[Cardiac arrhythmias and superior vena cava syndrome revealing a Richter's syndrome]. / Troubles du rythme cardiaque et syndrome cave supérieur révélateurs d'un syndrome de Richter.

Richter's syndrome is the aggressive transformation of chronic lymphocytic leukemia in a diffuse large cell lymphoma. The locations and the clinical manifestations are varied. We report the case of a Richter's syndrome revealed by cardiac arrhythmias and superior vena cava syndrome in a patient of 78 years followed during 2 years for chronic lymphocytic leukemia.

Physical influences on right ventricular infarction and cardiogenic shock in acute myocardial infarction.

AIM: To determine if complicated acute myocardial infarction (AMI) is related to specific cosmophysical activities. METHODS: The study group included 1170 patients who had undergone primary percutaneous coronary intervention (PCI) for AMI in 2000-2006. Geomagnetic and cosmic ray (neutron) activity (GMA, CRA) on the day of PCI were derived from international observatories. The findings were compared among patients with right ventricular infarction (RVI), cardiogenic shock, and uncomplicated AMI. RESULTS: Relative to the whole study period, the mean CRA was higher on days on which PCI was performed for RVI (n=123, 10.5%) (p = .0003) and cardiogenic shock (n=102, 8.72%) (p = .018). When the same artery was involved (LAD, RCA, CRX), CRA was significantly higher for complicated than for uncomplicated AMI (RVI group: p = .006, p = .00027, p = .014, c ardiogenic shock: p = .009, p = .029, p = .089, respectively). At the highest levels of GMA, more RVI cases were seen than cases of cardiogenic shock (p = .06). CONCLUSION: RVI and cardiogenic shock were associated with higher CRA than uncomplicated AMI. RVI occurred more often on days of high GMA than cardiogenic shock. Higher CRA may induce more myocardial damage in patients predisposed to AMI.

Atherothrombosis: environmental links.

BACKGROUND: During the past decades, many studies were published considering cosmo-terrestrial influences on different sites of human homeostasis. The aim of this study was to summarize some of those studies in the field of cardiovascular medicine, concentrating on environmental physical activity--Solar (SA), Geomagnetic (GMA), and conversely, Cosmic Ray (CRA)--links with atherothrombosis, the basic mechanism of most vascular catastrophes in modern society. METHODS: A preview of a number of comparative studies between clinical events-acute myocardial infarction (AMI), sudden cardiac death (SCD), stroke (CVA), laboratory data of coagulation, inflammation (daily, monthly), with parameters of SA, GMA, CRA, and closely linked to CRA, high energy space proton flux at high energies. The clinical and laboratory data were from studies in Lithuania and Israel. The physical data were from space-science institutions in the USA and Russia (until 1990-USSR). STATISTICS: Student's t-test and Pearson correlation coefficients and their probabilities were used. RESULTS: A significant relation was found between the level of GMA (I-IV) and blood coagulation parameters, (platelet count and aggregation, fibrinogen, INR [ratio of patient's prothrombin time to normal], inflammation markers--serum C-reactive protein (CRP), elements of anti-phospholipid syndrome, number of deaths from ischemic CVA, SCD, outpatients death from AMI. The monthly occurrence of AMI (total and all subtypes) was connected with CRA. Monthly deaths from CVA (mostly ischemic) were correlated with CRA, and both events were closely connected with atherothrombosis. CONCLUSION: Three basic components of atherothrombosis-blood coagulation, inflammation, atheroma disruption are connected with environmental physical activity--CRA is predominant in plaque disruption, cellular damage, electrical instability, GMA in the activation of coagulation and inflammation.

[Rules of good clinical practice for atrial fibrillation in family practice]. / Règles de bonne pratique clinique pour la fibrillation auriculaire en médecine générale.

The epidemiologic observations show that atrial fibrillation is a major challenge of public health. This article underlines the central role of the general practitioner to detect and treat the arrhythmia precociously, and to follow attentively the treatment (in particular, but not only, anticoagulant and antiarrhythmic therapies). The choice between various therapeutic strategies is reviewed. The family practitioner is also placed best to educate the patient to manage his pathology and his treatment in an optimal way. Pharmacological prospects exceeding the antiarrhythmic ones are evoked, as well as the contribution of nonpharmacological strategies, either already accepted in current practice, or under development.

Cardiac arrhythmia and geomagnetic activity.

BACKGROUND: The purpose of this paper is a review of a number of studies considering links between life threatening cardiac arrhythmias, sudden cardiac death (SCD) and the level of environmental physical activity factors like geomagnetic activity (GMA) and opposite them cosmic ray and high energy proton flux. This is a part of studies in the field named Clinical Cosmobiology. METHODS: Temporal distribution of cardiac arrhythmias and SCD daily and monthly were compared to the level of GMA, space proton flux, cosmic ray activity according to neutron activity (impulse/min) on the earth's surface. The cosmophysical data was obtained from the cosmic science institutions in the USA, Russia and Finland (cosmic ray data, partially). RESULTS: As it follows from the results of the quoted studies there is an inverse relationship between the frequency of cardiac arrhythmic events and SCD and the level of daily GMA. CONCLUSION: Now studies are in progress considering the role of neutron (cosmic ray) activity in the natural history of the mentioned events. According to the various studies, we can presume that the GMA has some protective effect on cardiac arrhythmias and SCD.

Neutrons and sudden cardiac death (SCD) codes 121-125 ICD 10.

Recent studies have shown that (1) monthly neutron activity (NA) (imp/min) correlates with monthly number of acute myocardial infarction (AMI); (2) NA is higher on days of automatic implantable cardioverter defibrillators (AICD) discharges for VT, VF. Here we checked the level of NA in relation to timing and type of sudden cardiac death (SCD) patients [n=848 (579, 68.28% male)] obtained from the Kaunas registry for the years 2002-2004. All underwent Forensic Medicine post mortem examination and classification according to ICD10 by code 121-125. Daily NA data were obtained from Oulu U-ty, Finland and Moscow Monitoring Station of the Russian Academy of Sciences. No difference in NA was found on days with or without SCD. In men < 65, SCD occurred on days with higher NA than in women of the same age (p = 0.01) or in > 65 y old men (p = 0.045). Days of SCD with myocardial ruptures showed the highest level of NA, significantly higher than on all days (n = 669) of SCD (p = 0.037) and all 1096 days of the study (p = 0.0048). Three groups were accompanied by significantly higher NA: repeated AMI, myocardial ruptures (codes122, 123), and coronary atherothrombosis without AMI, related to electrical heart instability. The mechanism of possible neutron role in pathophysiology needs special studies.

Are neutrons involved in the pathogenesis of life-threatening cardiac arrhythmias?

Geomagnetic fields protect the earth from the adverse effects of cosmic rays, whose activity can be indirectly measured by monitoring the level of neutrons in the environment. The number and days of discharges from automatic implantable cardioverter defibrillators (ICD) in patients with cardiac arrhythmias are inversely correlated with the daily level of geomagnetic activity (GMA). The aim of the present was to determine whether neutron levels on days of AICD discharges are higher than average. Days on which discharges occurred were recorded in 31 patients bearing ICDs for managing ischemic cardiomyopathy. Daily neutron levels obtained from the monitoring data of the Russian Academy of Sciences in Moscow were analyzed using Student's t test. The mean (+/-SD) daily neutron level for the 1096-day period was 8299.29 +/- 294.236 imp/min (median 8252), and for days of ACID discharge, 8423.93 +/- 274.187 imp/min (median 8443) (p = 0.0002). The mean neutron activity on days of AICD discharges in response to ventricular disturbances was significantly higher than the mean level over the 1096-day study period. Whether this relation is a direct result of low GMA or due to an independent role of neutrons in the pathogenesis and timing of cardiac arrhythmias is unknown.

Changes in autoimmune markers of the anti-cardiolipin syndrome on days of extreme geomamagnetic activity.

UNLABELLED: The possible relation between various biological or medical phenomena and changes in environmental physical activity, such as Solar, Geomagnetic Activity (GMA); Cosmic Ray; Proton, and other particle flux, have been reported. These phenomena seem to be reflected, among others, in the immune system, resulting in changes in immunoglobulin (Ig) levels or outbursts of epidemics. AIM: to examine a possible association of GMA with another aspect of the immune system--autoimmunity. Fluctuations of levels of anticardiolipin (IgG; IgM, IgA subtypes) and lupus anticoagulant (Kaulin clotting time and Dilute Russell's viper venom time) autoantibodies, serving as anticardiolipin syndrome (ACLS) markers, were monitored during days of severe GMA storms and compared with those of lowest/quiet GMA days. Cosmophysical data were obtained from the NOAA National Space Service Center and the National Geophysical Data Center, USA. RESULTS: A significant rise in the levels of anti beta2Gp1-IgA (p = 0.0001); and KCT (p = 0.019) was observed on days of the GMA storms. CONCLUSION: On days of major GMA storms, significant changes in the autoimmune marker levels of ACLS were observed compared with quiet days. An involvement of those changes in clinical events related to GMA storms is possible.

Suicide-homicide temporal interrelationship, links with other fatalities, and environmental physical activity.

UNLABELLED: Homicide and suicide are extremes in human behavior. The aim of this study is to investigate the connection by time between suicide and homicide, between them and other fatalities, and their links with the level of cosmophysical activity. METHODS: Using the national database of Lithuania (1990-2002) we found that 547,875 deaths, 4,638 homicides (3,374 male) and 19,527 (16,019 male) suicides were registered in that period. Their temporal distribution over 156 months was compared with solar and cosmic-ray activity. Pearson correlation coefficients and their probabilities were established. RESULTS: There was a correlation between monthly rates of homicide and male groups. Female suicide rates correlated with male and total homicide numbers. Both homicide and suicide rates were inversely correlated with solar and cosmic-ray activity. Suicide numbers, but not homicides, were inversely related to geomagnetic activity. Suicide rates were inversely correlated with total, cardiovascular, traffic accident, and sudden deaths; homicide with total, traffic accident, and sudden deaths. CONCLUSION: Temporal distribution of homicide and suicide is significantly interrelated. Both are linked to parameters of cosmophysical activity. The influence of cosmic rays deserves special attention.

[Syncopes: evaluation and management]. / Les syncopes: évaluation et prise en charge.

The optimal management of patients presenting with syncope depends on the aetiology of symptoms. The first step is to differentiate patients without heart disease from others. The clinical history and the examination are the most useful, and in almost half the cases, suggest a presumptive diagnostic. In patients without heart disease, tilt test and autonomic nervous system testing are the investigations with the greatest yield. In patients with heart disease, hemodynamic and electrophysiologic studies are frequently needed. Neurologic investigation are rarely useful and only needed if syncope is associated with focal neurologic manifestations. In some cases implantable ECG loop recorder has proved to be useful. In most of the patients, correlation of symptoms and results of investigations results in appropriate therapeutic strategy.

Cosmic rays activity and monthly number of deaths: a correlative study.

We studied the relation between the intensity of cosmic rays, the level of solar/geomagnetic activity, and the monthly numbers of deaths in a large hospital in Israel and in all Lithuania. The Israeli data include 30526 hospital deaths, two groups of fatal suicides (2359, 2763), and 15435 suicidal attempts for two periods of 108 and 236 consecutive months. The national data for the entire Republic of Lithuania include 424925 deaths for the period of 120 consecutive months. Cosmic rays intensity was measured by an Apatity neutron monitor. We obtained the data on solar, geomagnetic radiovawe propagation, ionosphere ionization hours, proton flux of two energy levels (>90 and 60 MeV) from the National Geophysical Data Center at Goddard Space Flight Center, National Space Environment Center at Boulder, Colorado, USA, and from the Institute of Terrestrial Magnetism, Ionosphere and Radio Wave Propagation (IZMIRAN), Russia. We calculated Pearson coefficients and their probabilities for correlation between monthly space activity level and monthly number of male and female deaths from different causes. Cosmic rays activity revealed significant negative correlation with solar/geomagnetic activity indices and related physical phenomena levels. This activity strongly correlated with flux of protons with the energies >90 MeV proton flux and did not exhibit significant correlation with 60 MeV proton fluxes. Cosmic rays intensity correlation with monthly numbers of deaths was strong for noncardiovascular deaths, suicides, and traffic accidents. The correlation was much weaker for deaths caused by ishemic heart disease and strokes.

[The cardiology department]. / Le Service de Cardiologie.

Cardiology was present since the very beginning of the Erasme hospital. The Department of Cardiology was created in 1979. This department is made of a hospitalization unit (54 beds), a coronary care unit (12 beds) and a large technical unit. Clinical activity has increased tremendously and this had led to an important research activity in the fields of cardio-respiratory and metabolic adaptation to exercise, particularly after cardiac transplantation, of cardiovascular epidemiology, of clinical pharmacology and in pulmonary as well as systemic hypertension.

The effect of geomagnetic activity on cardiovascular parameters.

Multidirectional changes in the natural history of many cardiovascular syndromes have been linked to different levels of daily and monthly geomagnetic activity (GMA). Previous studies have found that in periods of high GMA, there were more admissions for acute myocardial infarction and more cases of anterior wall myocardial infarction. Results also indicated: higher out-patient mortality and a trend towards higher hospital mortality from acute myocardial infarction; higher diastolic arterial pressure in healthy subjects and in treated hypertensive patients; higher prolactin and 17-corticosteroid levels in the peripheral blood; more severe migraine attacks and more admissions for CVA and cerebrovascular insufficiency in male patients; changes in many blood coagulation cellular gradients (platelet count, basophils in the peripheral blood), a rise in platelet aggregation, fibrinogen level and a drop in leukocyte adhesiveness. Periods of low GMA showed a related increase (negative correlation) in in-hospital non-myocardial infarction-related cardiovascular deaths. Only in times of lowest GMA did inferior wall myocardial infarction exceed anterior wall myocardial infarction. Low GMA was also associated with higher levels of growth hormone and 11-ketosteroids in the peripheral blood, more sudden deaths, some increase in electrical heart instability number of ventricular and supraventricular extrasystoles and higher rate of ventricular tachycardia. The monthly occurrence of pregnancy-induced hypertension was negatively correlated with GMA level. Gender differences were noted in some of the parameters. Other studied parameters did not show changes related to GMA. These included hemoglobin level, electrolyte level, heart beat and pulse rate. Moreover, some observed cardiovascular fluctuations that were related to the level of GMA, also showed differences in the rising and dropping parts of the 11-year cycle of solar activity. It has been suggested that some of the changes observed in many clinical syndromes may be related to the concomitant activation of the serotoninergic system.

Distribution of monthly deaths, solar (SA) and geomagnetic (GMA) activity: their interrelationship in the last decade of the second millennium: the Lithuanian study 1990-1999.

Thirty percent of cardiovascular deaths cannot be explained by known risk factors. In this study, we sought links between 1) circannual rhythmicity, solar activity (SA) - sunspot number, solar radioflux and geomagnetic activity (GMA) - Ap., Cp., Am. with monthly number of deaths looking for environmental influence on mortality at the end of the second millennium. The Lithuanian national death data from for 120 consecutive months according to the IDC (1990 - 1999, n = 424925 deaths) was studied: 157189 from IHD (72144 male, 85045 female), 50228 from stroke (19062 male, 31166 female), 33722 from accidents (26193 male, 7529 female), 10655 from road accidents (8127 male, 2528 female) and 14810 from suicide (12137 male, 2673 female), 217508 - non cardiovascular (134308 male, 83200 female). Monthly death numbers (total, < 65y, 65-74, > 74y old for IHD and Stroke, and by gender) were compared with time of year, SA and GMA indices obtained from the National Geophysical Data and National Space Services Center, USA. Circannual rhythmicity indices, Pearson correlation coefficients and their probabilities were obtained and analyzed. The interrelationships of deaths from IHD and stroke and some other pathologies were also studied. In addition a multivariate linear regression analysis was done in order to evaluate the influence of time (month), Solar (S.A.) and Geomagnetic (GMA) activity on the temporal distribution of deaths. The total IHD monthly death number was significantly linked with GMA indices (r = 0.2-0.24, p = 0.03-0.075), but not with SA. IHD correlated with SA (r = 0.25-0.27, p = 0.006-0.0026), only in the 74 year age group. p = 0.0001) In the 65-74 age group, there was an inverse relationship with SA (r = -0.46-0.44) and no significant relationship to GMA. The IHD death number was correlated with GMA only in the < 65 and > 74 year age group (r = 0.30-0.36, p = 0.001-0.001). 2) Stroke-related deaths showed an inverse correlation with SA and GMA only for the 65-74y age group (r = -0.5, p = 0.0001 - SA, r = -0.4, p = 0.0001- GMA) and with GMA at age < 65 only for males (r = 0.20-0.25, p = 0.03-0.04). 3) Both IHD and stroke were strongly circannual rhythmic with acrophase at month 1.27 (IHD) and 1.32 (stroke) - first half of February, (p = 0.0001). 4) The IHD / stroke death ratio was correlated both with SA and GMA (r = 0.35, p 0.0001 - SA, r = 0.40-0.44, p = 0.0001 - GMA). 5) There was a strong inverse monthly deaths correlation between IHD and suicide (n = 14,810, r = -0.53, p = 0.0001). Stroke and suicide were also related, but to a much weaker extent (r = -0.217, p = 0.017). Accidents were inverse related to S.A. (r = -0.286, p = 0.0015), but not to GMA. Road Accidents - with both S.A. (r = 0.427, p < 0.0001) and GMA (r = 0.258, p = 0.004); with acrophases in October for road and November for other fatal accidents. Non cardiovascular deaths were annually rhythmic only for female - acrophase in early February, and for both gender inverse related to S.A. (r = -0.57, p < 0.0001) but not with GMA. Suicide victims had their acrophase in July (p < 0.0001) and were inverse related to S.A. (r = -0.6, p < 0.0001) and GMA (r = -0.27, p = 0.002). At the onset of the third millennium, the temporal distribution of deaths is still related to environmental physical activity. Those links differ for each of the pathologies, and by age and gender.

Combination of minimally invasive coronary bypass and percutaneous transluminal coronary angioplasty in the treatment of double-vessel coronary disease: Two-year follow-up of a new hybrid procedure compared with "on-pump" double bypass grafting.

OBJECTIVE: Percutaneous transluminal coronary angioplasty (PTCA) or surgery can be chosen as first-line therapies in multiple-vessel coronary disease. A mammary-to-left anterior descending (LAD) graft is the most important statistical determinant of a favorable outcome after coronary artery bypass grafting (CABG) and can be performed with lower morbidity off pump through a minithoracotomy. PTCA and stenting of the "non-LAD" vessels compete with CABG in terms of patency rates. Our purpose was to compare a combination of minimally invasive direct coronary artery bypass (MIDCAB) and PTCA with double CABG as a treatment for double-vessel coronary artery disease involving the proximal LAD. METHODS: Two matched groups of 20 patients with double-vessel coronary disease undergoing either sequential MIDCAB and PTCA (group 1) or double CABG on cardiopulmonary bypass (group 2) were compared. Angiographic control, complications, hospital costs, quality of life, and 2-year follow-up of ischemia are reported. RESULTS: All bypasses were patent at early control. Three adverse events were noted in group 1 and 17 in group 2. The hybrid-procedure group exhibited a shorter intensive care unit stay, fewer blood products transfused, less pain, better early quality of life, faster return to work, and similar cost. Three patients required a second PTCA in group 1, one of which for restenosis. At 2 years all the patients are asymptomatic with no residual ischemia. CONCLUSIONS: We conclude from this pilot study that the hybrid procedure is feasible and appears to be a safe therapy for double-vessel coronary artery disease and that it appears to generate less perioperative morbidity than classic double CABG does. Therefore we believe that there is room to undertake prospective randomized studies on a larger-scale basis.