[Results of the Sainte-Anne - Lyons series of 318 oligodendroglioma in adults]. / Résultats de la série Sainte-Anne - Lyon de 318 oligodendrogliomes intracrâniens de l'adulte.

INTRODUCTION: Incidence of cerebral oligodendrogliomas is increasing because of better recognition made possible by improved classifications. We studied a homogeneous series using the Sainte-Anne grading scale in order to better understanding the history of these tumors with or without treatment and to assess prognosis and associated factors. PATIENTS AND METHODS: A retrospective series of 318 adult patients with oligodendroglioma (OLG) treated at Hôpital Sainte-Anne, Paris (SA) and Hôpital Neurologique, Lyons (L) between 1984 and 2003 was analyzed: 182 grade A OLG (SA + L), 136 grade B among which a homogenous series of 98 (SA) were included. For grade A: age at diagnosis ranged from 21 to 70 (mean: 41), sex ratio was 1.28. For grade B: age at diagnosis ranged from 12 to 75 (mean: 45.5), sex-ratio was 1.58. The main first symptoms were: epilepsy (A: 91.5%; B: 76%), intracranial hypertension (A: 7.9%; B: 14.6%), neurological deficit (A: 5.1%; B: 17.7%). The most frequent locations were: frontal, insular and central for both A and B. Mean size was 55 mm for grade A, 62 mm for B. Calcifications were found in 20% of A, 48.5% of B. No tumor was enhanced on imaging (CT/MRI) in grade A, all but 7 in grade B. All patients underwent surgery either for biopsy (A: 47.2%; B: 53%), or removal which was partial (A: 26.4% vs B: 19.4%) or extended (A: 36.3% vs B: 37.8%). Fifty-six patients underwent 2 procedures and 12 three procedures. Radiotherapy was performed in 76.9% of grade A, and 91% of B patients, in the immediate postoperative period for 71% A and 82.7% B. Chemotherapy was delivered for 36% of grade A (in the event of transformation to grade B or failure of radiotherapy) and 67.5% of B patients. Among grade A tumors, 38% transformed into grade B within a mean delay of 51 months with a mean follow-up of 78 months. RESULTS: Median survival was 136 months for grade A and 52 for grade B. Survival at 5, 10 and 15 was 75.5%, 51% and 22.4% for grade A vs 45.2%, 31.3% and 0% for grade B respectively. In univariate and multivariate analysis, grade A survival was associated with age at diagnosis, tumor size, large removal and response to radiotherapy. Grade B survival was associated with age at diagnosis, wide removal and sharply defined limits of the tumor on imaging. CONCLUSIONS: Analysis of both published data and this series underlines many prognostic parameters. It shows that OLG are heterogeneous tumors even in each grade (A and B). Treatment should consequently progress towards more targeted procedures for patients mainly with postoperative radiotherapy and chemotherapy.

Cardiac contusion in blunt chest trauma: a combined study of transesophageal echocardiography and cardiac troponin I determination.

BACKGROUND: The role of cardiac troponin I (cTnI) is well established in acute myocardial ischemia. However, its role in myocardial contusion remains to be clarified. Since transesophageal echocardiography (TEE) appears, at present, to be the best method for the diagnosis of myocardial contusion, the aim of this study was to measure the concentration of cTnI in patients with blunt chest trauma studied using TEE. METHODS: Thirty-two patients (27 males, 5 females, mean age 44+/-20 years), admitted to the Trauma Center of our Institution with clinical and/or radiological signs of acute blunt chest trauma, underwent biplane TEE within 24 hours of injury; serial blood samples were taken to measure cTnI levels (normal values < 0.4 ng/ml), using fluorimetric enzyme immunoassay. RESULTS: Abnormal levels of cTnI were found in 17 patients (53%): 7 patients had levels of cTnI between 0.4 and 1 ng/ml, whereas 10 patients had levels > 1 ng/ml. Segmental wall motion abnormalities consistent with myocardial contusion could be identified by echocardiography in 6/10 patients with cTnI levels > 1 ng/ml (60%) but in no patients with normal cTnI levels or with titers between 0.4 and 1 ng/ml; mean cTnI levels showed a significant difference between the two groups of patients with and without echocardiographic signs of myocardial contusion (2.6+/-1.6 vs 0.6+/-1.4 ng/ml, p < 0.001). CONCLUSIONS: Abnormal titers of cTnI suggesting myocardial contusion may be found in more than half of patients with blunt chest trauma; however, myocardial injury can be detected by TEE only for cTnI levels > 1 ng/ml; cTnI concentrations ranging between 0.4 and 1 ng/ml might be indicative of myocardial microlesions, not detectable by echocardiography, even if TEE is used; cTnI assay could therefore be suggested as a screening test before performing TEE after blunt chest trauma.

Renal resistive index and left ventricular hypertrophy in essential hypertension: a close link.

The aim of this study was to evaluate renal Doppler resistive index in patients with mild to moderate essential hypertension (EH) and to correlate its changes with the presence of left ventricular hypertrophy assessed by echocardiography. Twenty-eight EH patients (19 males, 9 females, mean age 56.2 +/- 8.6 years) and 13 normotensive subjects (7 males, 6 females, mean age 57.6 +/- 7.9 years) were studied; all patients underwent a complete echocardiographic study (M-mode, two-dimensional and Doppler) and a color Doppler echography of renal and intrarenal arteries. After the renal Doppler waveform was obtained, resistive index was calculated by peak systolic velocity (S) and lowest diastolic velocity (D) with the formula S-D/S. EH patients were divided into two subgroups on the basis of left ventricular mass (LVM): Group EH1 with normal LVM (15 patients) and Group EH2 with increased LVM (13 patients). All patients evidenced normal renal morphology and function and received no therapy throughout the entire observation period. Renal resistive index was significantly higher in EH patients than in controls; however, the maximum difference was observed between normotensive subjects and the EH patients with increased LVM (p < 0.00001). At univariate analysis, significant correlations were found between renal resistive index and age, body mass index, left ventricular relative wall thickness and LVM. However, when multiple regression analysis was used, only age (p < 0.01) and LVM (p < 0.05) remained significant predictors of resistive index. In conclusion, our data show that in EH patients resistive index, which is considered an expression of arterial impedance, is well correlated with the presence of left ventricular hypertrophy, presently considered the best index of the severity of hypertensive disease. This correlation may be the expression of the involvement of two target organs in hypertension.

[The sports fitness of patients operated on for aortic coarctation: assessment by exercise Doppler echocardiography]. / Idoneità sportiva in pazienti operati di coartazione aortica: valutazione mediante ecocardiografia Doppler da sforzo.

BACKGROUND: The aim of this study was to assess the utility of Doppler echocardiography both at rest and during isotonic exercise in evaluating competition eligibility of patients with repaired coarctation of the aorta (CoAo). METHODS: Seventeen young patients (11 male, 6 female; mean age 17.1 +/- 7.9 years) with previous surgical repair of CoAo were examined. Mean follow-up after repair was 10.3 +/- 3.5 years. All patients underwent complete Echocardiographic examination (M-mode, 2D and Doppler) and an exercise test on an ergometric bicycle, with continuous wave Doppler monitoring of flow velocity in descending aorta, with a transducer positioned in the suprasternal notch. Peak and mean Doppler gradients in descending aorta were measured both at rest and during exercise, using the simplified Bernoulli equation. According to peak Doppler gradient at rest, patients were divided into two subgroups: Group IA = patients with peak gradient lower than 25 mmHg; Group IB = patients with peak gradient greater than 25 mmHg. Finally, 17 healthy subjects (Control Group), matched for age and body surface area, were examined. RESULTS: Systolic and diastolic blood pressure both at rest and during exercise were not significantly different in the 3 groups. Patients of Group IB showed a significant increase of left ventricular mass (124.0 +/- 24.4 vs 85.8 +/- 24.1 g/m2, p < 0.01), and during exercise, a significant increase of peak gradient (68.3 +/- 27.2 vs 23.5 +/- 9.0 mmHg, p < 0.0001) and mean gradient (34.8 +/- 11.5 vs 11.9 +/- 5.0 mmHg, p < 0.0001) at the level of the descending aorta. In patients of Group IA, echocardiographic parameters were not different in comparison with the Control Group, whereas Doppler gradients during exercise were only slightly greater than those observed in the Control Group (peak gradient 36.9 +/- 13.0 vs 23.5 +/- 9.0 mmHg, p < 0.05; mean gradient 19.6 +/- 6.0 vs 11.9 +/- 5.0 mmHg, p < 0.05). However, 4 patients of Group IA showed a peak gradient during exercise greater than 40 mmHg (this value was equivalent to the mean value plus 2 Standard Deviations, observed in the Control Group) with the presence of diastolic flow, whereas exercise systolic blood pressure was lower than 200 mmHg. CONCLUSIONS: Thus, as a result of this study aimed at evaluating competition eligibility in patients with repaired CoAo, two subgroups of patients have to be distinguished according to Doppler echocardiography results: a) patients with peak Doppler gradient at rest greater than 25 mmHg, for whom competition is forbidden; b) Patients with peak gradient lower than 25 mmHg who must be investigated with exercise Doppler echocardiography to exclude an abnormal increase of Doppler gradients, even if exercise blood pressure is within normal limits.

[Transesophageal color-coded Doppler echocardiography: diagnosis of regurgitation of mitral valve prosthesis]. / Ecocardiografia Doppler a codice di colore per via transesofagea: diagnostica dei rigurgiti protesici mitralici.

In patients with mechanical mitral prosthesis, the presence of dysfunction and regurgitation of the prosthesis may be difficult to assess by standard precordial color flow Doppler. Moreover, the kind of mitral prosthesis regurgitant jet is often impossible to determine. We have recently studied 4 patients with clinically suspected mitral prosthesis dysfunction. In all of them the conventional transthoracic color flow technique was unable to evidentiate prosthesis regurgitation, whereas the transesophageal color flow Doppler assessed a partial displacement with a peri-prosthetic regurgitation in 3 patients, and a prosthetic endocarditis with intra-prosthetic regurgitation in 1. All studies were performed using an Aloka SSD 860 and 5 MHz transesophageal color Doppler transducer, using a topical anesthesia with 10% lidocaine. The procedure was well tolerated without any complication in all patients. Transesophageal color flow Doppler has specific improved capabilities over transthoracic conventional color flow Doppler and represents an important advance even for the noninvasive evaluation of patients with suspected mitral prosthesis regurgitation.

[Multiparameter evaluation of tricuspid insufficiency using two-dimensional echocardiography, Doppler and contrast echocardiography]. / Valutazione multiparametrica dell'insufficienza tricuspidalica mediante ecocardiografia bidimensionale, Doppler ed ecocontrastografia.

The evaluation of the presence and severity of tricuspid insufficiency is still difficult even if many criteria of grading are available for different techniques. In this study the data obtained from Doppler mapping of the right atrium, from the analysis of the hepatic vein flow and from the contrast echocardiography of the inferior vena cava in 56 patients with mitral or mitral-aortic valvulopathy and with clinically suspected tricuspid insufficiency were submitted to the cluster analysis. This analysis was used to redistribute the study population according to the following parameters: diameter of the inferior vena cava, maximal systolic and diastolic flow of the hepatic veins, the length of regurgitant jet in right atrium and the duration of contrast in vena cava. The aim was to identify the variability range of each degree of severity. None of the analyzed parameters "per se" identifies the regurgitation severity because there is a large variability in the intermediate degrees. The cluster analysis shows a definite pattern of parameters for each cluster (1 = no significant regurgitation, 2 = mild, 3 = moderate, 4 = severe insufficiency).(ABSTRACT TRUNCATED AT 250 WORDS)

Urinary excretion of kallikrein following myocardial infarction.

Kinin has been hypothesized to be involved in the mechanism of the procordialgia, collapse, and shock in myocardial infarction. In spontaneous and experimental animal infarction, the long-lasting lowering of plasma kininogen is perhaps the expression of kinin release from the plasma precursor. More recently, a durable reduction of plasma prekallikrein and of the plasma inhibitor of kallikrein, both evaluated with the kaolin contact method, has been demonstrated to support the implication of the kinin system in the course of myocardial infarction. In the present study, the dialy urinary excretion of kallikrein, according to the Porcelli and Croxatto method, has been studied in a group of patients with acute myocardial infarction and in a group of control patients, Differences between the two groups have been observed. They consist mainly in strong daily oscillations in the amount of urinary kallikrein excretion during the 24 hour period in the group of patients with myocardial infaction. At this moment, however, it is not possible to give a definite interpretation of these results.