[Hemoptysis in an elderly man with RENDU-Osler-Weber disease]. / LE CAS CLINIQUE DU MOIS. La maladie de Rendu-Osler-Weber. Prise en charge d'une hémoptysie chez un patient gériatrique.

Rendu-Osler-Weber disease, also known as hereditary haemorrhagic telangiectasia, is a genetic disease characterized by an autosomal dominant transmission that causes multiple angiodysplasic lesions, and multiple arteriovenous malformations. Among these, pulmonary arteriovenous malformation is the most common, and is found in approximately 70% of patients that suffer from this syndrome. In a representative population sample, it is recognized that 90% of the patients that have a pulmonary arteriovenous malformation suffer in fact from Rendu-Osler-Weber disease. This article presents the case of an 85 year-old man that, in the course of a pulmonary infection, develops haemoptysis and epistaxis, and in whom a voluminous pulmonary arteriovenous malformation is discovered.

Suggestively increased rate of infant death in children of fra(X) positive mothers.

A review of the Leuven data on the fragile X syndrome indicates that sudden infant death is frequently observed in the progeny of obligate female carriers. This observation may be another indication of a central nervous dysfunction in infants with this type of X-linked mental retardation.

Hemodynamic profile of patients with acute myocardial infarction at risk of infarct expansion.

To identify patients at risk of cardiac expansion during hospital stay for a first acute myocardial infarction (AMI), 41 patients underwent right-sided cardiac catheterization soon after admission and serial 2-dimensional echocardiography on days 1, 3 or 4 and between days 7 and 10. Infarct expansion was recognized by echocardiography in 11 patients (27%), most often on the second recording (day 3 or 4). Age, sex, time from onset of pain to catheterization, peak levels of creatine kinase and creatine kinase-MB isoenzyme, heart rate, mean pulmonary artery wedge pressure and left ventricular stroke work index were similar in the 2 groups. Patients in whom infarct expansion developed had a higher incidence of previous systemic hypertension (73% vs 27%, p less than 0.01) and anterior AMI (91% vs 30%, p less than 0.001) and a higher mortality rate at 1 year (73 vs 7%, p less than 0.001) than those who did not. They also had higher systolic (139 +/- 24 vs 126 +/- 18 mm Hg, p less than 0.05) and diastolic (91 +/- 14 vs 75 +/- 13 mm Hg, p less than 0.001) arterial pressures, lower stroke volume index (31 +/- 10 vs 40 +/- 10 ml/m2, p less than 0.01) and much higher systemic vascular resistance (SVR) values (1,713 +/- 380 vs 1,253 +/- 264 dynes s cm-5, p less than 0.0001). In the subgroups of patients with anterior AMI, differences were significant for diastolic arterial pressure, stroke volume index, SVR and mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Assay of epithelial membrane antigen (EMA) in human serum by ELISA.

An enzyme linked immuno sorbent assay (ELISA) for an epithelial membrane antigen (EMA) was described. Possible cross reactions with various antigens were investigated. In sera, EMA has been found in all the subjects studied. In normal population, levels were in the range of 500 ng/ml +/- 125 (S.D.) A significant increase was observed at the end of pregnancy and during lactation. A large number of patients suffering various benign and cancerous diseases were studied. The elevated levels found in breast and pulmonary pathology indicated that this assay could be useful in the follow-up of patients suffering from these diseases.

Significance of precordial ST-segment depression in inferior acute myocardial infarction as determined by echocardiography.

Despite numerous studies, the significance of precordial ST-segment depression in inferior wall acute myocardial infarction (AMI) remains unclear. No clinical studies have used 2-dimensional (2-D) echocardiography to compare AMI location in patients with or without so-called reciprocal ST changes. Therefore, the clinical, electrocardiographic, echocardiographic and angiographic features of 22 patients with their first transmural inferior AMI were prospectively examined. During the first day of AMI an echocardiographic mapping of the area of necrosis was obtained using all conventional views and a ventricular segmentation related to anatomic landmarks. Patients were categorized according to the presence (group I, n = 13) or absence (group II, n = 9) of precordial ST-segment depression, defined as more than 1 mm, measured 80 ms after the J point in at least 2 of the leads V1 to V4. Basal posterolateral akinesia was observed in 11 of the 13 patients in group I and in no patient in group II (p less than 0.001). Posterior right ventricular free wall akinesia was more frequent in group II (p less than 0.02). There was no difference in the prevalence of significant left anterior descending artery (LAD) narrowing (group I, 4 patients; group II, 3 patients). Posterolateral involvement should be strongly considered in the presence of precordial ST-segment depression in association with transmural inferior AMI.