[Changes in plasma atrial natriuretic factor, plasma and urinary cyclic GMP during exercise in coronary patients and healthy subjects]. / Variations du facteur atrial natriurétique plasmatique et du GMP cyclique plasmatique et urinaire au cours de l'exercice chez le coronarien et le sujet sain.

The concentrations of plasma ANF and plasma and urinary cyclic GMP were measured at rest and during exercise in 12 normal subjects (reference group) and 20 patients with coronary artery disease (coronary group). In both groups, plasma ANF and c GMP increased during exercise and fell one hour after (F = 3.8, p = 0.029 and F = 13.3, p = 0.0001, respectively) whereas the urinary c GMP increased one hour after exercise (F = 5.3, p = 0.029). In the control group, ANF increased on effort and fell during recovery to above its resting value whereas the plasma c GMP remained unchanged throughout the test. In the coronary group, no significant increase in ANF was observed on effort (wide dispersion of values) whereas the c GMP increased during effort and fell to below testing value during the recovery phase. The ANF of the coronary group was globally higher than the ANF of the control group (F = 4.7, p = 0.04). The plasma c GMP of the coronary group was comparable to that of the controls (F = 2.1, p = 0.15) despite higher concentrations at rest (p < 0.05) and during exercise (p < 0.05). However, there was a positive interaction between the efforts of exercise and the pressure of coronary disease on the concentration of plasma c GMP (F = 6.7, p = 0.0024). There was no difference in urinary c GMP between control and coronary subjects (F = 1, p = 0.33).(ABSTRACT TRUNCATED AT 250 WORDS)

[Jejunal perforation by cholesterol embolus: a case treated surgically]. / Perforation jéjunale par embolie de cholestérol: à propos d'un cas traité chirurgicalement.

A case of ischaemic jejunal perforation which could be attributed to mesenteric cholesterol emboli is reported. The jejunal pathology had been preceded by other, more classical sites of systemic cholesterol embolization that occurred immediately after arterial catheterization in this male patient with aneurysm of the abdominal aorta. Emergency segmental resection of the jejunum was performed with satisfactory immediate results. Histological examination of the operative specimen confirmed that the perforation was caused by cholesterol emboli. Cholesterol embolization of the intestine may have various clinical consequences which are reviewed by the authors.

[Hand disorders in pianists]. / Pathologie de la main du pianiste.

During the past 10 years numerous studies have been devoted to the pathology of musicians. A few of these studies exclusively concern pianists. From a questionnaire filled and returned by 44 pianists we were able to determine the type and frequency of the symptoms encountered. Pain and stiffness are the principal symptoms, the 4th and 5th fingers being those most affected. Three pathologies predominate in the literature: overuse syndrome, entrapment neuropathy and functional dystonia. The often long and difficult curative treatment rests on rehabilitation. Training in the fundamental postures the pianists must adopt should enable them to reduce the occurrence of these pathologies.

[Spontaneous complete rupture of the thoracic aorta. Apropos of a case surgically treated with success]. / Rupture spontanée complète de l'aorte thoracique. A propos d'un cas opéré avec succès.

The authors report the case of a 74-year-old hypertensive man hospitalised with chest pain accompanied by shock and hemo-mediastinum. The diagnosis of spontaneous rupture of the thoracic aorta, suspected by aortic arteriography, was confirmed by thoracic CT scan with injection of contrast medium. Emergency surgery revealed a 4 cm longitudinal linear tear of the horizontal aorta, with neither dissection nor aneurysm. Simple suture during extra-corporeal circulation with normothermia and the heart beating, was successful after prolonged postoperative intensive care. This case of complete and spontaneous acute rupture of the horizontal thoracic aorta appears to be the first to have been successfully treated surgically.

[Evaluation of urinary excretion of cyclic guanosine monophosphate in clinical cardiology]. / Evaluation de l'excrétion urinaire du GMP cyclique en clinique cardiologique.

The prognostic importance of levels of urinary excretion of cyclic GMP (cGMPu), the second messenger of the atrial natriuretic factor (ANF) was studied in different cardiac pathologies in 31 patients (19 males and 12 females, average age 66 +/- 15 years) and compared with 31 control subjects of the same age (+/- 4 years) and sex. In the control group, the average cGMPu was 0.35 +/- 0.17 mumoles/24 hours/m2, and, with respect to urinary creatinine, increased with age (r = 0.54, p = 0.002). In the 16 patients with cardiac failure, the cGMPu was very high (1.03 +/- 0.59 mumoles/24 hours/m2, p less than 0.001) without any significant correlation with NYHA functional class although it fell after treatment. After myocardial infarction (8 cases including 3 with cardiac failure), the cGMPu was also high (0.49 +/- 0.33 mumoles/24 hours/m2) but it did not differ significantly from the control values in the 9 atrial arrhythmias without cardiac failure. The cGPMu was related to the cardiothoracic ratio but not to any blood gas parameter or echocardiographic measurement. In conclusion, the cGMPu is more stable and easier to measure than the ANF. It would seem to be a sensitive marker of cardiac failure complicating the most common cardiac pathologies observed in clinical practice.

[Bilateral renal embolism during thrombolytic therapy with tissue-type plasminogen activator in a patient with thrombosis of the left ventricle]. / Embolie rénale bilatérale au cours d'une fibrinolyse par l'activateur tissulaire du plasminogène, chez un patient porteur d'un thrombus ventriculaire gauche.

The authors report a case of bilateral renal embolism during thrombolytic treatment in the acute phase of myocardial infarction in a 77 year old patient in whom echocardiography had shown a left ventricular thrombus. After reviewing the literature, the risk of embolic complications of thrombolytic therapy would seem difficult to evaluate because of the difficulty of diagnosis, but they exist irrespective of the type of thrombolytic agent used.

[Evaluation of the myocardial ischemic and arrhythmogenic risk of digitalized angiography by venous route. Apropos of a comparative trial of ioxaglate and iopamidol]. / Evaluation du risque ischémique myocardique et arythmogène des angiographies numérisées par voie veineuse. A propos d'un essai comparatif de Ioxaglate et de Iopamidol.

Cardiac tolerance to digital subtraction angiography by venous route (DSAV) was evaluated during a prospective study of a continuous series of 100 patients of both sexes investigated for various arterial diseases, and classified previously as "cardiac" and "non-cardiac". A permanent 12 lead ECE recording by sequences of 3 allowed study of ischemic and rhythmic changes provoked by randomly allocated injections of contrast media, Ioxaglate or Iopamidol. Major cardiac complications were not observed in the 98 patients studied (2 excluded), but in 32.6% auricular extrasystoles (AES) and/or ventricular extrasystoles (VES) were noted and in 19.4% a painless widening of the ST segment of 0.5 mm or more. The and ST widening were more frequent in the VES 40 patients classed as "cardiac" than in the 58 "non cardiac" (35% against 8.6%, p less than 0.01 and 37.5% against 6.9%, p less than 0.001 respectively). The two products did not differ with respect to their effect on frequency of repolarization anomalies, whereas Ioxaglate provoked more VES than Iopamidol (30% against 8%, p less than 0.02). It is concluded that cardiac tolerance to DSAV is good, but that the frequency of VES and painless repolarization ischemic disorders observed, even with only weakly hypertonic contrast media of non ionic type, suggests that their indications be limited and that certain precautions are necessary in cardiac patients.

[Update on the treatment of systemic scleroderma]. / Actualités dans le traitement de la sclérodermie systémique.

Renewed clinical trials of drugs used for many years and the availability of new symptomatic therapies allows selection of appropriate treatment for progressive systemic sclerosis. Colchicine damages intracytoplasmic microtubules and when administered at a dose of at least 1.5 mg per day during early stages of the disease reduces cutaneous sclerosis without improving other manifestations of scleroderma. D-penicillamine inhibits bridge formation during collagen maturation, acting mainly on cutaneous infiltration with more uncertain effects on visceral localizations of the disease. It can be effective against pulmonary lesions but, as with colchicine, must be prescribed early. Its action is delayed and its side effects limit its use. Corticoids are of very limited efficiency and although they may be useful for relief of muscular and articular localizations they have been accused of precipitating onset of renal insufficiency. Immunodepressants have until now been assessed as ineffective. The demonstration in patients with progressive systemic sclerosis of abnormal activation of immunity system cells suggested the use in this collagen disease of a new immunosuppressive agent, cyclosporine A, but clinical utility of this drug remains to be demonstrated. In systemic sclerosis efficacy of plasma exchange is mainly directed against vasomotor disorders and digital ulcerations, but study results are difficult to assess because of associated therapies. Constraints and risks of this treatment also considerably reduce its interest. The coagulation factor XIII acts as a stabilizing factor of collagen. It reduces cutaneous infiltration but its efficacy is based on results of a single controlled trial and its use is limited by the need for repeated intravenous injections.(ABSTRACT TRUNCATED AT 250 WORDS)

[Scintigraphic appearance and particular arteriographic aspects intrahepatic cholestasis]. / Foies de cholostases. Aspects scintigraphiques et artériographiques particuliers.

Based on one case history, it is reviewed here that prolonged cases of obstructive jaundice can take on deceiving appearences, and all the more so when they fall within the framework of a "biological gap". Extensive distension of the extra and intrahepatic bile ducts are at the basis of images with multiple, radiating hilar gaps on scintigraphy, and of "chicken nests" and "Swiss cheese" at hepatographic times in selective hepatic arteriography. These rather uncommon images should lead to a diagnosis of a surgical cholestatic liver.