Symptomatic bradycardia caused by mianserin at therapeutic doses.

An acute episode of symptomatic sinus bradycardia, occurred in a 50-year-old female patient after she had been given a single therapeutic dose of mianserin. Heart rate was corrected by atropine injection. Re-administration of mianserin resulted in the recurrence of bradycardia. Further examination showed no cardiac abnormalities. This case is the first report of conduction defect in a patient given therapeutic doses of mianserin.

[Demographic characteristics and response to antihypertensive treatment. Study using fixed doses of diltiazem]. / Caractères démographiques et réponse au traitement antihypertenseur. Etude à dose fixe avec le diltiazem.

Since the stepped care approach has been widened to four classes of antihypertensive drugs, demographic considerations enter into the choice of the first line drug. Calcium antagonists have been claimed to be more active in older patients because the average BP decrease after dose titration could be greater in this age group than in younger people. In this study, the response to a fixed dose of diltiazem has been related to different demographic factors. The selected patients have been treated with diltiazem 120 mg b.i.d. in monotherapy for at least 14 days irrespective of their response to a lower dose. There were 231 patients (115 M, 116 F). Their average age was 59 +/- 11 years (24 to 82) and their treatment duration was 44 +/- 27 days. Diltiazem lowered BP from 171 +/- 1/103 +/- 7 mmHg to 156 +/- 1/91 +/- 1 mmHg. The decline in both SBP and DBP with diltiazem was significantly related to their control values (r = 0.31 and 0.28 respectively, p less than 0.0001 for both). Although control SBP was related to age (r = 0.40, p less than 0.0001), its decrease with diltiazem was not. Neither control DBP nor its decrease with diltiazem were related to age. Although the average SBP was higher in patients over 60 years than in younger patients (176 +/- 2 mmHg, n = 124 vs 166 +/- 2 mmHg, n = 107, p less than 0.01), its decrease with diltiazem was not significantly greater (- 16 +/- 2 vs - 15 +/- 1 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)

[Percutaneous angioplasty in iliac obstructions. Immediate and long-term results]. / Angioplastie percutanée avec endoprothèse dans les occlusions iliaques: résultats immédiats et à distance.

During the last 35 months, mechanical recanalisation was obtained in 25 (19 men, 6 women, aged 39 to 92 years, average 59 years) out of 30 patients admitted for percutaneous andovascular management, associating angioplasty and endovascular stents, of iliac artery occlusion of over 5 months duration. Forty-three balloon-expandable stents (27 Palmaz, 16 Strecker) were implanted in 29 iliac arteries (15 external, 14 common iliac arteries) with occlusions 2 to 7 cms long (average: 4.6 cm) either after balloon angioplasty (22 cases) or without angioplasty (7 cases) because of a suspected fresh thrombus suggested by easy recanalisation by the guide wire and with the aim of avoiding fragmentation and embolisation of the thrombotic material. In this type of case, a Strecker stent was preferred, a choice also justified by an "obligatory" contro-lateral approach (5 cases). With the exception of these cases, the treatment of first intention was to insert one or more Palmaz stents by a homo-lateral approach. Two haematomas with no complications and 1 reocclusion at the 24th hour, revascularised by urokinase with a good 6 months result, were observed. After the insertion of one Palmaz stent in one patient, a non-occlusive thrombus, probably due to embolism, was observed straddling the homolateral superficial and profunda femoral arteries, but it was of no clinical consequence. After thromboaspiration and angioplasty by a contro-lateral approach, the arterial lumen was recanalized with a sustained result at 18 months. Clinical Doppler and angiographic (digitised intravenous angioplasty) controls were obtained every 6 months in 22 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Worsening of proximal thrombosis after insertion of a temporary caval filter (3 cases)]. / Aggravation de thromboses proximales après insertion d'un filtre cave temporaire (trois cas).

We report three cases of extensive thrombosis of the inferior vena cava after insertion of a temporary cava filter in patients with hypercoagulable state. The indication of implantation of a temporary cava filter in these kinds of patients have to be questioned. A primary implantation of a definite filter should be preferred.

[Prevention of per- and postoperative myocardial ischemia in non-cardiac surgery by intravenous diltiazem]. / Prévention de l'ischémie myocardique per- et postopératoire en chirurgie non cardiaque par le diltiazem intraveineux.

A controlled double-blind trial was carried out to assess the efficacy and safety of a continuous intravenous infusion of diltiazem in preventing perioperative myocardial ischaemia in patients with coronary artery disease. Sixty-six patients undergoing non cardiac surgical procedures (vascular surgery, n = 37; other, n = 29) were randomly chosen to receive either diltiazem (group D, n = 32); or placebo (group P, n = 34); there was no difference between these groups in the number of patients in each NYHA class (I: 13/16; II: 14/14; III: 5/4) or having had a previous myocardial infarct (20/22). ECG leads CM5 and CL5 were recorded continuously with an ICR 7200 Holter monitor. After starting recording, either placebo or a loading dose (0.5 mg.kg-1) of diltiazem was given, followed by an infusion of 5 micrograms.kg-1.min-1. Anaesthesia was induced by thiopentone and suxamethonium, and maintained with nitrous oxide (50%), fentanyl and either halothane or droperidol. The number of myocardial ischaemic episodes was significantly (p less than 0.05) lower in group D (2 ST depressions in two patients) than in group P (8 ST depressions in six patients, 2 myocardial infarcts and 1 pulmonary oedema). No conduction disturbance was observed; the lowest cardiac frequency was found in group P (32 b.min-1). Systolic and diastolic arterial blood pressures were lower in group D than in group P, but no difference was found in heart rate and rate-pressure product.(ABSTRACT TRUNCATED AT 250 WORDS)

Demographic factors and the antihypertensive effect of diltiazem.

The maximum blood pressure (BP) decrease obtained after dose titration with calcium antagonists is said to be greater in older patients. Because the dose necessary to achieve this maximum effect may also vary, it is not clear whether the sensitivity to treatment is actually increased in older patients. We evaluated the possible influence of pretreatment BP, age, and weight on the BP and heart rate (HR) response to 14-day treatment with a fixed dose of 120 mg diltiazem twice daily (b.i.d.) in 231 hypertensive patients aged 24-82 years (44 +/- 27). Diltiazem decreased BP from 171 +/- 1/103 +/- 7 to 156 +/- 1/91 +/- 1 mm Hg. Decreases in both systolic and diastolic BP (SBP, DBP) were related to their pretreatment values (p less than 0.0001 for both). Although pretreatment SBP was related to age (p less than 0.0001), its decrease with diltiazem was not. Neither pretreatment DBP nor its decrease with diltiazem was related to age; BP decrease was not superior in elderly patients (aged greater than 60 years) as compared with that in younger patients (SBP -16 +/- 2 vs. -15 +/- 1 mm Hg, NS; DBP -13 +/- 1 vs. -12 +/- 1 mm Hg, NS). In conclusion, the response to this average dose of diltiazem is related to pretreatment BP and is not affected by patient's age. Because this result is at variance with the concept that calcium antagonists are more effective in the elderly, this concept should not be used as a general therapeutic guideline.

Chronic liver disease after low daily doses of amiodarone. Report of three cases.

A few cases of alcohol-like chronic liver disease have recently been described in patients on high daily doses of amiodarone (400-600 mg) for 5-24 months. We report here 3 cases in which similar lesions were observed after low daily doses of amiodarone. Daily dosage was 200 mg in 2 cases, 400 mg then 200 mg in the third one, and duration of therapy ranged between 36 and 60 months. Symptomatology was limited to hepatomegaly and/or mild elevation of serum aminotransferases. Liver biopsy showed alcohol-like lesions with fibrosis in 2 cases and cirrhosis in 1 case. Electron microscopy disclosed hepatic phospholipidosis. These cases indicate that chronic liver disease may be observed even when amiodarone is prescribed at low daily dosage, provided that duration of treatment is long. They also suggest that rather than the daily dosage, the cumulative dose of amiodarone is a major factor in the development of hepatic injury.