[Rapid decrease of serum endothelin-1 levels after treatment with ACE inhibitors in chronic cardiac failure]. / Diminution rapide des taux sériques d'endothéline-1 après traitement par inhibiteur de l'enzyme de conversion dans l'insuffisance cardiaque chronique.

Circulating endothelin-1, a very strong peptide vasoconstrictor first discovered in 1988, is raised in cardiac failure. This increase contributes to the deleterious effects of cardiac failure. Although specific anti-endothelin drugs are under development in this condition, the effects of more commonly used drugs on circulating endothelin-1 levels are not well known. The aim of this study was to evaluate the effects of ACE inhibitor therapy on plasma endothelin-1 levels in cardiac failure. The plasma endothelin-1 levels were measured in 24 patients (stages III and IV of the NYHA classification), before and after treatment with angiotensin converting enzyme inhibitor (Captopril: test doses, then 75 mg/day). A control group of 10 paired patients was used to shake off the effects of bed rest and hospital salt-free diet. The initial endothelin-1 levels were high but equivalent in the control and study groups: 9.13 +/- 1.87 fmol/mL vs 8.98 +/- 1.92 fmol/mL. Plasma endothelin-1 decreased significantly in the study group 72 hours after beginning ACE inhibitor therapy (7.44 +/- 1.95, p < 0.02) but remained higher than normal (p < 0.01), whereas the values in the control group remained the same. This study demonstrates a decreases in plasma endothelin-1 levels 72 hours after onset of ACE inhibitor therapy in patients with stable severe cardiac failure. This results, already suggested by many experimental studies and certain ancillary clinical trials, could explain some of the beneficial effects of ACE inhibitors in this condition.

Investigation of the thoracic aorta in cholesterol embolism by transoesophageal echocardiography.

OBJECTIVES: To examine the thoracic aorta of patients with severe cholesterol embolism (CE) by transoesophageal echocardiography (TOE). METHODS: The thoracic aorta of 20 consecutive patients with CE was compared with that in a control population matched for age and risk factors by TOE. Patients were prescribed steroids after CE was diagnosed. Follow up is reported and compared with results in the literature. RESULTS: Aortic plaques and debris were more common in patients with CE than in the control population (p < 0.001 and p < 0.0001, respectively). The mean (SD) number of aortic plaques in the CE patients was 2.6 (0.7). This aortic atheroma was found predominantly in the descending aorta. One patient died during a mean (SD) follow up of 24 (10) months. CONCLUSIONS: Aortic atheroma, as detected by TOE, should be considered as the main source of CE. In addition, the prognosis in our series, in which steroids were systemically prescribed, is much better than in others reported in the literature.

[Pulmonary hypertension caused by talcoma in a couple of drug addicts]. / Hypertension artérielle pulmonaire sur talcome chez un couple de toxicomanes.

The authors report a case of severe pulmonary hypertension (PHT) in a couple of HIV seropositive heroin addicts. The parallel clinical course in these two patients with only mild immunodeficiency and the fact that they both had the same supplier were in favour of PHT secondary to talcoma. In the light of these cases, one wonders whether, as suggested by certain epidemiological studies currently underway, drug addiction should be considered to be a cause of PHT in its own right. According to the authors, this approach would underestimate the incidence of this disease in this particular population and would therefore bias the epidemiological data.

[Severe pulmonary hypertension complicating a long treatment with dexfenfluramine]. / Hypertension artérielle pulmonaire sévère compliquant un long traitement par la dexfenfluramine.

The authors report a case of severe pulmonary hypertension after long-term dexfenfluramine treatment in a 48 year old man with no previous medical history. Dexfenfluramine, which has previously been reported to cause pulmonary hypertension, is an amphetamine-like anorexic agent, a pharmacological group known to predispose to this type of side effect. The possibility of this complication should be born in mind before prescribing the drug. In particular, it would seem to be particularly important not to exceed the recommended length of treatment especially as potential reversibility of pulmonary hypertension on withdrawal of the drug has been reported in one case.