[Endo arterial investigation: suspicious for the cholesterol crystal embolism disease]. / Explorations endo-arterielles: se mefier de la maladie des embols de cholesterol!!

BACKGROUND: Cholesterol crystal embolism (CCE) is a rare disorder which can complicate cardiac catheterization, angiographic studies and cardiovascular surgery. The CCE exposes to a great risk of renal failure and it can even threaten life by means of a multi visceral failing syndrome. AIM: Report a new case of CCE following cardiac catheterization. CASE: We report the observation of a 63-year-old patient who had a coronary angiography via the right femoral artery after a myocardial infarction. This examination has showed a multi-vessel coronary disease. 15 days later, the patient presented purplish and painful discoloration of his toes. The laboratory findings showed a mild inflammatory syndrome and eosinophilia at 700 / microL. There was not a renal dysfunction nor proteinuria nor hematuria. We performed a skin biopsy and made the diagnosis of CCE. Trans oesophageal echography objectified an irregular atherosclerotic plaque in the isthmic aorta. The CT scan revealed a spindle-shaped aneurysm in the end of the abdominal aorta. This aneurysm contains a marginal surrounding thrombosis with high embolic risk. The patient was put under clopidogrel, enoxaparin, simvastatin, colchicine and atenolol and operated successfully. CONCLUSION: The two particularities of this observation are, on one hand, the absence of a renal involvement, which represents the main prognostic factor of the CCE. On the other hand, the CCE has revealed a very unstable aneurysm of the aorta which could be complicated during the cardiac catheterisation. The CCE is a difficult diagnosis that must be remembered before any cardiac catheterisation, because it often reflects unstable aortic atherosclerotic lesions.

[Predictive factors of normal coronary angiography]. / Les facteurs predictifs d'une coronarographie normale.

The aim of this study is to compare two groups of patients Group A consisted of 120 patients (70 men and 50 women) hospitalised for anginal symptoms, with either clinical or electrical positive exercise test and/or ischemic events on a 24 H electrocardiography and having angiographically normal coronaries Group B consisted of 120 patients (102 men and 18 women) hospitalised for an acute coronary syndrome with pathological coronaries. The analysis of the 2 groups showed that in the group A the average age was lesser (56 years vs 60 years), women's percentage was higher (41% vs 15%) and cardiovascular risk factors were less frequent. Data from non invasive tests was significantly different in the 2 groups: the exercise test showed both clinical and electrical ischemic events in 35% of the patients in group A versus 75% in group B (p < 0.01) and the 24 h electocardiography showed ST depression in 9% of patients in group A versus 25% in group B (p < 0.01%). The coronary angiography is an invasive and an expensive procedure. The results of our study allow us to modulate its indications, especially in young women patients, with few or no cardivascular risk factors and with only electrical positive exercise test.

[Cardiogenic shock in the acute phase of myocardial infarction]. / Le choc cardiogenique a la phase aigue de l'infarctus du myocarde.

Cardiogenic shock (CC) is the most common cause of death in acute myocardial infarction (MI) and it has been often associated with fatal evolution. The aim of this study is to emphasize the positive impact of myocardial revascularisation especially percutaneous coronary angioplasty (PTCA) on short and mid term survival of 35 patients hospitalised for acute MI with CC. All the 11 patients who were on conventional therapy died, whereas the hospital mortality rate of the 24 patients who underwent primary PTCA was 41%. PTCA in CC complicating MI is highly effective and reduces the mortality rate in the literature from 80% to 40%. For this reason PTCA should be performed in each case of MI with CC seen in the first 6 hours.

[Contracted endocardial fibroelastosis in children: report of a case]. / La fibroelastose endocardique contractée de l'enfant: a propos d'un cas.

Endocardial fibroelastosis is un uncommon disease and it has a very bad prognosis since fatal evolution is usual before 2 years old. We report the case of a 20 years old woman who is affected with the contracted form of this disease associated with atrial septal defect (ASD) and mitral regurgitation. This disease was discovered by endocardial biopsy when she was 4 years old and underwent surgical resection of endocardial fibrosis, a patch on the ASD and mitral valve replacement. She was rehospitalised 15 years later with heart failure although continuous digitoxin therapy.

[Postpartum myocardial infarct (apropos of a case)]. / Infarctus du myocarde du post-partum (a propos d'un cas).

We report the case of a 26 years old woman, who was hospitalized for an acute anterior myocardial infarction, which happened 17 days after delivery. The culprit lesion was a coronary dissection observed on the coronary angiogram which was performed on the 7th day. This dissection cicatrised spontaneously at the control coronarography performed 3 months later. Conventional medical treatment seems to be sufficient, although the use of thrombolysis in our case was safe and successful.

[Repolarisation anomalies simulating anterior myocardial infarction during ischemic cerebrovascular accident]. / Anomalies de la repolarisation simulant un infarctus du myocarde antérieur au cours d'un accident vasculaire cérébral ischémique.

The authors report the case of a woman admitted to hospital for minor trauma of the left hip and who presented major ST segment elevation on the second day suggesting an acute anterior wall myocardial infarction at the same time as a cerebrovascular accident. Complementary investigations and follow-up excluded the diagnosis of myocardial infarction with normalisation of the ECG on the 5th day. ECG changes during cerebrovascular accidents may be very variable ranging from extrasystoles to ST elevation mimicking myocardial infarction. They carry a poor prognosis with an increased risk of sudden death necessitating continuous ECG monitoring until the ECG reverts to normal. The cardiac involvement is not ischaemic but due to disease of the insular cortex of the brain which induces myocytolysis (centered around the intra-cardiac nerve endings) due to the sudden liberation of catecholamines. These lesions may be treated by propranolol or phentolamine.

[Coxiella burnetti infectious endocarditis. Apropos of a case]. / L'endocardite infectieuse à Coxiella burnetti. A propos d'un cas.

Chronic forms of Q fever (endocarditis) are rare, but are responsible for severe and desperately recurrent infections, resulting in multiple valve replacements with a reserved prognosis. The authors report the case of a 35-year-old patient with a known history of rheumatic fever, who developed blood culture negative infectious endocarditis on a mitral bioprosthesis. The diagnosis of Q fever was based on serological arguments. Despite long-term antibiotic therapy, serology remained strongly positive and was associated with repeated mitral valve disinsertion. The patient died immediately after the fourth operation in a context of haemodynamic failure. This clinical case emphasizes the importance of performing Q fever serology in any case of culture negative endocarditis and the therapeutic difficulties encountered in chronic recurrent endocarditis.

[Socio-ethical considerations in the sex preferences for infants (analysis of a pertinent survey of 200 women)]. / Considerations socio-ethiques sur le choix du sexe de l'enfant (a partir d'une enquete portant sur 200 femmes)

PIP: This survey on sex preference was done in 5 Basic Health and Maternal-Child Health Centers in the region of Tunis, Tunisia. A questionnaire was presented to a sample of 200 women of various social positions, 75% of them were 30 years old. 95% of the sample had several children, 50% had more than 3. When asked what sex was their preference for their next children, 38% wanted sons, 36% wanted girls. They said that their husbands preferred to have sons. Women preferred a son when a majority of their children were girls, unlike the fathers who were said to prefer sons, even though sons were already a majority of their children. 67% of the women wanted to know the sex of their future child before birth (Only 36% were in that state of mind in France at that time). 58% of the women wished to have the control of the determination of their future child's sex. These trends toward the control of a child's sex follow a traditional pattern, which reinforces the acceptability of modern medical methods.^ieng