[Beneficial effects of direct call to Emergency Medical Services on time delays and management of patients with acute myocardial infarction. The RICO (obseRvatoire des Infarctus de Côte-d'Or) data]. / Influence de l'appel au "15" sur les délais et la prise en charge des patients présentant un infarctus du myocarde. Données de RICO (obseRvatoire des Infarctus de Côte-d'Or).

The influence of direct calls to specialized Emergency Medical Services in case of suspected myocardial infarction has not been extensively studied. The RICO registry is an exhaustive registry implemented in all six institutions participating in primary care of patients with acute myocardial infarction in one French administrative department (Côte-d'Or). From January 2001 to October 2001, 322 patients were admitted for acute myocardial infarction, among whom only 57 (18%) had directly called emergency medical services after the onset of symptoms. The baseline characteristics of patients who had directly called the emergency services were not different from those of the patients who had not. However, the time from symptom onset to first medical intervention (48 versus 105 minutes, p = 0.02) and from first medical intervention to hospital admission (60 versus 103 minutes, p = 0.02) were markedly shorter in patients who had directly called the emergency medical services. This resulted in a significant increase in the use of reperfusion therapy (70% versus 38%, p = 0.003), including a higher proportion of primary angioplasty (33% versus 20%, p = 0.04). This study documents the beneficial effect of a direct call to the Emergency Medical Services by the patients themselves. Too few patients, however use this opportunity and actions should be taken for informing the lay public of the benefits of this medical service.

Abnormalities in mucin gene expression in Crohn's disease.

Alterations in the structure and/or quantity of mucins could alter the barrier function of mucus and play a role in initiating and maintaining mucosal inflammation in Crohn's disease. To investigate the hypothesis of a mucin gene defect in Crohn's disease, we analyzed the expression of the different mucin genes in the ileal mucosa of patients with Crohn's disease and controls. mRNA expression levels were assessed by a quantitative dot blot analysis and compared (i) between healthy and involved ileal mucosa of patients with Crohn's disease and (ii) between healthy mucosa of patients with Crohn's disease and controls. Expression of the different mucin genes was heterogeneous among controls and patients with Crohn's disease, except for MUC6 in controls. Nevertheless, MUC1 mRNA expression was significantly decreased in the involved ileal mucosa of patients with Crohn's disease when compared to the healthy mucosa (p = 0.02). Moreover, the expression levels of MUC3, MUC4, and MUC5B were significantly lower in both healthy and involved ileal mucosa of patients with Crohn's disease compared to controls (p < or = 0.05). The decrease of expression levels of some mucin genes (more particularly MUC3, MUC4, and MUC5B) in both healthy and involved ileal mucosa suggests a primary or very early mucosal defect of these genes in CD.

Aberrant expression of a human mucin gene (MUC5AC) in rectosigmoid villous adenoma.

BACKGROUND & AIMS: Rectosigmoid villous adenomas (RVAs) account for approximately 10% of all colorectal tumors. They have distinct pathological features, including abundant mucus secretion, possible malignant transformation, and multiple recurrences after conservative treatment. The aim of this study was to determine the nature of any changes in mucin gene expression in RVAs. METHODS: In situ hybridization was used to examine mucin messenger RNA expression in a series of 22 patients with an RVA. Five normal rectal and colonic mucosae and five rectal adenocarcinomas were used as controls. RESULTS: In the 22 RVAs, we found an overexpression of MUC2 and an aberrant expression of MUC5AC. This MUC5AC expression was more intense in RVAs with low-grade dysplasia than in those cases with high-grade dysplasia. Moreover, in 4 cases, it was detected at a distance from the tumor in areas previously considered as normal by endoscopic and histological examination. CONCLUSIONS: MUC5AC seems to be a specific marker for RVAs and thus may be useful for the early detection of RVA recurrences after endoscopic laser treatment.

[Lipomatous septal hypertrophy. Apropos of 3 cases]. / Hypertrophie lipomateuse septale. A propos de trois cas.

Lipomatous hypertrophy of the inter-atrial septum is characterised by fatty accumulation in the inter-atrial septum. Long unrecognised, it has been discovered anew by virtue of the use of transesophageal echocardiography. The authors report three cases, including one presenting as acute ischemia of the right lower limb. After studying the contribution of imaging techniques to its diagnosis, the authors consider the principal differential diagnoses of this condition.

[Assay of proteins in the urine and cerebrospinal fluid. Choice of a method in centrifugal analysis]. / Dosage de la protéinurie et de la protéinorachie. Choix d'une méthode en analyse centrifuge.

The study consists in adapting two methods allowing estimation of proteins in cerebrospinal fluid and urine on a centrifugal analyzer using Coomassie Blue-SDS and benzethonium chloride. Results obtained with the two reagents are compared with turbidimetric technic using trichloroacetic acid, by statistic methods.

[Pseudotumoral mitral endocarditis. Diagnostic and therapeutic problems apropos of a case report with review of the literature]. / L'endocardite mitrale pseudo-tumorale. Problèmes diagnostiques et thérapeutiques à propos d'une observation avec revue de la littérature.

The authors report an observation of infectious endocarditis of the mitral valve with voluminous pseudo-tumoral growth. The developmental, symptomatic and etiological characteristics of this form of endocarditis were specified through a review of the literature. Echocardiography provides the best means of early detection of these large vegetations but it is not always easy to distinguish them from other left intra-auricular tumors, more especially as several cases of infectious myxoma have been described. Spontaneous development of mitral endocarditis is very harmful, as are infected left intra-auricular tumors, and surgical treatment of these disorders seems essential as soon as the infectious process has been arrested.

[Acute ischemia of the lower limbs in nephrotic syndrome in a young woman]. / Ischémie aiguë des membres inférieurs au cours d'un syndrome néphrotique chez une jeune femme.

A thirty-year-old woman, who had onset of nephrotic syndrome during the last part of her pregnancy, experienced recurrent acute ischemia of both lower limbs, leading to three conservative surgical procedures one month after delivery. Investigations disclosed no cause of embolism and were suggestive of thrombosis. The arteriography showed a diffuse reduction in diameter of the aorta and iliac vessels without localised stenosis or other vascular lesions. This complication is presumably related to several factors associated with the reduction in arterial diameter: hypovolemia, hyperfibrinemia, hyperlipidemia and abnormalities of hemostasis.

[Value of continuous electrocardiographic recording using the Holter method in the diagnosis and surveillance of myocardial ischemia]. / Valeur de l'enregistrement électrocardiographique continu par la méthode de Holter pour le diagnostic et la surveillance de l'ischémie myocardique.

A series of 80 patients underwent continuous electrocardiography by Holter monitoring (ECG-H) for 24 hours to detect myocardial ischaemia. Fifty five patients were not on anti anginal therapy. The results of ECG-H were compared with those of exercise electrocardiography (ECG-E) (33 cases) and coronary angiography (50 cases). The ECG-H was positive in 31 of 43 patients (72%) with clinical (5 patients) or angiographic (38 patients) signs of ischaemic heart disease. The ECG-H was negative in 11 out of 12 patients (92%) with normal coronary; angiography. The sensitivity and specificity of ECG-H (57% and 92%) were inferior to those of ECG-E (75% and 100%) in the 33 untreated patients undergoing all three investigations. Twenty five recordings were compared with the ECG-E to assess anti anginal therapy. In asymptomatic patients ECG-H showed pathological ST depression in 10 cases, the ECG-E being positive in 1 7 cases. Anginal chest pain was induced on ECG-E in 5 out of 7 cases with a positive ECG-E and negative ECG-H. The lower sensitivity of the ECG-H compared to the ECG-E is related to several factors: 1) the sensitivity of the ECG-E increases with the number of exploratory electrodes; 2) reduced levels of physical activity decrease the sensitivity; in false negative cases the heart rate on ECG-H was only 74 +/- 7% of that corresponding to the threshold of positivity of the ECG-E, compared to 97 +/- 16% of the threshold heart rate in true positives (p less than 0,001); 3) the sensitivity of the ECG-H and ECG-E depends on the severity and distribution of the coronary lesions; false negative results were commoner in single vessel disease (57%) than in double or triple vessel disease (24%) (p less than 0,01). Anginal pain during the test increased the sensitivity to 92%. The specificity of the ECG-H is partially dependent on the recognition of positional variations of the ST segment. These were observed in 10% of cases but were generally easy to distinguish by their beat-to-beat appearances. The satisfactory specificity of the ECG-H in this study is also related to the high incidence of coronary artery disease in the population under study (80%). The predictive value of a positive test (Bayes theorem) was 97%, but that of a negative test was only 41%.