[An independent observatory in Vendée on ST-elevated acute myocardial infarction (the OVISCA Register). A Departmental evaluation of demographic trends, mortality and delays before treatment]. / Observatoire Vendéen indépendant des syndromes Coronarien aigus avec sus-décalage du segment ST (Registre OVISCA). Évaluation départementale, évolution démographique, mortalité, délais de prise en charge.

AIM: Mortality from acute myocardial infarction has been falling during the past 30 years. The aim of the study was to evaluate the temporal trends of demographics, mortality rates, and time to treatment in patients admitted for acute ST elevation myocardial infarction (STEMI) in Vendée. PATIENTS AND METHODS: From 2008 to 2016, 1994 patients hospitalised in CHD Vendée for STEMI <48hours were included. Two groups were compared, 838 patients admitted between 2008 and 2011 (group 1), and 1156 admitted between 2013 and 2016 (group 2). RESULTS: Between the 2 periods, mean age was comparable (63.8 vs. 64.4 years), the gender ratio decreased (from 3.15 to 2.79 ; P=0.25). The mean duration of hospital stay was 0.8 day shorter (P=0.008). Treatment at discharge was optimum in 97.5% patients versus 92% (P<0.001). Left ventricular ejection fraction was comparable (50.6% vs. 50.2%). There was a non-significant trend to a decrease in hospital mortality (from 6.3% to 4.4%; p=0.12), and 6-month mortality (from 6.9% to 5.9%; P=0.51). There was a reduction in the use of emergency call-outs (74.9% to 68.9%; P<0.01), but an increase in direct presentations from 44% to 48.7% (P<0.05). The time before calling was comparable (2.5hours vs. 2.3hours; P=04.7). The "door-to-balloon" time decreased (0.71 vs. 0.55hour; P<0.001). The mean time between pain and angioplasty increased (5.7 vs. 6.8hours; P<0.05). CONCLUSIONS: In vendee, from 2011 to 2016, hospital and 6-month mortality of STEMI trend to decrease non-significantly. The door to balloon time decreased, although emergency call-out rates and delays did not. Considerable efforts are still required with respect to patient information and education. Our registry offers an excellent tool to improve practices, the aim being to ensure its integration in the CRAC-France PCI registry.

201Tl myocardial imaging in a cardiac rejection episode.

Serial myocardial imaging using thallium Tl 201 was performed in the early follow-up of two patients with orthotopic cardiac transplantation. In one patient, non-homogeneous uptake, small defects and an irregular myocardial edge were observed during a moderately acute rejection crisis revealed by endomyocardial biopsy. The abnormal gammagraphic findings and histological changes were coincident and exhibited a parallel reversal. We emphasize the connection between these two events. The mechanisms which could explain these phenomena are discussed.

Ureteral reflux of recipient's own kidneys. A potential source of error in renal transplant evaluation.

After transplantation, pre-existent vesicoureteral reflux caused a hot paravesical area mimicking urine extravasation.

Scintigraphic demonstration of a diaphragmatic defect as the cause of massive hydrothorax in cirrhosis.

A 64-year-old man presented with a massive right-sided hydrothorax associated with cirrhosis of the liver. There was no clinical evidence of ascites nor other underlying disease. The usual complementary tests failed to demonstrate any causative abnormality. Chest and abdominal scintigraphy after intraperitoneal injection of 99mTc-human serum albumin disclosed early filling of the pleural space by the radiopharmaceutical and suggested a diaphragmatic defect as the cause for this rare association.

[67gallium. Diagnostic possibilities and usefulness as a tracer]. / El citrato de 67Galio. Posibilidades diagnósticas y utilidad como rastreador.

As a consequence of its affinity to leukocytes and tumour cells, 67Gallium-Citrate is a good isotope for detecting infections and tumoral pathology. Its sensitivity is greater for lymphatic system malignancies, primary lung cancer, primary liver carcinoma and melanoma. It is a useful method with more sensitivity than diagnostic specificity.

[Indirect isotopic lymphography. Technic and clinical applications]. / La linfografía isotópica indirecta. Técnica y aplicaciones clínicas.

Interstitial lymphoscintigraphy is a diagnostic method useful in the staging and follow-up of several tumours as well as in the etiological evaluation of limb edema. It is a simple technique with minimal invasivity which can be performed even in those regions inaccesible to radiographic lymphography. Because of its great sensitivity and low specifity it requires careful interpretation.

Ureteral fistula after renal transplantation: the significance of delayed images.

Urinary leakage after renal transplantation is a serious complication that can lead to diagnostic difficulties. A case is reported of urinoma secondary to ureteral fistula characterized in the routine study by a photon-deficient area. Only the image obtained at 6 h allowed a correct diagnosis. The causes for this are discussed and the need to include a delayed study in the follow-up protocol of these patients is emphasized.