[False and true hypertension in the aged subject. Diagnostic errors and potential solutions]. / Fausses et vraies hypertensions artérielles du sujet âgé. Les erreurs diagnostiques et leurs solutions potentielles.

Arterial hypertension has the same definition in elderly people as in young adults. Epidemiologically, it has clearly been demonstrated that in the elderly it is a risk factor of morbidity and cardiovascular mortality. The international reference method for measuring blood pressure is by auscultation and mercury manometer. However, this indirect measurement is the source of many errors due to the material or the observer, or inherent in the method. A typical example of this is pseudohypertension in the elderly. Several solution are offered to improve the reliability of indirect blood pressure measurement, the most convincing one being the use of scientifically validated autonomous instruments relying on the oscillometry system. Ambulatory blood pressure measurement is interesting, being of diagnostic, therapeutic and probably prognostic value, but all this has to be confirmed in elderly subjects.

[Mycotic aneurysms]. / Les anévrysmes mycotiques.

Mycotic aneurysms are aneurysms infected by bacteria or fungi. These may be secondary to an endocarditis, or they may be primary, and then are developed from a septicemia or bacteremia. The diagnosis, often difficult, is sometime only made during complications, the most severe of which is rupture. This diagnosis must be aided by new imaging techniques such as ultrasonography, tomodensitometry, magnetic resonance imaging. The treatment is medical (antibiotics) and surgical.

[Experience at an Internal Medicine service in the postoperative follow-up of 403 patients operated on at a cardiovascular surgery service]. / Expérience d'un service de Médecine Interne dans les suites postopératoires de 403 patients opérés dans un service de Chirurgie Cardio-vasculaire.

Over the last 3 years, 403 patients operated in the Department of Cardiovascular Surgery of Broussais Hospital have been transferred to a Department of Internal Medicine for secondary postoperative care. A total of 245 non-cardiac complications (64%) and 134 cardiac or vascular complications (36%) were observed in 321 of these 403 patients (80%). Infections accounted for 26% of non-cardiac complications (63/245). They included 9 cases of mediastinitis, 2 cases of septicemia, 6 endocarditis, 6 wound infections, and 40 other infections (ENT, gastrointestinal, pulmonary, urogenital). The non-cardiac, non-infectious complications comprised mainly delayed healing (39 cases) and pleuropulmonary (29 cases), ENT (9 cases), gastrointestinal (31 cases), urogenital (12 cases), hematological (17 cases) and neuropsychiatric (9 cases) complications; and, finally, 37 inflammatory syndromes. The cardiac complications were pericarditis with or without tamponade (24 cases), arrhythmias or conduction disturbances (50 cases), haemodynamic (54 cases) and vascular (6 cases complications. These very varied complications sometimes occurred late and could be latent. They resulted in prolongation of the duration of hospitalization, so increasing the overall health costs.

[Clinical study of the action of dobutamine in acute cardiac insufficiency]. / Etude clinique de l'action de la dobutamine dans l'insuffisance cardiaque aiguë.

78 patients were treated with dobutamine for a severe episode of heart failure at a mean dose of 9.51 micrograms . kg-1 . min-1 for an average of 5 days. 59 of these patients had ischaemic heart disease, including 34 with recent infarcts. The monitoring of treatment was essentially clinical, consisting of repeated measurement of the heart rate, the systolic and diastolic blood pressure and the diuresis. A haemodynamic survey was performed in only 25 cases. 48 patients were improved. 24 of these patients had no clinical or radiological signs of heart failure at the end of the treatment. Dobutamine significantly increases the blood pressure (97.7 +/- 24.9 to 105.8 +/- 21 mm Hg), the diuresis and the cardiac index (2.02 +/- 0.51 to 2.52 +/- 0.54 l . min-1 . m-2) and it significantly decreases the mean capillary pressure (25.36 +/- 6.20 to 21.03 +/- 6.94 mm Hg). The tolerance was very satisfactory, particularly in terms of the heart rate, ventricular excitability and the progression of the coronary disease. This clinical study confirms the value of dobutamine in the treatment of severe heart failure, either alone or in combination with vasodilators. The authors do not believe tha haemodynamic monitoring is essential at the doses used, which means that dobutamine could be used more widely in these indications.