[Dumesnil's method: is it viable?]. / La méthode de dumesnil: est-elle fiable?

BACKGROUND: Left ventricular (LV) ejection fraction (EF) is an indicator of left ventricular systolic function and is a potent predictor of cardiovascular mortality. LVEF is assessed by a variety of methods, however echocardiography is the most used in clinical practice. Simpson biplane multiple disc method (BMDM) is recommended by the American Society of Echocardiography; Dumesnil's method based on doppler echocardiography seems to be simpler and theoritically less influenced by distortion of LV geometry. OBJECTIVE AND METHODS: To assess the accuracy and reproducibility of Dumesnil's method a group of 100 patients proposed for coronarography with left ventricular angiography, prospectively underwent LVEF measurements by both BMDM and Dumesnil's method. RESULTS: Compared with LV angiography, the correlation coefficient for the Dumesnil's method was r = 0.85 and it was r = 0.9 for BMDM. Correlation in patients with LV regional asynergy were respectively r = 0.69 and r = 0.85. Intraobserver and interobserver variabilities were less then 7% for both echocardiographic methods. CONCLUSION: Although Dumesnil's method is less accurate than BMDM, it is simpler, more rapid with a satisfactory reliability and reproducibility.

Anticoagulant profile of iopamidol and meglumine amidotrizoate and their lack of thrombin generation: an in vitro study.

The aim of this in vitro study was to sketch the subtle anticoagulant profile of iopamidol 300 mg l/ml (low osmolality non ionic contrast medium) and meglumine amidotrizoate 370 mg l/ml (high osmolality ionic contrast medium) in situations where variable amounts of clotting factors are observed and to check whether thrombin-generation significantly occurred in non anticoagulated blood-contrast materials mixtures. In the first experiment, mixtures of deficient plasmas with a routine plasma pool provided different ranges with variable amounts of clotting factors II, V, VIII, X, XI and XII. For each clotting factor level studied within these ranges, an activated partial thromboplastin time was determined with either contrast material loaded thromboplastin (5% v/v) or glucose loaded thromboplastin (5% v/v) used as a control. In the second experiment fibrino-peptide A (FpA) or modified antithrombin III (ATM) assays were performed in either (9:1) non anti-coagulated blood contrast materials mixtures or blood-glucose mixtures (control). Differing aPTT prolongation profiles were observed when clotting factors V, VIII, XI and XII were lowered in the plasma. However, neither iopamidol nor amidotrizoate induced an aPTT prolongation with decreasing clotting factor II. In the second experiment no significant thrombin generation was observed as both blood-contrast materials mixtures showed significantly lower FpA and ATM levels (p < 0.001) than glucose control after 5 minutes and 10 minutes incubation at room temperature. These findings provide evidence that the use of iopamidol in angiographic procedures does not increase risk of clotting or hemorrhage.

[Hydatid cyst of the heart of multivesicle type. Apropos of a case]. / Kyste hydatique du coeur de type multivésiculaire. A propos d'un cas.

The authors report the case of a 30 year-old man on whom the diagnosis of hydatic cyst of the heart (HKC) was strongly suspected on bi-dimensional echocardiography and confirmed by surgery. This case is interesting because this HCH, completely latent clinically, was discovered by echocardiography performed in view of a localized infra-epicardic ischemia, the major contribution of bi-dimensional electrocardiography enabling to make a quick and easy anatomical and topographic diagnosis, the primary nature of this hydatic localization which does not affect any other organ, and finally the multivesicle aspect of the cyst, rather unusual in single localizations of hydatic cyst of the heart. A brief review of the literature is then presented.

[A sociologic study of health care accessibility in an urban milieu in Tunis]. / Une étude sociologique de l'accès aux soins en milieu urbain à Tunis.

In developing countries, the study of access to medical care reveals the inequality of health coverage. In rural areas, the two main limiting factors are the lack of health services and the difficulty of access, especially distance. But the relevant factors in urban areas have been little studied. In Mellassine, which is the largest slum of Tunis, we studied the behaviour of 400 under-4 children's mothers in relation to health care. The following factors proved relevant: sex of the child, size of the family, father's profession, level of education, material resources; distance, cost and quality of reception of health services; finally the cultural pattern, particularly the representation of children disease by the mothers. Such an approach allows a reflection to reduce the inequality of access to medical care.