[Abdominal aorta aneurysms discovered in cardiac rehabilitation]. / Anévrismes de l'aorte abdominale découverts en réadaption cardiaque.

We reported two cases of unusual discovery of asymptomatic surgical abdominal aortic aneurysm (AAA) after a coronary artery bypass graft and a valve surgery. Attending cardiac rehabilitation, the patients were transferred for prompt surgery. Beyond these observations, it is of great importance that screening of AAA could be done during echocardiography.

[Cardiac rehabilitation in "sports" patients]. / La réadaptation cardiaque des patients « sportifs ¼.

BACKGROUND: Cardiac rehabilitation (CR) addresses for the greater part a middle-aged sedentary population. Nevertheless, some patients referred in CR are active or sportive, and care for these patients is less known. AIM OF THE STUDY: To compare the results of CR between a little or not active population and an active or athletic population. PATIENTS AND METHODS: Every patient referred in a CR department in Loire-Atlantique between 2010 and 2016 were included either in the group 1 (sedentary or little active) or in the group 2 (at least once a week physical training).) RESULTS: Among 2916 patients included, 2288 patients did two exercise tests, the functional capacity in the group 1 (n=2117) increased from 4.7±1.2 to 5.6±1.3 METs versus 6.5±1.7 to 7.6±1.8 METs in the group 2 (n=171), the gain was similar in both groups from 19±13% to 18±14% (P=0.16). The 6minutes Walking Test respectively increased from 445±91 to 517±89 versus 518±87 to 603±73 meters with a gain of 18±18 versus 18±16% (P=0.93). The prognosis is yet to be best in the group 2 in accordance to a best maximal functional capacity (P<0.01). CONCLUSION: Cardiac rehabilitation is useful in active or athletic patients and should be prescribed based on the current recommendations.

[The daily living activities of the cardiac patient: Monocentre study]. / Les activités de la vie quotidienne du patient cardiaque: étude monocentrique.

BACKGROUND: The main aim of cardiac rehabilitation is for the patient to sustain physical activity at home. The daily living activities (DLA) are important to take into account. AIM OF THE STUDY: Analyze the DLA of patients in CR. PATIENTS AND METHODS: One thousand seven hundred and eighty patients (mean age: 60.9±11 years) followed a CR programme between 2010 and 2015. They were tested for several DLA with their cardiac frequency (CF). The observed CF was included in the Karvonen's formula, used for the prescription of physical activity. RESULTS: The coefficient of Karvonen was situated between 0.54 to 0.69, which was compatible with the prescribed physical training. Nevertheless, when the maximal exercise capacity was less than 5 METs, the coefficients were higher (0.53-0.89). CONCLUSION: It was useful to test the cardiac patients for DLA during a CR programme. The use of Karvonen's formula allowed to compare these exercises with recommended physical training. We must be prudent when the maximal physical capacity is less than 5 METs.

[Cardiac rehabilitation after myocardial infarction in France: still not prescribed enough]. / La réadaptation cardiaque après infarctus du myocarde en France : un taux d'abstention trop élevé

Despite well-documented benefits for patients after myocardial infarction, cardiac rehabilitation is underutilized in most countries. In France, a recent study showed a participation rate of 22.7 %, with huge regional disparities for unknown reasons. In this paper, we analyze some demographic particularities for explaining these curious results. Then, we review in the literature the complex factors influencing patient's referral in cardiac rehabilitation (patient's believes, role of the physician, health system's organization…), and the best ways of improving cardiac rehabilitation rate or finding adequate alternatives.

[Pulmonary embolism and right diaphragmatic paralysis: "one train can hide another"]. / Embolie pulmonaire et paralysie diaphragmatique droite "un train peut en cacher un autre".

The authors report the case of an 84 year old woman admitted for a mild pulmonary embolism associated with severe hypoxaemia. The association of a right diaphragmatic paralysis with renewed patency of a foramenovale and creation of a right-to-left shunt is probably an underestimated cause of refractory hypoxaemia.

[Myocardial infarction with normal coronary arteries: role of transesophageal echocardiography]. / Infarctus du myocarde à artères coronaires saines: place de l'échographie cardiaque transcesophagienne.

We report the case of 74 years-old female patient hospitalized for a ST+ acute coronary syndrome with normal coronary angiography. The association of a patent foramen ovale, a deep venous thrombosis and a pulmonary embolism led us to conclude the diagnosis of paradoxical coronary embolism. This case allows us to remind different etiologies to be considered in case of myocardial infarction with normal coronary arteries, and the interest of transesophageal echocardiography for the diagnosis of its etiology.

[Heparin-induced thrombocytopenia: a case of persistent thrombocytopenia]. / Thrombopénie induite à l'héparine: à propos d'une thtombopénine persistante.

Heparin-induced thrombocytopenia is rare. It should be considered if there is a reduction of at least 40% in the number of platelets and/or a level<100,000/mm3 in any patients who have received heparin in the previous 100 days. On stopping heparin, the rise in platelets is classically rapid, and normal levels are usually obtained in under 7 days. We report a case of heparin-induced thrombocytopenia, which was marked by a severe thrombocytopenia that only returned to normal 19 days after stopping heparin, in a patient treated initially with non-fractionated heparin for a pulmonary embolism secondary to an extensive deep venous thrombosis of the right lower limb.

Hepatitis C virus infection risk factors in patients admitted in hospital emergency departments in Picardy. Value of oriented screening based on recommendations of the 'Direction Générale de la Santé'.

OBJECTIVE AND DESIGN: Oriented hepatitis C virus (HCV) screening on the basis of transfusion, previous or current parenteral drug addiction, invasive procedures, and in family members of patients with hepatitis C, was recommended in France by the 'Direction Générale de la Santé' (DGS). The aim of this study was to estimate the frequency of these risk factors in patients admitted in hospital emergency departments in Picardy. METHODS: Between 1 June and 31 July 1996, physicians of the emergency units of seven hospitals in Picardy were asked to question admitted patients about risk factors mentioned in the DGS recommendations, and to suggest a screening test when at least one of these risk factors was present. RESULTS: Among 1648 patients, 68.7% had at least one of these risk factors. Screening was accepted by 723 patients, 58.7% of those with at least one risk factor, and more than 70% of those with history of transfusion and/or drug addiction. It was immediately performed in 451, and 2.4% had anti-HCV antibodies. The prevalence of anti-HCV antibodies was 1.5% in patients without history of transfusion or drug addiction and 7.9% in those with at least one of these two risk factors. CONCLUSION: Oriented screening based on transfusion or drug addiction history seems to have better efficiency than the screening policy recommended by the DGS. Poor reliability of answers about medical history was observed probably because of stress related to emergency circumstances. A screening test proposed to patients with these major risk factors by their usual physician would be probably more efficient.

Comparison of hepatitis C virus serotyping and genotyping in French patients.

BACKGROUND: Hepatitis C virus (HCV) serotyping has been proposed as an alternative assay to determine the respective genotype as it is more rapid, simple and less expensive than polymerase chain reaction (PCR) based typing methods. OBJECTIVES: A serotyping assay was compared with a genotyping assay to determine the infecting hepatitis C virus type in chronically HCV infected patients eligible for interferon therapy. STUDY DESIGN: An enzyme immunoassay (HC01, Murex) was tested to identify HCV types 1, 2 and 3 specific antibodies in 134 PCR-positive sera from chronically infected patients which had been previously genotyped by a reverse hybridization assay (INNO-LiPA HCV I, Innogenetics). Respectively nine and seven sera were from HIV-seropositive and hemodialysis patients. Unreactive sera and those with discrepant results were retested by a new version (HC02) extended to types 4, 5 and 6. RESULTS: The distribution frequency of HCV genotypes was subtype 1a, 16.4%; subtype 1b, 46.3%; subtype 2a, 7.5%; subtype 3a, 20.9%; type 4, 4.5%; type 5, 0.7%; and co-infections, 3.7%. Among all the patients, 95% were of type 1, 2 or 3. The antibody reactivities of hemodialysis (1/7; P < 0.05) and HIV-seropositive patients (4/9; P = 0.06) were lower than for the patients seen at the hepatology unit (87/118). For these latter patients, the serotyping assay was interpretable in 71% and concordant in 64% of the samples with the genotyping assay. Out of the 84 samples with interpretable results, 75 sera were correctly serotyped (89% specificity). The two mixed results obtained by serotyping did not correspond to genotype co-infections (n = 3) and reciprocally. Six discrepancies were ruled out by the new assay, but the 2 untypeable sera remained unsolved, and four out of six sera with genotype 4 were serotyped as type 5. CONCLUSIONS: Serotyping could be an attractive approach if the reactivity was improved and the subtyping possible.

Enzyme electrophoresis, sero- and subtyping, and outer membrane protein characterization of two Neisseria meningitidis strains involved in laboratory-acquired infections.

Two cases of laboratory-acquired infections due to Neisseria meningitidis were suspected to have occurred in two French hospitals. The first case occurred shortly, i.e., 3 days, after one strain had been handled by a laboratory technician, and the link between this strain and the strain causing meningitis was easily established. In the second case, infection occurred 3 weeks after 10 strains had been handled by a technician. In this case, it was necessary to use high-resolution markers in order to establish the link between the infecting strain and 1 of the 10 strains handled. The antigenic formulae of the two infecting strains (serogroup:serotype:subtype) were, respectively, C:NT:P1.12 and B:2a:P1.2. Outer membrane protein profile analysis and multilocus enzyme electrophoresis unequivocally confirmed the identity of the respective strains.

[Pharmacokinetics of ofloxacin administered orally in elderly subjects with bronchial or urinary tract infections]. / Pharmacocinétique de l'ofloxacine administrée par voie orale chez le sujet âgé atteint d'infections bronchiques ou urinaires.

The pharmacokinetics of ofloxacin orally administered were investigated at the steady-state in sixteen elderly patients older than 65 years. Patients with either urinary tract of respiratory tract mild infectious were divided into two age-dependent groups A and B. Group A: eight patients (65-80 years) received 200 mg of ofloxacin by the oral route every 12 hours and group B: eight patients older than 80 years, received 200 mg of ofloxacin by the oral route every 24 hours. The pharmacokinetic study was performed on treatment day 5. Plasmatic levels and urinary excretion of ofloxacin during 12 or 24 hours were assayed by means of high pressure liquid chromatography. Wide variations in plasma ofloxacin concentrations were observed within each group (Cmax range, group A: 1.9-9.2 mg/l, group B: 1.6-10.0 mg/l). Similar variability was observed for ofloxacin elimination parameters (CI/F, renal CI(R)/F) and half-life. In contrast, within-group and between-group differences in the volume of distribution adjusted for weight were not significant (group A: 1.22 +/- 0.44 l.kg; group B: 1.49 +/- 0.53 l.kg), but these values were approximately half those observed in the young adult. Plasmatic [CI/F] and renal clearance [CI(R)/F] of ofloxacin were correlated with creatinine clearance in both groups and in the overall population studied. Then the overall population was classified in terms of creatinine clearance [group 1: greater than 50 ml/min; group 2: less than or equal to 50 (minimum 20) ml/min]. The pharmacokinetics of ofloxacin in the elderly are characterized by a decrease in the volume of distribution and in plasmatic and renal clearances.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diffusion of ofloxacin in infected ascitic fluid]. / Diffusion de l'ofloxacine dans l'ascite infectée.

The ofloxacin diffusion was investigated in 13 cirrhotic patients with spontaneous bacterial peritonitis. Plasma and ascitic samples were collected at times H1, H31 and H8 after a first dose of 200 mg per os, in these 13 patients, after 4.5 or 6 days of 200 mg per os each 8 hours in 9 out of them. After the first dose, the plasmatic and ascitic concentrations, measured by High Performance Liquid Chromatography (HPLC), were between 0 and 3.62 mg/l, 0 and 1.95 mg/l respectively. The steady state concentrations are higher than the MIC'S for the organisms most commonly involved, comparable in the plasma and the ascitic fluid is good and suggest the interest of its use in this indication.

[Course of the diffusion of cefotiam in infected ascitic fluid]. / Evolution de la diffusion du céfotiam dans le liquide d'ascite infecté.

The cefotiam (CFT) penetration in infected ascitic fluid was investigated in 12 cirrhotic patients. CFT (1 g every 8 h) was given intravenously and measured by HPLC in plasmatic and ascitic samples. The mean ascitic concentrations (+/- SEM), 1 h, 3 h and 8 h after the first injection (J1) were 14.6 +/- 4.6, 11.8 +/- 3 and 8.4 +/- 2.9 micrograms/ml respectively. These values were 38, 62 and 88% of the corresponding mean plasmatic concentrations and higher than the MIC's for the organisms most commonly involved. The mean plasmatic and ascitic concentrations, a few days later (4.5 or 6 days) (Jn) were not significantly different from the corresponding values at J1. A significant decrease of polymorphonuclear cell count was observed between J1 and Jn. These results suggest that CFT diffusion into ascitic fluid is independent of inflammation and CFT is an adequate antibiotic in cirrhotic patients with infected ascitic fluid.

[Pharmacokinetics of ofloxacin in the elderly (65-85 years) with normal renal function after a single oral dose of 200 mg]. / Pharmacocinétique de l'ofloxacine chez le sujet âge (65 à 85 ans) à fonction rénale normale après prise orale unique de 200 mg.

Ofloxacin is a fluoroquinolone that is mainly eliminated through the kidneys. We studied ofloxacin pharmacokinetics following administration of a single oral 200 mg dose to each of 16 elderly patients (77 +/- 2.4 years). Serum and urine concentrations were assayed using high performance liquid chromatography. Peak serum ofloxacin concentrations were 3.60 (+/- 0.36) micrograms/ml; residual concentrations were 1.33 (+/- 0.15) and 0.62 (+/- 0.10) micrograms/ml at 12 and 24 hours respectively. Urine concentrations approximating 100 micrograms/ml were found up to the 12th hour. As compared to healthy adults, in elderly subjects ofloxacin distribution volume (85.3 +/- 6.3 l) was decreased by 34%, apparent clearance (4.97 +/- 0.53 l/h) was divided by 2.6 and elimination half life (13.3 +/- 1.2 h) was almost doubled. A linear correlation was found between individual apparent ofloxacin clearances and creatinine clearances. In view of these significant changes in ofloxacin pharmacokinetics found in elderly subjects, we advocate reducing the usual dosage by half.