[Hemorrhagic complications of antivitamin K. Report of 75 hospitalized patients]. / Complications hémorragiques des antivitaminiques K. A propos de 75 patients hospitalisés.

Hemorrhagic complications are the most frequent complications of antivitamin K (AVK) treatments and can be life-threatening. We report 75 patients from a University Hospital. They were 40 males and 35 females (median age 74 years, 20-94), and were classified into 3 grades according to clinical picture: grade 1 (no surgery or transfusion, grade 2: surgery or blood transfusion needed, grade 3: death). 43 patients had grade 1 complications, 27 grade 2, and 5 grade 3 complications. The most frequent complications were muscular hematomas (36 patients), sub-cutaneous hematomas (14 patients), digestive bleeding (13 patients), hematuria (12 subjects). Eight patients had intracerebral bleeding, of whom 3 died. The treatment time was very variable (1 to 988 weeks). Only half patients had a prothrombin rate (PR) below 20% but two thirds had an INR above 5. This study showed that PR was a poor predictor of hemorrhagic complications. INR was a better parameter. For 15 patients, we considered that the indication was unadapted or questionable, among whom 2 died. This work suggests that the promotion of AVK prescription rules should go on.

Echocardiographic definition of left ventricular hypertrophy in the hypertensive: which method of indexation of left ventricular mass?

OBJECTIVES: It has been suggested that hypertensives at high risk of cardiovascular complications can be identified on the basis of their left ventricular mass as determined echographically. However, there is as yet a lack of consensus on the mode of indexation (body surface area, height, height 2.7) of left ventricular mass (LVM), and on the cut-off values for definition of left ventricular hypertrophy (LVH). The main objective of this study is to test the influence of the different modes of indexation for LVM on the prevalence of LVH in a population of never treated hypertensive patients on the basis of cut-offs for LVM based upon its relationship with ambulatory blood pressure (BP) measurement. METHODS: A population of 363 untreated hypertensives was investigated using a standardised procedure. The men and women were analysed separately. We studied the relationship between mean daytime ambulatory systolic BP and LVM and calculated the LVM cut-off for a BP of 135 mm Hg using three different methods of indexation. On the basis of these criteria, the population was divided into those with and those without LVH. RESULTS: The prevalence of LVH was found to be higher when LVM was indexed to height2.7 (50.4%) or height (50.1%). Prevalence was lowest when LVM was indexed to body surface area (48.2%), which tended to minimise the hypertrophy in obese individuals. Only indexation by height 2.7 fully compensates for relationships between height and ventricular mass in this population. CONCLUSIONS: Indexing LVM to height 2.7 thus appeared to give a more sensitive estimate of LVH by eliminating the influence of growth. Cut-offs of 47 g/m2.7 in women and 53 g/m2.7 in men corresponded to a cardiovascular risk indicated by a daytime systolic BP >/=135 mm Hg.

Left ventricular filling in the hypertensive patient: long-term course and influence of treatment.

BACKGROUND: Hypertension is accompanied by abnormalities in left ventricular filling; however, there is a lack of agreement on the extent of the influence of antihypertensive treatment on them. HYPOTHESIS: The present study was designed to evaluate the long-term course of these abnormalities in both treated and untreated hypertensive patients. METHODS: Left ventricular filling assessed by pulsed Doppler echocardiography of mitral flow was studied over a long follow-up period in both untreated and treated hypertensive patients. This retrospective study included 73 hypertensive patients who had not received any treatment. They had been followed up for at least 3 years and were divided a posteriori into two groups: Group 1 comprised the untreated patients, while Group 2 included the patients who had received antihypertensive treatment throughout the follow-up period. RESULTS: In the overall population, age and heart rate measured during the Doppler examination were the only parameters that correlated significantly with mitral flow. No significant changes in blood pressure or left ventricular mass were observed in Group 1 (14 patients) over the study period. There was a slight but nonsignificant decrease in E/A ratio of mitral flow. In the treated patients, there was a drop in heart rate-adjusted E/A ratio, despite a reduction in blood pressure and left ventricular mass, at mean follow-up of 5 years. CONCLUSION: Antihypertensive therapy did not arrest the long-term reduction in E/A ratio in hypertensive patients despite reduction in blood pressure and left ventricular mass.

[Inflammatory arteriopathy of the arms in the course of Horton disease. Report of six cases]. / Artériopathie inflammatoire des membres supérieurs au cours de la maladie de Horton. A propos de six cas.

We report 6 cases of upper limb involvement in giant cell arteritis; upper limb involvement revealed the disease in 4 cases and clinical symptoms were present in 5 (upper limb pain, Raynaud's phenomenon). Upper limb pulses were not palpable and blood pressure unmeasurable in all. Duplex ultrasonography found signs of inflammatory arteriopathy in 4 cases (hypoechogenous halo of the arterial wall and acceleration of flow velocity). Arteriography was performed in 5 cases and showed long and regular stenoses. In the last case, arteriography was not done because the duplex exploration gave an easier diagnosis. With this technique, the diagnosis of upper limb involvement, frequent in autopsy series of giant cell arteritis, might be made more often. Corticosteroid therapy is indicated and surgery should be discussed only in emergency situations.

Ambulatory measurement of the timing of Korotkoff sounds in a group of normal subjects: influence of age and height.

Ambulatory measurement of timing of Korotkoff sounds (QKD interval) gives an estimate of arterial distensibility derived from the velocity of the pulse wave over a vascular territory that includes the ascending aorta. The main advantages of the method are that it is entirely automatic, non-operator-dependent, and highly reproducible, and produces a measure independent of instantaneous blood pressure. This study of a group of 180 normal subjects aged between 10 and 78 years was designed to produce references values and to study the influence of height. The results confirmed the reduction with age of arterial distensibility in the whole population. However before the age of 30, QKD100-60 was positively correlated with height according to the relationship QKD100-60 = 0.73 height (cm) + 91, but not with age. This equation enables calculation of the theoretical value of QKD100-60 as a function of height for any patient to which the observed value can be expressed as a percentage. This effectively eliminates the influence of height, which reflects the length of the arterial segment under investigation.

Reduction in arterial distensibility in hypertensive patients as evaluated by ambulatory measurement of the QKD interval is correlated with concentric remodeling of the left ventricle.

Relationships between ambulatory arterial pressure and arterial distensibility as assessed by ambulatory measure of the QKD interval and echocardiographic measurement of left ventricular mass and relative wall thickness were evaluated in a population of 163 untreated hypertensive patients. The height-corrected QKD100-60 interval was significantly correlated with left ventricular mass (LVM; r = -0.29, P<.001) and with relative wall thickness (r = -0.31, P<0.001). In a multivariate analysis, LVM was significantly correlated with mean arterial pressure, pulse pressure, and age, whereas the relative wall thickness was correlated with the QKD interval and the mean arterial pressure. The concentric character of the LVH of the hypertensive patient was thus linked to the reduction in arterial distensibility.

[Thrombosis of the inferior vena caval and right atrium in amoebic abscess of the liver]. / Thrombose de la veine cave inférieure et de l'oreillette droite au cours d'un abcès hépatique amibien.

Amoebic abscess of the liver is sometimes complicated by deep venous thrombosis but extension to the right atrium is rarely observed. The authors report the case of inferior vena caval thrombosis extending to the right atrium in a case of amoebic hepatic abscess. The patient was treated initially by antibiotherapy with metronidazole associated with intravenous anticoagulation. Rapid extension of the thrombus despite this treatment led to the initiation of thrombolysis. There were no embolic complications and the outcome was good. Apart from the rarity of this complication, this case poses the problem of the management of these patients. No previous reports of the use of thrombolysis were found in the medical literature. In the light of previous publications and the present case, the authors suggest investigation by CT scanning, echocardiography and venous Doppler ultrasonography in all cases of hepatic amoebic abscess.

A short standardized protocol for measuring the QKD interval: comparison with 24 h monitoring and reproducibility.

BACKGROUND: Ambulatory measurement for the QKD interval is a new method for evaluation of the rigidity of large arterial trunks. Reliable indices of arterial rigidity can be distilled from the large number of measurements (usually around 100) obtained during 24 h monitoring. OBJECTIVE: To describe a shorter standardized protocol (4 h) including a 15 min effort test on an ergometric bicycle designed to reduce examination time and generate a wider range of heart rates and blood pressures, to test the equivalence of this short protocol with 24 h monitoring and to test its reproducibility. DESIGN: The results of the short protocol were compared with 24 h monitoring results for 15 subjects. The reproducibility of the short protocol for 15 subjects examined twice within 7 days was studied. RESULTS: We found a good correlation between the values obtained with this method and those from 24 h recordings, with comparable reproducibilities in the determination of QKD for systolic blood pressure 100 mmHg and heart rate 60 beats/min. CONCLUSION: A short (4 h) standardized protocol including an exercise test could replace 24 h ambulatory monitoring to assess arterial distensibility through QKD measurement.