[Risk factors in a young population with acute myocardial infarction: one year prospective study]. / Facteurs de risque de l'infarctus du myocarde du sujet jeune: registre prospectif sur un an.

OBJECTIVE: The objective of this work is to give epidemiological data, established in a prospective way, on the myocardial infarction in young and its risk factors. METHODS: All patients admitted to the CHG of Pau for myocardial infarction, old, for the men of less than 45 years and for the women of less than 55 years, of November the 1st 2002 to October 31st, 2003, are included. RESULTS: Twenty-seven patients (11.2%) do a myocardial infarction including 44.4% women. The found traditional risk factors are: smoking (92.6%), absence of regular physical activity (81.5%), dyslipidaemia (66.7%), family history of cardiovascular disease (48.2%), hypertension (37.0%), obesity (18.5%), oral contraception (11.1%), diabetes (7.4%), personal thrombotic history (7.4%). The principal emergent risk factors highlighted are: stress (66.7%), inhibitor of the activation of the plasminogene (57.1%), C-reactive protein (50%), lipoprotein a (41.7%), fibrinogen (33.3%), elevated plasma homocysteine (25%), excessive alcohol use (22.2%). None patients does not have an absolute cardiovascular risk > 20%. The clinical characteristics, coronarographic data and the acute treatments were also listed. The prognosis is worse for the women with more risk factors, more complications, and risk of more significant ventricular replanning. CONCLUSION: The principal risk factors of the myocardial infarction in young can be modifiable. The prevention is of primary importance. The therapeutic education of the patients corresponds to the total assumption of responsibility required by this pathology.

[Prehospital management of acute myocardial infarction. Data from a consecutive cohort of 115 patients in a French region in 2002]. / Prise en charge préhospitalière de l'infarctus du myocarde à la phase aiguë dans la région sanitaire VI. Evaluation prospective sur l' année 2002.

The treatment of acute myocardial infarction is in evolution. Several strategies are utilized ranging from thrombolysis to percutaneous angioplasty (PCI), and the combination of both treatments; the latter providing an interesting compromise between treatment delay and efficiency of early myocardial reperfusion. We reviewed the early treatment strategies of acute myocardial infarctions undertaken by Samu in region 6 (south west of France) in 2002. Of a cohort of 115 patients, 83 patients (72.1%) had a revascularisation strategy: 56 (48.7%) had a primary PCI, and 27 (23.4%) had thrombolysis (92.6% being performed in the prehospital treatment). In those undergoing thrombolysis, 13 patients (48%) had ongoing features of ischaemia; excluding 4 patients who died during transport, all had a PCI at the admission in hospital. For the 14 patients with successful thrombolysis, 5 had facilitated PCI at the admission, 8 had a delayed angioplasty and 1 patient did not have angiography. Although the number of patients receiving thrombolysis in this study was small, this treatment was begun 62 minutes before primary PCI. There are important intra and extra hospital delays to the commencement of PCI. The easy utility of thrombolysis together with the potential to PCI argue in favour for a strategy of prehospital thrombolysis associated with a facilitated angioplasty.

[Pulmonary embolism and disseminated intravascular coagulation after being bitten by a Bothrops lanceolatus snake. Apropos of a case]. / Embolie pulmonaire et coagulation intravasculaire disséminée après une morsure de serpent Bothrops lanceolatus. A propos d'une observation.

The authors report the case of a Bothrops lanceolatus snake bite complicated by severe pulmonary embolism a few hours after admission. This thromboembolic complication developed despite heparin therapy and was followed by disseminated intravascular coagulation (DIC). Vascular thrombosis and pulmonary embolism are rare after Bothrops lanceolatus snake bite as patients are usually hypocoagulable due to DIC. In this case, the thromboembolism was probably caused by the procoagulant effect of the thrombin-like enzymes of the snake venom which may have been injected directly into the vein of a young woman taking a contraceptive pill. A specific antivenin which has recently become available fort treatment may decrease the complications of Bothrops lanceolatus snake bite.

[Left ventricule function and sickle-cell anemia. Echocardiographic study]. / Fonction ventriculaire gauche et drépanocytose. Etude échocardiographique.

The dimensions of the cardiac chambers and left ventricular function were studied by echocardiography in 40 patients with homozygous sickle cell disease (SS) and 25 patients with heterozygous sickle cell trait (12 AS, 10 SC, 3 BS) and compared with the same parameters in 30 normal subjects. Patients with homozygous SS disease had significantly larger left atrial (32.2 +/- 6.47 mm vs 26.62 +/- 5.64 mm; p less than 0.001), left ventricular (46.4 +/- 8.49 mm vs 39.97 +/- 5.29 mm; p less than 0.001) and right ventricular (17.95 +/- 5.08 mm vs 15.5 +/- 3.17 mm; p less than 0.02) dimensions: they also had higher indexed myocardial surfaces (11.48 +/- 2.36 cm2/m2 vs 8.21 +/- 1.97 cm2/m2; p less than 0.001) and indexed end diastolic left ventricular volumes (101.84 +/- 22.74 ml/m2 vs 65.05 +/- 10.81 ml/m2; p less than 0.001), a higher cardiac index (4.77 +/- 1.33 l/mn/m2 vs 3.58 +/- 1.08 l/mn/m2; p less than 0.001) and stroke volume (71.77 +/- 32.86 ml vs 49.56 +/- 13.39 ml; p less than 0.001). Peripheral resistances were significantly lower (1341 +/- 469 vs 1626 +/- 368 dynes/s/cm-5; p less than 0.01) as were the velocities of circumferential fibre shortening (VCF) (1.11 +/- 0.20 circ/s vs 1.28 +/- 0.24 circ/s; p less than 0.01). Two thirds of homozygous SS disease patients (27/40) had appearances of an anaemic heart with eccentric left ventricular hypertrophy, normal left ventricular systolic function, an increased cardiac index (5.01 +/- 1.19 l/mn/m2) and low peripheral arterial resistances.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of eptifibatide during salvage angioplasty with coronary stenting after failure of thrombolysis. Report of a series of 41 patients]. / Intérêt de l'eptifibatide au cours de l'angioplastie de sauvetage avec stenting coronaire après échec de thrombolyse. A propos d'une série de 41 patients.

AIM: To evaluate the risks and the significance of the use of an anti-GPIIb/IIIa, in this case Eptifibatide, during angioplasty following presumed failure of thrombolysis in the acute phase of myocardial infarction. METHOD: Patients thrombolyzed following MI < 6 hours. Presumed failure of reperfusion with full dose thrombolysis. Analysis evaluated the success of angioplasty associated with anti-GPIIb/IIIa treatment and the hospital phase outcome. RESULTS: 41 consecutive patients, 32 male (78%) and 9 female (22%), were included. Infarction concerned the anterior region in 22 cases (54%) and inferior in 19 cases (46%). Fibrinolysis was performed using Alteplase in 28 patients (68%) and Reteplase in 13 patients (32%). Radial access was performed in 32 cases (78%). All of the patients received Eptifibatide with a bolus then infusion from their admission to the haemodynamic suite, on average 1 h 30 after the start of thrombolytic treatment. A total of 49 stents were implanted in 41 patients. A flux of TIMI 3 was obtained in 37 patients (90.2%). TIMI 2 in 2 patients (4.9%) and no reflow in 2 patients (4.9%). Four counter-pulsions by intra-aortic balloon were necessary (9.8%) for cardiogenic shock. No decrease in TIMI flux was observed after the angioplasty procedure. The main complications were a death from cardiogenic shock in one patients (2.4%), a non-fatal digestive tract haemorrhage in 2 cases (4.9%) and a single femoral haematoma requiring transfusion. CONCLUSION: The initial results were encouraging: high success rates, rare vascular complications, a probable consequence of the radial approach. The association of an anti-GPIIb/IIIa, Eptifibatide, therefore appears achievable during angioplasty with the positioning of a coronary endoprosthesis following the presumed failure of full dose thrombolysis.

[Double aneurysm occurring on a venous aortocoronary graft]. / Double anévrysme sur greffon veineux aorto-coronaire.

The authors report the case of a 48-year old patient admitted to hospital for unstable angina 13 years after primary myocardial revascularisation by a saphenous vein aorto-coronary bypass graft. Routine chest X-ray showed a left para-hilar opacity which CT scan and angiography confirmed to be aneurysmal and pseudoaneurysmal dilatations of the saphenous vein bypass graft.

[Congenital diverticulum of the right ventricle apropos of a case complicated by pulmonary endocarditis]. / Diverticule congénital du ventricule droit à propos d'un cas compliqué d'endocardite pulmonaire.

Congenital diverticulum of the right ventricle is an extremely rare abnormality, usually discovered by chance during evaluation of a more complex cardiac malformation. We report a case of isolated diverticulum of the right ventricle in a 14-year old boy who also had pulmonary valve endocarditis secondary to acute osteomyelitis. Owing to the evolutive risks inherent in the diverticulum and to the persistence of highly mobile pulmonary valve vegetations 5 years after the initial infectious episode, surgical treatment of the lesions had to be performed. The diagnostic, evolutive and therapeutic problems raised by right ventricular diverticula are discussed.

[Takayasu disease revealed by dorsalgia]. / Dorsalgies révélant une maladie de Takayasu.

UNLABELLED: Takayasu arteritis is an uncommon inflammatory arteritis especially in children. We report a case. CASE REPORT: A 11-year-old boy presented dorsalgia with inflammatory syndrome. One year later, the investigation of an hypertension with asymmetric blood pressure revealed an aortic coarctation and a bilateral renal arteries stenosis leading to Takayasu's arteritis diagnosis. CONCLUSION: Takayasu's arteritis must be evokated in young children in case of associated hypertension and inflammatory syndrome.

[Severe neonatal hyperthyroidism which reveals a maternal Graves' disease]. / Hyperthyroïdie néonatale sévère, révélatrice d'une maladie de Basedow maternelle.

Two of every thousand pregnancies are complicated by Graves' disease. Diagnosis is suggested by maternal disorders (tachycardia, exophthalmia, weight loss.) or fetal disorders (tachycardia, intra-uterine growth retardation, preterm birth.). Due to transfer into the fetal compartment of maternal antibodies which stimulate the fetal thyroid by binding to the thyroid thyrotropin (TSH) receptor, only 1% of children born to these mothers are described as having hyperthyroidism. Neonatal thyrotoxicosis disappears with clearance of the maternal antibodies; clinical signs usually disappear during the first four Months of life. The most frequent neonatal clinical signs of thyrotoxicosis are tachycardia, goiter, hyperexcitability, poor weight gain, hepatosplenomegaly, stare and eyelid retraction. Diagnosis is based on determination of the blood level of triiodothyronine (T3), thyroxine (T4) and TSH. To confirm the nature of hyperthyroidism, thyroid-stimulating immunoglobulins (TSI) should be assayed. The kinetics of TSI provides a guide for therapeutic adaptation and disappearance of TSI is a sign of recovery. Rare cases of familial non-autoimmune hyperthyroidism have been shown to be caused by germline mutation of the thyrotropin receptor. We report a case of severe neonatal hyperthyroidism which led to the diagnosis of maternal Graves' disease.

Direct Angioplasty for Acute Myocardial Infarction in Elderly Patients Using Transradial Approach.

BACKGROUND: In acute myocardial infarction (AMI), immediate outcome seems to be better after direct coronary angioplasty (DCA) than thrombolysis. Right transradial approach (RTRA) has been currently advocated as an alternative catheterization method for coronary angioplasty, but it is an exceptional technique in the treatment of AMI. PURPOSE: The goal of this prospective study was to evaluate feasibility and safety of DCA using the RTRA in elderly patients. METHODS: All patients, 70 years or older with AMI (less than 6 hours after the onset of symptoms), were included in this study. Exclusion criteria were ischemic Allen Test, and previous thrombolytic treatment. Left heart catheterization, with selective coronary angiograms were realized in all of them, using RTRA. RESULTS: Forty six patients, (mean age 76Â+/-5, range 70-85), (31 men, 15 women), were included. Coronary catheterization using RTRA was not possible in 4 patients, (9.1%), and DCA was not necessary in 2 other patients with two distal lesions (4.5%). In the 40 remaining patients, transradial coronary angioplasty of the infarct related vessel could be successfully achieved in 40 patients, (100%) with balloon alone in 21 patients, (52.5%), or stents in 19 patients, (47.5%). Two patients with cardiogenic shock died (in hospital mortality: 4.5%). In 2 patients, recurrent angina needed new angioplasty using the same RTRA (4.5%), and in 2 other patients, asymptomatic postprocedural right radial artery occlusion was observed. Before the 24th hr, 30/40 patients (75%) could stand up with an early discharge, (7Â+/-4 days). CONCLUSION: DCA using RTRA for AMI in elderly patients can be easily realized, with a high rate of success, without any more major local complications than using the usual femoral route, allowing earlier getting up and discharge.

[Chloroquine neuromyopathy. One case in prophylactic maleriatherapy (author's transl)]. / Neuromyopathie à la chloroquine. Un cas au cours d'un traitement prophylactique antipaludique.

A case of neuromyopathy due to chronic chloroquine intoxication is reported. The neuromyopathy developped 9 months after malaria suppression therapy with chloroquine was started. The clinical picture was that of a peripherical neuropathy in the lower limbs and of a generalized myasthenic syndrome. Muscular biopsy showed typical pictures of "vacuolar myopathy". The metabolism of the drug was normal. The patient improved soon after chloroquine was discontinued.