Cardiac arrest recorded on ambulatory electrocardiograms.

To characterize the events that precede and precipitate sudden cardiac death (SCD), the long-term electrocardiograms of 27 patients who had SCD while being monitored were analyzed. In 20 patients, SCD was associated with ventricular tachyarrhythmias (ventricular tachycardia [VT]/ventricular fibrillation [VF]) and in 7 it was associated with bradyarrhythmias. Seventeen of the patients were men and 10 were women. Twenty-one patients had coronary artery disease, 2 had idiopathic dilated cardiomyopathy, 2 had mitral stenosis and 1 patient had mitral valve prolapse. Four patients with VT/VF had a previous nonfatal cardiac arrest. In the 20 patients with tachyarrhythmia-related SCD, 3 or more VT beats always preceded degeneration to VF. In 5 patients, the frequency or complexity of ventricular arrhythmias increased in the hour before SCD. In 11 of 20, there was a 20% or greater increase in underlying heart rate in the hour before SCD. The R-on-T phenomenon was observed in 4 patients. The long-short phenomenon initiated VT/VF in 2 patients. Only 2 patients with VT/VF were resuscitated. No patient with bradyarrhythmia -related SCD had manifest atrioventricular block or bundle branch block. Two of 7 patients had an episode of nonsustained bradycardia in the hour before arrest. No patient was resuscitated. In conclusion, VT that degenerates into VF is the most common arrhythmia associated with SCD. VT/VF is frequently preceded by an increase in heart rate and complex ectopy. VT is most often initiated by late ventricular premature complexes. Twenty-five percent of patients who have SCD have associated bradyarrhythmias that may occur without premonitory events.

Anatomic and hemodynamic effects of catheter-delivered ablation energies in the ventricle.

Twenty dogs were studied to characterize the anatomic, hemodynamic and pathologic effects of catheter-delivered cardioversion (CDCV) in the left ventricle. Five dogs each received 1 CDCV of either 50, 100, 200 or 300 J at the left ventricular apex. The injury occurred at the posteroinferior apex. Structural integrity of the ventricle remained intact. Energy doses of 50 and 100 J resulted in focal subendomyocardial injury. Higher energy levels resulted in localized transmural injury. There was a linear dose-related correlation between the volume of injury and delivered energy. Electrocardiographic changes were seen immediately in all dogs. Fifteen dogs had acute, transient ventricular arrhythmias. One dog died with refractory arrhythmias. Minimal hemodynamic changes were associated with the CDCV. Unique histopathologic changes were observed. Thus, local tissue destruction can be produced with CDCV. The extent of injury is dose-related and is associated with minimum hemodynamic changes. The lesion may be acutely arrhythmogenic.

Prognosis in patients with intra-Hisian conduction disturbances.

Intra-Hisian delay is usually associated with fascicular conduction abnormalities. We report our experience in 23 patients who had intra-Hisian delay as their only conduction defect. First-degree intra-Hisian delay (His bundle deflection greater than or equal to 30 msec) was present in 17 patients, 5 of whom also had split His potentials. Three of these patients received permanent pacemakers, all of whom had a history of syncope. Higher degrees of intra-Hisian delay were observed either spontaneously or in response to atrial pacing in 6 patients. Five of these patients were treated with permanent pacing, 4 of whom had symptomatic bradyarrhythmias and/or syncope. No patient has had a recurrence of symptoms following pacemaker insertion during the mean 31-month follow-up. No patient with first-degree intra-Hisian delay not receiving a pacemaker developed symptomatic bradyarrhythmias or syncope during a mean follow-up of 21 months.

[Radiological double contrast features of early lesions in Crohn's colitis (author's transl)]. / Frühveränderungen bei Crohnscher Kolitis im Doppelkontrast.

We have performed 131 double contrast barium enemas in 81 cases of granulomatous colitis or ileocolitis. 53 cases showed "early lesions": Inflammatory mucosa, lymphoid hyperplasia, aphtoid or varioliform ulcers and primary complexes. In 39% "early lesions" were the only granulomatous lesions of the colon. Several types of "early lesions" may appear in the same patient. 18 patients were subjected to a series of double contrast barium enemas. The lesions progressed in 12 cases and regressed in 6 cases. "Early lesions" may develop into segmental coblestone pattern. The radiological findings were confirmed by endoscopy or operation in 91% of our cases. A perfect double contrast barium enema is necessary to detect these "early lesions" which are important for diagnosis, treatment and possibly even for the prognosis in this disease.

[Intramural hematoma of ileum during anticoagulant therapy: study by double contrast intestinal transit (author's transl)]. / Hématome intramural de l'iléon sous traitement anticoagulant exploré par transit du grêle en double contraste.

Observation of a 52 years old man who is treated by anticoagulant who presents a subocclusive syndrome caused by an intramural hematoma of ileum. The radiological features are described in double contrast. Interest of the double contrast intestinal transit is discussed.

[Radiological aspects of gastric localizations of malignant non-Hodgkin's lymphoma. Apropos of 50 cases]. / Aspects radiologiques des localisations gastriques des lymphomes malins non hodgkiniens. A propos de 50 observations.

The authors describe radiological features of non Hodgkin's gastric lymphomas based on a study of 50 cases, with endoscopic correlation in 43 cases. Radiographic appearance is categorized as infiltrative (40 per cent), ulcerative (26 per cent), polypoid (10 per cent) and polymorphic (24 per cent). Gastric carcinoma is the most important differential diagnosis. Since staging, therapy and prognostic are different in these two diseases, accurate radiologic diagnosis is of particular importance. Combination of several peculiar radiologic signs suggest gastric lymphoma in 56 per cent of all the cases (16 per cent for endoscopy alone); this fact demonstrate the necessity of barium meal for a more accurate diagnosis of gastric lymphomas.

[Radiological aspects of rectal and colonic localizations of malignant non-Hodgkin's lymphoma. Apropos of 30 cases]. / Aspects radiologiques des localisations rectales et coliques des lymphomes malins non hodgkiniens. A propos de 30 cas.

The authors review radiological and endoscopical data of 30 patients with primary or secondary colonic and rectal non Hodgkin's lymphomatous involvement, and describe the radiologic pattern of this peculiar entity. Confirmation of the diagnosis is based in all cases on the pathological study of surgical specimens or per endoscopical biopsy. Eight patients (26%) presented non specific involvement secondary to small bowel or gastric localisation. The other patients (74%) had intrinsic lesions who may either remain localised (commonly endo-enteric type) or extend to whole of the colon (infiltrating type). After a description of the radiological features of these wide spectrum lesions, the authors consider the differential diagnosis and the respective contribution of colonic endoscopy and barium enema.

[An unusual etiology of recurrent ulcerative colitis : Behçet's disease. Value of the double contrast barium enema (author's transl)]. / Une cause exceptionnele de colite ulcéreuse récidivante : la maladie de Behçet. Apport du lavement baryté en double contraste.

A recurrent ulcerative colitis in a Behcet's disease. The radiological features of this colitis are studied by a follow up of double contrast baryum enema. The diagnostic with Crohn's colitis is discussed.

[The double contrast small bowel enema in Crohn's disease. 32 examinations (author's transl)]. / Le transit du grêle en double contraste dans la maladie de Crohn. A propos de 32 examens.

The authors have performed 150 double contrast small bowel enema. The results of 32 radiological examinations in Crohn's disease are reported. Four elementary alterations of the mucosal pattern can be described:--folding modifications,--mucosal defects,--different ulcers,--association between defects and ulcers drawing the classic "cobblestone" pattern. The transmural lesion is evident by fistules, strings, dilatations and mesenteric retractions. The conventionnal radiologic examination of the small bowel is satisfactory to show the manifestations of transmural lesion; but the double contrast enema is clearly more performing to characteristic mucosal lesions. So it appears indispensable to use this method for exploration of every Crohn's disease, to complete the conventionnal repletion enema.

[Meckel's diverticulum in the adult. Double-contrast study of 7 cases]. / Le diverticule de Meckel de l'adulte. Etude en double contraste de 7 observations.

The authors report 7 cases of Meckel's diverticulum on a series of 500 double contrast small bowel enema (1,4%). In two cases, the diverticulum is not recognized by repletion study. So, they find that the double contrast small bowel enema is the most accurate method to detect a Meckel's diverticulum.

[The barium meal in chronical mesenteric ischemia. A report of a case with malabsorption (author's transl)]. / Le transit du grêle dans l'ischémie mésentérique chronique. A propos d'une observation avec malabsorption.

A 50 years old man with clinical manifestations of intestinal ischemia associated with malabsorption. On abdominal angiography an obstruction of the 3rd jejunal artery is seen. Barium meal revealed a diffuse jejunopathy with disappearance of mucosal folds and intestinal biopsy showed a complete loss of villi.

[Granulomatous colitis presenting as ischemic colitis]. / Une colite granulomateuse d'allure ischémique.

The authors describe a case of granulomatous colitis mimicking a non gangrenous ischemic colitis. The radiological features are thumbprinting, ulcerations, then stenosis and sacculation. The resected specimen reveal some granuloma without necrosa.

[Radiological features of small bowel involvement in Henoch-Schönlein syndrome of the adult. Report of 6 cases]. / Aspects radiologiques des localisations intestinales du purpura rhumatoïde de l'adulte. A propos de 6 observations.

Henoch's purpura involve often the small intestine. These involvement are rarely visualised by radiology. They consist of submucosal edema with thickening of the folds and hematoma with intramural thumbprints on the mesenteric border. The lesions are segmental. The disease process is reversible and healing is complete without stenosis or fibrosis.

[Radiological features of non-gangrenous ischaemic colitis (author's transl)]. / Aspects radiologiques de l'ischémie colique non gangreneuse. A propos de 22 observations.

The authors have performed barium enema in 22 cases of non gangrenous ischaemic colitis. The diagnosis was established on the clinical, endoscopic and radiological data. The barium enema's radiological features and their evolution are described in particular thumbprinting, ulcerations, stenosis and sacculations. All these radiological signs were confirmed by endoscopic investigation or pathological examination. Abdominal angiography are carried out in 10 cases. The preferential site of the lesions is the descending colon. The differential diagnosis with other colitis are discussed and the diagnosis is easier when the barium enema is performed soon.

[Radiological double contrast examination in Crohn's colitis. A report about 115 cases (author's transl)]. / Exploration radiologique en double contraste de la colite granulomateuse de Crohn. Etude de 115 observations.

The authors had examined by double contrast barium enema in 115 cases of Crohn's ileo-colitis. They described the radiological double contrast features. The "early lesions" are always surrounded by a healthy-looking mucosa. The advanced lesions are segmentary: shallow limited ulcers, shallow confluent ulcers, cobblestone pattern and nodular pattern. Several types of lesions may appear in the same patient. The distribution of the lesions is asymmetrical with skip areas and gradual size of the lesions. The parietal lesions are well demonstrated by double contrast, especially the sacculations. Our radiological findings are confirmed by endoscopical features and excised specimens in 100 cases. A double contrast barium enema is necessary to well described the lesions especially the "early lesions" which are important for differential diagnostic, with ulcerative colitis, for surgical treatment in evaluating the extend of the disease and possibly even for prognosis in this disease.

[Oesogastrointestinal involvement in Behcet's disease. A report of one case (author's transl)]. / Localisations digstives de la maladie de Behçet. A propos d'une observation.

The authors describe the radiological features of a patient with Behcet's disease, who had oesogastric ulcers and a terminal ileitis as major part of this clinical syndrome. The radiologic appearance of these localisations are discussed. The similarities of Behcet's disease to Crohn's disease are outlined.