[The wearable cardioverter defibrillator]. / Le gilet défibrillateur portable.

Sudden cardiac death affects close to half a million people a year in Europe and accounts for 50 % of cardiovascular deaths. Unfortunately, only a minority of these events occur in front of witnesses, which reduces the chances of survival. In order to limit this risk, an internal automatic defibrillator can be implanted in patients at risk of sudden cardiac death. However, there are circumstances when the patient is at risk of sudden cardiac death and this device cannot be implanted. In order to limit this risk, certain patients can be equipped with a wearable defibrillator.

: La mort subite frappe près d'un demi-million d'individus par an en Europe et représente 50 % des décès d'origine cardiovasculaire. Elle est malheureusement souvent le premier événement cardiovasculaire et les chances de survie des patients dépendent alors d'une réanimation précoce. Certains patients ont cependant pu être identifiés comme à haut risque de mort subite et peuvent être protégés par l'implantation d'un défibrillateur automatique implantable. Toutefois, il existe des circonstances transitoires au cours desquelles un défibrillateur automatique ne peut être implanté. Certains patients peuvent alors être équipés d'un gilet défibrillateur portable qui permet de les protéger, avec un taux de cardioversion d'arythmie ventriculaire maligne proche de 100 % et un faible taux de chocs inappropriés.

[Cholelithiasis and cholecystectomy in infants]. / Lithiases vésiculaires et cholécystectomie chez le nourrisson.

Cholelithiasis is rare in children and even more so in infants. We report the case of a 3-month-old patient with cholestatic jaundice secondary to an obstruction of the terminal portion of the bile duct. The treatment applied in this patient was a cholecystectomy with trans-cystic cholangiography and common bile duct clearance. The evolution was excellent. The current literature on biliary lithiasis in children and infants is poor in large cohort studies. The various treatments proposed, if necessary, include biliary lavage by percutaneous puncture, endoscopic retrograde cholangiopancreatography with sphincterotomy and laparoscopic or open cholecystectomy with intraoperative cholangiography. None of these procedures has shown superiority over the others. Therefore, no treatment algorithm is currently defined. Patients are treated on a case-by-case basis according to their symptoms, previous history and the level of expertise of each centre for these rare, difficult and specific procedures.

La pathologie lithiasique biliaire est rare chez l'enfant et encore plus chez le nourrisson. Nous exposons le cas d'une jeune patiente de 3 mois présentant un ictère cholestatique secondaire à un obstacle de la portion terminale du cholédoque. Le traitement appliqué chez cette patiente a été une cholécystectomie avec cholangiographie trans-cystique et désobstruction du cholédoque. L'évolution a été excellente. La littérature actuelle sur la pathologie lithiasique biliaire de l'enfant et du nourrisson est pauvre en études de grande cohorte. Les différents traitements proposés, si nécessaire, comportent le lavage biliaire par ponction percutanée, la cholangiopancréatographie rétrograde endoscopique avec sphinctérotomie et la cholécystectomie par voie laparoscopique ou ouverte avec cholangiographie peropératoire. Aucune de ces procédures n'a montré de supériorité par rapport aux autres. Aucun algorithme de traitement n'est donc actuellement défini. Les patients sont traités au cas par cas selon leurs symptômes, leurs antécédents et le niveau d'expertise de chaque centre pour ces procédures rares, difficiles et spécifiques.

[CT coronary angiography for the diagnosis of coronary heart disease]. / Contribution du scanner coronaire au diagnostic de maladie coronarienne.

Coronary computed tomography is an emerging technique for the diagnosis of coronary heart disease. Based on a clinical case, we discuss the diagnostic evaluation of chest pain and the role of coronary CT.

[Assessment and management of aortic stenosis]. / Evaluation et traitement de la sténose aortique.

Surgical aortic valve replacement is the sole validated treatment of aortic stenosis. The indications for surgery rely on risk/benefit ratio and on the official recommendations. A symptomatic patient with severe aortic stenosis should be submitted to surgery. The indication of valve replacement is more difficult in asymptomatic patients. The decision should integrate a combination of an exercise test and prognostic parameters associated with poor outcome. Most of them are obtained by Doppler echocardiography. Patients presenting with severe aortic stenosis and low transvalvular gradient constitute a subgroup of patients who require appropriate echocardiographic assessment to determine the potential benefit and risk of surgery. Transluminal aortic valve implantation is a new modality for patients at high surgical risk.

Comparison between the natural postnatal maturation and the spermine-induced maturation of the rat intestine.

In the suckling rats, orally provided spermine induced structural and biochemical changes in the intestine, which are characteristics of the postnatal maturation. This induced maturation was compared to that occurring spontaneously. Eight mumol spermine were administered orally once a day, for one or three days, to suckling rats which were 11 days old at the beginning of the experiment. The animals were killed 0, 2, 4, 6, 8, 10 hours or 3 days after the first treatment. Control rats from the same litter were treated in the same way but received only the vehicle. In order to complete the study of the naturally occurring maturation, another group of rats was killed when they were 12, 13, 15, 16, 17, 18, 19, 20, 21 or 30 days old. Animal and intestine weights were measured. Disaccharidase specific activity, and protein, DNA and RNA contents were estimated in the small intestine. Histological and ultrastructural aspects of the intestinal mucosa were examined. For all these parameters, the maturation induced by spermine ingestion appeared close to that occurring naturally at weaning. Consequently, dietary spermine induces all the morphological and biochemical modifications characterizing the intestinal postnatal maturation in the suckling rat suggesting a role of the polyamines in the naturally occurring processes.