Impact of the dynamic and static component of the sport practised for electrocardiogram analysis in screening athletes.

To interpret the electrocardiogram (ECG) of athletes, the recommendations of the ESC and the Seattle criteria define type 1 peculiarities, those induced by training, and type 2, those not induced by training, to rule out cardiomyopathy. The specificity of the screening was improved by Sheikh who defined "Refined Criteria," which includes a group of intermediate peculiarities. The aim of our study was to investigate the influence of static and dynamic components on the prevalence of different types of abnormalities. The ECGs of 1030 athletes performed during preparticipation screening were interpreted using these three classifications. Our work revealed 62/16%, 69/13%, and 71/7% of type 1 peculiarities and type 2 abnormalities for the ESC, Seattle, and Refined Criteria algorithms, respectively(P<.001). For type 2 abnormalities, three independent factors were found for the ESC and Seattle criteria: age, Afro-Caribbean origin, and the dynamic component with, for the latter, an OR[95% CI] of 2.35[1.28-4.33] (P=.006) and 1.90[1.03-3.51] (P=.041), respectively. In contrast, only the Afro-Caribbean origin was associated with type 2 abnormalities using the Refined Criteria: OR[95% CI] 2.67[1.60-4.46] (P<.0001). The Refined Criteria classified more athletes in the type 1 category and fewer in the type 2 category compared with the ESC and Seattle algorithms. Contrary to previous studies, a high dynamic component was not associated with type 2 abnormalities when the Refined Criteria were used; only the Afro-Caribbean origin remained associated. Further research is necessary to better understand adaptations with regard to duration and thus improve the modern criteria for ECG screening in athletes.

[Relations between ethnicity and child malnutrition in rural Benin]. / Liens entre appartenance ethnique et malnutrition infantojuvénile en milieu rural béninois.

UNLABELLED: Relations between ethnicity and child malnutrition in rural Benin. RATIONALE: In a therapeutic feeding center in northern Benin, we found disparities between the three main ethnic groups in the proportions of children hospitalized; undernutrition seemed more frequent and severe in the Gando than in the Bariba and the Fulani groups. This survey sought to identify risk factors for malnutrition. METHODS: We used a standardized questionnaire to interview women from these three groups, all with a child aged 5 years or younger. RESULTS: The study included 165 mothers from the three main ethnic groups, 62 of whom had weaned a child. Children from the Bariba group seemed to have access to better sanitary and nutritional conditions than those from the Gando and Fulani groups: higher quality water (from boreholes), more frequent access to latrines, higher usage of bed nets, higher likelihood of birth in a medicalized environment, early breastfeeding, and progressive and voluntary weaning. During and after weaning, children from the Fulani group received more milk-based food than the other groups. In the Fulani group, therefore, the supply of milk of animal origin may compensate for some less favorable practices related to childbirth and breastfeeding. CONCLUSION: We identified several factors, probably influenced by socioeconomic and cultural conditions, that probably affect child undernutrition. Sanitary and nutritional education programs should be conducted to target specific ethnic groups of this region.

[An aortic insufficiency diagnosed under cabergoline]. / Une insuffisance aortique diagnostiquée sous cabergoline.

We report the case of a restrictive aortic insufficiency diagnosed on a 53-year old woman while being treated by low dose of cabergoline for hyperprolactinemia. Such valves involvements had already been described with cabergoline and other dopamine agonists, drugs the patient was previously exposed to. However, chronology of events leads us to suspect cabergoline, although such effects had only been described with much higher doses. This case may recommend to perform echocardiograms upon patients treated by cabergoline, and probably such a caution may be enforced in patients previously exposed to other dopamine agonists. On another hand, the diagnostic of a restrictive valvulopathy may lead to suspect a iatrogenic origin including dopamine agonists.

[Infant-juvenile malnutrition in Fo-Boure (Benin): Anthropometric data and management of malnourished children]. / Malnutrition infantojuvénile à Fo-Bouré (Bénin): données anthropométriques et prise en charge des enfants malnutris.

UNLABELLED: Acute malnutrition or emaciation in childhood is defined by a low ratio weight/height. In Benin, 8% of the children are concerned. In the north of Benin, the situation is alarming. The aim of this survey is to specify: (1) the characteristics of infantile malnutrition in rural area in the north of Benin and (2) the management of the malnourished children. SUBJECTS AND METHODS: A descriptive survey was conducted in a paediatric dispensary. Anthropometric data of children from 0 to 60 months were collected. The children with severe malnutrition were admitted to a nutritional rehabilitation centre. The methods were those recommended by the World Health Organization and were adapted to the local resources. RESULTS: The anthropometric data of 239 children were analyzed. The prevalence of emaciation was 33%. Thirty-eight children were admitted to the centre. Twenty-nine of the children recovered. DISCUSSION: This survey confirms the precarious situation in the north of Benin, which may be explained by socio-economic and climatic factors. It can be prevented partly by better food availability, but also by an education on mothers. The strategies must be updated according to their effectiveness in terms of public health and their local acceptability. CONCLUSION: The prevalence of malnutrition in Fo-Bouré is beyond the value used by WHO to define the zones where the nutritional situation requires nutritional rehabilitation centres.

[Aortic insufficiency under weak doses of cabergoline for non-tumoral hyperprolactinemia]. / Insuffisance aortique sous faibles doses de cabergoline pour hyperprolactinémie non tumorale.

Used in its neurological indication, cabergoline is known to induce cardiac valve regurgitations, essentially mitral and aortic valvular diseases, by its action on the 5HT2b receptors. Until now, it was assumed that the dose and the duration of exposure were the major factors of appearance. We describe a case of aortic insufficiency which developed in a patient given low doses of cabergoline (0.5 mg weekly) for non-tumoral hyperprolactinemia. Because of previous use of appetite suppressants and of bromocriptine, the exclusive responsibility of cabergoline remained uncertain. The potential gravity of these valvular heart diseases emphasizes the importance of careful cardiologic examination before and during treatment.

[Tropical ecopathology: up hill and down dale Buruli ulcer]. / Ecopathologie tropicale: ulcère de Buruli par monts et par vaux.

Buruli ulcer (Mycobacterium ulcerans) sees its incidence increase particularly in West Africa. Our Non Governmental Organization (Projet Humanitaire Afrique Nord Sud) studied the distribution of cutaneous ulcer (of which Buruli ulcer) between a flooded site (Bonou) and a dry site (Ketou) in Benin. The ratio "prevalence of Buruli ulcer in our patients of Bonou on prevalence of Buruli ulcer in our patients of Ketou" was 7.5 with a confidence interval at 95% at [1.4 - 41.4]. There is a link between a watery ecosystem and the emergence of Buruli ulcer. Buruli ulcer is overrepresented in the under 15 age group. It can interest all the zones of the tegument whereas the other ulcers concern especially the lower limbs. Thus doctors could not be unaware of the importance of ecological factors ... in precarious medium where diagnosis is based on interrogation, clinical examination and field experience.

[Declared diseases, observed diseases and health priorities in a Benin rural district]. / Pathologies déclarées, pathologies observées et priorités de santé dans un district rural au Bénin.

A project of a humanitarian action was preceded by a health diagnosis of a population in the rural district Bonou in Bénin. A diagnosis of perception was set up by the interviews among the population and the local health professionals. That diagnosis was completed by an objectified diagnosis originating from the analysis of 460 consultations performed in Bénin end 1998- beginning 1999. The cross-sorting between the diagnosis of perception and the objectified diagnosis pointed out four public health problems: malaria, bronchial asthma, infectious diarrhoeas and Buruli ulcer with respective prevalences of 9%, 6%, 3% and 0.9%. The prevalence of bronchial asthma fluctuates from 4% in dry areas to 8% in wet areas (Chi 2 = 3.50; p = 0.06). The role of house dust mites is suspected because of those ecological arguments to which is added clinical reasoning. Bronchial asthma was chosen as a priority health problem because of the feasibility and acceptance of a survey which aims at pointing out the allergic etiology. The confirmation of that etiology will enable in that case the decrease of the allergenic pressure, particularly well adapted solution in the Southern countries. Therefore a humanitarian action is foreseen to apprehend the etiologies of bronchial asthma in the rural district Bonou in Bénin in 2000.

Clinical characteristics affecting success or failure of PTCA in patients with multiple vessel disease and poor candidates for surgery.

A special form of complex coronary angioplasty is represented by the extension of indications for percutaneous transluminal coronary angioplasty (PTCA) to patients with multivessel disease (MVD) for whom surgery is not indicated, and thus for whom surgical standby is not available. Over a two-year period, 254 consecutive coronary patients with multivessel disease underwent PTCA under such conditions. These patients could not benefit from surgery for various reasons. Of the 612 arteries involved, 155 were occluded, 47 had been previously bypassed. A distal nonbypassable lesion in one of the three major arteries was found in 244 patients, 61 had suffered from a previous infarct, 24 demonstrated an ejection fraction below 0.40, and in 19 a single patent vessel was found. Fifteen patients were in cardiogenic shock and 69 procedures were undertaken for unstable angina. Of this latter group, 25 emergency PTCA were attempted for refractory unstable angina, and 44 additional emergency procedures were directed to the treatment of acute infarct. A total of 40 intra-aortic counterpulsations were needed. As far as possible the procedure aimed at full revascularization. Immediate outcome is strongly affected by the clinical context, and despite a rather constant initial success rate (88-95%), the procedural mortality (directly related or not) can change dramatically with clinical factors.(ABSTRACT TRUNCATED AT 250 WORDS)

[Refractory unstable angina. Emergency treatment by coronary artery angioplasty under aortic counterpulsion]. / Angor instable rebelle. Traitement d'urgence par angioplastie coronaire sous contrepulsion aortique.

We report our experience of 15 transluminal coronary angioplasties performed in an emergency in 13 patients (mean age 67 +/- 8 years) with refractory unstable angina. The procedures were conducted under diastolic counterpulsation effected by means of an intra-aortic balloon. The angina was of the threatening infarction type on 11 occasions and of the threatening extended infarction on 4 occasions. Electrocardiographic abnormalities were recorded in the anterior (11 cases) or in the inferior (4 cases) territory. Three patients had a very alarming haemodynamic status, with acute pulmonary oedema in two and cardiogenic shock in one. After intra-aortic counterpulsation was installed and the clinical signs were stabilized, coronaro-ventriculography was performed, leading to a decision of immediate angioplasty since age, underlying diseases, myocardial function and diffused lesions made most of the patients unsuitable for surgery. In multiple vessel patients electric and angiographic data were used to locate the tight stenosis (92% in all cases) responsible for the acute coronary ischaemia. The stenosis was found to affect the anterior interventricular artery in 9 cases, the circumflex artery in 2 cases, the right coronary artery in 2 cases and a saphenous shunt on the anterior interventricular artery in 2 cases. Immediate arteriographic and clinical success was obtained in 12 out of 15 cases (80%); there were 3 failures with 2 transmural infarctions. Later on, 2 patients underwent aorto-coronary bypass and 1 died of myocardial failure and pulmonary superinfection 3 weeks after the procedure. Ten of our 13 patients were stabilized and were discharged under medical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ischemic cerebrovascular accident and sport activity. 6 cases]. / Accident vasculaire cérébral ischémique et activité sportive. 6 observations.

Six cases of ischaemic stroke which occurred during sporting activities are reported. The authors insist on the unusual features of the ischaemic events which had the same characteristics as other ischaemic strokes in young subjects: frequent involvement of the main cerebral arteries, good vital and functional prognosis in short--and mid-term. They consider that three factors might have concurred in precipitating the ischaemic accident, viz.: fibromuscular dysplasia (observed in 3 patients), warm summer weather encouraging haemoconcentration and poor physical training in 5 out of 6 cases.

[Aneurysms of the atrial septum. From diagnosis to treatment. Apropos of 33 consecutive cases]. / Les anévrysmes du septum interauriculaire. Du diagnostic à la thérapeutique. A propos de 33 cas consécutifs.

Although rare, aneurysms of the atrial septum are the object of a renewed interest, for they are found with an ever increasing frequency due to technical advances in echocardiography and they have been blamed for a number of disorders, including arrhythmias and embolic accidents. We report here a series of 33 consecutive cases of atrial septal aneurysm discovered by two-dimensional echocardiography over a 5-year period. There were 21 children and 12 adults. In children, the aneurysm was usually associated with a congenital heart disease (17/21 cases). Spontaneous closure was observed in 3 cases where that disease was an isolated septal defect. In adults the aneurysm was usually isolated, but it was complicated by repeated transient ischaemic accidents in 3 patients. No arrhythmia ascribable to the aneurysm was observed.

[Primary pulmonary arterial hypertension]. / Hypertension artérielle pulmonaire primitive.

Primary pulmonary hypertension (PPH) currently remains an entity of which the precise mechanism, most likely vasospastic, is not completely explained. The diagnosis of PPH remains an exclusion diagnosis; it will be considered only after ruling out a secondary pulmonary hypertension. Non-invasive techniques such as sonography, cardiac Doppler should permit an earlier diagnosis and an easier monitoring of these patients whose prognosis remains poor in spite of the sporadic efficacy of a treatment with vasodilators. Heart-Lung transplant could be a future prospect; however, if the first reports seem encouraging, the follow-up is currently insufficient to appreciate the possible long-term advantage.

[Interruption of the aortic arch without patent ductus arteriosus. Apropos of a case associated with partial atrioventricular canal]. / Interruption de l'arche aortique sans canal artériel. A propos d'un cas associé à un canal atrio-ventriculaire partiel.

The authors report a case of type A interruption of the aortic arch with the subclavian arteries arising from the descending aorta which was of special interest because of the absence of a patent ductus arteriosus. Therefore, the systemic circulation was assured from the carotid arteries which perfused the vertebral arteries retrogradely via the circle of Willis. The association of a partial endocardial cushion defect and hypoplasia of the ventricle explained the surgical failure. A review of the literature of interruption of the aortic arch without a ductus confirmed that this was a rare condition and, paradoxically, well tolerated in the absence of associated malformations. On the other hand, the left ventricular lesions, usually present in the classical forms with patent ductus arteriosus, operated in the neonatal period, increase the operative risk.