The efficacy and tolerance of indapamide in essential hypertension: a multi-centre study in 981 patients.

A multi-centre open trial involving 150 cardiologists throughout France was undertaken to assess the efficacy and tolerance of indapamide in the treatment of essential hypertension. An identical protocol was used by all of the cardiologists. A total of 981 patients (mean age 58 years) was included in the trial after an observation period of 1 month during which blood pressure was recorded regularly. Patients were included if they had permanent essential hypertension with a diastolic pressure of 95 mmHg or more. Mean systolic and diastolic blood pressures at the end of the initial observation period were 179/103 mmHg. The treatment period lasted for 4 months during which the patients received 1 tablet of indapamide (2.5 mg) each morning. Blood pressure was measured after 6 and 16 weeks of treatment, and clinical and biological acceptability was also assessed. After 6 weeks of treatment, mean systolic and diastolic blood pressure levels decreased to 158/90 mmHg: after 16 weeks these mean figures were 150/86 mmHg. Blood pressure levels became normal with indapamide treatment alone in 80% of patients. A slight decrease in serum potassium levels was noted in the first 6 weeks of treatment and then became stable. Clinical acceptability was considered good or excellent in 89% of cases and few non-specific side-effects were reported.

[Value of echocardiography in heart surgery]. / Intérêt de l'échocardiographie en chirurgie cardiaque.

Between October 15th 1981 and January 31st 1982, 297 echocardiogrammes were performed in the department of cardiac surgery at Broussais Hospital, 31 of which were requested and carried out as emergency procedures by day or night, 187 pre- or postoperatively and 79 in the out-patient clinic. M mode and 2D echocardiographies were performed at the bedside when necessary, namely in the intensive care unit pre- and postoperatively. The examination was performed by trained personnel, both in the out-patient clinic and in the intensive care unit. In the 31 cases in which the examination was requested as an emergency, the information obtained practically always contributed to establishing the right diagnosis and to correct therapeutic intervention. In 24 cases, the emergency occurred in the post-operative period: 18 cases of cardiac failure, of which echocardiography contributed to the indication of reoperation in 4 cases, the contra-indication of reoperation in 11 cases, and the need for emergency catheter studies in 2 cases. In one case the examination was unnecessary. In 6 other cases, suspected intracardiac thrombosis was excluded. There were 7 requests for emergency echocardiography in the preoperative period and the information obtained contributed to the indication for emergency surgery in 3 cases, and guided the operative strategy. The need for urgent surgery was refuted in 3 cases. The examination was unnecessary in 1 case. The results of echocardiography were very reliable. It does not seem to have provided any misleading information; the examination was incomplete in only 10% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cardiac hydatidosis]. / L'hydatidose cardiaque.

Cardiac localizations in hydatid disease are uncommon and often latent. A mass at the apex of the heart was discovered in a 42-year-old patient who presented with abnormal EKG repolarization. This mass was anechoic. Coronography demonstrated an avascular lesion with displaced coronary arteries. A hydatid cyst was suspected. No other visceral localizations of hydatid disease were detected. The patient refused surgery and was seen two years later with acute pericarditis and rapidly developing cardiac tamponade. A very large amount of pericardial fluid and a single hydatid cyst were discovered upon surgery. The cyst was aspirated and sterilized and the protruding cyst wall was resected. A severe postpericardotomy syndrome and positivation of hydatid disease serological tests occurred during the postoperative course. The patient was then given flubendazole. Prompt recovery occurred and the patient is still doing well under therapy two years later. In hydatid disease, an isolated cardiac localization is uncommon and often latent and may be revealed by complications. Prompt diagnosis should be made by echocardiography.

[Neurologic complication of lymphography. Apropos of a case]. / Complication neurologique de la lymphographie. A propos d'un cas.

A lymphography was performed as a diagnostic procedure in a 69-year-old female patient hospitalized for protracted fever. Akinetic mutism with left hemiparesis occurred 10 minutes after the injection of ultrafluid lipiodol. The patient died 13 days later. Neurologic complications of lymphography are extremely rare but may be life-threatening. Speculations as to the mechanisms which may be responsible for these complications, through a modification of the usual distribution of the contrast media, include lymphovenous shunts, lymphatic vessel compression or obstruction, pulmonary arteriovenous shunts and right-to-left intracardiac shunts. These mechanisms may facilitate cerebral embolization of the contrast media. Indications of lymphography must be restricted in patients with patent lymphatic obstruction.