[Apropos of 100 cases of malaise in infants]. / A propos de cent malaises du nourrisson.

Among 4,411 children hospitalized from May 1985 through April 1987, 100 infants (mean age three months) had exhibited an apparently life-threatening event. Management included careful history taking by interviewing parents, a thorough physical evaluation, routine laboratory tests, and cardiorespiratory monitoring. A variety of further investigations were usually performed to look for gastroesophageal reflux (GER), vagal hyperreflectivity, or sleep-related cardiorespiratory disorders. Leading causes, that often occurred in combination, included GER (66 per cent of cases), and vagal hyperreflectivity (13%). Atypical breath-holding spells, ENT causes, and neurological causes were documented in 8%, 6% and 5% of cases respectively. Medical treatment of the GER proved effective in 90% of cases. Metoclopramide (Primperan, 10 drops/kg/d) was effective in 62% of infants with GER and was well tolerated. Diphemanil methylsulfate (Prantal, 10 mg/kg/d) satisfactorily controlled vagal hyperreflectivity. Monitoring was prescribed in 43% of cases.

Coronary arteriography in acute transmural myocardial infarction.

Coronary arteriography was performed 16 +/- 3 days (range 7 to 21 days) in 106 patients with acute transmural myocardial infarction (61 posterior infarct, 45 anterior infarct). Coronary arteriography was performed without serious complications. Only 44% of patients with anterior infarct had total occlusion of the left anterior descending artery while a significant stenosis of the vessel was observed in the others -27% had a single vessel disease, 49% had two lesions and 22% had three lesions; one patient had angiographically normal coronary arteries. Among the patients with posterior infarction, 21% had one vessel disease and double or triple lesions accounted for 39% of each. Sixty per cent of patients with anterior infarction and 45% with posterior infarction had no collateral vessels. In the others patients collateral circulation had a protective effect only in anterior infarction. Age has no effect on the distribution and number of lesions nor on the development of a collateral circulation. The location and severity of the lesions were not different in patients who presented with arrythmias and those who did not.

[Coronary artery spasms]. / Le spasme des artères coronaires.

In a series of 2000 coronary arteriographies, spasm of the coronary artery was found in 52 cases, which were divided into three groups: 41 cases of "iatrogenic" spasm caused by stimulating the ostium of the coronary artery (usually the right) with the tip of the catheter; 8 cases of spasm on top of an organic fixed lesion; 4 cases of coronary spasm on a coronary artery which was reported as "radiologically normal". The study includes a review of the circumstances which favour or impede discovery of coronary spasm, as well as a provocation test using methyl ergometrine. This test seems to be specific in that it only produced coronary spasm in patients with Prinzmetal's syndrome, and excluded the cases of angina with normal coronary arteriography. The patients with spasm on top of a fixed organic lesion underwent a successful aorto-coronary bypass graft together with resection of the pre- and sub-aortic nerve plexus. Patients with a spasm in an artery which was "arteriographically normal" were treated medically by nitrate compounds and vaso-dilators. Three of these patients had an excellent result with medical treatment. Treatment failed in the fourth patient, who then obtained benefit from straight-forward resection of the pre- and sub-aortic nerve plexus with an excellent result which has been maintained for over six months.