Prevalence and predictors of white-coat hypertension in a large database of ambulatory blood pressure monitoring

The objective of this study was to determine both the prevalence of white-coat effect and white-coat hypertension [WCH] and which selected clinical variables were predictors of WCH. A total of 2462 patients underwent ambulatory blood pressure monitoring either in borderline hypertension [group 1] or for assessment of antihypertensive treatment [group 2] or for hypotension [group 3]. In the overall population 33.0% of patients showed WCH, 32.8% in group 1 and 37.0% in group 2. In multivariate analysis, sex and grade of hypertension were independent predictors of WCH in groups 1 and 2

[Anti GPIIB-IIIA treatment in coronary angioplasty-about 51 cases]

The glycoprotein IIb-IIIa inhibitors are extremely effective antiplatelet drugs. However their efficacy is tainted by their prohibitive cost. The objective of this work is the evaluation of the use of the glycoprotein IIb-IIIa inhibitors in the coronary angioplasty in terms of indication, patients profile and tolerance. Among the 51 patients included in the study 72,5% were treated with tirofiban; whereas 27,5% received abciximab. The glycoprotein IIb-IIIa inhibitors were respectively used in 19,6%, 43,1%, 35,3%, and 2% of the cases in the acute coronary syndromes with ST segment elevation, in the interventionnelle cardiology and the intra stent restenosis. In term of vigilance, only one major hemorrhagic accident was detected. A rigorous follow-up of the biological parameters of the patients makes it possible however to deal with this effect quickly. The introduction of a new therapeutic class, as expensive as, of antiplatelet drugs into a hospital must be the object of clinical evaluation. Finally, this study must be exercised, in particular within the framework of the pharmacovigilance

Complication de l'anticoagulation inefficace: la thrombose des protheses valvulaires cardiaques

Thrombosis of a mechanical valvular prosthesis is often a dramatic fatal complication. All thromboembolic risk factors lead to valvular thrombosis, the most common cause is insufficient anticoagulant treatment. The aim of this paper is to explain the importance of anticoagulation which remains the best preventive treatment. From 1995 to 2001, a total of 9 valvular thrombosis patients 6 females and 3 males-aged 26 to 50 years have been reported. 7 patients had mitral valve affection, one had aortic valve and the last one had tricusped affection. All of them received an insufficient anticoagulant regimen, 5 developed auricular fibrillation arrythmia. The delay between appearance of symptoms and management was 14 to 96h; 8 pateints had urgent operatins. 4 of them had a mechanical valvular replacement prothesis, one had bioprosthesis, 2 had thrombectomy, one had thrombolysis and one died during the operation. Mortality rate was 45% [4 patients], all of them were in a state of cardiogenic shock at their admission, 3 died at the immediate post operative period. Follow up of 5 patients for 3 years showed a good evolution. These data demonstrate that informing the patient and his family about the bad prognosis and the difficulty of treating these valvular thrombosis could be presented through a rigorous control of anticoagulant treatment

Chrurgie des anevrismes de l'aorte acsendante

Evaluation of the short and middle term morbidity and mortality rate of ascending aortic aneurysm surgery. Material and methods: It is a retrospective study of 21 ascending aortic aneurysm patients operated between May 1996 and may 2003. The interventions were of Bentall's type in 11 cases [4-25], Carbrol's in 6 cases [6-28%] and Weath's type in 4 cases [19%]. A total of 21 patients-16 males and 5 females- average age of 45 years +/- 8-12 [15-68]. Four patients [19%] had acute complicated discecting aneurysm. Two patients [5-9%] had MARFAN'S syndrome. Sixteen patients [57 +/- 6,3%] had aortic regurge grade II to IV. Seventeen patients [81%] had NYHA'S functional class II-III. Average aneurysmal diameter was 57 mm +/- 6,3 [48-80mm]. Operative mortality rate was nil. Hospitalisation period was 19 +/- 4 days [16-40 days]. Three patients had complete atrioventricular heart block. Lately 2 patients died as a result of thromoembolic accidents. The ascending aortic aneurysm surgery can be achieved with immediate results similar to surgical aortic valve replacement. The mode of surgery and necessity of a long course of anticoagulant treatment affect the middle and long term prognosis

Remplacement valvulaire aortique associe au pontage cronaire

The progress achieved in the cardiac surgery and resuscitation fields allowed an enlargement of surgical indications to invalue inoperable patients. A typical example is the association of aortic valve stenosis with coronary stenosis in elder patients. The authors report a series of 6 male patients who underwent an aortic valve replacement associated with coronary artery bypass grafting [CABG] at the cardioc surgery department "B", between May 1996 and May 2003. The average age was 64,5 years [52-74]. All of them had a significant and symptomatic aortic valve stenosis. One patient had left ventricular dysfunction. All the patients had a stable hemodynamic status in the preoperative period. Five patients benefited from bioprosthesis valve, while the 6th patient had a mechanical one. The mean number of bypass was 2,1 per patient. The mean time of aortic cross clamp was 97min. Hospital mortality was nil. One patient developed acute renal insufficiency, while an other suffered from myocardial infarction and pulmonary infection. The aortic valvular replacement associated with CABG is a highly risk surgery. The operative indications that give best prognosis depend on the age factor [less than 70 years] and timing factor of surgery [suitable timing]

Cerebral infection by candida albicans

We present a case of cerebral infection by candida albicans in a previously healthy 64-year-old man who had symptoms indicative of raised intracranial pressure without fever. Computed tomography scan and magnetic resonance imaging revealed multiple cerebral granulomas. Diagnosis was made after stereotactic biopsy. The patient's symptoms improved progressively with decrease in the size of lesions after antifungal therapy. No lesions were detected outside the central nervous system. However, he died 3 weeks later from pulmonary embolism. Candida albicans of the central nervous system is uncommon and occurs rarely in immunocompetent patients. As the neurologic sings and symptoms are vague, most cases of cerebral candidiasis are diagnosed just before death or during postmortem study. We have reviewed the main clinico-pathologic features of neurocandidiasis