ABSTRACT
Three crystallographic structures highlight the acid-base half-equivalence point of hydrogen-bond donor (thio)amido-benzimidazoles induced by fluoride or benzoate salts with concomitant hydrogen-bonding and deprotonation as a merged synergic process.
Subject(s)
Angiogenesis Inhibitors/adverse effects , Antibodies, Monoclonal/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Coronary Thrombosis/diagnosis , Rectal Neoplasms/drug therapy , Ventricular Dysfunction, Left/etiology , Adult , Antibodies, Monoclonal, Humanized , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bevacizumab , Coronary Thrombosis/chemically induced , Drug Therapy, Combination , Female , Fluorouracil/administration & dosage , Humans , Organoplatinum Compounds/administration & dosage , Oxaliplatin , Rectal Neoplasms/secondaryABSTRACT
Based on a retrospective study, we report the clinical and electrophysiological characteristics of 62 cases of effort-induced atrio-ventricular block (AVB). The diagnosis of effort-induced AVB was established by stress test and/or Holter ECG. This series consisted of 18 women and 44 men with a mean age of 64 +/- 13 years. AVB presented in the form of poor adaptation to effort in 41 patients (66%), fainting and/or presyncope suggestive of Stokes-Adams attacks in 20 patients (32%), associated with poor adaptation to effort, except in 5 patients. 48 patients (77%) did not have any underlying heart disease. The ECG was normal in 25 patients (40%) or abnormal, demonstrating a 1st degree AVB and/or an intraventricular conduction disorder. On electrophysiological investigation, the AVB was type II (Mobitz II) in 48 patients (77%), generally 2/1. The block was infranodal, either in or below the His bundle, in 56 patients (90%). When it was situated above the His bundle, it was organic and degenerative, situated at the AV node, at the node-His junction, or even proximally in the His bundle. Effort-induced AVB implies DDD atrioventricular stimulation. The presence of this anomaly should be investigated in patients with poor adaptation to effort, but also when the clinical picture is dominated by Stokes-Adam attacks.
Subject(s)
Heart Block/physiopathology , Physical Exertion , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Arrhythmia Agents/administration & dosage , Atropine/administration & dosage , Electrocardiography , Electrophysiology , Female , Heart Block/diagnosis , Heart Block/etiology , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
In order to determine the role of tilt testing in the aetiological diagnosis of syncope unexplained by electrophysiological investigation, the authors retrospectively studied the results of this test in 275 patients with a mean age of 64 +/- 16 years. These 275 patients were divided into two groups: group I: 43 patients with a mean age of 50 +/- 19 years presenting with vagal syncopes, group II: 232 patients with unexplained syncope, probably vagal: group IIa (120 patients, mean age: 67 +/- 15 years), sudden syncope: group IIb (112 patients, mean age: 67 +/- 13 years). The electrophysiological investigation was inconclusive in every case. In group II, 50% of tilt tests were positive (19% under basal conditions, 31% after isoproterenol), with 61% of positive tests in group IIa, including 31% on the basal test, and 38% of positive tests in group IIb, including 11% on the basal test. In group I, 84% of tests were positive (33% on the basal test, 51% after isoproterenol), indicating a sensitivity of the test of 84%. In 96 patients with a doubtful electrophysiological investigation, the tilt test was positive in 70% of cases, allowing specific treatment or a pacemaker to be avoided in the majority of cases. 84% of vasovagal syncopes were therefore confirmed by tilt testing; 50% of syncopes unexplained by electrophysiological investigation were demonstrated to be of vasovagal origin. The author emphasize the value of tilt testing in certain discordant situations in which the clinical context is disturbing and/or electrophysiological investigation is not completely reassuring.
Subject(s)
Syncope/etiology , Tilt-Table Test , Aged , Aged, 80 and over , Humans , Middle Aged , Posture , Prognosis , Sensitivity and Specificity , Syncope/diagnosis , Syncope/therapyABSTRACT
The authors report a case of a cerebral embolism, with a rapidly resolving course, during late fibrinolysis using tissue plasminogen activator in a patient with a posterolateral myocardial infarction. A review of the literature is used as basis for considering the effects of fibrinolytic treatment on left intraventricular thrombi during the acute phase of myocardial infarction. The risk of systemic embolism during such treatment is stressed.
