[Post-traumatic constrictive pericarditis with fast course]. / Péricardite constrictive posttraumatique à évolution rapide.

A case is reported of a 46-year-old male patient who sustained a blunt thoracic injury with an anterior flail chest, and right haemopneumothorax. He was intubated and ventilated because of acute respiratory failure. There were initially no signs suggesting any myocardial injury. It was not before day 20 that the electrocardiogram showed a QS wave in leads V2 and V3. The hypothesis of an antero-septal myocardial infarct was not confirmed by echocardiography, which only revealed slight thickening of the posterior pericardium. From day 50 on, the patient had tachycardia, raised jugular venous pressure, and effort dyspnoea. Echocardiography (day 59) showed an anterior and posterior pericardial effusion (about 500 ml), marked pericardial thickening, and inferior vena caval collapse during inspiration, with normal myocardial wall movements. Drainage pericardiocentesis was therefore carried out, followed by, four days later, a pericardiectomy. A small ecchymosis was found on the anterior aspect of the right ventricle. The pericardium was thickened, fibrous, hyperhaemic, Case is y stuck to the epicardium. Eight months later, echocardiography showed that the posterior pericardium remained thickened, and there was a very small residual effusion. Movements of the septum had returned to normal.

[Effects of nifedipine in patients with chronic obstructive bronchitis and pulmonary hypertension undergoing artificial respiration]. / Effets de la nifédipine chez les bronchitiques chroniques obstructifs avec hypertension pulmonaire soumis à la ventilation artificielle.

During an acute decompensation of chronic obstructive pulmonary disease (COPD) associated with pulmonary arterial hypertension (PAHP), the right cardiac ventricle is unable to tolerate the increased workload required to overcome the increase in pulmonary arterial pressure (Ppa). As a result, the cardiac (CI) and systolic (SI) indices decrease much more than in those patients without PAHP. This study aimed to evaluate the effects of nifedipine on haemodynamic parameters and oxygen availability (QO2) when given to mechanically ventilated COPD patients with PAHP during an acute decompensation. The series included 14 patients aged 68 +/- 8 yr, admitted to an intensive care ward for an acute decompensation of COPD, with Ppa greater than 20 mmHg. They remained haemodynamically stable throughout the study period. The measurements were made 20 min after the Swan-Ganz and radial artery catheters were set up (t0), and one hour after administration of 10 mg sublingual nifedipine (t1). Thereafter this agent was given three times a day. A further set of measurements were carried out in seven patients, 24 h after the first dose of nifedipine (t2). At t1, there was a significant increase in CI (+12.3%) and QO2 (+14.1%), whereas Ppa, indexed pulmonary vascular resistances, indexed systemic vascular resistances (SVRI) and PaO2 decreased significantly (-9.2%; -20%; -12.8% and -6.4% respectively). At t2, QO2 was significantly higher (+18.4%), whereas Ppa and SVRI were significantly lower, than at t0. PaO2 and the shunt fraction (Qs/Qt) returned to basal values, with a significant decrease in Qs/Qt when compared with t1.(ABSTRACT TRUNCATED AT 250 WORDS)

[Bronchial stenosis of vascular origin in pulmonary arterial hypertension]. / Sténose bronchique d'origine vasculaire en cours d'hypertension artérielle pulmonaire.

A case is reported of bronchial stenosis due to a vascular cause in a patient with chronic obstructive lung disease, cor pulmonale and pulmonary arterial hypertension. This led to right lower lobe atelectasis and acute respiratory failure (pHa 7.24; PaCO2 85 mmHg; PaO2 44 mmHg) with important right-to-left shunting. This diagnosis was only suggested on day 7 by fibreoptic bronchoscopy and confirmed a week later by tomography and digital angiography. Nifedipine, used to reduce the pulmonary arterial hypertension, increased the cardiac index (31.min-1.m-2 to 3.3.1.min-1.m-2) and oxygen transport (488 ml.min-1.m-2 to 554 ml.min-1.m-2), despite increasing the shunt effect (Qs/QT: 26% to 31%). This and the antiinflammatory action of methylprednisolone were probably responsible for the favourable outcome.

[Mediastinal infusion by a multilumen central venous catheter]. / Perfusion médiastinale par cathéter veineux central multiperforé.

A case of mediastinal perfusion by a left internal jugular vein catheter is reported. The catheter was of Shaldon type with six lateral side-holes. The patient displayed progressive pulmonary oedema and peripheral vasoconstriction, whereas clinically the catheter seemed to work quite well. Only radiological control with injection of radiopaque dye demonstrated mediastinal penetration of the catheter tip including the most distal side-hole. The five more proximally located holes remained in intravascular position. The authors advocate radiographic catheter control with radiopaque dye in every catheterized patient demonstrating cardiorespiratory manifestations of unknown origin.

[Changes in plasma ionized calcium levels during fluorescein angiography]. / Variation du calcium ionisé plasmatique au cours de l'angiographie en fluorescence.

The authors have demonstrated a significant decrease of the plasmatic ionized calcium level in 84 patients during retinal fluorangiography likely due to a chemical bond between calcium and fluorescein. The side effects noticed during the procedure were similar to that quoted in the literature; their frequency, however, was not correlated with the decrease of the plasmatic ionized calcium level, even though the magnitude of the decrease was twice as great in the patients who experienced some trouble as in those who did not. This lack of correlation may be related to the too small patients sample. A greater frequency of side effects has been noticed in patients treated by calcium inhibitors.