[Principles of hemodynamics and sonographic techniques for the evaluation of arteries]. / Notions d'hémodynamique et techniques ultrasonores pour l'exploration des artères.

Arterosclerosis is the main cause of arterial lesions and leads to arterial stenoses. In order to preserve distal perfusion, flow velocities increase at the site of stenosis due to reduced peripheral resistance. Doppler sonography (US) allows detection of hemodynamic abnormalities at the site of stenosis and evaluation of its impact on distal flow. Several parameters and imaging features including resistive indices and systolic velocities are measured in order to characterize the degree of stenosis and its impact on perfusion. In addition, B-mode US allows morphologic evaluation of lesions. Doppler US is useful to evaluate lower limb arteries, renal arteries and neck arteries.

[Left superior vena cava: a simple diagnosis by transthoracic echocardiography. A case report]. / Veine cave supérieure gauche: un diagnostic simple par échocardiographie transthoracique. A propos d'un cas.

Persistent left superior vena cava is an anomaly of the systemic venous return occurring in 0.5% of the general population. We report the case of a patient with an incidental diagnosis made during a dyspnea while he had chronic pulmonary disease. The diagnosis was suspected by the presence of a markedly dilated coronary sinus and confirmed by a simple contrast injection into the left antecubital vein. Transesophageal echocardiography and magnetic resonance imaging confirmed the existence of 2 superior vena cava with the left superior vena cava draining into the coronary sinus. This congenital anomaly is of minimal hemodynamic significance when isolated. The diagnosis can be useful for placement of central catheters from left superior approach.

Procedural characteristics of primary coronary angioplasty in diabetic patients with acute anterior myocardial infarction.

BACKGROUND: Mortality and morbidity rates are higher in diabetics compared to non-diabetics after acute myocardial infarction (AMI). Previous angiographic studies regarding primary angioplasty for the treatment of AMI found that angioplasty was similarly successful in diabetics and non-diabetics. However, it is noteworthy that patients of "real life" are often far from the population randomised in prospective protocols. The aim of this study was to examine the procedural characteristics of consecutive diabetic patients hospitalised for anterior AMI and treated with primary angioplasty as compared to non-diabetics. METHOD: We analysed 28 consecutive diabetics and 74 non-diabetics who underwent primary angioplasty for anterior AMI (< 12 h from the onset of symptoms) during 15 consecutive months between 2000 and 2001 in our institution, depending on the presence or absence of diabetes. RESULTS: Among analysed data, we found that in diabetics compared to non diabetics: (i) the delay before arrival in the cath-lab was significantly longer (5.5 +/- 2.7 vs 4.2 +/- 2.8 h); (ii) there was a less important collateral flow coming from the non-culprit arteries towards the culprit artery; (iii) there was a less important rate of recovery of a normal flow (TIMI 3) in the culprit artery after coronary angioplasty (67% vs 91%). CONCLUSION: Our study demonstrates that several procedural characteristics could explain the poorer prognosis of AMI treated by primary angioplasty in the diabetic population. The longer delay found in diabetics before arrival in hospital could probably be improved.

Increased plasma concentrations of interleukin-18 in acute coronary syndromes.

OBJECTIVE: To examine the relation between plasma concentrations of interleukin-18 (IL-18), the interferon gamma inducing factor, and clinical instability of coronary artery disease. DESIGN AND SETTING: Observational study in a university hospital. PATIENTS: 11 patients with unstable angina and negative troponin I, 21 patients with acute non-Q wave myocardial infarction (MI), 21 patients with acute Q wave MI, 9 patients with stable angina, and 11 controls. MAIN OUTCOME MEASURES: Plasma IL-18 concentrations and their relation to clinical instability and myocardial dysfunction. RESULTS: Plasma concentrations of IL-18 were significantly increased in the unstable angina and MI groups in comparison with the stable angina and control groups (p < 0.01). No difference in IL-18 concentrations were found between patients with unstable angina, patients with non-Q wave MI, and patients with Q wave MI. Plasma IL-18 concentrations significantly correlated with decreased left ventricular ejection fraction (p = 0.01). CONCLUSIONS: Plasma IL-18 concentrations are increased in patients with acute coronary syndromes and correlate with the severity of myocardial dysfunction.