[Hypoglycemia caused by cibenzoline. Apropos of a new case]. / Hypoglycémies dues à la cibenzoline. A propos d'un nouveau cas.

The rare cases of hypoglycemia reported during treatment with cibenzoline, have been observed with drug overdoses, in combination with kidney failure, and with ECG signs of drug intoxication. A case report involving an 80 year old man is presented. He had a moderate degree of kidney failure and was on high drug dosage, considering his age and weight. Nevertheless, serum concentrations of cibenzoline were normal, and the QRS wave was not widened on the ECG. The hypothesis of an individual susceptibility to this agent is postulated. The absence of any ECG changes is emphasized. Monitoring of blood sugar is routinely required in patients treated with cibenzoline.

[Thromboembolic complications and permanent endocavitary stimulation catheters]. / Accidents thrombo-emboliques et sondes endocavitaires de stimulation permanente.

Based on four cases of phlebitis associated with permanent intravenous cardiac stimulation catheters, the authors review the pathophysiology, clinical signs, diagnosis and treatment of this disease. The insertion of the catheter causes varying degrees of radiologically detectable thrombosis in 30 to 50 per cent of cases. The most frequent clinical presentation is the typical picture of phlebitis of the upper limb due to axillo-subclavian thrombosis. However, clinical signs are only present in 0.5 to 5 per cent of cases (1.7 per cent of cases in the present series). The risk of this complication can not be predicted on the basis of delay after the implantation. The incidence is increased in patients with more than one stimulating electrode, but this disease is not confined to this group of patients. The thrombosis may affect the superior vena cava or the right cardiac cavities, when it may also be associated with pulmonary embolism, as in one of the cases in this series. One case with arteriolar involvement (phlegmatia cerulea) is also described. The diagnosis may require impedance rheoplethysmography, two dimensional echocardiography, isotope phlebography or contrast phlebography, which remains the most frequently used technique. The treatment is medical, consisting of intravenous or subcutaneous heparin. Fibrinolysis may be indicated in cases with recent superior vena cava thrombosis and or other complications. To our knowledge, no controlled studies have been performed to define the optimal treatment. Long term prophylactic anticoagulant therapy is useless. There is never any indication for removal and replacement of the catheter responsible or for the removal of useless catheters left in place in patients with multiple implants.

[Pheochromocytoma and aortocoronary bypass. Double surgical procedure]. / Phéochromocytome et pontage aorto-coronaire. Double intervention chirurgicale.

Based on a personal case of a 47 year old woman with an adrenal medullary pheochromocytoma and stenosis of the left anterior descending artery treated by aorto-coronary bypass grafting after ablation of the pheochromocytoma, the authors illustrate the frequency and precocity of organic coronary artery disease in 27 cases in the literature. Chest pain and electrocardiographic changes are often attributed to functional ischaemia but the high incidence of organic coronary artery disease in the series analysed confirms the need for coronary angiography in doubtful cases. It is reasonable to start by removing the pheochromocytoma and, only then, consider coronary angiography with a view to coronary bypass surgery: the risks of a hypertensive crisis seem to be reduced when this protocol is followed.

[Isolated primary dissection of the right coronary artery]. / Dissection primitive isolée de l'artère coronaire droite.

A 59 year old female had unstable angina threatening infarction, together with Prinzmetal's syndrome in the postero-diaphragmatic area, and a transient second degree atrio-ventricular block. Selective arteriography revealed complete dissection, as an isolated and primary finding, in the right coronary artery. Operation consisted of dividing the coronary artery at the superior limit of the dissection, of suturing together the separated layers of the artery, and finally an end-to-end aorto-coronary bypass. The patient is living without any functional symptoms 15 months after the initial episode, but a follow-up arteriogram showed that separation of the two layers of the dissection was persisting. This condition has caused rapid or sudden death in 47 of the 51 reported cases, often occurring in females at the beginning of pregnancy. This mortality rate justifies early operation as soon as the diagnosis is made by coronary arteriography.