Risk factors for return visits and rehospitalizations to the child emergency psychiatric unit: A retrospective study over 2 years at Saint-Étienne University Hospital.

PURPOSE: This retrospective study aimed to achieve a better understanding of risk factors leading children and adolescents hospitalized in an emergency psychiatric ward to return visits, and to propose preventive devices. METHOD: From January 2, 2010 through February 29, 2012, 180 children and adolescents younger than 17 years were hospitalized in a total of 261 stays in the emergency psychiatric ward of University hospital of Saint-Étienne (France). We assessed clinical and sociodemographic characteristics of these patients and traced any of their return visits to the same unit through December 31, 2012. Risk factors for patients' repeated visits were calculated using multivariate analysis, and the cumulative incidence of returns using the Kaplan-Meier method for censored data. We used confidence interval of relative risk, considering 0.05 to reflect significance. RESULTS: Over the 2 years of the study, 77 (42.8%) of the 180 patients revisited the emergency psychiatric ward; 62 (80.7%) of these required further hospitalizations. Multivariate analysis linked the patients' psychiatric history (RR=2.5) and pursuit of vocational education (RR=4) with the risk of return. Return visits rose from 27.2% at 6 months to 41.2% at 2 years. CONCLUSION: Knowledge of risk factors would allow implementation of secondary or tertiary preventive devices. Students could undergo early screening of psychiatric pathologies using mobile screening teams which would save money, avoid hospitalizations, and when necessary, facilitate both hospitalization and return visits.

ViralORFeome: an integrated database to generate a versatile collection of viral ORFs.

Large collections of protein-encoding open reading frames (ORFs) established in a versatile recombination-based cloning system have been instrumental to study protein functions in high-throughput assays. Such 'ORFeome' resources have been developed for several organisms but in virology, plasmid collections covering a significant fraction of the virosphere are still needed. In this perspective, we present ViralORFeome 1.0 (http://www.viralorfeome.com), an open-access database and management system that provides an integrated set of bioinformatic tools to clone viral ORFs in the Gateway(R) system. ViralORFeome provides a convenient interface to navigate through virus genome sequences, to design ORF-specific cloning primers, to validate the sequence of generated constructs and to browse established collections of virus ORFs. Most importantly, ViralORFeome has been designed to manage all possible variants or mutants of a given ORF so that the cloning procedure can be applied to any emerging virus strain. A subset of plasmid constructs generated with ViralORFeome platform has been tested with success for heterologous protein expression in different expression systems at proteome scale. ViralORFeome should provide our community with a framework to establish a large collection of virus ORF clones, an instrumental resource to determine functions, activities and binding partners of viral proteins.

[Neuro-anatomic activations of prepotent responses in schizophrenia in Hayling's task]. / Inhibition des réponses automatiques au test du Hayling dans la schizophrénie.

OBJECTIVES: In schizophrenia, alteration in the prefrontal cortex can induce some deficiencies of the executive functions, and among them errors in inhibition of prepotent responses. This type of inhibitory processes was called "restraint function" by Hasher et al. It implies a conscious and voluntary inhibition which demands attentional resources. Among the tasks exploring this function, the Hayling completion sentence task (Burgess and Shallice) appears to be the most specific. Moreover, healthy subjects performing this task in functional magnetic resonance imaging (fMRI) show activation of the prefrontal cortex. In this study, we investigated inhibitory processes in schizophrenic patients using two versions of the Hayling completion sentence task, a behavioural version and an fMRI version in order to assess both performance levels and brain correlates of inhibitory processes. METHODS: Forty-eight schizophrenic participants according to DSM-IV, (mean age: 32.8, S.D. 7.7), stabilized for at least one month, receiving antipsychotic medication and with IQ higher than 70 (mean: 96.86, S.D. 20.67) and education level (mean: 11.15, S.D. 3.26) participated in the behavioural study. They were matched on age (mean: 33.8, S.D. 7.6) and education level (mean: 12.28, S.D. 2.87) with thirty-two healthy controls. Nineteen of schizophrenic participants (mean age: 33, S.D. 6.9 and IQ: 99, S.D. 10.74) were assessed by an fMRI adaptation of the Hayling task, matched with 12 controls (mean: 33.9, S.D. 7.3). All the participants had to perform the Hayling task and a speed accuracy task. The Hayling task consists in sentences for which the last word is missing. In the initiation condition, the participants had to complete the sentence with the appropriate word, whereas in inhibition condition the participants had to complete the sentence with inappropriate and unrelated words. RESULTS: Compared to controls, schizophrenics showed an increased number of errors in the inhibition of prepotent responses associated with increased reaction times, even when considering information processing speed. fMRI results showed fairly similar frontal activations in both groups. Nevertheless, schizophrenic patients presented principally large activations in dorsolateral and ventrolateral frontal cortex, the superior frontal sulcus, the frontal pole and the premotor cortex, and stronger activations (bilateral) in the posterior parietal cortex. Control subjects demonstrated a network of deactivated brain regions whereas the schizophrenics did not. DISCUSSION: Our results are in favour of poorer efficacy of restraint function, sometimes comprising impairment of inhibitory processes inducing errors in schizophrenics. This deficiency might be considered as insufficiency in attentional resources and/or in working memory. Hence patients cannot simultaneously restrain prepotent response and find appropriate controlled strategy for correct completion of the task. Moreover, bilateral patterns of parietal hyperactivation and absence of patterns of deactivation seem also in favour of an attentional hypothesis. The Hayling task might be interesting for assessment of inhibitory processes in schizophrenia.

Hepatitis C virus infection protein network.

A proteome-wide mapping of interactions between hepatitis C virus (HCV) and human proteins was performed to provide a comprehensive view of the cellular infection. A total of 314 protein-protein interactions between HCV and human proteins was identified by yeast two-hybrid and 170 by literature mining. Integration of this data set into a reconstructed human interactome showed that cellular proteins interacting with HCV are enriched in highly central and interconnected proteins. A global analysis on the basis of functional annotation highlighted the enrichment of cellular pathways targeted by HCV. A network of proteins associated with frequent clinical disorders of chronically infected patients was constructed by connecting the insulin, Jak/STAT and TGFbeta pathways with cellular proteins targeted by HCV. CORE protein appeared as a major perturbator of this network. Focal adhesion was identified as a new function affected by HCV, mainly by NS3 and NS5A proteins.

[Preliminary comparative study of the personality disorder evaluation DIP instrument with the semi-structured SCID-II interview]. / Etude préliminaire comparative de l'instrument d'évaluation des troubles de la personnalité DIP avec l'entretien semi-structuré SCID-II.

INTRODUCTION: This work deals with the comparative study of two standardised instruments, which can be used to diagnose personality disorders (PD): the SCID-II and the DIP. Each instrument used as a self-questionnaire followed by a semi-structured interview by the same clinician was applied to 21 patients suffering from PD. The DIP (DSM-IV and ICD-10 Personality), which is a recent instrument, consists of a self-questionnaire (DIP-Q) and a semi-structured interview (DIP-I), created by Bodlund and Ottosson. It makes it possible to evaluate PD from criteria based on the DSM-IV as well as the ICD-10. We translated it into French then evaluated it in comparison with another instrument, the Structured Clinical Interview for DSM-IV Axis II PD (SCID-II) whose validity was demonstrated by Bouvard. METHOD: For the self-questionnaire (SCID-auto), we used CUNGI'S computerised version. The present version of the semi-structured interview SCID-E (French translation by Bouvard et al.) evaluates the 10 PD of the DSM-IV, the depressive personality and the passive-aggressive personality, included in the DSM-IV appendix B. The DIP-Q questionnaire is made up of 140 right/wrong items referring to the 10 PD of the DSM-IV and the eight disorders of the ICD-10. The DIP-I is the self-structured interview created by Ottosson et al. and it is built on the same pattern as the SCID-II. It provides diagnoses for all DSM-IV and/or ICD-10 PD as well as the schizotypic disorder. The DIP-I is usually preceded by a general "scan" interview in order to assess an existing personality disorder corresponding to Axis I of the DSM-IV or the ICD-10. In our study, we substituted a Mini International Neuropsychiatric Interview (MINI) questionnaire for this interview. Twenty-four patients suffering from one or several PD were chosen among ambulatory or out-patients by clinicians from the Saint-Etienne Psychiatric University Hospital Center. The diagnosis was not revealed to the examiner during the study. The subjects filled in the DIP-I and the SCID-II self-questionnaires. The answers to each test were first processed through a computer, then the patients were seen over the following weeks for the DIP-I and SCID-II semi-structured interviews. For both questionnaires, we only explored the diagnostic categories reaching pathological level (as was recommended by the authors). Considering the small number of patients involved, we used nonparametric tests: Wilcoxon test, Mac Nemar test and the Kappa. RESULTS: As far as the self-questionnaire results are concerned, we noticed important differences for the schizoid and the schizotypic PD between the DIP-Q (ICD) and the DIP-Q (DSM). The most represented PDs are the paranoiac, borderline, avoiding and obsessional personalities. After the semi-structured interviews, it appears that only 30 to 50% of the diagnoses obtained through self-evaluation were confirmed (with the exception of the schizotypic personality and the antisocial personality for the SCID with perfect agreement between self and clinical evaluation). Globally, the agreement between diagnosis by self-evaluation and diagnosis by semi-structured interview is not very satisfactory. Finally, a cluster analysis of the results of the three semi-structured interviews put together reveals that five patients show at least one PD diagnosed in the three clusters, two have no diagnosis, six patients have one or several PDs in clusters B and C, three patients have some in clusters A and C, and five patients only have some in cluster C. Our results lead to several remarks: the size of our group is small, but it must be pointed out that the investigations for each patient took about three hours, which made it difficult for the patients to agree when the clinicians proposed the study; three patients originally included could not be evaluated because of suicidal behaviour. In their self-administered form, the SCID and the DSM version of the DIP-Q broadly diagnose a little more than three PDs per patient, whereas the ICD version of the DIP-Q diagnoses more than five. The administration of semi-structured interviews leads to an average of 1.3 diagnosis for the DIP-Q DSM-IV and 1.6 for the ICD against 1.9 PD for the SCID interview. These results correspond to the literature data. There are differences between the SCID and the DIP-I, as regards to the way they were used: the SCID-II makes it necessary to repeat the questions positively answered in the self-questionnaire, whereas the DIP-I explores all the criteria of the whole diagnosed PD, which may favour the inclusions. Concerning other instruments compared to the SCID-II in the international literature, our results with the DIP are globally satisfactory. CONCLUSION: The results must be interpreted with some care, considering the small number of patients. Important discrepancies were noticed between the diagnoses obtained through self-evaluation and the semi-structured interview, mainly for the A and C personality clusters of the DSM-IV, showing the tests to be extremely sensitive, but not specific enough for detection. However, the agreement between both instruments referring to the DSM-IV is satisfactory. The main interest of our work was to make the first French translation of the DIP known and to compare it to another instrument, which has often been evaluated previously.

[Legal and ethical implications in the protection of data collected from electronic medical records and used for epidemiological statistics and surveillance: a situational analysis]. / Les aspects juridiques et éthiques de la protection des données issues du dossier médical informatisé et utilisées en épidémiologie: un point de la situation.

With the emergence of new information and communication technologies (NICT) in the daily practice of medicine, personal medical data have become exportable. Certainly, they represent an interesting source for epidemiologists who were often lacking complete data sets all the way through to morbidity data; but once these data leave the confines of the structure of a medical office, they must be protected in order to respect the fundamental ethical principles which form the basis of the doctor-patient relationship. Given the fact that medical data are not considered merchandise, there is the need to lead a process of reflection which aims to adapt the existing ethical rules and regulations to norms which conform to this new environment. There is also a need to compile a report on the overall European situation, and more specifically the French case.

Effect of amifostine on toxicities associated with sequential chemotherapy and radiation therapy for unresectable non-small-cell lung cancer: results of a phase II trial.

PURPOSE: To determine the effect of amifostine on the safety and efficacy of induction chemotherapy with high-dose cisplatin and vinblastine followed by large-field thoracic irradiation to 60 Gy in patients with stage IIIA or IIIB non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Twenty-six patients with unresectable stage IIIA or IIIB NSCLC were entered onto the study between May 1991 and November 1994. Patients received amifostine (740 or 910 mg/m2) followed by cisplatin (120 mg/m2) on days 1 and 29. Vinblastine (5 mg/m2) was given weekly for 5 weeks with no amifostine pretreatment. Following chemotherapy, patients received amifostine (340 mg/m2 4 days a week for 5 weeks, or 200 mg/m2 5 days a week for 6 weeks) 15 minutes before definitive thoracic radiation therapy to a total dose of 60 Gy in 6 weeks. RESULTS: Twenty-five patients were assessable for response and survival. The objective response rate was 60%. One-, 2-, and 3-year survival rates were 55%, 23%, and 23%. There was no grade 3 or greater renal toxicity during chemotherapy or grade 3 or greater esophagitis during radiation therapy. Neutropenia (secondary to vinblastine use) was the only grade 4 toxicity. There were no treatment-related deaths. CONCLUSION: Amifostine can be administered safely with high-dose cisplatin, vinblastine, and radiation therapy for NSCLC. The response rate and survival data provide no evidence that amifostine impairs response to treatment. Amifostine appears to reduce cisplatin-related nephrotoxicity and radiation-induced esophagitis.

Study of treatment variation in the radiotherapy of head and neck tumors using a fiber-optic on-line radiotherapy imaging system.

On-line radiotherapy imaging systems allow convenient daily acquisition of portal images for treatment verification. The information can also be used to study treatment variability. Using a prototype fiber-optic imaging system, we have measured the treatment variation of 17 head and neck patients. Daily digital portal images were acquired for the on-cord left and right lateral fields. Treatment variations were quantified using the Cumulative Verification Image Analysis (CVIA) method developed at our institute. In the CVIA method, daily portal images were aligned according to three anatomical points predefined on a digitized simulation, or prescription, image. After each image alignment, the block position was cumulated in a bit-map and superimposed on the prescription image to give a cumulative verification summary image. Iso-frequency distributions, or contours, of the block overlap were calculated and examined with respect to the prescription treatment area. The range of the treatment variation was large for the 17 patients. On average, separation of the 0% to 100% block overlap contours was about 10 mm, and the 20% to 80%, 5 mm. The block overlap contours were also used to calculate the frequency with which the prescription area as defined on the simulation film had been treated. The fraction of the prescription area treated depended on the accuracy of the treatment setup and patient repositioning, as expected. At best, approximately 95% of the prescribed area was irradiated 100% of the time during the entire course of radiotherapy. At worst, approximately 70% of the prescribed area was irradiated 100% of the time. These results demonstrate that despite immobilization, large setup variation can still occur. Presenting treatment variation data as population averages does not reflect on the large variation that may be observed in the individual patient.

Modulation of harmaline-induced rhythmic discharge of the inferior olive by juxtafastigial stimulation.

We previously reported induction or suppression by juxtafastigial stimulation of the rhythmic complex spike discharge of Purkinje cells in harmaline treated rats. In this paper we show that this modulation of the cerebellar rhythmic activity implies the involvement of inferior olive neurons. These results are discussed in the general framework of the olivo-cerebello-bulbar circuitry. A modulatory control of the inferior olive neuron activity by the raphe system is suggested to explain part of these results.

[Effects of juxtafastigial stimulation on the rhythmic activity of Purkinje cells in harmaline-treated rats]. / Effets de la stimulation juxtafastigiale sur l'activite rythmique des cellules de Purkinje chez le rat sous harmaline.

In the anaesthetized rat, harmaline induces an olivary activation which results in rhythmic complex-spike (CS) discharges of Purkinje cells (4--8/sec) in the vermian cortex. The temporal organization of the rhythmic CS activity was studied. While some Purkinje cells present long periods of continuous rhythmic activity, the rhythmic CS discharge of other cells is modulated by periodical suppression of activity, with a total cycle length of about 10 sec. This organization can be modified by electrical stimulation of the juxtafastigial region (JF). During periods without spontaneous rhythmical CS firing, single JF shocks produce a late reflex response (200--300 msec) of the Purkinje cells, which appears as a repetitive sequence of CS (up to 30) at the harmaline-like induced frequency. The response obtained is the same whether the electrical stimulus is single or given in succession at regular intervals; however, in order to obtain such an effect, the frequency of the JF stimulation has to be inferior to the rhythmic CS frequency produced by the drug. At a higher stimulation rate (10 c/sec, 3 sec) the JF-induced response of Purkinje cells is abolished and we observe the suppression--4 to 8 sec following stimulation - of any rhythmic CS activity. This experimental modulation of rhythmic activity of the Purkinje cells (inducement or suppression of the CS firing), controlled indirectly by the olivary system, reproduces the spontaneous fluctuations of the thythmicity under harmaline. A neurophysiological model is presented and the functional significance of the results is discussed.

Neural organization in the brainstem circuit mediating the primary acoustic head startle: an electrophysiological study in the rat.

In awake rats the latency of auditory startle recorded electromyographically in the neck is about 5 ms, suggesting that the primary component of this brainstem reflex is mediated by a neural circuit with only a few synapses. In the present work, neural relays on acoustic head startle circuit are studied in alpha-chloralose-anesthetized rats by means of precise measurements, at putative brainstem relays, of the click-evoked potential latency and of the latency of nuchal EMG startle-like response elicited electrically from each recorded site using the same bipolar electrode. Allowing 0.6 ms for total synaptic transmission time in every relay nuclei, systematic comparisons of the shortest latencies of evoked potentials and shock-elicited startle, as well as estimations of conduction velocities in pathways from cochlea to C1-C5 spinal cord, suggest that one primary acoustic head startle circuit consists of ventral cochlear nucleus (postsynaptic evoked potential: 1.4 ms; startle: 3.6-4.0 ms), ventral nucleus of the lateral lemniscus (evoked potential: 2.3 ms; startle: 2.7-2.8 ms), medial bulbar reticular formation (evoked potential: 3.2-3.6 ms; startle: 2.1 ms), spinal interneuron and motoneuron. The nucleus reticularis pontis caudalis (NRPC) cannot be considered as an head startle relay intercalated between the ventral nucleus of the lateral lemniscus (VNLL) and the medial bulbar reticular formation (MBRF) because mean latencies of field potentials in the pontine RF and the LL nucleus are the same (2.3 ms). Moreover, startle-like responses in neck muscles are elicited through the three brainstem regions with latency differentials which exclude the possibility of a classical synaptic delay either between VNLL (2.8 ms) and NRPC (2.5 ms) or between NRPC and bulbar RF (2.1 ms). Nevertheless, NRPC probably remains a main primary relay on the acoustic startle circuitry; very short latency auditory responses (2.3 ms) are evoked in NRPC by clicks, and low current stimulations of this reticular region produce startle-like activity in neck muscles with a latency of only 2.5 ms. Two other alternative paths consisting of the VCN and NRPC which then would project directly, or through an unknown bulbar site, upon the spinal motor center are hypothetically proposed in conclusion.

Hyperbaric effects on sensorimotor reactivity studied with acoustic startle in the rat.

In three experiments, startle responses to brief intense tone-bursts (30 msec, 110 dB, 6000 Hz) and single pulse (0.1 msec) stimulation of the cochlear nucleus and the nucleus reticularis pontis caudalis are studied under high pressures of heliox (from 0 bar to 50 bars) in the rat. For each rat (N = 12), mean amplitude and latency changes in startle responses (nuchal electromyography and whole-body accelerometry) are compared at normobaric pressure and during compression, at a speed of 100 bar/H. The results indicate that high pressures decrease (50% of control size) tone evoked startle by acting on the peripheral auditory organ, probably through middle and/or inner ear barotrauma. The large increases in electrically-elicited startle (250% of control size) from the cochlear and reticular nuclei, under hyperbaric conditions, suggest that high pressures affect sensorimotor reactivity by excitatory action on synaptic transmission in the relays of the acoustic startle reflex arc at the lower brainstem and spinal levels. Startle latencies remain unaffected by the heliox high pressures studied here.

Factorial structure of the 20-item Toronto Alexithymia Scale: confirmatory factorial analyses in nonclinical and clinical samples.

OBJECTIVE: The 20-item Toronto Alexithymia Scale (TAS-20) measures three intercorrelated dimensions of alexithymia: (1) difficulties identifying feelings (DIF), (2) difficulties describing feelings (DDF), and (3) externally oriented thinking (EOT). The aim of the study was to test the three-factor model of the TAS-20 using confirmatory factorial analyses (CFA). METHOD: 769 healthy subjects and 659 patients meeting the DSM-IV criteria for substance use disorders or eating disorders completed the TAS-20. The correlation matrices for each of the samples were analyzed with LISREL 7.16. RESULTS: In each sample, the three-factor model was found to be replicable. CONCLUSION: The three TAS-20 subcales can be used to explore the distinct facets of the alexithymia construct.

Harmaline effects on the sensory-motor reactivity: modifications of the acoustic startle pattern.

The effects of harmaline, an indoleamine and a MAOI, were tested on the acoustic startle pattern. EMG measures of the startle reflex, the pinna reflex as well as the characters of the vertex evoked responses to brief intense tone bursts (60 msec, 110 dB, 8000 Hz) were simultaneously studied in 4 alert guinea-pigs. The basic experimental design was a 4 by 4 latin square, with the treatments being given at 2 day intervals. The four harmaline-HCl treatments were isotonic saline, 0.25, 5.0, and 10.0 mg/kg. Compared with saline baselines, all the doses resulted, throughout the 60 min session, in overall high significant depressions of the startle reflex, the pinna reflex and the initial wave of the acoustic evoked potential at the vertex. In contrast, harmaline had little or no influence on amplitude and latency of the late wave of the vertex response. The effects of harmaline on the general behavior of the guinea-pig are also reported. These results may support an involvement of serotonergic systems in the modulation of the sensory-motor reactivity at the brainstem level. Nevertheless, the probably more complex cortical processes involved in startle responsiveness do not appear univocally affected by the indoleamine drugs such as harmaline.

Are depression and denutrition good predictors of dexamethasone suppression test (DST) in anorexia nervosa?

This study was conducted to investigate the corticotropic axis in anorexia nervosa. In 93 female inpatients who met DSM-III-R criteria for anorexia nervosa, subsample (n = 64) with DSM-III criteria was also considered. Using stepwise regression analysis, this study examined the relationship between independent variables ie, age, body mass index, scores on depression scales and postdexamethasone serum cortisol, considered as a dependent variable. In patients who met DSM-III criteria, 16.7% of the variance of serum cortisol can be explained. The main predictors are depressive retardation, emaciation and age. Using stepwise logistic regression the main categorical predictors of the test suppression vs non suppression are of the same nature. The condition of realisation of DST are discussed.

[Coronary vasospasm: a cause of sudden death. Case report of reversible heart arrest with spontaneous coronary spasm documented by angiography]. / Le spasme coronaire: une cause de mort subite. A propos d'un cas d'arrêt circulatoire réversible avec spasme coronaire spontané angiographiquement documenté.

The authors report a case of cardiac arrest occurring in a patient who had just entered the catheter laboratory for coronary angioplasty. Opacification of the left coronary artery revealed a proximal occluding double spasm unrelated to the distal stenoses for which angioplasty had been requested. Resuscitation and antispastic therapy with intracoronary injection of a nitrate derivative resulted in a complete recovery without any sequellae. The role of coronary spasm in sudden death and the value of the ergometrine test in patients with coronary stenosis are discussed.

[Value of potassium canrenoate in the prevention of arrhythmia during the acute phase of myocardial infarction]. / Intérêt du canrénoate de potassium dans la prévention des troubles du rythme à la phase aiguë de l'infarctus du myocarde.

This study was based on a series of 486 patients with acute myocardial infarction. All were treated with heparin and nitrite derivatives. 320 patients received 600 mg/24 h Potassium Canrenoate for 5 days (long duration); 90 patients received 1000 mg of Potassium for the first 36 hours only. 76 patients did not receive the drug and served as controls. The biochemical changes due to Potassium Canrenoate are discussed with special emphasis on the serum and intraerythrocytic potassium levels. The antiarrhythmic action of the potassium was assessed directly (the number of ventricular extra systoles decreased significantly) and indirectly (the amount of antiarrhythmic therapy required in association was three times less in patients treated by Potassium Canrenoate). The mortality rate changed from 17 to 12%. The beneficial effect of Potassium Canrenoate is attributed to the maintenance or the restoration normal potassium levels of ischaemic myocardial tissue.

[Efficacy of oral bepridil in ventricular arrhythmias in stable coronary insufficiency]. / Efficacité du bépridil per os sur les troubles du rythme ventriculaire chez l'insuffisant coronarien stable.

The electrophysiological properties of bepridil suggest a possible ventricular antiarrhythmic effect. This prospective multicentre trial was undertaken to study the antiarrhythmic efficacy of oral bepridil on ventricular arrhythmias in patients with stable coronary insufficiency and more than 1 000 ventricular extrasystoles per 24 hours or ventricular tachycardia. The patients were divided into 3 groups according to the arrhythmias observed and the dosage used. In group I, the dosage was 300 mg/day and 12 out of 44 patients (27%) responded favourably to two criteria of efficacy (decrease of 84% of the number of ventricular extrasystoles; suppression of complex ventricular extrasystoles). In group II, the dosage was 300 mg/day, and then increased to 500 mg in non responders. Using the same criteria of efficacy, 13 out of 19 positive results were observed (68.4%). Group III comprised all cases of ventricular tachycardia; bepridil was effective in 3 out of 6 cases, associated with amiodarone in 1 case. The results demonstrate an antiarrhythmic effect of bepridil which is modest at 300 mg/day but which becomes more marked at the dosage of 500 mg/day.

[Comparison of stress testing and thallium 201 testing in the diagnosis of coronary insufficiency according to the functional class of angina. 154 cases with coronary angiography]. / Comparaison de l'épreuve d'effort et du thallium d'effort dans le diagnostic de l'insuffisance coronaire, selon la classe fonctionnelle de l'angor. A propos de 154 cas coronarographiés.

154 patients investigated for chest pain underwent 12 lead exercise electrocardiography and also exercise 201-Thallium myocardial scintigraphy performed at coronary angiography. 92 patients had typical angina; in this group the sensitivity and specificity of exercise electrocardiography was good (91% and 86% respectively) and exercise myocardial scintigraphy did not give significantly better results. On the other hand, in cases when exercise electrocardiography was negative (27%) exercise myocardial scintigraphy was positive in 75%. 201-Thallium did not discriminate between ischaemia and necrosis in patients with previous myocardial infarction, ischaemia alone causing hypofixation on basal myocardial scintigraphy. 62 patients had atypical chest pain. The low incidence of coronary artery disease in this group (30%) increases the value of exercise 201-Thallium scintigraphy as it is both more sensitive (59% compared to 21%, p less than 0,05) and more specific than exercise electrocardiography (43% compared to 85%, p less than 0,1). 29% monotruncular lesions had negative exercise electrocardiography and myocardial scintigraphy. However, multivessel and left main coronary disease may be excluded with great probability by a negative exercise 201-Thallium scintigraphy.