[Bepridil and torsades de pointes: are the precautions of use respected?]. / Bepridil et torsades de pointes: les précautions d'emploi sont-elles respectées?

The torsades de pointes with bepridil are serious side-effects, known right from 1982, and for which definite therapeutic recommendations were decreed in 1984 then in 1991. The observations of 7 new cases drove us to discuss about the respect for these recommendations. From the study of these 7 middle-aged patients (+/- esm) 76.9 +/- 2.4, we have noticed that they all combined 3 risk-factors at least with an average (+/- esm) 3.71 +/- 0.29 (range 3-5). The non-respect for the methods of prescription of bepridil leads to serious trouble in the rate of heartbeat and can threaten vital prognosis. So, it is advisable for the practicians to be warmly and precisely informed and prescribe another anti-angina-pectoris treatment in high risk-patients.

[Aneurysms of the intra-atrial septum complicated by cerebral ischemia in young subjects. 4 cases]. / Anévrysmes du septum inter-auriculaire compliqués d'ischémie cérébrale chez le sujet jeune. 4 observations.

Transoesophageal echocardiography has improved the detection of potential sources of cerebral embolism. We report our experience with a group of 38 patients under 45 years of age who were examined after an arterial ischaemic cerebral event. We observed 4 patients (2 males, 2 females; age 17, 24, 38 and 40 years) with an atrial septal aneurysm. Cerebral ischaemia was permanent in 3 patients and temporary in 1 and a cerebral embolism was the most probable cause based on angiographic findings. The atrial septal aneurysm was only diagnosed by transoesophageal echocardiography (type IA in case 3, IB in the others). A patent foramen ovale was observed in 3 and this abnormality, which is known to have a high prevalence in the general population, could at most be an aggravating factor. In our series, we can assume a causal association between atrial septal aneurysm and stroke in young patients (10.5% among 38 young stroke patients vs 3% of 30 patients referred for other reasons). The treatment is still under discussion although the consensus would favour surgery if another heart malformation is associated, if a visible thrombus is identified or if repeated cerebrovascular events occur despite adequate anticoagulation. Studies conducted in large series of patients should provide more adequate therapeutic schemas.

High levels of tumor necrosis factor-alpha and interleukin-6 in the ascitic fluid of cirrhotic patients with spontaneous bacterial peritonitis.

We prospectively measured the concentrations of immunoreactive tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), and interleukin-6 (IL-6) in the serum and ascitic fluid of 14 alcoholic cirrhotic patients with spontaneous bacterial peritonitis (SBP) and 16 alcoholic cirrhotic patients with sterile ascitic fluid. TNF-alpha levels in ascitic fluid were significantly higher for the patients with SBP: 399.57 +/- 129.23 pg/mL vs. 35.76 +/- 5.57 pg/mL (P < .001). IL-6 levels in ascitic fluid were also significantly higher for the patients with SBP: 170,713 +/- 57,109 ng/mL vs. 5,414 +/- 973 ng/mL (P < .001). By contrast, serum levels of TNF-alpha and IL-6 were just slightly more elevated than normal values. The concentration of IL-1 in the ascitic fluid of all patients was elevated, but there was no difference between patients with SBP or sterile ascites in this respect. In the patients with SBP, levels of TNF-alpha and IL-6 in ascitic fluid decreased during the first 48 hours of antibiotic treatment. Our results suggest that measurements of TNF-alpha and IL-6 in ascitic fluid may become useful markers both for the diagnosis of SBP and for monitoring the treatment of cirrhotic patients.

[Phlebitis following travel]. / Phlébite du transport. 16 observations.

The term of economy class syndrome has been used to describe the deep vein thrombosis which may follow air travel. The mechanisms suggested for this include tendency to clot formation in the legs secondary to the reduced venous return induced by the sitting position with direct compression of popliteal and femoral veins, and secondary to dehydration and haemo-concentration. However, these conditions are also observed with others means of transport. We describe 16 patients with deep vein thrombosis following travel by bus, car, truck and train. These 16 patients represent 3.4 percent of 465 patients with thromboembolism managed over a 52-month period in our department. All but one patients had one or more risk factors for deep vein thrombosis. The mean duration of the trip was 14.2 hours and the first symptom occurred less than a week after the journey in 75 percent of the patients. These first symptoms suggested deep vein thrombosis in 8, pulmonary embolism in 5, and deep vein thrombosis with pulmonary embolism in 3 patients. Regular non alcoholic drinks and regular walks seem to be sufficient to prevent deep vein thrombosis in the great majority of travellers. However, low dose heparin on a temporary basis or elastic stockings could be considered in high risk subjects.