[DVT and combined oral contraceptives: update of the pluridisciplinary CNGOF-FNCGM-GEHT-SFMV group]. / Thrombose et contraception estroprogestative : mise au point du groupe de travail pluridisciplinaire CNGOF-FNCGM-GEHT-SFMV.

Thrombotic risk among combined oral contraceptives (COC) users has recently been debated following a court action initiated by a patient. Recent epidemiological data, as well as accumulating biological data underlying these data, have led French Health authorities to modify COC prescription and reimbursement modalities. A short synthesis is proposed by a multidisciplinary group of experts from four French societies (CGOF, FNCGM, GHT, and SFMV).

An assessment of wall motion, perfusion and glucose metabolism in recent myocardial infarction: a comparison in patients with and without revascularization.

The aim of this study was to compare the extent and severity of wall motion abnormalities, perfusion and glucose metabolism, in recent myocardial infarction in patients with and without revascularization. Forty-nine patients were studied (82% men; mean age 58 years) by using echocardiography, 201Tl single photon emission computed tomography (SPECT) rest and redistribution, and 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) SPECT at a mean of 9.2 days (range, 1-24 days) after myocardial infarction. Twenty-seven of the 49 patients underwent revascularization while the other 22 received medical therapy before echocardiography and studies using radionuclides. A contrast angiogram was obtained for each patient. A follow-up echocardiogram at 3 months was obtained for 44 patients. Images were read blindly, using a 17 segment model, with semi-quantitative analysis. In the whole group, the extent of hypokinesia was 15%+/-14 (mean+/-SD); the extent of mild defects was determined as 5%+/-6 by using 201Tl at rest, 6%+/-9 by using 201Tl redistribution, and 4%+/-6 by using 18F-FDG (P<0.0005, echocardiogram/radionuclides). Echocardiography showed that the extent of akinesia-dyskinesia was 16%+/-18 in revascularized patients and 28%+/-18 in non-revascularized patients (P=0.017). With regard to moderate and severe defects, 201Tl rest showed 19%+/-16 and 28%+/-17, respectively (P=0.047); 201Tl redistribution 17%+/-15 and 26%+/-15, respectively (P=0.043); and 18F-FDG 17%+/-13 and 24%+/-15, respectively (NS). In echocardiography, the extent of hypokinetic segments decreased from 16%+/-15 at baseline to 10%+/-11 at 3 months (P=0.045), in revascularized patients. It is concluded that, in recent myocardial infarction, hypokinesia extent on echocardiogram is greater than mild perfusion or metabolic defect extent, reflecting stunning and so the use of radionuclide techniques appear more accurate for defining the extent of myocardial infarction. Non-revascularized patients showed a significantly greater extent of akinesia-dyskinesia and moderate-severe perfusion defects than did revascularized patients, which can be considered a result of therapy. It is suggested that 201Tl rest perfusion be used for the assessment of myocardial infarction soon after revascularization.

Resultados clínicos de la resincronización ventricular en pacientes con insuficiencia cardíaca severa / Results of intraventricular resynchronization in patients with severe cardiac failure

BACKGROUND: Intraventricular resynchronization with pacemakers is a promising therapy for patients with refractory cardiac failure and intraventricular conductions delay. However its long term effects are not well known. AIM: To report the results of this therapy in patients with cardiac failure. PATIENTS AND METHODS: Fourteen patients (11 male), whose mean age was 68 years, with a severe and refractory cardiac failure, have been treated in our unit using intraventricular resynchronization with pacemakers. Eight had a coronary heart disease and six a dilated myocardiopathy. The pacemaker was implanted transvenously, with conventional stimulation in atrium and right ventricle. The left ventricle was stimulated through an epicardial vein, accessed through the coronary sinus. RESULTS: In one patient the high thresholds did not allow a left ventricular stimulation. In the other 13 patients, a clinical improvement was observed in 11 (85 per cent), that has been sustained for a mean of 8.2 months. The ejection fraction improved form 23.5 to 32.4 per cent (p < 0.001), the 6 min walking test improved from 347 to 437 m (p = 0.003) and the functional capacity changes from 3.3 to 2.7 (p < 0.001). Three patients died during follow up. One was the patient in whom the stimulation failed and two had a sudden death. No complications of the procedure were observed. CONCLUSIONS: In this series, intraventricular resynchronization with pacemakers was effective in 11 of 13 patients, improving functional capacity and ejection fraction. Sudden death could be avoided adding a defibrillator to the pacemaker system.

[SPECT tomography with F 18-fluorodeoxyglucose in a recent myocardial infarction clinical case]. / Tomografía SPECT con F18-fluorodeoxiglucosa en infarto reciente del miocardio. Caso clínico.

We report a 50-year-old woman with a recent myocardial infarction in whom a myocardial perfusion single photon emission computed tomography (SPECT) with Thallium201 was done simultaneously with a F18-fluorodeoxyglucose (FDG) SPECT to study glucose metabolism. Myocardial infarction was located in the anteroseptal and apical regions and an echocardiography, done at the second day of evolution, showed a septo-apical hypokinesia. On the tenth day, a coronary angiography showed a critical lesion of the anterior descending coronary artery and an angioplasty with stent placement was performed on the next day. On the twelfth day, a resting, redistribution 201Tl SPECT to study viability and a FDG-SPECT with a dual head high-energy collimator camera were done. Images, acquired 45 min after injection, were analyzed visually. In anterior and medial apical sectors, discordance between flux and metabolism, considered a classical mismatch, was observed. Echocardiographic hypokinesia disappeared three month after revascularization.

Cardiorespiratory reflex due to pulmonary J receptors stimulation by acetaldehyde in rats.

Acetaldehyde (AcH) administered intravenously or into the right ventricle induces reflex bradycardia, hypotension, and apnea in the rat. The efferent pathway for this reflex is vagal and probably secondary to pulmonary J receptors stimulation. Located between the alveoli and the pulmonary capillary, J receptors are accessible through the pulmonary circulation and the airways. For this reason, a method for indirect nebulization (IN) of AcH into the airways, that provides a continuous record of respiration without changes in intrapulmonary pressure, was developed. IN of AcH (n = 14) induced bradycardia (64 +/- 3.1%), hypotension (34 +/- 4.2%), and apnea (79%), which were blocked by vagotomy (n = 9). The latencies (s) for bradycardia (0.34 +/- 0.06), hypotension (0.68 +/- 0.11), and apnea (0.25 +/- 0.11) were significantly shorter than those obtained by the intravenous route. Three rats that did not develop apnea had an equivalent response, where both tidal volume and minute ventilation decreased about 40% and these effects were also blocked by vagotomy. Indirect nebulization of AcH allowed us to demonstrate that pulmonary J receptors are responsible for this reflex response.

[Fetal echocardiography. I. The technic and fundamentals]. / Ecocardiografía fetal. I: Técnica y fundamentos.

This study describes the method and principles of fetal echocardiography, analyzing the technics and the utility of bidimensional mode, M mode and Doppler ultrasound on congenital fetal cardiopathies. The importance of early diagnosis in the structural alterations and fetal cardiac arrhythmias is emphasized.

[Fetal echocardiography. II. Biometry of the normal fetal heart]. / Ecocardiografía fetal. II: Biometría del corazón fetal normal.

Normal fetal hearth biometry is analyzed by echocardiography in 80 pregnant women with 20 and 40 gestational weeks. Intraventricular septum, aorta, left and right ventricular dimensions were obtained. All dimensions showing progression with gestational age.

[Fetal echocardiography. III. The antenatal diagnosis of structural and rhythm changes]. / Ecocardiografía fetal. III: Diagnóstico antenatal de alteraciones estructurales y del ritmo.

We present 119 echocardiographies in 90 high-risk pregnancies, 20 to 40 weeks gestational age. There were found 18 fetuses with abnormal examinations (20%), six of them with structural alteration (6.6%), and 14 arrhythmias (15.5%). The diagnostic correlation in structural alterations with a sensibility of 83% and 100% specificity, and 100% of sensibility and specificity in arrhythmias. The importance of antenatal diagnosis in cardiac malformations and arrhythmias is described.

[Anorexia nervosa and pregnancy]. / Anorexie mentale et grossesse.

We report the case of a pregnancy associated with severe anorexia nervosa. The patient weighed 33 kg for 1 m 51 at conception. The pregnancy was obtained during a spontaneous cycle. Despite nutritional and psychological case, the patient continued to lose weight and weighed only 28 kgs at 33 weeks of amenorrhea, when she gave birth to a hypotrophic child of 1130 gr after artificial starting. The case provides discussion of the relation ship between anorexia nervosa and pregnancy.

Cardiorespiratory inhibitory reflex induced by intravenous administration of acetaldehyde in rats.

In urethane anesthetized rats, intravenous administration of a bolus of acetaldehyde (diluted 50 times its volume in Ringer Locke solution) induced after a latency of about 1 second, a triple reflex response characterized by transient bradycardia, hypotension and apnea. Intensity of both bradycardia (r = -0.78) and hypotension (r = -0.74) were dose dependent (p less than 0.001). The triple response was blocked by vagotomy. Atropine and hexamethonium blocked bradycardia and hypotension and pretreatment of rats with reserpine (0.5 mg/100 g b.wt., IP) did not change the magnitude of the reflex response. The bolus effect was discarded by injecting the same volume of Ringer Locke solution in control test experiments. Administration of acetaldehyde directly into the left ventricle induced neither bradycardia nor hypotension, thus discarding a Bezold-Jarish reflex response. Administration of acetaldehyde directly into the right ventricle induced an increase in reflex bradycardia, hypotension and apnea with a shorter latency as compared to the intravenous route. The results suggest that the response induced by acetaldehyde is mediated by a reflex increase in vagal tone and probably is initiated in pulmonary vagal afferent fibers associated with the pulmonary J receptors.

Cardiorespiratory reflex effects induced by intravenous administration of ethanol in rats.

Intravenous administration of a bolus of ethanol (40 mg/100 g b.w.) to rats induced bradycardia, hypotension and apnea. Bradycardia was dose dependent (r = -0.78, p less than 0.001). Acute bilateral vagotomy blocked bradycardia and hypotension. Apnea, however, persisted in all cases but was of short duration and occurred after a significant delay as compared to an untreated group. Atropine (0.1 mg/100 g b.w.) and hexamethonium (0.75 mg/100 g b.w.) blocked bradycardia and early hypotension. Pretreatment with reserpine (0.25 mg/100 g b.w. IP 24 and 48 hours before the experiment) significantly increased bradycardia induced by ethanol as compared to untreated animals. In rats pretreated with reserpine and vagotomized, IV ethanol did not induce bradycardia, early hypotension or apnea. A bolus of ethanol (20 mg/100 g b.w.) given directly into the left ventricle did not induce reflex changes in heart rate or respiration, while the same dose of alcohol given IV decreased heart rate by 53 +/- 8.9%. Thus, the ethanol effect seems to be initiated in pulmonary J receptors. Bradycardia appeared to be mediated both by increase in vagal tone, and to a lesser extent, by sympathetic withdrawal. Hypotension was due mainly to bradycardia, and apnea might be caused by a dual mechanism, reflex (early) and direct on the respiratory center (late).

Regulatory function of Thy1-negative cells. I.--Evidence for cells without the Thy1-surface marker and without phagocytic properties, enhancing the IgM antibody response.

Dextran-activated Thy1-cells are effective in enhancing the IgM anti-body response of syngeneic and allogeneic spleen cells to an unrelated antigen. This regulatory activity is mediated through a soluble B-cell-enhancing factor (BEF) which is released by activated cells. Removal of macrophages by silica-treatment does not abolish the regulatory activity of remaining cells. BEF can be considered as an auxiliary factor which does not substitute for either T cells or macrophages in in vitro antibody production.

A simple method to obtain an in vitro primary immune response to dinitrophenyl coupled to bovine gamma-globulin.

This paper describes a simple method of achieving a primary in vitro response to dinitrophenyl coupled to a soluble protein. Mice are carrier-immunized, then irradiated and restored with spleen cells from normal donors. Spleen cells are then cultured in the presence of dinitrophenyl on homologous carrier. The anti-hapten antibody synthesis is dose-dependent, and the highest response is obtained with the lowest dose used in the experiments. The higher level of hapten conjugation reduces the immune response.