rapid ELISA test, HTS and 2 reference examinations, venous Doppler of the lower limbs and a PS, completed by pulmonary angiography if the PS did not permit diagnosis and the venous Doppler was negative. RESULTS: One hundred and six patients were selected over a recruitment period of 18 months. The prevalence of PE was of 45% (48/106). Forty-four of the 48 PE of the series were central form. HTS was considered dubious in 10 patients (10.4%, PE+ n = 2, PE- n = 8). The results of D-dimers were negative in only 34.5% patients without PE (20/58). Pulmonary angiography was necessary in 15 patients. The negative and positive predictive values of D-dimers were respectively of 100 and 55.8% (48/86) and those of HTS respectively 100 (46/46) and 92% (46/50). CONCLUSION: The diagnostic strategy of clinical suspicion of PE, starting with determination of D-dimers by rapid ELISA test followed by helicoidal thoracic scanner in the case of a positive result, was particularly effective in this series of patients with a high prevalence of PE. These results must be confirmed in a larger series and in a general emergency unit.

Genetic heterogeneity of familial hyperkalaemic hypertension.

BACKGROUND: Familial hyperkalaemic hypertension (FHH) is a Mendelian form of low-renin hypertension characterized by hyperkalaemia and hyperchloraemic acidosis despite a normal glomerular filtration rate. To date, three different loci have been identified, on chromosomes 1, 17 and 12. OBJECTIVE: To test for genetic linkage between the three FHH loci and three new affected kindreds. DESIGN AND METHODS: Clinical, biological and genetic analyses were made of three kindreds, including 11 affected individuals among 25 members. Genotyping was performed using four series of microsatellite markers spanning the chromosomes 1, 17 and 12 loci, and the thiazide-sensitive Na-Cl cotransporter (SLC12A3) gene. RESULTS: Segregation of the trait in each kindred was compatible with an autosomal transmission, the affected individuals displaying reasonably consistent biochemical abnormalities and the expected variability in arterial hypertension. Multipoint linkage analysis excluded linkage with the four candidate loci in kindreds 1 and 2, but not with the chromosome 1 locus in kindred 3. CONCLUSION: These results demonstrate further genetic heterogeneity and that a fourth gene is responsible for FHH in at least two unrelated kindreds. They suggest a variety of molecular defects leading to FHH.

Improvement of cardiac neuronal function after carvedilol treatment in dilated cardiomyopathy: a 123I-MIBG scintigraphic study.

UNLABELLED: Carvedilol can induce important clinical and hemodynamic improvements in patients with chronic heart failure resulting from severe left ventricular (LV) dysfunction. This study examines the impact of carvedilol on cardiac neuronal function using 123I-metaiodobenzylguanidine (MIBG) scintigraphy in dilated cardiomyopathy. METHODS: Twenty-two patients with chronic heart failure (19 men, 3 women; mean age, 54 y; age range, 34-64 y) assessed as New York Hospital Association (NYHA) class II or III and with initial resting radionuclide LV ejection fractions (LVEF) < 0.40 were enrolled in the study. Patients had long histories of symptomatic LV dysfunction despite optimal diuretics and angiotensin-converting enzyme inhibitor treatment. Over a 6-mo period, 50 mg/day carvedilol was administered to these patients. Planar 123I-MIBG scintigraphy provided measurements of cardiac neuronal uptake (as heart-to-mediastinum count activity ratio [HMR]), 4h after intravenous injection of 185 MBq MIBG. Hemodynamic, clinical, radionuclide LVEF and HMR data measured at the outset and after 6 mo of carvedilol were compared. RESULTS: Resting heart rate decreased from 81 +/- 13 to 71 +/- 9 bpm (P = 0.003). After carvedilol therapy NYHA functional classification for these patients improved from 2.6 +/- 0.5 to 2.3 +/-0.5 (P = 0.04), LVEF improved from 22% +/- 9% to 30% +/- 13% (P = 0.005), and HMR improved from 145% +/- 23% to 170% +/- 25% (P = 0.0001). CONCLUSION: Carvedilol induces improvements of clinical symptoms and cardiac neuronal and systolic functions in patients with dilated cardiomyopathy and chronic optimal treatment.

The reversibility of cardiac neuronal function after removal of a pheochromocytoma: an I-123 MIBG Scintigraphic Study.

PURPOSE: Twelve patients with proved pheochromocytoma evaluated in our institution between 1991 and 1997 are described. METHODS: The patients' urinary excretion rates and their metabolites (vanylmandelic acid and metanephrines) were significantly greater than normal before surgery. Echocardiography showed normal left ventricular ejection fractions (72% +/- 8%). All of the patients underwent planar I-123 metaiodobenzylguanidine (MIBG) scintigraphy to assess cardiac neuronal uptake 4 hours after and locate a pheochromocytoma 24 hours after intravenous injection of 185 MBq (3 mCi) I-231 MIBG. Ten patients with pheochromocytoma had positive tumoral findings with I-123 MIBG scintigraphy. Twelve patients had significant impairment of cardiac neuronal uptake of MIBG, with a heart:mediastinum ratio averaging 142% +/- 18% (normal value, 230% +/- 30%, P < 0.05). Postoperative cardiac MIBG imaging was performed in all patients (at 6 +/- 3 months). RESULTS: After surgical removal of the pheochromocytoma, cardiac MIBG uptake and the heart:mediastinum uptake ratios improved significantly (197% +/- 20%, P < 0.05) in all the patients. Urinary excretion rates and metabolites returned to the normal range. However, no significant correlation was found between cardiac MIBG uptake and urinary excretion rates and metabolites after the tumors were removed. CONCLUSION: Removing a pheochromocytoma reversed cardiac neuronal function as assessed by MIBG scintigraphy.

Direct coronary stenting without balloon predilation in acute coronary syndromes.

BACKGROUND: This prospective, observational study was designed to evaluate the feasibility and the safety of a new strategy for stenting in acute coronary syndromes: direct stent implantation without predilation of the culprit lesion. This strategy might reduce both the cost of the procedure and the rate of no-reflow, a phenomenon that is more frequently observed during dilation of unstable plaques. METHODS AND RESULTS: Between September 1997 and March 1998, 122 carefully selected patients with unstable angina or acute myocardial infarction were included in this study. Highly calcified lesions and vessels with excessive proximal tortuosity were excluded. The procedure was successful in 96% of cases. In 5 cases the stent failed to pass through the stenosis and was successfully retrieved in the guiding catheter in 3 cases. In 2 cases the stent was lost in the peripheral circulation. Transient no-reflow occurred in only 3 cases and was rapidly reversed by rescue use of an intracoronary bolus injection of a glycoprotein IIb/IIIa receptor inhibitor in 2 cases. A patient treated by primary angioplasty with cardiogenic shock on admission died 48 hours after the initial procedure because of irreversible cardiac failure. One-month clinical follow-up was obtained by telephone for all patients; no major coronary events occurred during this period. CONCLUSIONS: Direct coronary stenting without balloon predilation can be safely performed in acute coronary syndrome-related lesions in selected patients. A randomized, controlled study is warranted to confirm the promising results of this pilot study, especially regarding the low rate of the no-reflow phenomenon.

Detection of cardiac myxoma by F-18 FDG PET.

Intracardiac tumors occur infrequently and are difficult to diagnose with CT and MRI. The authors describe the successful imaging of a right atrial myxoma with F-18 FDG PET.

[Treatment of refractory cardiac insufficiency by peritoneal ultrafiltration. Literature review]. / Traitement de l'insuffisance cardiaque réfractaire par ultrafiltration péritonéale. Revue de la littérature.

The management of heart failure that has become refractory to conventional drug treatment is an increasingly frequent problem for clinicians. Peritoneal dialysis, by ultrafiltration, is an effective method to treat refractory oedema, thereby improving the functional symptoms of these patients. The objective of this article is to review the data, of the literature and to define the results and indications of this treatment, which still remains and exceptional modality.

Impairment of cardiac neuronal function in acute myocarditis: iodine-123-MIBG scintigraphy study.

UNLABELLED: Abnormalities of norepinephrine uptake have been found to reflect impairment in adrenergic nerve function that has influenced the cardiac outcome of patients with heart failure. The aim of this study was to explore the cardiac neuronal function by using 123I-metaiodobenzylguanidine (MIBG) scintigraphy in patients with acute myocarditis. METHODS: We studied 15 patients (age range 42 +/- 10 yr) with clinical, biological, electrocardiographic and radionuclide left ventricular ejection fraction (LVEF) (41% +/- 7%) data indicating myocarditis and 10 normal subjects (age range 36 +/- 7 yr, mean radionuclide LVEF 69% +/- 8%, p < 0.05). Fourteen patients had positive histologic findings of myocarditis and 1 had nonspecific histological data. All patients underwent planar cardiac imaging after intravenous injection of 185 MBq 123I-MIBG and right ventricular biopsy within 7 days. A chest anterior view was acquired 4 hr later. Heart-to-mediastinum ratio activity was measured, as previously described in our laboratory. RESULTS: Significant impairment of cardiac neuronal uptake of MIBG was observed and based on a reduction of heart-to-mediastinum ratio (148% +/- 16% versus 234% +/- 36%, p < 0.05). A significant correlation was observed between LVEF and MIBG uptake in patients (y = 1.58x +/- 83.7, r = 0.72, p < 0.01). CONCLUSION: Acute myocarditis is associated with an injury of the cardiac adrenergic neuronal function. In addition to the inflammatory injury of the myocytes, the impairment of adrenergic function may be involved in the cardiac pump failure induced by myocarditis.

Pharmacological approaches to the prevention of restenosis after coronary angioplasty.

Restenosis in the months following a successful percutaneous transluminal coronary angioplasty (PTCA) remains the main limitation to this technique for myocardial revascularisation. Despite intensive investigation in this area, no pharmacological therapy has yet been found to be useful in preventing restenosis after conventional balloon angioplasty. The occurrence of restenosis, which is now known to be caused by both vessel remodelling and neointimal hyperplasia, might be reduced in the future by a combined mechanical and pharmacological approach. Although systemic administration of 'antirestenosis' drugs has not yet been tested to prevent restenosis after coronary stenting, it is very likely that pharmacological inhibition of neointimal hyperplasia within coronary stents will take advantage of local delivery techniques. In addition to local drug delivery catheters that are available, the stent itself may be coated with polymers and serve as a platform for drug delivery. The continued attractiveness of PTCA, as an alternative to medical treatment or bypass surgery for patients with coronary artery disease, will depend upon our ability to control the restenotic process.

[Current status of post-infarction cardiogenic shock and revascularization]. / Choc cardiogénique de l'infarctus du myocarde et revascularisation. Données actuelles.

Despite improved management of myocardial infarction, the incidence of cardiogenic shock remains constant at about 7.5% of cases. Patients who develop cardiogenic shock are older and much more often women. The site of infarction is usually anterior, transmural with greater left ventricular systolic dysfunction and a higher increase in cardiac enzymes. Diastolic intra-aortic balloon pumping is the usual treatment but survival only seems to be increased in patients undergoing revascularisation. Surgical revascularisation and circulatory assist devices have been proposed but patient selection in these studies was biased and optimised the results. The effect of thrombolysis was analysed in a subgroup of patients in the GISSI study. The 30 day mortality was 69.9% in 146 patients treated by streptokinase and 70.1% in patients given placebo. Thrombolysis only benefitted patients with an anterior myocardial infarction aged less than 65 and treated within 6 hours of the onset of pain. Although there are no randomised studies of the value of angioplasty in patients in cardiogenic shock. Several uncontrolled series suggest that this type of procedure reduces short and long-term mortality. However, the prognosis is not as good when unselected consecutive groups of patients are studied in whom infarction is complicated by cardiogenic shock immediately and who undergo "aggressive" revascularisation: 72% of patients die in hospital and there are few long-term survivors. The prognosis appears to be particularly poor in patients over 70 years of age with a previous history of myocardial infarction or who undergo prolonged pre-hospital cardiopulmonary resuscitation. However, the implantation of coronary stents associated with circulatory assist devices seems to improve the prognosis of infarction complicated by cardiogenic shock by ensuring adequate coronary flow and reducing the risk of reocclusion.