[Randomized comparison of 4F and 6F catheters for diagnostic coronary angiographies via the femoral approach]. / Comparaison randomisée des cathéters 4 F versus 6 F pour la réalisation des coronarographies diagnostiques par voie fémorale.

The use of 6F catheters has been validated for coronary angiography. The use of small-caliber catheters is a more recent development. The aim of this study was to assess the feasibility, the cost and complications of coronary angiography using the femoral approach with 4F catheters. The authors undertook a randomized prospective study of 4F Care Infiniti catheters (N = 100) and 6F Spertorque Plus catheters (N = 100) in hospitalised patients. Criteria of non-inclusion were valvular pathology, acute myocardial infarction, aorto-coronary bypass or aorto-femoral bypass procedures. No statistical difference was observed between the two groups with respect to feasibility, to duration of the procedure, or of irradiation or to cost. The quality of the angiograms was good except in one patient in the 4F group; 4 patients in the 6F group required a 4F catheter to complete their examination. Left ventricular catheterisation was more difficult with 4F catheters (p = 0.016). Use of 4F catheters was associated with injection of significantly less contrast (p = 0.00007), reduced the duration of compression (p < 10(-6)) and its complications (p = 0.004). The authors conclude that 4F catheters are safe and well tolerated. They are associated with less patient morbidity, without any loss in quality of the angiogrammes. Other studies in valvular heart disease and after coronary bypass surgery should lead to the generalisation of their use in all coronary patients.

[Anti-digoxin antibodies in severe digitalis poisoning in an 11-day old infant. Review of the literature]. / Anticorps antidigoxine au cours d'une intoxication digitalique sévère chez un nouveau-né de 11 jours. Revue de la littérature.

Acute digitalis intoxication bringing into play the prognosis for survival is a rare complication in children, particularly in the neonatal period. We describe the case of an accidental massive digitalis intoxication in a newborn aged 11 days, which caused a complete atrioventricular block and a state of cardiogenic shock. The outcome was favorable four hours after administration of the first dose of anti-digoxin antibodies, with a complete reversal of clinical and electrocardiographic signs. The onset of first-degree atrioventicular block 48 hours afterward made us consider the possibility of the tissular salting-out effect of the digoxin and led us to administer a second dose of specific antibodies. The originality of this case has to do with the severity of the initial clinical picture, its total reversal with antibodies and the salting-out phenomena that followed. The case reminds us, along with the data in the literature, the criteria of wrong prognoses in massive digitalis intoxication in the child and the indications for anti-digoxin antibodies.

[Pericardial tamponade and third-degree atrioventricular block revealing a primary cardiac lymphoma]. / Tamponnade et bloc auriculoventriculaire révélant un lymphome cardiaque primitif.

Secondary and primary cardiac tumors are rare, and primary cardiac lymphoma are exceptional. We report a 78-year-old non immunodeficient male, with pericardial tamponade and third-degree atrioventricular block. Analysis of the pericardial fluid and tissue was not contributive. À transvenous biopsy of the cardiac tumour revealed non-Hodgkin large B-cell lymphoma (CD45+ CD20+ CD3-BCl2+). Therapy is based on chemotherapy. However, prognosis remains poor for this type of tumor commonly revealed by a pericardial effusion.