[Ventricular tachycardia by branch to branch re-entry. Familial case with Steinert's disease]. / Tachycardie ventriculaire par réentrée de branche à branche. Cas familial avec maladie de Steinert.

Ventricular tachycardia by branch to branch reentry is a rare arrhythmia. It occurs in cardiomyopathies associated with conduction defects. During tachycardia a His potential precedes each QRS complex which usually has a left bundle branch block appearance. The authors report two familial cases of ventricular branch to branch tachycardia (son and mother) without cardiomyopathy. The diagnosis of Steinert's disease was made post-mortem in these two patients. In cases of branch to branch ventricular tachycardia, the diagnosis of myotonic dystrophy should be excluded. Conversely, endocavitary electrophysiological investigation with ventricular stimulation should be proposed for symptomatic patients (dizzy spells, syncope) to diagnose branch to branch ventricular tachycardia, even in cases with conduction defects which could also explain the symptoms.

[Radiofrequency ablation in auricular flutter. Predictive factors of primary success and medium term results]. / Ablation par radiofréquence du flutter auriculaire. Facteurs prédictifs du succès primaire et devenir à moyen terme.

Ninety-one consecutive patients underwent radiofrequency ablation of chronic or paroxysmal atrial flutter. The average age of the patients was 66. There was a previous history of atrial fibrillation in 38% of cases and of cardiac surgery in 14.3% of cases. The primary success rate was 79% (92% in cases of common flutter). The predictive factors of success were the type of flutter (p < 0.001), left ventricular (p < 0.01) and left atrial dimensions (p < 0.01) at echocardiography. The length of the cavo-tricuspid isthmus measured by echocardiography had no influence on the initial result but, in primary success, did affect the parameters of the procedure (duration and number of applications of radiofrequency energy). After an average of 11 +/- 2 months, sinus rhythm was maintained in 67% of patients. There were recurrences of flutter in 27.5% of cases and of atrial fibrillation in 5.5% of cases: 85% of these episodes occurred during the first six months after ablation. A second procedure was carried out in 12 patients for recurrence of flutter (92% primary success rate). After an average follow-up of 8.4 months, 4 patients had a recurrence and required a third procedure (100% success rate). In cases of failure of ablation, the rhythm was converted by a shock or atrial pacing: 47.3% of these patients remained in sinus rhythm with antiarrhythmic therapy with a 12 month follow-up. Radiofrequency ablation of atrial flutter is, therefore, a safe method, the difficulty of which is mainly related to anatomical factors: the medium-term results are better than those of other therapeutic methods.

[Lactobacillus acidophilus endocarditis]. / Endocardite à Lactobacillus acidophilus.

BACKGROUND: Lactobacillus is a commensal germ found in the buccal cavity, the digestive tract and the vagina. Usually non-pathogenic except in case of dental caries, it can occasionally be the causal agent in severe endocarditis. CASE REPORT: A 70-year-old woman developed endocarditis on an aortic valve bioprosthesis. Lactobacillus acidophilus was isolated from blood cultures of the valve after surgery. COMMENTS: Forty-four cases of Lactobacillus endocarditis have been reported in the literature to date. Mortality is high (26%). The main difficulty in treatment is germ tolerance to penicillin and aminosides found in all cases. Cure requires high dose parenteral antibiotics and surgery in many cases (26%).

[Asymptomatic acute cytolytic hepatitis due to fluindione and associated with resistance to treatment: a case report and review of the literature]. / Hépatite aiguë cytolytique asymptomatique à la fluindione s'accompagnant d'une résistance au traitement. A propos d'un cas. Revue de la littérature.

The authors report a case of asymptomatic acute cytolytic hepatitis due to fluindione (Previscan) associated with relative and selective resistance to this drug prescribed as a relay of heparin therapy for deep venous thrombosis following immobilisation of a sprained ankle in a 22 year-old patient. The main complications of oral anticoagulants are bleeding. Very severe immuno-allergic complications, especially hepatic, have been described with phenindione therapy. A review of the literature revealed a very low incidence of fluindione-induced hepatitis (7 cases), only two of which were fully documented since the commercialization of this molecule in 1971. No fatalities were reported: resistance to the treatment seemed to be associated. The exact mechanism (toxicity or immuno-allergy) has not been determined although the fact that fluindione is one of the indanedione family is in favour of the latter hypothesis.