Sleep, morning alertness and quality of life in subjects treated with zopiclone and in good sleepers. Study comparing 167 patients and 381 good sleepers.

From 20,000 households regularly surveyed by a national survey institute (Sofres), two groups were selected and questioned (using a 23-item questionnaire) about sleep vigilance and quality of life. The first group was composed of insomniacs using zopiclone for the last 12 months and no other CNS treatments (167 subjects). The second group was composed of 381 "good sleepers" selected as having no or occasionally one sleep disturbance in the last 12 months. No difference was found between the two groups in average total sleep time. Sleep disturbances were statistically equal in the two groups except for difficulties in initiating sleep which is more present for zopiclone users (13% vs 3%). Vigilance was mostly comparable in both groups.Five aspects of quality of life explored by the questionnaires (the professional, relational and sentimental, domestic, leisure and safety aspects) appeared to be comparable in the two groups.

[Evaluation of tolerance during intravenous administration of low dose of isosorbide dinitrate in the treatment of unstable angina]. / Evaluation du phénomène d'échappement lors de l'administration intraveineuse du dinitrate d'isosorbide à posologie modérée dans le traitement de l'angor instable.

The eventuality of tolerance was assessed in 19 patients with unstable angina treated by continuous intravenous infusion of 50 micrograms/min of isosorbide trinitrate (ISDN) in association with heparin and betablocker therapy. The tolerance phenomenon was evaluated by the hypotension produced by the ISDN infusion and by the amplitude of fall in blood pressure produced by an intravenous bolus of 1 mg of glyceryl trinitrate (GTN) according to the principle of crossed tolerance to the two nitrate derivatives. Under these conditions of administration, the authors observed partial attenuation of the blood pressure response to continuous ISDN infusion and absence of cross tolerance between ISDN and intravenous GTN. The co-prescription of intravenous N-acetylcysteine at a dosage of 10 g/24 hours in 10 of the 19 patients did not affect the blood pressure or the response to the GTN bolus compared with the 9 other patients who had received placebo after double-blind randomisation. The results of this study do not indicate if the maintenance of vascular sensitivity to nitrate derivatives at least for 72 hours, was related to the choice of a relatively low dose and/or the use of ISDN rather than another nitrate derivative, in particular glyceryl trinitrate. The use of intravenous ISDN at a low dose over a 3 day period in the usual conditions of prescription for unstable angina does not seem to induce a quantitatively significant phenomenon of tolerance.

[Study of dynamics and left ventricular function using radioisotopic technics in the heart cavities]. / Etude de la dynamique et de la fonction ventriculaire gauche par l'examen radio-isotopique des cavités cardiaques.

The imaging of the cardiac cavities with appropriate tracer materials (99 m Technetium or 113 m Indium), the recording of intracardiac dilution curves by radionuclide angiography and dynamic studies by gamma cinecardiography give global and regional parameters of left ventricular function which are reliable and reproducible: an index of cardiac output, intracardiac circulation times and ventricular volumes. The assessment of left ventricular contraction and global and regional ejection fractions is facilitated by coupling the gamma camera and the electrocardiogramme and computer analysis of the results. "First passage" recordings may be used to differentiate the right from the left heart chambers. "Equilibrium" studies give detailed information at rest, under stress (or leg-raising) and under pacing and/or trinitrin. Average and maximal rates of contraction derived from the ejection fraction and left ventricular contraction times are indices comparable to the rate of fibre shortening. The calculation or regional parameters point by point such as the ejection fraction, contraction time and ejection volume gives a more accurate and sensitive estimation of left ventricular function than the global left ventricular indices. They are many practical applications in cardiology especially in coronary artery disease: monitoring the changes in the acute phase of myocardial infarction, the selection of patients for aorto-coronary bypass surgery and their pre- and post-operative controls. These non-invasive, easy and reliable cardiac studies justify the development of laboratories of nuclear cardiology within departments of cardiac physiological investigation.

[Isotopic methods and primary congestive cardiomyopathies]. / Méthodes isotopiques et cardiomyopathies primitives congestives.

28 patients with primary congestive cardiomyopathy in heart failure identified by cineangiographic criteria (end-diastolic volume greater than 120 ml/m2; parietal thickness less than 11 mm; normal coronary angiography), underwent 131-Cesium and 201-Thallium myocardial scintigraphy in antero-posterior and LAO projections, and 17 also underwent angiocardiography with 99 Technetium labelled albumin. This condition usually gives an appearance of an enlarged heart with diffuse or localised (antero lateral wall) hypofixation, dilatation of the left ventricular, left atrial and right ventricular cavities and a very low ejection fraction with diffusely hypokinetic wall motion. Radio-Isotopic methods may help discriminate primary and ischaemic cardiomyopathy but are not diagnostic. A low ejection fraction and marked diffuse hypofixation are poor prognostic indices. Radio-Isotopic methods are valuable in the classification of primary cardiomyopathy.

Topograhic relation between the myocardial uptake of radiothallium and left ventricular kinetics in myocardial infarction.

Myocardial images with thallium 201 are recorded on a computer with the ECG tracing and the cardiac cycle divided into 16 consecutive images. The patients then recieve 99Tcm albumin for first pass and a subsequent ECG gated series for comparison with the myocardial studies. These images can be superimposed and allow the topographic relationships of thallium uptake and ventricular contractility as reflected by the blood pool, to be seen. Quantitative parameters such as ejection fraction and stroke volume are also obtained. Examples in clinical practice are given.

[Comparative study of left ventricular kinetics by gamma-cinecardiography and ventriculography]. / Etude comparée de la cinétique ventriculaire gauche par gamma-cinécardiographie et ventriculographie.

50 patients were investigated by both left ventricular cine-angiography, and "balanced" gamma-cine-cardiography in the frontal and LAO positions. Measurements of the ejection fraction and the mean and maximal speeds of contraction were made by the two techniques. The correlation was good (r = 0.89 for the ejection fraction). A morphological analysis of the dynamic findings in the two methods in the 12 cases with discordered left ventricular kinetics showed that once again the results were very similar. A numerical presentation of the data from the radioisotope studies was made either as a group of sequential ventricular contours successively from diastole to systole, or to give a functional picture which would provide the value for one kinetic paramter at any one time (for example, the regional equivalent of the ejection fraction). To overcome the problems of superimposition in the RAO position in the "balanced" technique, the recordings of the first radioisotope study in RAO were combined with a study of balance in 50 other patients, and the correlation was excellent. These two isotope techniques, which can be carried out in the same examination and which may be repeated without risk, perfectly complement each other, and very few of the results were incapable of interpretation.

Dynamic cardiac scintigraphy with a multi-imaging device.

Cardiac kinetics can be visualized in two ways after i.v. injection of radiopharmaceutics for labeling either the myocardium or the cardiac chambers. The simpler way is the acquisition of the data in analog mode, using a multiimaging device. Thanks to a short time constant for the image advance, the cardiac cycle is divided into 16 frames, the first being triggered by the R wave of the ECG. The data of a large number of synchronized cycles are integrated on a film. This permits an almost continuous way to follow the kinetics of the studied compartments along the cycle. Several views can be registered successively. This procedure yields separately immediate information on the morphology and dynamics of the myocardium, and chambers. To evaluate quantitatively various parameters of left ventricular function a data processor is connected to the gamma camera. Examples of the two types of data are shown and demonstrate that both are useful for appreciating the value of kinetics though they are not yet accurate enough to replace in every case contrast radiologic techniques. Nevertheless, the indications for these procedures are continuously growing, due to technical progresses and the noninvasive nature of the investigation.

[Study of congenital cardiopathies with left-right shunt using gamma-angiocardiography]. / Etude des cardiopathies congénitales á shunt gauche-droite par la gamma-angiocardiographie

Red blood cells labelled with radioactive Technetium were injected intravenously, and the passage of the tracer through the cardio-pulmonary system recorded using a scintillation camera coupled with a numerical dosimeter. The results are presented as serial analoque pictures taken at the rate of two per second, as numerical tracings which are later processed, and as flow charts from predetermined areas of interest: the chambers of the heart, the lung parenchyma, and the aorta. This study is concerned with 58 patients with a left-to-right shunt, and about 40 normal examinations were used as a baseline for comparison. In cases of left-to-right shunt, the finding on the tracings is of abnormally prolonged activity in the lungs after a normal passage through the right side. The intensity-duration curves highlight this finding, and show an early recirculation peak in the right side of the heart and a slowing of pulmonary emptying, which can be evaluated numerically from the ratio C2/C1. A correlation has been found between this value and the ratio of pulmonary to systemic flow as calculated by oximetry. The correlation is even closer if a comparison is made between the curves of pulmonary radioactivity and the dye dilution curves. In certain cases, the shunt can be localised to the atrial or ventricular level. There are many indications for this safe investigation: --the diagnosis and monitoring of the flow through a left-to-right shunt in a child; --confirmation of the closure of septal defects after surgery; --clarification of an infudibulo-pulmonary syndrome.

[Treatment by urokinase of myocardial infarction and threatened infarction. Randomised study of 120 cases]. / Le traitement par l'urokinase des infarctus du myocarde et syndromes de menace. Etude randomisée de 120 cas]

Two randomized series of 60 cases of myocardial infarction or menace syndrome have been treated at the acute stage, one by Heparin alone, the other by the combination Urokinase-Heparin. The average dosage was 300 mg Heparin in the first series, of 2,700,000 CTA units of Urokinase combined with 240 mg of Heparin in the second series. After the first 24 hours, equal heparinization was performed in both series up to the third week. Significantly different results were obtained in the two series. They favour Urokinase and concern: -- the disappearance time of pain, -- the course of the arrhythmias and of cardiac failure, -- the regression or limitation of the necrosis q waves and the lesion areas on the electrocardiogram. Finally the 30th-day overall mortality was 13% in the Heparin series and 3% in the myocardial infarction on the way of constitution, or which have done so for less than 24 hours.