Serum uric acid is not independently associated with plasma renin activity and plasma aldosterone in hypertensive adults.

BACKGROUND AND AIMS: In experimental investigations conducted in rats, raising serum uric acid (SUA) levels resulted in the stimulation of intrarenal renin expression. Studies in humans exploring the association of SUA with plasma renin activity (PRA) yielded conflicting results. Moreover, little is known about the relationship of SUA with plasma aldosterone concentration (PAC). The study aimed to assess the relationship between SUA levels, PRA, and PAC and the influence of age, gender, body mass index (BMI), and hyperuricemia on these relationships in subjects with essential hypertension (EH). METHODS AND RESULTS: We enrolled 372 hypertensive patients (mean age 45 ± 12 years, men 67%) with uncomplicated EH that was not pharmacologically treated. The study population was divided in tertiles according to SUA levels. While PRA did not differ significantly across the three tertiles, PAC was higher in subjects belonging to the uppermost tertile of SUA than those in the lower ones (p = 0.0429); however, this difference lost statistical significance after adjustment for age, sex, BMI, and serum creatinine. Univariate correlation analyses showed significant associations of SUA with PRA (r = 0.137; p = 0.008) and PAC (r = 0.179; p < 0.001). However, these relationships were not significant after correcting for confounding factors in multiple linear regression analyses. We did not observe statistically significant effect modification by gender, age, BMI, and hyperuricemia. CONCLUSION: SUA levels are weakly associated with PRA and PAC in adults with untreated EH. These relationships were lost after adjustment for age, sex, BMI, and serum creatinine.

Relationships between mild hyperuricaemia and aortic stiffness in untreated hypertensive patients.

BACKGROUND AND AIMS: Clinical studies exploring the relationship between serum uric acid (SUA) and arterial stiffness yielded conflicting results. Only in a few of these studies, arterial distensibility was examined by measuring aortic pulse wave velocity (PWV), which is considered the gold standard for evaluating arterial stiffness. In none of the previous investigations was the influence of SUA on aortic distensibility assessed, taking into account the effect of albuminuria. The purpose of our study was to comprehensively analyse the relationships between SUA and aortic PWV in a group of essential hypertensive patients. METHODS AND RESULTS: We enrolled 222 untreated and uncomplicated hypertensive subjects (mean age: 44 ± 10 years; 60% males), without gout. In all patients, SUA and urinary albumin excretion rate (AER) were determined. Moreover, carotid-femoral (c-f) PWV was measured. C-f PWV was significantly higher in hypertensive patients belonging to the uppermost tertile of SUA distribution, compared to subjects of the lowest tertiles (10.9 ± 2.2 vs. 10 ± 1.8 vs. 9.9 ± 1.7 m s(-1); p = 0.001). In univariate analysis, SUA correlated with c-f PWV (r = 0.24; p < 0.001). This association disappeared when AER was added in a multiple regression model, including SUA, age, mean arterial pressure, gender, metabolic syndrome components and glomerular filtration rate. CONCLUSION: The results of our study showed that, in essential hypertensive subjects, there is a positive relationship between mild hyperuricaemia and aortic stiffness. This association weakened after adjustment for covariates and lost statistical significance after further correction for albuminuria.

Absence of an independent association between serum uric acid and left ventricular mass in Caucasian hypertensive women and men.

BACKGROUND AND AIM: Experimentally uric acid may induce cardiomyocyte growth and interstitial fibrosis of the heart. However, clinical studies exploring the relationship between serum uric acid (SUA) and left ventricular (LV) mass yielded conflicting results. The aim of our study was to evaluate the relationships between SUA and LV mass in a large group of Caucasian essential hypertensive subjects. METHODS AND RESULTS: We enrolled 534 hypertensive patients free of cardiovascular complications and without severe renal insufficiency. In all subjects routine blood chemistry, including SUA determination, echocardiographic examination and 24 h ambulatory blood pressure (BP) monitoring were obtained. In the overall population we observed no significant correlation of SUA with LV mass indexed for height(2.7) (LVMH(2.7)) (r = 0.074). When the same relationship was analysed separately in men and women, we found a statistically significant correlation in female gender (r = 0.27; p < 0.001), but not in males (r = -0.042; p = NS). When we grouped the study population in sex-specific tertiles of SUA, an increase in LVMH(2.7) was observed in the highest tertiles in women (44.5 ± 15.6 vs 47.5 ± 16 vs 55.9 ± 22.2 g/m(2.7); p < 0.001), but not in men. The association between SUA and LVMH(2.7) in women lost statistical significance in multiple regression analyses, after adjustment for age, 24 h systolic BP, body mass index, serum creatinine and other potential confounders. CONCLUSIONS: Our findings do not support an independent association between SUA and LV mass in Caucasian men and women with arterial hypertension.

Species-specific functional interactions of DNA polymerase alpha-primase with simian virus 40 (SV40) T antigen require SV40 origin DNA.

Physical and functional interactions of simian virus 40 (SV40) and polyomavirus large-T antigens with DNA polymerase alpha-primase were analyzed to elucidate the molecular basis for the species specificity of polymerase alpha-primase in viral DNA replication. SV40 T antigen associated more efficiently with polymerase alpha-primase in crude human extracts than in mouse extracts, while polyomavirus T antigen interacted preferentially with polymerase alpha-primase in mouse extracts. The apparent species specificity of complex formation was not observed when purified polymerase alpha-primases were substituted for the crude extracts. Several functional interactions between T antigen and purified polymerase alpha-primase, including stimulation of primer synthesis and primer elongation on M13 DNA in the presence or absence of the single-stranded DNA binding protein RP-A, also proved to be independent of the species from which polymerase alpha-primase had been purified. However, the human DNA polymerase alpha-primase was specifically required for primosome assembly and primer synthesis on SV40 origin DNA in the presence of T antigen and RP-A.

The mouse DNA polymerase alpha-primase subunit p48 mediates species-specific replication of polyomavirus DNA in vitro.

Mouse cell extracts support vigorous replication of polyomavirus (Py) DNA in vitro, while human cell extracts do not. However, the addition of purified mouse DNA polymerase alpha-primase to human cell extracts renders them permissive for Py DNA replication, suggesting that mouse polymerase alpha-primase determines the species specificity of Py DNA replication. We set out to identify the subunit of mouse polymerase alpha-primase that mediates this species specificity. To this end, we cloned and expressed cDNAs encoding all four subunits of mouse and human polymerase alpha-primase. Purified recombinant mouse polymerase alpha-primase and a hybrid DNA polymerase alpha-primase complex composed of human subunits p180 and p68 and mouse subunits p58 and p48 supported Py DNA replication in human cell extracts depleted of polymerase alpha-primase, suggesting that the primase heterodimer or one of its subunits controls host specificity. To determine whether both mouse primase subunits were required, recombinant hybrid polymerase alpha-primases containing only one mouse primase subunit, p48 or p58, together with three human subunits, were assayed for Py replication activity. Only the hybrid containing mouse p48 efficiently replicated Py DNA in depleted human cell extracts. Moreover, in a purified initiation assay containing Py T antigen, replication protein A (RP-A) and topoisomerase I, only the hybrid polymerase alpha-primase containing the mouse p48 subunit initiated primer synthesis on Py origin DNA. Together, these results indicate that the p48 subunit is primarily responsible for the species specificity of Py DNA replication in vitro. Specific physical association of Py T antigen with purified recombinant DNA polymerase alpha-primase, mouse DNA primase heterodimer, and mouse p48 suggested that direct interactions between Py T antigen and primase could play a role in species-specific initiation of Py replication.

Nucleotide sequence of a transactivating Bombyx mori nuclear polyhedrosis virus immediate early gene.

The open reading frame (ORF) of 1572 bp contained in the 3.8 kb ClaI fragment of BmNPV encodes a viral regulatory protein which transactivates the delayed early AcMNPV 39K gene. Transactivation is induced in uninfected cells following transfection with a plasmid containing only the ClaI fragment. Hitherto immediate early gene promoter activity of the included 631 bp leader sequence is evident since no other viral elements are needed for the transcription of the regulatory gene.

Pharmacologic-guided trial of sequential methotrexate and thioguanine in children with advanced malignancies.

PURPOSE: Based on in vitro studies that have shown synergistic effects of sequential administration of methotrexate (MTX) and thioguanine (6-TG), we conducted a pharmacologically guided trial of sequential MTX and 6-TG to determine the following: (1) the maximum-tolerated dose (MTD) of 6-TG; (2) the nature of the dose-limiting toxicity; and (3) the modulation effect of MTX on 6-TG given by this sequence and schedule. PATIENTS AND METHODS: Thirty-one children with advanced malignancies (acute leukemia, n = 10; lymphoma n = 10; and solid tumors, n = 11) were treated weekly for 3 weeks with a 2-week rest; treatment consisted of a fixed dose of MTX (30 mg/m2 over 24 hours) followed by a 2-hour infusion of 6-TG in escalating doses. RESULTS: Measurement of plasma MTX, 6-TG, and mononuclear 5-phosphoribosyl-1-pyrophosphate (PRPP) levels indicates that the desired biochemical modulation and serum levels were achieved. Nonhematologic toxicities were mild and the dose-limiting toxicity was bone marrow depression. A 300-mg/m2 dose of 6-TG with MTX is considered the MTD. Responses were noted in patients with lymphoma. CONCLUSION: Encouraging antitumor effects were produced with this regimen in heavily pretreated patients with lymphoma, particularly Hodgkin's disease (HD). The durations of responses were 17, 13+, 12, 9, and 7+ months. A phase II trial of the MTX/6-TG combination is warranted for the treatment of relapsed lymphoma.

Vitamin D receptor gene polymorphisms and plasma renin activity in essential hypertensive individuals.

Several studies analyzed 25-hydroxyvitamin D (25[OH]D) and blood pressure (BP) relationship with mixed results. Moreover, a relationship between the risk of hypertension and vitamin D receptor (VDR) gene polymorphisms, FokI and BsmI, was reported. This study was aimed to analyze these relationships in essential hypertensive (EH) patients. Seventy-one EH patients, 18-75 years old, were enrolled. Patients underwent clinical BP, 24-h ambulatory BP monitoring, 25[OH]D and plasma renin activity (PRA) evaluations. FokI and BsmI VDR polymorphisms were analyzed and compared with those of 72 healthy controls. In EH patients, the median 25[OH]D levels were lower than 30 ng ml(-1). We found a significant negative correlation between 25[OH]D and 24-h systolic BP (r = -0.277, P = 0.043). This correlation persisted in backward stepwise multivariate analyses (ß = -0.337; P = 0.022), after adjustment for age, gender, body mass index, glomerular filtration rate, and PRA. We did not observe statistically significant correlation between 25[OH]D and PRA. We compared the allelic frequencies and genotype distribution between patients and controls, and FokI and BsmI VDR polymorphisms were not associated either with hypertensive status or with PRA. Further wide studies are needed to clarify this relationship.

Novel codon utilization within the vaccinia virus thymidine kinase gene.

The nucleotide and predicted amino acid sequences of the thymidine kinase genes encoded by vaccinia virus and herpes simplex virus (type 1) were analyzed, and there was no evidence of any significant homology. The manner in which the triplet code was used by each virus was also examined. The frequencies of codon utilization by the herpes virus gene were very similar to those used by most human genes, whereas the vaccinia virus gene was quite distinct, suggesting novel evolutionary and regulatory mechanisms.

[Significance of ST segment depression in the precordial leads during the acute phase of inferior myocardial infarction]. / Signification du sous-décalage du segment ST dans les dérivations précordiales à la phase aiguë de l'infarctus du myocarde inférieur.

Reciprocal changes of the ST segment in the acute phase of inferior myocardial infarction are common but their significance remain controversial. We studied this problem by comparing the ECG on admission of 83 patients with acute inferior myocardial infarction, with the clinical outcome and haemodynamic and angiographic data obtained on average 3 weeks after the onset of symptoms. Fifty nine patients (Group I) had ST depression greater than or equal to 1 mm in at least one of the leads V1 to V4; 24 patients (Group II) had no ST depression in this territory. The patients in Group I were older (59.6 +/- 6.4 vs 54 +/- 5.3 years, p less than 0.01), had higher total CPK (1 835 +/- 940 vs 875 +/- 305, p less than 0.01) and MB fractions (269 +/- 102 vs 95 +/- 35), more complications during the hospital period (80%, mainly haemodynamic vs 38%, p less than 0.01) and more severe left ventricular dysfunction: ejection fraction 52.2 +/- 6% vs 59.2 +/- 7%, p less than 0.05; cardiac index 2.75 +/- 0.4 l/min/m2 vs 3.25 +/- 0.3 l/min/m2, p less than 0.005). There was no difference in left ventricular wall motion between the groups on biplane angiography. However, coronary angiography showed left coronary disease to be more common in Group I (84%) than in Group II (37%), p less than 0.005. Left anterior descending and left circumflex disease was equally common. Patients with persistent ST depression after 48 hours had lower ejection fractions than those in whom it regressed within 48 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hemodynamic study during 48 hours of delayed-release isosorbide dinitrate (repeated oral administration) in the acute phase of myocardial infarction complicated by left ventricular insufficiency]. / Etude hémodynamique pendant 48 heures du dinitrate d'isosorbide à libération prolongée (prise orale répétée) à la phase aiguë de l'infarctus du myocarde compliqué d'insuffisance ventriculaire gauche.

The aim of this study was to evaluate the haemodynamic effects of slow release isosorbide dinitrate (IDN) 40 mg oral preparation over a 48 hour period in patients with acute myocardial infarction complicated by left ventricular failure. Fourteen patients (8 male, 6 female) were treated by repeat dose ISD (8 hourly) and the haemodynamic changes were recorded at 1 hr, 2 hrs, 6 hrs, 12 hrs, 24 hrs, and 48 hrs. After 48 hours treatment the heart rate was unchanged; mean arterial blood pressure fell from 109.5 +/- 5.6 mmHg to 93.5 +/- 6.2 mmHg (-15%) (p less than 0.01). Cardiac index rose from 2.4 +/- 0.57 1/min/m2 to 2.8 +/- 0.65 1/min/m2 (+16%) (NS); diastolic pulmonary artery pressure fell from 22.5 +/- 7.07 mmHg to 13.7 +/- 4.5 mmHg (-39%) (p less than 0.003); systolic pulmonary artery pressure fell from 40.5 +/- 12.2 mmHg to 28.6 +/- 11.6 mmHg (-30%) (NS). Systemic vascular resistance fell from 2 095.2 +/- 63 dynes/s/cm5 to 1 537 +/- 60 dynes/s/cm5 (-22.3%) (NS). Finally, total pulmonary resistance fell from 561.9 +/- 15 dynes/s/cm5 to 301.9 +/- 14.5 dynes/s/cm5 (-47%) (p less than 0.003). The most valuable effect was therefore the reduction in left ventricular filling pressures which was maximal after about 48 hours. Two groups of patients were identified according to the clinical outcome. The patients in Group I (11 cases) were improved by the fall in diastolic pulmonary artery pressure, the rise in cardiac index and the reduction of systemic valvular resistance.(ABSTRACT TRUNCATED AT 250 WORDS)

[Aneurysm of the interauricular septum by hernia of Vieussens' valve, and suspected coronary embolism]. / Anévrysme de la cloison inter-auriculaire par hernie de la valvule de Vieussens et suspicion d'embolie coronaire.

During the hemodynamic evaluation of a young patient with heart failure whose electrocardiogram showed sequels of anterior necrosis, an aneurysm of the fossa ovalis was seen at cineangiography. Selective coronary angiography showed an interruption of filling of the anterior interventricular artery just distal to the branching of the first septal artery: it raised therefore the possibility of the embolic origin of that myocardial infarction. In connection with this case study, angiographic aspect, pathogenesis and the embolic role of the aneurysm of the fossa ovalis were discussed.

[Coronary transluminal angioplasty using 6-french diagnostic catheters. A preliminary study]. / Angioplastie transluminale coronaire avec des cathéters-guides 6 french. Etude préliminaire de faisabilité.

This preliminary study was undertaken to assess the potential indication and limitations of the use of 6 French guiding catheters for percutaneous transluminal coronary angioplasty (PTCA). Between September 1992 and October 1993, 100 consecutive patients with an average age of 64 +/- 11 years underwent 6 F angioplasty for: stable angina (38.7%), unstable angina (32.4%), non Q-wave or infarction recanalized by thrombolytic therapy (18%), and acute myocardial infarction (10.8%). Eighty per cent of the pTCAs were performed immediately after diagnostic coronary angiography. Single vessel disease accounted for 93.7% of cases. Of the 118 lesions treated, 46.6% were types A or B1, 44.9% were type B2 and 8.4% were type C. The success rate of 6 F PTCA was 96.4% using an average of 1.08 guides and 1.25 balloon catheters per patient. Stenosis decreased from 83 +/- 10% to 26 +/- 16%. There were 4 technical failures: in 1 case it was not possible to pass a chronic occlusion, in 1 case coronary dissection was complicated by infarction, and in 2 cases a 7 F guiding catheter was required for successful PTCA. No patients required emergency coronary bypass surgery and there were no fatalities during the procedure. Four patients required perfusing balloon catheters and 8 were stented with a Palmaz-Schatz endoprosthesis with the 6 F catheter. These results are comparable to those obtained with larger diameter guiding catheters. In view of the good coronary ostial tolerance, the lower rate of local complications at the site of arterial puncture and the possibility of earlier mobilisation of patients after the procedure, the indications for 6 F PTCA should increase.

[Paradoxical atrioventricular block within the bundle of His]. / Bloc auriculo-venticulaire paradoxal intrahisien.

We have been able to record an atrio-ventricular block dependent upon bradycardia, but also no tachycardia, in a patient of 76 who presented with syncopal attacks. The basal electrocardiogram showed no significant delay in atrio-ventricular or intraventricular conduction. Intracavitary electrophysiological investigation allowed us to localise the site of this block in the main trunk of the bundle of His; we also established, under basal conduction conditions, a first degree block with an exactly similar relationship to the duration of the preceding diastole.

[Implantation of permanent cardiac pacing electrodes by the retropectoral transvenous approach. Results of a series of 152 cases]. / Mise en place des sondes de stimulation cardiaque permanente par les veines rétro-pectorales. Résultats d'une série de 152 cas.

When the cephalic vein is unsuitable for the introduction of pacing electrodes, the retropectoral veins near the external border of pectoralis major near its subclavian attachment, approached through the same incision, may provide a suitable alternative. It was not possible to catheterise the cephalic vein in 23,8% of 756 consecutive implantations of endocavitary pacing electrodes. The retropectoral veins were looked for in 172 cases and found and used in 159 cases (92,4%). This percentage of success increased to 97,6% in the latter 83 attempts. These veins are usually very distensible. No complications or accidents were recorded. The only disadvantage was the relatively long dissection time. The stability of the pacing electrodes with this approach was excellent as reoperation was only required in 3% of cases (2 displacements and 3 exit blocks or pericardial migrations). This approach is therefore practicable in the large majority of cases in which the cephalic vein cannot be used. The multiplicity of the retropectoral veins should allow the introduction of two electrodes if sequential atrioventricular pacing were to be chosen. In addition, this approach would be useful when an atrial pacing electrode is to be added to a preexisting ventricular pacing electrode and one hesitates to puncture the subclavian vein because of the risk of damaging the electrode already in place. When direct subclavian puncture is the technique of choice of the operator, the retropectoral veins may be used when the subclavian approach is contraindicated or impossible. In any case, denudation of the retropectoral veins leads to fewer incidents than when the latter approach is used.

[A method of processing information on cineangiography of the right ventricle]. / Méthode d'exploitation informatique de la ciné-angiographie du ventricule droit.

This paper describes our experience in making a programme for computer processing of biplane right ventricular cineangiography for the measurement of volumes and analysis of wall motion. The volumes were determined by a method of integration to the geometric model of a triangular pyramid i.e. trunco-pyramidal (IM.TP). The classical ellipsoidal integration method i.e. trunco-conal (IM.TC) and biplane and monoplane planimetry based on the model of a triangular pyramid (PM.TP) were used as references. Nineteen post-mortem RV casts were used to validate the programme. The correlations between the true volumes and the angiographic measurements were excellent (r = greater than 0.99) with both methods of integration, very good (r = 0.99) using the biplane PM.TP and very satisfactory (r = 0.91) with the monoplane PM.TP. The line of regression was very close to unity with the IM.TP and 0.9 with the PM.TP; this indicates the excellent adaptation of the triangular pyramid model to the shape of the RV. The IM.TP was used in a group of 20 right ventriculographies of patients without cardiac disease: the following results were obtained: EDV = 70.3 +/- 6.6 cm3/m2; ESV = 31.7 +/- 3.9 m3/m2; systolic index = 38.6 +/- 4.5 cm3/m2; ejection fraction = 0.55 +/- 0.04. The correlation of the values of systolic index by cineangiography and thermodilution (39.9 +/- 5.7 cm3/m2) was good (r = 0.86; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Immediate coronary angioplasty in the acute phase of myocardial infarction. French multicenter study: December 1983]. / L'angioplastie coronaire d'emblée en phase aiguë d'infarctus du myocarde. Etude multicentrique française: décembre 1983.

Following the introduction of intracoronary thrombolysis in the acute phase of myocardial infarction (AMI), transcutaneous coronary angioplasty (TCA) was originally conceived as a logical complementary procedure to treat residual stenosis and so prevent the frequent post-thrombolysis reocclusion (20-30 p. 100 of cases). With increasing experience TCA of first intent appeared rational, more rapid and effective, ensuring coronary recanalisation (CR), suppression of residual stenosis and the prevention of reocclusion in the same procedure with with the objective of reducing the number of coronary bypass grafts (CBG) in patients with single vessel disease. A French multicentre study of 22 cases was organised by 9 centres. The average period between onset of symptoms and intervention was 2 hours 10 mins (range 30 mins-5 hours 30 mins). The average duration of the procedure was only 30 mins. 16 patients had anterior and 6 patients inferior AMI. Coronary angiography showed 12 occlusions (54.5 p. 100) and 10 sub-occlusions with 6 cases of delayed opacification. All patients had successful initial TCA with no major complications. The arterial occlusions decreased from 100 p. 100 to 31 p. 100 and the subocclusions from 94 to 12 p. 100. 2 patients died in the hospital period, one at the 48th hour of controlateral AMI and the other one at the 5th day of reocclusion. Three patients developed reocclusion at the site of the original TCA. Complete regression of ECG changes was observed in 31.8 p. 100 of cases. Complete recovery of normal left ventricular function was observed in 8 of the 17 patients who underwent follow-up investigations (47 p. 100 of cases).(ABSTRACT TRUNCATED AT 250 WORDS)

[Coronary angioplasty immediately after intracoronary thrombolysis during the acute phase of myocardial infarction]. / L'angioplastie coronarienne immédiatement après thrombolyse intracoronarienne en phase aiguë d'infarctus du myocarde.

Since the introduction of intracoronary thrombolysis in the acute phase of myocardial infarction, all workers have observed a high incidence of coronary reocclusion (about 20%) essentially in the first hours and days after coronary recanalisation (CR). This had led to some groups carrying out transluminal coronary angioplasty (TCA) at the same time as CR by thrombolysis in situ to treat significant residual postthrombolysis stenosis. This french multicentre study carried out in 5 centres concerned 9 men (average age: 46.1 years) with 5 anterior infarcts (total thrombosis of the LAD artery) and 4 inferior infarcts (total thrombosis of the right coronary artery-RCA). Intracoronary trinitrate was ineffective in relieving the occlusion in all cases. In 5 cases, the thrombolytic protocol was streptokinase (SK) 3 000 u/min for 60 minutes; in the other 4 cases, the plasminogen-urokinase (Pg-UK) protocol was used. Thrombolysis was successful in all 9 cases. The results of TCA performed at the same time were also good (8/9 successes; 4 LAD and 4 RCA) without any complications during the procedure. There was only one immediate post-TCA reocclusion on a LAD artery. In all cases the initial ECG appearances of infarction remained, CR only appearing to prevent extension of the necrosis. The successful results of CR + TCA were maintained in 6 out of 7 patients reinvestigated 2 days to 6 months (average 6 months) after the initial procedure: the only case of reocclusion occurred after 48 hours on a RCA. The overall procedure never exceeded 2 hours.

[Coronarography by percutaneous puncture of the axillary artery. Value in arteriopathies of the lower limbs]. / Coronarographie par ponction percutanée de l'artère axillaire. Intérêt dans les artériopathies des membres inférieurs.

Coronary angiography by a percutaneous femoral approach using the Judkins-Bourassa technique with special preformed catheters is widely used. This approach is potentially dangerous or impossible in patients with severe lower limb arteriosclerosis even after operation and so the investigation has to be done by Sones' technique (denudation of the humeral artery). There is, however, another upper limb approach which does not involve arterial denudation: percutaneous right or left axillary artery catheterisation. This paper reports the experience of a multicentre study of this method in 105 patients. This study is of interest as an arterial catheter introducer was used which, does not compress the artery, prevents bleeding when the catheter has to be changed and reduced the risk of thromboses or laceration of the axillary artery. 73 of the 105 patients had lower limb arteriosclerosis 5 had aortic aneurysms and 1 patient had a previous history of femoral artery embolism. There was a primary indication for this approach in 21 cases. The left axillary artery was used in 83 cases (79%) and the right axillary artery in 22 cases (21%). The coronary catheters were those usually used with the femoral approach. The left side was chosen preferentially as it avoided the brachiocephalic trunk and facilitated the catheterisation of the coronary ostia and of aorto-coronary bypass grafts. Selective catheterisation of the left coronary artery was achieved in 21 out of 22 cases (95%) and of the right coronary artery in all 22 cases (100%) by the right axillary route. Both left and right coronary arteries were selectively catheterised in all cases by the left axillary approach.(ABSTRACT TRUNCATED AT 250 WORDS)

[Accentuation of myocardial ischemia during coronary recanalization in the acute phase of myocardial infarction]. / Accentuation de l'ischémie myocardique contemporaine de la recanalisation coronarienne en phase aiguë d'infarctus du myocarde.

Coronary recanalisation during the acute phase of myocardial infarction, especially by in situ infusion of thrombolytic agents, is accompanied in most cases by rapid regression of chest pain and a reduction in the degree of ST elevation. However, a multicentre retrospective study of 104 attempts at recanalisation, including 78 successful procedures, showed in 10 cases (12.8 p. 100), an apparently paradoxical accentuation of the chest pain with or without increased ST elevation, at the time of angiographically demonstrable recanalisation. This phenomenon may be interpreted as being the result of aggravation of the ischaemia of the border zone, the objective of therapy. Several pathogenic hypotheses, all with experimental proof, may be suggested to explain these observations (haemorrhagic infarction, non reperfusion, ischaemic contraction due to massive intracellular flow of calcium, etc.). It is usually associated with arrhythmias and may be considered to be a reliable sign of recanalisation. It may also explain certain cases of persistence of chest pain and ECG changes despite the demonstration of a permeable epicardial artery on initial coronary angiography.