[Puerperal thrombosis of the right ovarian vein. Clinical and radiological aspects apropos of a case]. / Thrombose puerpérale de la veine ovarienne droite compliquée d'embolies pulmonaires. Aspects cliniques et radiologiques a propos d'un cas.

The authors report the case of puerperal thrombosis of the right ovarian vein complicated by recurrent small pulmonary emboli in a 32 year old woman. The clinical features of this rare condition are reviewed. The echographic, angiographic and CT scan and magnetic resonance imaging abnormalities are described. The authors underline the value of non-invasive radiological investigations for early diagnosis. The patient was rapidly improved by medical therapy with antibiotics and heparin.

[Aortic and mitral endocarditis caused by Haemophilus paraphrophilus with abscess of the aortic ring and cerebral embolism]. / Endocardite aortique et mitrale à Haemophilus paraphrophilus avec abcès de l'anneau aortique et embolies cérébrales.

We report the first case of aortic and mitral Haemophilus paraphrophilus endocarditis complicated by abscess of the aortic annulus in a 30-year old man with post-rheumatic mitral regurgitation. We recall the peculiar clinical features and course of this bacterial endocarditis of uncommon origin. We insist, in particular, on the occurrence of cerebral embolism and on the two-dimensional echocardiographic diagnosis of an aortic annulus abscess confirmed at surgery. Cure was obtained by aortic and mitral valve replacement and by the prolonged antibiotic therapy made necessary by the presence of cerebral lesions. After 3 months, there were no neurological sequelae, but doppler-echocardiography showed a persistent washed out pouch the reports of which with the surrounding structures were determined by transoesophageal echocardiography: moderate aortic regurgitation was detected at that level.

[Nyctohemeral changes in arterial pressure in hospitalized subjects]. / Etude des variations nycthémérales de la pression artérielle chez les sujets hospitalisés.

Systolic and diastolic arterial blood pressures (SBP, DBP) were measured in 181 consecutive patients (pts) by non-invasive method (oscillometric recorder SpaceLabs 90202). Hospitalised pts (N = 54) and ambulatory pts (N = 127) did not differ significantly in 24 hrs mean SBP, diurnal SBP, DBP nor heart rate (HR): respectively 132.9 vs 136.1 137.6 vs 138.2 86.2 vs 84.4 mmHg 79.6 vs 77.1 bpm. The circadian variation of HR was identical in the 2 groups. During night (0-6 hr AM) pressures decreased significantly less in hospitalised pts than in outpatients: respectively SBP - 6.4 vs - 17.9 p. cent DBP - 5.7 vs - 17 p. cent SBP day/SBP night ratio 1.06 vs 1.17 (p less than 0.001). This "equalization" was observed since the first day of hospitalisation, even if pts were not restricted to bed (pts in intensive care unit were excluded). It did not depend on age, sex, mean SBP nor antihypertensive treatments. Heart work, as evaluated by HR.SBP product, did not differ significantly during the day in the 2 groups. In hospitalised pts it decreased twice less and remains at a significantly higher level than in outpatients: respectively - 166 vs - 300 906 vs 792 cmHg/min (p less than 0.001). The standard deviation of SBP was significantly correlated with the SBP day/SBP night ratio (r = 0.64 p less than 0.001). The chronology of the circadian variations of HR and SBP are identical, but their amplitude differed in hospitalised pts suggesting that the regulatory mechanisms of HR and SBP are different.

[Effects of oral and injectable flecainide in patients with an accessory atrioventricular pathway]. / Effets de la flécaïnide injectable et orale chez les patients ayant une voie accessoire auriculo-ventriculaire.

Flecainide, a new Vaughan-Williams Class Ic anti-arrhythmic agent, was used in 21 patients with an accessory AV conduction pathway which was apparent in 16 cases (WPW syndrome), latent in 1 case and concealed in 4 cases (block in the anterograde direction). Seventeen patients had spontaneous and inducible arrhythmias; 13 supraventricular tachycardias (SVT) due to orthodromic reentry including the accessory AV pathway and 4 atrial arrhythmias. Intravenous flecainide (2 mg/kg over 5 minute period) terminated the 13 cases of SVT in an average of 3 minutes by depressing then blocking retrograde conduction in the accessory pathway and 3 out of 4 cases of atrial arrhythmias. Conduction in the accessory pathway was blocked in the anterograde direction in 75% of cases and depressed in the rest; it was blocked in the retrograde direction in about half the cases and depressed in the rest. Intravenous flecainide completely prevented the induction or arrhythmias in 13 out of 17 patients (76%). Oral flecainide blocked the accessory pathway in the anterograde direction in 68.7%, and in the retrograde direction in 62% of patients, and prevented arrhythmias during provocative testing in 82% of patients (14 out of 17). With an average follow-up of 20.7 +/- 2.6 months with oral doses adapted to body weight and to the response to IV flecainide only one recurrence of atrial fibrillation was observed, a 100% prevention of spontaneous SVT and 94% prevention of all arrhythmias (16 out of 17 cases). The predictive value for the response to oral therapy of the tests of regularisation of SVT by IV flecainide and of the tests of non-provocation of SVT with oral or IV flecainide was excellent (100%). The cardiac tolerance was very good in these 21 patients (17 of whom had no valvular or myocardial lesion). There were 6 minor cases of general intolerance to oral therapy which were not dose related, only 1 of which required interruption of therapy. Flecainide appears one of the best choices for the treatment of preexcitation syndromes and their related arrhythmias at the present time.