Left atrial and left atrial appendage function in paroxysmal atrial fibrillation.

PURPOSE: In patients with paroxysmal atrial fibrillation (PAF) little information is available about left atrial (LA)function, and there is less information about LA appendage (LAA) function, and about their relations. METHODS AND RESULTS: 46 patients were selected for catheter ablation (CA) because of nonvalvular PAF.Transthoracic, tissue Doppler and transoesophageal echocardiography was performed before CA. LA volumes and volume index (LAVI) were calculated. LA function was assessed by LA filling fraction (LAFF), LA emptying fraction (LAEF), systolic fraction of pulmonary venous flow (PVSF) and late diastolic velocities of mitral annulus(Aa,, A5at) LAA function was assessed by peak LAA emptying flow velocity (PLAAEFV). Diastolic dysfunction(DD) was also assessed. Dilated LAVI in 32, LA dysfunction in 20, DD with elevated LV filling pressure in 19 patients was found. Aa,at and Aa,p correlated with LAFF (r:0.53; p<0.001 and r:0.43; p<0.05), LAEF (r:0.51;p<0.001 and r:0.63; p<0.001), PVSF (r:0.49; p<0.001 and r:0.46; p<0.005) and PLAAEFV (r:0.58; p<0.001 and r:0.45; p<0.01). CONCLUSIONS: In PAF patients Aa velocity is useful to assess LA function and correlates positively with other TTE derived LA functional parameters and LAA function by TEE derived PLAAEFV.

[Magnetic resonance imaging applications in obstetrics]. / Applications de l'imagerie par résonance magnétique en obstétrique.

PURPOSE: To review the main indications and results of magnetic resonance imaging in the pregnant women. MATERIAL AND METHOD: We reviewed MRI practice during the pregnancy based on our own experience in a prenatal diagnostic center and data in the literature. Rapid improvement in MRI technology has allowed more extensive use, giving a good contrast-to-noise ratio and multiplanar imaging. RESULTS: Although ultrasound provides primary screening information, final diagnosis may require further investigations. MRI, to be performed in the second and third trimester, is the non-invasive second line tool of choice in this context. The most widespread indications are for brain disease: search for a cause of ventriculomegaly or biometric abnormality, confirmation of a malformative or acquired lesion. Progressively, indications were widened to head and neck, thorax, abdomen and pelvis areas. Moreover, systematic indications include previous fetal pathology or the pregnancy context. Other MRI indications have been suggested: placental malposition, pelvimetry and maternal genito-urinary tract. CONCLUSION: MRI is becoming the natural and necessary second line imaging technique, with increasing indications. It must be kept in mind however that all pathological conditions cannot be depicted by these morphological studies.

[Subdural hematomas in children: role of cerebral and spinal MRI in the diagnosis of child abuse]. / Collections sous durales de l'enfant: place de l'IRM cerebrale et medullaire dans le diagnostic de maltraitance.

PURPOSE: To determine if the presence of multiple subdural hematomas (SH) of varying signal intensities at MRI was suggestive of repeated injuries allowing a diagnosis of non accidental head injury (NAHI). MATERIAL AND METHODS: We included 13 patients (9 boys/4 girls; mean age 15.3 weeks) with suspected NAHI and bilateral SH. Six patients had MRI during acute admission (first week) and seven patients between 10 and 30 days after head trauma (mean 12.6 days). A total of 8/13 patients had spinal MRI. We assessed the distribution and signal intensity of SH, brain, epidural and spinal cord abnormalities. Our findings were compared to medico-legal investigations in 7/13 patients to evaluate the correlation between the age of SH on MRI and the date of injuries. RESULT: Lesions detected included cerebral edema, ischemia, contusions and cranio-cervical axonal injury and 2/8 patient had spinal epidural hematomas. Multiple SH with varying signal intensities were seen. The commonest location was the frontoparietal areas (100%) and suboccipital region (77%). In 5/6 cases, MRI during the acute admission revealed multiple and small SH having the same signal intensity. When MRI was performed later multiple SH of varying signal intensity were found in 54% of cases. We found a good correlation between the age of the SH and the date of suspected injuries in all cases. Nevertheless, in 5 patients, other SH of various ages were present suggesting rebleeding. CONCLUSION: Our findings confirm the value of MRI in the detection of brain and spinal cord lesions and SH of varying signal intensities in non accidental head injury. MRI is not able to predict whether different signal intensities correspond to spontaneous repeated bleedings or repeated injuries. The presence of these lesions without clinical evidence of accidental trauma justifies a medico-legal evaluation to confirm the diagnosis of child abuse and to protect these patients.

Impact of culprit lesion morphology on prevalence of provoked myocardial ischaemia in patients with old myocardial infarction. A dipyridamole stress echocardiography, exercise electrocardiography and angiographic study.

We have recently shown that in patients with single vessel disease and no myocardial infarction, a complex plaque morphology makes myocardium more vulnerable to ischaemia during dipyridamole echocardiography testing. Whether coronary lesion morphology in the infarct-related artery in a chronic phase may also modulate prevalence of ischaemia in the same territory remains unknown. In order to determine the possible relationship between culprit lesion morphology in the infarct-related artery and the prevalence of homotopic ischaemia during stress tests, data from high dose dipyridamole echocardiography tests (up to 0.84 mg.kg-1 over 10 min), exercise electrocardiography and coronary angiography from 73 in-hospital patients with a previous myocardial infarction and patent infarct-related single-vessel disease (> or = 50% diameter reduction) were analysed. An angiographic culprit lesion was considered complex (Ambrose classification) when irregular borders, ulcers, thrombus and/or intraluminal lucencies were present. According to angiographic lesion morphology, two groups were identified: Group I, with simple-type culprit lesions; Group II, with complex type culprit lesions. Number of patients (I = 36; II = 37), age (I = 57 +/- II vs II = 55 +/- 9 years), ejection fraction (I = 58.8 +/- II 3 vs II = 56.5 +/- 10.2%), number of Q or non-Q wave myocardial infarctions, prevalence of rest angina (I = 9; II = II) or effort angina (I = 10; II = 10), culprit lesion stenosis severity (I = 57.9 +/- 7.2% vs II = 57.7 +/- 6.2% by computer analysis) and degree of infarct artery anterograde flow (I = 2.64 +/- 0.48 vs II = 2.56 +/- 0.50 by Thrombolysis in Myocardial Infarction definition) did not differ between the two groups (P = ns for all intergroup differences). Dipyridamole echocardiography test-induced ischaemia (considered as new or worsening abnormal wall motion) in the infarct-related artery territory was 25% in Group I and 59% in Group II (P < 0.01). Among positive dipyridamole echocardiography tests, low dose (0.56 mg.kg-1 over the 4 min) positivity occurred in two out of nine Group I patients and in 16 out of 22 Group II patients (22 vs 73%, P < 0.05). Exercise electrocardiography was positive in seven out of 32 Group I patients, and in 16 out of 35 Group II patients (22 vs 46%, P < 0.05). The peak rate pressure product tended to be higher in Group I than in Group II patients (282 +/- 65 vs 257 +/- 65 mmHg x beats.min x 10(2), P = 0.07). Thus, in patients with previous myocardial infarction and a patent infarct-related artery, complex culprit lesion morphology is associated with a higher prevalence of ischaemia and a lower ischaemic threshold during both exercise and dipyridamole stress testing. The morphology of culprit stenosis is important in modulating different stress responses in the chronic phase of myocardial infarction.

[Production of granules with controlled drug release rate (author's transl)]. / Herstellung eines Granulates mit regulierter Wirkstoffabgabegeschwindigkeit.

A procedure for microgranulation is described (cf. [7]) which is based on the use of formaldehyde-treated gelatin. The drug (Drotaverin: No-Spa) contained in the matrix is released, dependently of the formaldehyde concentration in the matrix, at a predetermined rate. The release (first-order kinetics) is rapid at low formaldehyde concentrations, and slower at higher formaldehyde concentrations.