[Left ventricle assist device: rehabilitation and management programmes]. / Patients sous assistance circulatoire mécanique mono-gauche en centre de réadaptation cardiaque. Retour d'une expérience de prise en charge.

Progress in the medical management of patients with heart failure with systolic dysfunction has been accompanied by a significant improvement in survival and quality of life. These strategies have also resulted in changes in the clinical profile as well as an increase in the number of patients with advanced heart failure. The technological developments in left ventricular assist devices provide real hope for these patients. This article related our experience of management and the rehabilitation program realized.

[Synthetic peptide vaccines].

This review considers the stages of the development of synthetic peptide vaccines against infectious agents, novel approaches and technologies employed in this process, including bioinformatics, genomics, proteomics, large-scale peptide synthesis, high-throughput screening methods, the use of transgenic animals for modelling human infections. An important role for the development and selection of efficient adjuvants for peptide immunogens is noted. Examples of synthetic peptide vaccine developments against three infectious diseases (malaria, hepatitis C, and foot-and-mouth disease) are given.

[Synthesis of beta-amyloid fragment 5RHDSGY10 and its isomers].

Peptide RHDSGY that represents the fragment of human beta-amyloid Zn-binding site and its isomers RH(D-Asp)SGY and RH(beta-Asp)SGY have been prepared by solid-phase synthesis and analysed by HPLC and various mass-spectrometric methods. The problem of low yield of peptide RHDSGY and its isomers attributed to 9-fluorenylmethoxycarbonyl (Fmoc)-amino acids and/or formation of side-products as RH(Asp-imide)SGY and RHDSGY (instead of RH(beta-Asp)SGY) was solved via selection of reagents for the removal of Fmoc groups from the growing peptide chain.

Iatrogenically-related, fatal methotrexate intoxication: a series of four cases.

Since the early eighties, the folic antagonist methotrexate (MTX) has been used in long-term treatment of rheumatoid arthritis. Because of the high toxic potential clinical and laboratory controls at regular intervals and patient education in order to avoid misadventure is of overriding importance. We present four cases of fatal MTX intoxication due to medical malpractice from the Tübingen Institute of Forensic Medicine autopsy material, which show the severe consequences of MTX overdose. It becomes evident that among non-rheumatologists there still is need for information about toxicity and dose limitation in MTX low-dose treatment.

[Transient left ventricular apical ballooning or the tako-tsubo syndrome]. / Ballonisation apicale transitoire du ventricule gauche ou syndrome du tako-tsubo. A propos de 10 nouveaux cas.

Recently, Japanese authors have described a new clinical entity associating apical akidyskinesia and basal hyperkinesias without significant coronary artery disease under the name of the tako-tsubo syndrome. This syndrome is usually observed in elderly women and the clinical presentation is usually that of an acute coronary syndrome. The authors report 10 cases of patients investigated between June 2003 and August 2004. All patients were women with an average age of 66 +/- 15 years. Seven patients had chest pain on admission with, in three cases, signs of cardiac failure. In 8 patients, a causal factor was identified: emotional stress in 7 cases and anaphylactic shock in one case. All patients underwent coronary angiography and ventriculography which showed typical changes in left ventricular contractility without significant coronary disease. The peak CPK and troponin values were 222 +/- 115 UI/l and 3.32 +/- 1.50 microg/l, respectively. One patient died in cardiogenic shock. In the other cases, normalisation of wall motion was observed in the month following the onset of symptoms. One patient developed 3rd degree atrioventricular block and required implantation of a pacemaker. This clinical entity must be taken into consideration in elderly women with acute coronary syndromes.