[Drug eluting stents in 2005: have the initial expectations been met?]. / Le stent "actif" en 2005: remplit-il ses promesses?

Drug eluting stent is a new technology aimed to prevent the development of neointimal hyperplasia and restenosis following percutaneous coronary intervention. This review describes the direction for their use at the present time and the future of their utilization with the summary of the principals clinicals trials.

Surface rendering of three-dimensional myocardial SPECT: clinical usefulness compared with bull's-eye and conventional tomograms.

BACKGROUND: A prospective study was conducted to evaluate the clinical usefulness of three-dimensional (3D) surface-shaded maps for routine practice of myocardial perfusion single-photon emission computed tomography (SPECT) by comparison with 2D slices and 2D bull's-eye qualitative analysis. METHODS AND RESULTS: Angiograms were performed on 201 consecutive patients, 155 with coronary artery disease (CAD) and 46 with no significant CAD. One-day 201TI stress/rest-reinjection protocol was performed in 110 patients, and 1-day 99mTc-sestamibi or tetrofosmin stress/rest protocol was performed in 91. The stress protocol was either exercise or dipyridamole (0.56 mg/kg) infusion. Three-dimensional surface maps were obtained by using a threshold for the transaxial data at 50%, 55%, 60%, 65%, and 70% of the maximum pixel value in the first 60 patients. Interpretation of 3D maps was based on the presence of a complete (transmural-looking) perfusion hole within the myocardial wall; doubtful patterns were considered pathologic or normal. Good diagnostic values were found for the 50% to 60% thresholds, but the 60% setting showed the best concordance with multislice and bull's-eye analysis; higher values drastically degraded the specificity. Considering doubtful patterns as normal clarified interpretation and led to a small loss in sensitivity but high gain in specificity. Applied to the whole population, the 3D maps using a 60% threshold provided similar diagnostic value to detect CAD as did conventional and bull's-eye analysis. Moreover, the 3D maps showed a trend toward higher specificity and a proportionally smaller decrease in sensitivity (sensitivity: 92.9%, 90.3%, 89.7%; specificity: 45.6%, 50.0%, 58.7% for tomograms, bull's-eye analysis, and 3D maps, respectively), especially for the detection of left anterior descending and right CAD. Multivessel disease was detected in an identical manner. Three-dimensional maps might improve detection of perfusion defects in the basal regions. However, 3D maps were found to be less sensitive than slices and particularly bull's-eye analysis for the reversibility of stress defects. CONCLUSIONS: Three-dimensional surface display of myocardial perfusion is a valuable independent tool for determining presence, extent, and location of CAD. It can convey useful first-look information to the referring physician, especially through a cine-rotational motion (as done in our practice through use of a floppy disk.

[Spontaneous idiopathic pneumopericardium in young patients. Review of the literature. Apropos of a new case]. / Le pneumopéricarde spontané idiopathique du sujet jeune. Revue de la littérature. A propos d'une nouvelle observation.

Spontaneous idiopathic pneumopericardium (SIPP) in young subjects is a rare disorder since, apart from the case described here, only 28 cases have been reported in the literature. It occurs mainly in young adults. The physiopathology of the disorder involves alveolar rupture, as described by Macklin. The symptoms of SIPP are dominated by chest pain, which usually develops suddenly and is combined with dyspnea. Clinical examination is not very helpful, cardiac auscultation detects either pericardial rubbing or a more suggestive metallic sound. Recovery usually occurs without treatment, but there is a risk of long-term recurrence. An unusual complication to be feared is aerial tamponade, which may be life-threatening and calls for emergency draining. The treatment of SIPP involves strict bed-rest, symptomatic treatment of the pain and clinical monitoring.

[Spontaneous pneumopericardium. Review of the literature apropos of 2 cases in the young adult]. / Les pneumopéricardes spontanés--revue de la littérature. A propos de deux observations chez l'adulte jeune.

Pneumopericardium is defined as the presence of air in the pericardial cavity. It is a rare condition in adults, usually due to trauma; it is commoner in the more exposed neonate and usually iatrogenic. The clinical presentation of chest pain and shortness of breath is associated with the pathognomonic auscultatory sign described by Bricheteau: a water-mill bruit. The diagnosis is confirmed by chest X-ray which shows the air-gap sign surrounding the cardiac silhouette. The principal differential diagnosis is a pneumomediastinum. The prognosis of pneumopericardium depends on the cause and complications of which tamponade and infection are the most serious and potentially life-threatening. The treatment of pneumopericardium is bed rest and surveillance when uncomplicated: evacuation of the air becomes necessary when complications set in.

[Ultra-sensitive TSH levels: an aid in the screening for amiodarone-induced thyroid dysfunction]. / Le dosage de TSH ultra-sensible: une aide au dépistage des dysthyroïdies induites par l'amiodarone.

Amiodarone modifies thyroid hormone secretion and hypothyroidism occurs in some cases. The latter diagnosis is often difficult and is of particular importance in these patients as it may have serious consequences for the heart. Early diagnosis is therefore essential but difficult because of the induced hyperthyroxinemia with maintenance of euthyroidism and a hypotriiodothyronemia. The diagnostic performance of an ultrasensitive method of measuring TSH (TSH-U), capable of distinguishing hyper and euthyroidism were compared with standard thyroid function tests and TSH stimulation with TRH in 50 patients treated with amiodarone. Only 6 of the 14 patients with hyperthyroxinaemia had TSH-U values in the hyperthyroid range: only one of these patients had an increased triiodothyronine. In 2 cases the THS-U was low but the T4L was normal. In 4 patients, increased TSH-U allowed diagnosis of latent or patent hypothyroidism. There was a close correlation between results of the TRH stimulation test and those of the TSH-U in all cases. This test may therefore be used as an initial screening test for thyroid dysfunction in patients on amiodarone and is simple, reliable and relatively cheap to perform. It makes it unnecessary to measure all thyroid hormonal parameters and the TRH test simultaneously.

[Dispersion of auricular refractory periods. Role of the intensity of the stimulation current]. / Etude de la dispersion des périodes réfractaires auriculaires. Le rôle de l'intensité du courant de stimulation.

In a series of 12 patients, the right atrial effective and functional refractory periods (ERP and FRP) were determined at 3 different sites and at 3 different intensities (threshold intensity and double and triple the threshold intensity). The mean of the range of the ERP in the same atrium was 43.4 ms and that of the FRP was 53.5 ms. These ranges appear to be independent of the intensity of stimulation. However, the values of the refractory periods were strictly correlated with the intensity of the stimulation current used. This correlation appeared to be much more marked for the ERP than for the FRP.

[Reduction of auricular fibrillation with fenoxedil: the probable role of the autonomic nervous system]. / La réduction de la fibrillation auriculaire par le fénoxédil: le rôle probable du système nerveux autonome.

It is still very difficult to study the mechanisms of action of anti-arrhythmic drugs in human clinical studies. The use of continuous electrocardiographic monitoring offers a number of advantages in this field. In this study, the authors evaluate the mechanisms of action of fenoxedil hydrochloride on atrial fibrillation. Holter monitoring suggests that there is a probable synergy between fenoxedil and the autonomic nervous system.

[Electrocardiographic criteria of left ventricular hypertrophy and unipolar aVR lead]. / Critères électrocardiographiques d'hypertrophie ventriculaire gauche et dérivation unipolaire aVR.

The introduction of data processing techniques into the interpretation of electrocardiograms and the rapid progress towards automatization require a multiplication of the criteria of decision and an exact evaluation of their performance. The ECG diagnosis of left ventricular hypertrophy depends on a large number of parameters. Only the aVR lead has not been fully exploited to date. This study proposes a corrected measurement of S in aVR, with an amplitude of S aVRc greater than or equal to 11 mm being the parameter with the best performance and the best predictability.