[Value of factor analysis in a wall motion study: preliminary application in the detection of left ventricular segmental contraction ischemic disorders by echocardiography]. / Apport d'une analyse factorielle à l'étude de mouvements: application préliminaire à la détection par échocardiographie des troubles de la contraction segmentaire du ventricule gauche ischémique.

PURPOSE: Factor Analysis of Medical Image Sequences (FAMIS) was tested to study the regional wall motion of the left ventricle at echocardiography. MATERIALS AND METHODS: FAMIS analyzed the time signal curves of each pixel. One flat curve and one curve describing the contraction-relaxation of the left ventricle were first estimated. The contributions of the curve of each pixel to the two previous curves were computed, yielding two "factor images". The spatial distribution of positive and negative coefficients of the second factor image was analyzed. The evaluation was carried out on 222 segments (20 patients, 18 parasternal short-axis views, 17 apical four-chamber views, and 15 apical two-chamber views). A first echocardiographer reviewed the factor images and the reading was compared to the conventional reading of the cine-loops by two other echocardiographers. Each segment was scored as normal, hypokinetic, akinetic, or dyskinetic. RESULTS: On normal segments, the positive coefficients of the second factor image were on the inner side, the negative coefficients were on the outer side. Dyskinesis yields the opposite pattern. Hypokinesis and akinesis give intermediate images. An absolute concordance was obtained on 71.2% of all segments between the two types of reading. Larger discrepancies were found for akinetic and hypokinetic segments. CONCLUSION: FAMIS is a promising tool to study regional wall motion of the left ventricle.

[Attitude of family of psychiatric patients to psychiatric research, especially to early detection of schizophrenic psychoses]. / Die Einstellung von Angehörigen psychisch Kranker zu psychiatrischer Forschung, insbesondere zur Früherfassung von schizophrenen Psychosen.

OBJECTIVE: To assess attitudes of relatives of mentally ill patients to psychiatric research, especially to early detection of schizophrenic psychosis, and to evaluate the potential stigmatization effect of an early diagnosis of schizophrenic psychosis. METHODS: A questionnaire was sent to relatives of mentally ill patients, all members of a self-help group in Switzerland. They were asked to answer structured questions about their personal attitude to psychiatric research in general, their willingness to support an affected person to participate in a research project, their attitude to early detection of schizophrenia and to the potential stigmatization of an early diagnosis. RESULTS: 88% of the relatives (n = 200) have a positive attitude to research in psychiatry. 47% would support their affected family member to participate in a research project whereas 39% would not. 52.5% fully share the expectation of psychiatric research to attain a better course by earlier detection of psychosis, 24.5% tend to agree. 20.5% of the respondents indicate a fear of stigmatization for the affected by earlier diagnosis, while 12% fear stigmatization for themselves. CONCLUSIONS: A surprising fact is the positive attitude of relatives to psychiatric research in general, but also to early detection of schizophrenic psychosis. But this cannot lead to the conclusion that relatives are supporting the participation of an affected family member in research. The small number of relatives that fears a stigmatization by earlier diagnosis of schizophrenic psychosis shows that stigmatization depends on other factors than the diagnosis, i.e. psychiatric hospitalization or medication side effects. These findings encourage psychiatric research to increase knowledge of the early phase of schizophrenia in favor of patients and their relatives.

[Early postoperative thrombolysis of Saint-Jude aortic valve prosthesis]. / Thrombolyse postopératoire précoce d'une valve de Saint-Jude aortique.

The authors report a case of thrombolytic therapy with streptokinase in the early postoperative period after aortic valve replacement with a Saint Jude medical prosthesis. After good initial progress, the patient had to be reoperated on the 12th postoperative day for sternal disunion. Reoperation was followed rapidly by progressive thrombosis of the aortic prosthesis demonstrated by repeated Doppler echocardiographic examination. The impossibility of eliminating mediastinitis led to medical thrombolysis. The outcome was favourable after a regressive cerebral embolic event. This case illustrates the value of Doppler echocardiographic examination in the postoperative period. Thrombolysis may constitute an alternative to reoperation when the operative risk is high. The risk of thrombolysis may not be as great as some believe.

[Transesophageal stimulation in the treatment of atrial flutter and tachysystole. Factor influencing immediate results]. / La stimulation transoesophagienne dans le traitement du flutter et de la tachysystolie auriculaire. Facteurs influençant les résultats immédiats.

The effectiveness and safety of transoesophageal atrial pacing in the treatment of atrial flutter and tachycardia have been well demonstrated. The purpose of this study was to determine the factors that could influence the results of this method at the end of the procedure. Seventy-seven transoesophageal atrial pacings were performed in 62 unselected consecutive patients with either flutter or atrial tachycardia. The following parameters could be evaluated in 55 patients: date of onset of the arrhythmia, echocardiographic diameter of the left atrium, maximum amplitude of oesophageal atrial potentials, voltage and frequency of stimuli in the last stage of pacing. Our results can be summarized as follows: In both flutter and atrial tachycardia taken globally, conversion to sinus rhythm was obtained in 37 p. 100 of the cases, and conversion to atrial fibrillation in 46.7 p. 100 of the cases. The failure rate was 19.4 p. 100; all failures were due to lack of atrial capture during pacing. The main factor or transoesophageal atrial capture is voltage. Patients must be able to tolerate the voltage needed for capture. In the case of flutter, when capture was achieved a normal-sized left atrium and a high maximum amplitude of oesophageal atrial potentials were factors indicating that conversion to sinus rhythm could be expected. This, however, did not apply to atrial tachycardia. -- Whatever the type of tachyarrhythmia, the more recent its onset the easier its reduction.

[Direct cardiac effects of angiotensins I and II and 2 converting enzyme inhibitors (captopril and perindopril). Indirect demonstration of a converting enzyme in the rat heart]. / Etude des effets cardiaques directs des angiotensines I et II et de deux inhibiteurs de l'enzyme de conversion (captopril et périndopril). Mise en évidence indirecte d'une enzyme de conversion au niveau du coeur de rat.

In order to establish the possible existence of a cardiac converting enzyme and its role in the pathophysiology of the myocardial ischemia, the direct cardiac effects of IEC and AI or AII were studied on the isolated rat heart perfused through the left atria. Three series of seven hypertensive rats (SHR) were used. The reduction of the aortic flow (QAO) due to ischemia (produced by a left coronary artery ligation of 10 mn) was brought into line with the reduction of the coronary flow (QCORO) and the weight of the heart. This reduction was 2.06 +/- 1.8 for the control, 1.96 +/- 1.27 when captopril (CAP) (10(-5) M) was added to the perfusion liquid and 1 +/- 0.42 when perindopril (PER) (1.2 x 10(-5) M) was added to the perfusion liquid (p less than 0.05 vs CAP). Four series of 10 rat hearts (Sprague Dawley) were used to study the changes on the working heart caused by short perfusions of AI or AII (10(-7) M) in the presence of IEC or saralasin (SAR 10(-7) M). AII caused a reduction of the QCORO of 2.1 +/- 0.26 ml/mn, an increase of the QAO of 2.5 +/- 0.9 ml/mn and an increase of the heart rate (HR) of 9 +/- 3.24 beats/mn. In the presence of CAP or PER the effects of AII were the same, however in the presence of SAR these effects were prevented. AI caused a reduction of the QCOR of 2.5 +/- 0.4 ml/mn, an increase of the QAO of 2.5 +/- 0.8 ml/mn and an increase of the HR of 18 +/- 4 beats/mn.(ABSTRACT TRUNCATED AT 250 WORDS)

[Tricuspid endocarditis with right-left auricular shunt through a patent foramen ovale]. / Endocardite tricuspidienne avec shunt auriculaire droite-gauche à travers un foramen ovale perméable.

The authors report the case of a tricuspid endocarditis secondary to Streptococcus bovis with important regurgitation and severe hypoxemia secondary to a right-left atrial shunt through a patent foramen ovale, requiring a surgical treatment which included the replacement of the tricuspid valve and closure of the dehiscence in the inter-atrial septum. The presence of a patent foramen ovale in the course of a tricuspid endocarditis has been exceptionally reported. This diagnosis deserves to be evoked in case of an unexplained hypoxic condition or a systemic embolism complicating a tricuspid endocarditis. The report emphasizes the advantage of ultrasonic examinations (contrast sonocardiography, pulsated Doppler) in order to demonstrate this right-left atrial shunt in addition to the data collected about the tricuspid valve.

[Effects of the level of polyunsaturated fatty acids of the diet on the functioning and depletion of energy substrates in the rat heart during perfusion by left atrial route]. / Effets de la teneur en acides gras polyinsaturés du régime sur le fonctionnement et la déplétion en substrats énergétiques de coeur de rat au cours de la perfusion par voie atriale gauche.

The effects of semi-liquid diets containing 6.6% in weight of refined sunflower seed oil (SSO) or hydrogenated coconut oil (HCO) on cardiac endogenous substrates and functional parameters of rats hearts were compared to a standard laboratory chow during seven days. No difference appeared for cardiac glycogen and lipid constituents. Cardiac performance, measured through left atrial perfusion was enhanced by SSO diet and HCO one altered it. A significative phospholipid depletion appeared during the 45 minutes perfusion only in the HCO group.

[Systemic arterial hypertension caused by discharge of catecholamines following ligation of ductus arteriosus]. / Hypertension artérielle systémique par décharge de catécholamines après ligature d'un canal artériel.

A case of severe systemic hypertension due to catecholamines discharge after ligation of a large patent ductus arteriosus in an 8 months old child is reported. The blood pressure was corrected by the association of alpha- and betablocker drugs which were withdrawn on the 15th post-operative day without recurrence. Transient increases in blood pressure are quite common after closure of a patent ductus arteriosus with a large shunt. Persistent hypertension greater than 160/110 mmHg is rare. It always regresses but may sometimes cause complications. Hyperactivity of the sympathetic nervous system has already been suggested as a possible cause. Massive discharge of catecholamines and the spectacular effect of the association of alpha- and betablocker therapy, reported here apparently for the first time, provide additional evidence in favour of this hypothesis.