Usefulness of subcutaneous nitrate for radial access.

OBJECTIVES: We made the hypothesis that adjunction of nitrate to lidocaine for local anesthesia may facilitate accessibility of radial access. BACKGROUND: Transradial approach is associated with a clear decrease in the rate of access bleeding when compared with femoral approach. The diffusion of this technique remains limited due to the small size and the spastic profile of this artery. METHODS: Eighty-four consecutive patients undergoing coronary procedures using radial approach were randomly assigned between two types of local anesthesia (double blind): 5 ml lidocaine (group L)-5 ml lidocaine + 0.5 mg dinitrate isosorbide (group LN). The primary endpoint was the duration of radial puncture (from beginning of local anesthesia to sheath insertion) and the total number of punctures. RESULTS: Sixty-two men and 22 women (mean age 59 +/- 8 y.o.) were included. Mean +/- SEM access duration was 3:33 +/- 3:11 min in group L when compared with 2:26 +/- 1:20 min in group LN (P < 0.05). Mean number of puncture was 1.50 +/- 1.0 in group L when compared with 1.16 +/- 0.5 in group LN (P = 0.05). There were no differences between two groups concerning pain score during anesthesia and sheath insertion. There was no difference between two groups concerning the rate of hypotensive and vagal reactions. Radial spasm occurred in four patients in group L and only one in the group LN. CONCLUSION: Local anesthesia using lidocaine plus nitrate is feasible and improves the accessibility of radial access.

[The type III aortic dissection. Diagnosis, outcome, contribution of the endovascular therapies to their management--a case report]. / La dissection aortique chronique du type III. Aspects diagnostiques, évolutifs et apport des techniques endovasculaires dans le traitement--a propos d'une observation.

The dissection of the descending aorta is a serious affection regarding to its mortality and its complications. It becomes chronic after the 14th day following the first signs of dissection. The authors report the case of a 55 years old patient who has presented a type III dissection diagnosed at the chronic period. The persistance of the pain has indicated the implantation of a stent at the intimal tear. This new endovascular treatement of the aorta diseases is a promising and less invasive alternative to the surgical treatement. It may reduce the morbidity and the mortality of this pathology but it needs an accurate and performant imaging techniques.

[Surgically treated chronic aortic insufficiency: prognostic value of preoperative echocardiography]. / Insuffisance aortique chronique opérée: valeur pronostique des données échocardiographiques préopératoires.

Between March 1979 and December 1998, 38 patients with isolated chronic aortic insufficiency underwent aortic valve replacement. The aim of this study is to determine whether preoperative echocardiography parameters are useful in predicting operative results in patients with aortic valve replacement for chronic aortic insufficiency. The global survival is 92% in one year and 89% in ten years. We conclude that on end systolic left ventricle diameter < 55 mm has good prognosis (p = 0.019) and there is a strong correlation between preoperative end systolic and post operative end systolic diameter an end diastolic left ventricular diameter > 70 mm and a left ventricular fractional shortening < 25% weren't predictive of a poor prognosis.