[Heart conduction disorders in long-term treatment with chloroquine. Two new cases]. / Troubles de la conduction cardiaque au cours d'un traitement prolongé par chloroquine. Deux nouvelles observations.

Cardiac complications are exceptional in long-term chloroquine therapy; congestive heart failure and restrictive cardiomyopathy may develop, but disorders of conduction are more frequent. The characteristics of these disorders emerge from 12 cases in the literature and from 2 personal cases. The usual disorder is fascicular block which may become a complete, syncopal, atrioventricular block, as in one of our 2 patients. The time elapsed between the beginning of treatment and the occurrence of these disorders (2 to 30 years) and the total dose of chloroquine received (100 to 2,500 g) are extremely variable. Retinopathy or neuromyopathy is present in 64 and 35 percent of the cases respectively. The diagnosis is confirmed by endomyocardial biopsy with electron microscopic study which shows vaculoar myopathy with numerous large secondary lysosomes containing a dense material of lamellar structure (myelinic figures, curvilinear bodies). Regression of heart conduction disorders after withdrawal of chloroquine seems to be inconstant and incomplete. The rare occurrence of this complication raises the question of genetic predisposition. We believe that chloroquine therapy should be contra-indicated in patients with a history of conduction disorders and that a 6-monthly electrocardiographic control of these patients would be justified.

[Chronic constrictive pericarditis responsible for an increase of CA 125 levels. Two cases]. / Péricardite chronique constrictive responsable d'une élévation du CA 125. Deux observations.

Despite its poor specificity, CA 125 is a widely used tumoral marker. Significant rises in serum CA 125 levels are found mainly in ovarian cancer, but they also occur in other malignant or benign pathologies such as chronic liver diseases. However, in benign pathologies the CA 125 concentrations hitherto reported did not exceed 850 U/ml. The authors report two cases of chronic constrictive pericarditis with ascites and pleural effusions in which a very high increase of serum CA 125 levels (above 1,200 U/ml) was directly related to the presence of pleural effusions.

[Variability of arterial pressure during consultation. Effect of the physician and patient characteristics]. / Variabilité de la pression artérielle de consultation. Influence du médecin et des caractéristiques du patient.

The decision to treat patients with high blood pressure depends largely on the level of pressure. However, a major difficulty is the great variability of blood pressure level in any individual patient. From May 1st 84 to July 1st 84, 259 patients were referred for the first time to the outpatient clinic and were seen by one of the four physicians. Before the consultation and during the medical interrogatory 18 + 8 measures were performed every 2 minutes by an automatic device using the oscillometric method. The physician measured the blood pressure (BP) using the auscultatory method according to the WHO recommendations, after the medical interrogatory. Measured by the physician, BP was 174 + 28/104 + 15 mmHg. Measured by the automatic device, BP was 158 + 22/94 + 14 mmHg. The correlation between the two methods was excellent (SBP: r = 0.88 and DBP: r = 0.82; p less than 0.001) but the mean of BPs automatically recorded was significantly lower (-15/11 mmHg) than the BP measured by the physician. The mean of the highest BPs recorded by the oscillometric method (179 + 26/108 + 16) was slightly higher than the BP recorded by the physicians. Blood pressure variability was defined by the standard error (SE) of BPs measured by the automatic device (SE: 11 + 4/7 + 2). SE was positively correlated with the BP level measured by the physician or by the machine and with the heart rate variability for both SBP and DBP, and with patient's age for SBP only. SE was negatively correlated with the coffee consumption and the tobacco consumption. Blood pressure variability was significantly higher in men than in women (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)