Intravenous anisoylated plasminogen streptokinase activator complex versus intravenous streptokinase in evolving myocardial infarction. Preliminary data from a randomised multicentre study.

The efficacy of a single intravenous bolus of anisoylated plasminogen streptokinase activator complex (APSAC 30U in 4 to 5 minutes) versus an intravenous infusion of streptokinase (1.5 X 10(6) U in 60 minutes) was assessed in 86 patients with evolving myocardial infarction of less than 6 hours duration in a cooperative randomised study. The patency of the infarct-related artery was assessed by coronary angiography at, on average, 90 minutes after therapy (mean time: APSAC 95 minutes, streptokinase 105 minutes). The treatment groups were similar with respect to sex, age, location of myocardial infarction and the delay from onset of pain to treatment. The 90-minute patency rate (grade 2 to 3) was 71.8% in the APSAC group and 55.8% in the streptokinase group; the difference was not statistically significant. There was no difference between the drop in fibrinogen concentrations in the 2 groups at 3 or 24 hours. The minimal concentration obtained at the first assessment was +/- 0.2 g/L in the streptokinase group and 0.5 g/L in the APSAC group. One patient in the APSAC group, who had a previous meningeal bleeding, had a non-fatal cerebrovascular accident. In a subgroup of 38 patients who had 3 control coronary angiograms at 90 minutes, 24 hours and 3 weeks, the patency rate was 63, 82 and 93%, respectively, in the APSAC group and 48, 88 and 92%, respectively, in the streptokinase group (the difference was not statistically significant). None of the patients in the APSAC group presented with reocclusion, whilst 3 patients in the streptokinase group had reocclusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Compact, open and general purpose cell of variable effective pathlength: direct absorption measurement of SO(4)(2-) in water.

The use of an optothermal window (OW) was proposed for the direct (no need for sample preparation) spectroscopic, non-destructive measurement of SO(4)(2-) in water at 1078 cm(-1). The presently determined limit of detection (LOD) of 1 mmol/L is comparable to that provided by CO(2) laser photoacoustic spectroscopy, but about one order of magnitude superior to that obtainable by the ATR method.

The optothermal approach to a real time monitoring of glucose content during fermentation by brewers' yeast.

During production of both normal and low-alcohol beers, sugar is fermented to ethanol, carbon dioxide and several flavour products. Tight control of fermentation is necessary in order to keep production costs low, and to prevent formation of excessive ethanol in low-alcohol beer. Several types of control devices based on, e.g., determination of carbon dioxide, ethanol, and extract have been developed so far; the main disadvantage of these devices is their unsuitability for on-line applications. Here, the optothermal window was used in a laboratory experiment as a new sensor for real time monitoring fermentation of glucose by Saccharomyces cerevisiae, and the results were compared to those obtained by conventional techniques.

[Value of nuclear magnetic resonance in dilated cardiomyopathy. Approach to intraventricular hemodynamics]. / Intérêt de l'IRM dans les myocardiopathies dilatées. Approche de l'hémodynamique intraventriculaire.

The value of magnetic resonance imaging (MRI) with multiechoes spin-echo sequences was investigated in 22 patients with dilated cardiomyopathy (group I) and 25 normal subjects serving as controls (group II). The results of MRI in group I were compared with those of echocardiography and radionuclide ventriculography. Measurements of left ventricular dimensions at echography and MRI showed a tendency, with MRI, to overestimate wall thickness and underestimate ventricular diameter. Thus, for diastolic LV we had 63.8 +/- 10.5 mm with MRI vs 70.6 +/- 7.6 mm with echography, the corresponding figures for posterior wall thickness being 112 +/- 1.4 mm vs 9.9 +/- 1.1 mm respectively. These differences seem to be due to MRI introducing a partial volume effect dependent on the thickness of slices and of their orientation in relation to the cardiac axis. MRI evaluation of left ventricular function by calculation of myocardial fibre shortening fractions correlated poorly with the echocardiographic value of the same parameter and with the radionuclide ejection fraction (r = 0.58 and 0.575 respectively; p less than 0.05). For better quantification of the cardiac pump function, planimetry of the endocardial contour during diastole and systole is required. It would seem that the value of MRI resides in the possibility it offers to explore left intraventricular haemodynamics by studying the "flow signal" obtainable from multiechoes sequences at different moments of the cardiac cycle. During systole, we found a left intraventricular signal that was reinforced on even echoes and much more intense in cardiomyopathy patients (scores = 1.61 +/- 1.06) than in controls (score = 0.77 +/- 0.7; p less than 0.01). The intensity score for this signal correlated with the ejection fraction in group I subjects (r = 0.82).

[Nuclear magnetic resonance in the diagnosis of aortic diseases]. / Apport de la résonance magnétique nucléaire dans le diagnostic des affections aortiques.

The diagnostic value of nuclear magnetic resonance imaging was assessed in a number of aortic pathologies: aneurysms of the thoracic and abdominal aorta, sinus of Valsalva aneurysms and dissection of the aorta. The imager was equipped with a resistor magnet providing a field of 0.15 Tesla. An electrocardiographic gating system was perfected. The images obtained were very satisfactory as they provided three dimensional morphological information and a qualitative assessment of blood flow. Further studies are now required with comparison with other invasive and non-invasive diagnostic methods to determine the clinical role of NMR imaging and to evaluate the diagnostic sensitivity and specificity of this new technique.

[A european multicenter and randomized study of APSAC versus streptokinase in myocardial infarction]. / Etude européenne multicentrique et randomisée de l'APSAC versus streptokinase dans l'infarctus du myocarde.

In a multicentre randomized open study conducted on two parallel groups the effectiveness of APSAC was compared with that of streptokinase (SK) in 116 cases of myocardial infarction treated during the first 2.75 hours. APSAC (30 IU) was administered by intravenous bolus injection over 2 to 5 minutes, and SK (1.5 million IU) by intravenous infusion over 60 minutes. The patency of the coronary artery responsible for myocardial infarction was evaluated by coronary arteriography performed 1.74 h on average after the beginning of treatment; it was 70 p. 100 in the APSAC group and 51 p. 100 in the SK group (p less than 0.05). The fall in plasma fibrinogen was similar in both groups (mean minimum level; 0.2 g/l). Haemorrhages occurred in 9/58 patients treated with APSAC (15.5 p. 100) and in 13/58 patients treated with SK (22.4 p. 100); these haemorrhages took place during the first 24 hours in 4 patients of the APSAC group and in 10 patients of the SK group. Five patients died: 2 in the APSAC group and 3 in the SK group. In a subgroup of 38 patients who underwent 3 control coronary arteriographies (at 90 min, 24 hours and 3 weeks), the patency rates were 63 p. 100, 82 p. 100 and 93 p. 100 respectively with APSAC and 44 p. 100, 86 p. 100 and 92 p. 100 respectively with SK (NS). No coronary reocclusion occurred in the APSAC group, as against 3 (1 early, 2 delayed) in the SK group. It is concluded that APSAC seems to be more effective than intravenous streptokinase; it is easier to administer (bolus injection) and does not carry a higher risk of haemorrhage.

[Recurrent peripheral neuropathy caused by thallium poisoning]. / Neuropathie périphérique récidivante par intoxication au thallium.

A 28-years old woman, working as a secretary, developed a rapidly progressive paraplegia with burning pain in the lower limbs. She recovered within 4 months but relapsed shortly after she was discharged. There was flaccid tetraplegia, associated with hyperalgesia of the limbs, diffuse muscle atrophy, blindness and alopecia. The patient needed respiratory assistance for 2 months. Bilateral optic neuropathy and paraparesis persisted after a 17 months follow-up. The clinical picture suggested thallium poisoning, which was confirmed by high thallium concentration in plasma and urine. The most likely cause was accidental poisoning with rodenticides.

[Beta-blockers in the acute phase of myocardial infarction. Echographic study]. / Bêtabloquants à la phase aiguë de l'infarctus du myocarde. Etude échographique.

The purpose of this study was to evaluate the ability of beta blocker therapy in decreasing the amount of necrosis during a first transmural myocardial infarction (as evidenced by a local and overall kinetic study using two-dimensional ultrasonography). Twenty patients were randomly placed into 2 groups. Ten patients received 15 mg of metoprolol intravenously followed by 200 mg daily of the drug orally. The results indicated that beta blockers are well tolerated clinically and hemodynamically, and that they significantly reduced the amount of necrosis (p less than 0.05 in anterior myocardial infarctions).

[Course and prognosis of apparently primary congestive cardiomyopathies in chronic alcoholic patients]. / Evolution et pronostic des cardiomyopathies congestives d'apparence primitive chez les sujets éthyliques chroniques.

The authors analyse a series of 36 chronic alcoholic patients with primary congestive cardiomyopathy. The clinical course of these cases was analysed in order to define the prognostic factors. All of the patients were male with a mean age of 47 years. 55 per cent of cases presented a functional deterioration. The 5 year mortality was 50 per cent. The high incidence of sudden death (38 per cent of deaths) was probably related to ventricular arrhythmias. The other deaths were due to end-stage heart failure. The survival did not differ significantly from that of primary congestive cardiomyopathy in non-alcoholic patients. It depends, above all, on the left ventricular function and is influenced by the initial value for the ejection fraction. Alcoholic withdrawal was found to be a beneficial prognostic factor when it was early, but it became ineffective in cases with major alteration in the left ventricular function. Ultrasound and radioisotope studies demonstrated the development of segmental kinetic disorders and intracavitary thrombi in the left ventricle. These lesions have a pejorative prognostic significance. The initial systolic diameter of the left auricle seems to have a prognostic value as it reflects the degree of activity of the disease.

[Septal subaortic hypertrophy. Apropos of 23 cases]. / Le bourrelet septal sous-aortique. A propos de 23 cas.

Septal subaortic enlargement is seen by two-dimensional echography and involves localized hypertrophy of the basal part of the interventricular septum, the thickness of which is greater than or equal to 13 mm. The present study relates to 23 septal subaortic enlargements. Means thickness of the enlargement was 17.0 mm and the longitudinal parasternal length was 22.1 mm. SAM was noted in 2 cases and mesosytolic closure of the sigmoid sinuses in one case. Left ventricular volume was much reduced in one third of cases, especially when enlargement was great. Compliance disorders were marked in one third of cases. Only the longest and thickest enlargements caused obstruction, which was noted in 18% of cases. Enlargement was most often associated with valvular (56% of cases) or hypertensive (48 P of cases) pathologies. No specific clinical, radiologic or electrical signs were noted; anomalies were due to pathology associated with the enlargements. A stable trend was generally seen in subaortic hypertrophy after a mean period of 33 months. Nevertheless, moderate increases in hypertrophy were seen in 20% of cases. In the great majority of cases, enlargement did not correspond to obstructive hypertrophic cardiomyopathy according to Goodwin's criteria, and etiology remains uncertain due to lack of histological data.

[Carotid sinus syndrome of mixed cardioinhibitory and vasodepressive form. Value of sequential atrioventricular stimulation]. / Syndrome du sinus carotidien à forme mixte cardio-inhibitrice et vasodépressive. Intérêt de la stimulation atrio-ventriculaire séquentielle.

The authors report an observation of cardioinhibitory and vasodepressive carotid sinus syndrome. The vasodepressive response was analyzed by electrophysiological exploration with determination of changes in arterial pressure. This pressure is increased automatically by the "pacemaker effect of a ventricular corrective response. The pressure drop can be limited by sequential stimulation. A review is given of the results and methods of cardiac stimulation in sinocarotid hypersensitivity.

[Revascularization in the acute phase of myocardial infarction. Study of left ventricular function in the 3d week and 6th month]. / Reperméabilisation à la phase aiguë de l'infarctus du myocarde. Etude de la fonction ventriculaire gauche à la 3e semaine et au 6e mois.

27 patients with primary myocardial infarction are treated, in the first 6 hours, with intravenous thrombolysis with immediate coronary angiographic control showing a patent artery in 76 p. cent of the cases. The treatment is completed with intracoronary thrombolysis (5 times) and transluminal angioplasty (6 times), enabling to obtain a patency rate of 88 p. cent. The overall left ventricular function is evaluated at D21 and in the 6th month (M6). Among anterior infarctions, those treated during the first three hours have a better ejection fraction (EF) at D21 than those treated later (40.3 p. cent +/- 6 versus 33.2 p. cent +/- -NS); this functional benefit is confirmed at M6 (42.8 p. cent +/- 12 versus 30.6 p. cent +/- 8; p less than 0.06). On the contrary, among inferior infarctions, the EF is comparable at D21 and M6 regardless of the early nature of the treatment. One patient died prematurely from a cerebral vascular accident which occurred during the thrombolysis. These results are in favor of a significant myocardial salvation in anterior infarctions revascularised at an early stage and of an active approach in order to obtain the most complete possible revascularisation.

[Value of global ejection fractions based on the presence or absence of left ventricular dyskinesia. A comparison between contrast angiography and angioscintigraphy]. / Validité des fractions d'éjection globales selon la présence ou l'absence de dyskinésies ventriculaires gauches. Comparaison entre l'angiographie de contraste et l'angioscintigraphie.

The total ejection fraction of the left ventricle is studied in 37 patients, most of them with coronary disease, according to two methods: contrast angiography in a single plane and angioscintigraphy (first passage and balanced), in order to compare the results according to the presence or the absence of dyskinesias. The two methods are performed in succession according to the usual views. The population is divided in two sub-groups according to the presence (17 patients) or the absence (20 patients) of segmental abnormalities. Segmental abnormalities are divided into 11 antero-apical aneurysms and 6 infero-posterior aneurysms. The correlations of the ejection fractions calculated according to the two methods and the two views, are usually satisfactory in the two sub-groups and especially as the parietal kinetics is homogeneous. In case of segmental abnormalities of the contraction, there are variations in the total ejection fractions depending on the technique and the views that are used, but the differences are not significant.

[Developmental profile of scintigraphic parameters within 3 weeks following primary myocardial infarction without any attempt at revascularization]. / Profil évolutif des paramètres scintigraphiques dans les trois semaines suivant un primo-infarctus du myocarde en dehors de toute tentative de reperfusion.

30 patients with a transmural primary myocardial infarction conventionally treated, are explored by myocardial scintigraphy using thallium 201, and calculation of a lesional score (L.S) and angio-scintigraphy on the first day (D1) and at three weeks (D21). The results of these examinations are compared to those of coronography at D21. Anterior necroses present a myocardial fixation defect and a dysfunction of the left ventricle which are more severe than in inferior necroses. Patients with a marked fixation defect (L.S 2) at D1, present a low ejection fraction (EF) becoming significantly worse at D21. Coronary permeability is accompanied by an appreciable improvement of the myocardial fixation from D1 to D21 and a stability of EF. On the contrary, if the occlusion persists, the fixation defect is stable and the EF decreases significantly. In this study, the coronary permeability appears to be associated to a perservation of the ischemic myocardium which may only be demonstrated by knowing the evolution of the various parameters during the first three weeks of the infarction.

[Echography in the surveillance of myocardial infarction during the acute phase]. / L'échographie dans la surveillance de l'infarctus du myocarde à la phase aiguë.

An attempt is made to determine feasibility and capabilities of two-dimensional echocardiography (2DE) during acute myocardial infarction (AMI). Seventy-four consecutive patients with AMI (22 anterior, 29 inferior, 4 lateral, 5 non-transmural) underwent 2DE; in sixty cases, suitable examination was available. Regional wall motion abnormalities were studied by 2 methods, i.e. qualitative in all patients and quantitative in 32 patients. Akinesis or dyskinesis occurred in 57 cases (21/22 in anterior, 4/4 in lateral, 29/29 in inferior, 3/5 in non-transmural AMI) and was observed very early (within the first 24 hours after onset of chest pain). Intraventricular clots were observed in 8 patients (in 7 patients during anterior or lateral AMI) without peripheral embolization. In conclusion, 2DE is a suitable method for evaluation of AMI, especially in early thrombi detection and qualitative wall motion analysis. Evolution of quantitative wall excursion is still under investigation but will be highly attractive, more easily repeatable at the bedside and cheaper than nuclear angiography.