Course of valvular strands in patients with stroke: cooperative study with transesophageal echocardiography.

BACKGROUND: Native valve strands might be related to the acute stage of thrombosis or might suggest a long-term valvular change. We aimed to estimate changes in the strands in patients with stroke through a serial transesophageal echocardiographic (TEE) study. METHODS AND RESULTS: A study was conducted among patients who were referred for TEE for stroke or cardiac pathology. Patients had TEE examinations with a 5-MHz multiplane TEE probe. Echocardiography was repeated 3 months later in patients with stroke. TEE was performed in 180 patients admitted to cardiology units and in 160 patients referred to neurology units. Among 34 patients with valvular strands, 30 were referred to neurology for stroke, whereas 4 patients were admitted to cardiology (18.8% versus 2.2%, difference 16.5%, 95% confidence interval 10% to 22.9%, P =.001). Strands were located on the mitral valve in 16 patients, the aortic valve in 6 patients, and both left heart valves in 8 patients. Among the 38 valves with strands, 17 (44. 7%) were morphologically normal, 4 (10.5%) were thickened, 7 (18.4%) were redundant, and 10 (26.3%) had both abnormalities. TEE showed other abnormalities in 16 (53.3%) patients, whereas 14 patients had only strands. Twenty-six (86.6%) patients had a second TEE study 3 months later. Strands were not found in 4 (15.4%) patients (95% confidence interval 4.3% to 34.9%). CONCLUSIONS: Valvular thickening or redundancy may predispose valves to strand formation. Native valve strands usually persist and thus reflect a chronic valvular change.

[Informed consent, what information is left after a therapeutic trial?]. / Consentement informé, que reste-t-il de l'information au terme d'un essai thérapeutique?

In order to evaluate the outcome of information given to patients included in a therapeutic trial after having signed a consent form, 77 patients (68 men, 9 women with an average age of 57.9 years) included in the IMPACT study (multicenter, randomised, double-blind protocol, the main objective of which was to assess the antiarrhythmic effect of oral administration of delayed action mexiletine in patients with a recent myocardial infarction), answered a questionnaire of 85 items. The quantity and degree of comprehension of the recalled information at the end of the trial were appreciated from the replies to 13 questions based on the definition or understanding of the most important details of the consent form and on a comprehension score with a maximum value of 14 points. The global quantity of information recalled after an interval ranging from 5 to 21 months was estimated at 60% of the information provided but the recall was not uniform according to the different elements of the consent form: the aim of the study, the concept of placebo, the nature of the active treatment, the randomisation and possible side effects were only correctly apprehended by 40 to 50% of patients: the type of patient included, the duration of the trial, the content of the gelules, the division between treatment/placebo and the concept of double-blind were known to 50 to 75% of participants: the sites of the test centres, the possibility of unmasking the "blind" are of withdrawing from the trial were correctly understood in 75 to 90% of cases. The global average comprehension score was 8.7.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of glucose, medium- and long-chain triglyceride gastric loads and forced exercise on food intake and body weight in rats.

The purpose of this study was to examine the effect of oesophageal loads of glucose, medium (MCT)-and long-chain (LCT) triglycerides, plus treadmill exercise on food intake and body weight in rats. On test days, male rats were administered a gastric aqueous solution of glucose, MCT, LCT or water via an oesophageal tube. One hour later, the animals were forced to run on a treadmill for two hours at a speed of 20 m/min at 0% grade. At the beginning of the 12-hour dark cycle (at 7 p.m.) runners were returned to their cages. On control days, the same gastric loads were administered, but the animals remained in their cages. Food intake was continuously measured during both the dark and light periods. A reduction in body weight and total food intake was found after exercise. The food intake suppressing effect of exercise was seen in the first hours of the dark period. Following MCT and LCT oil stomach loads FI decrease was comparable but the latency of the effect varied. Stomach loads of MCT oil induced a reduction in FI within the 0-3 h of food availability whereas LCT oil suppressed intake during the 3-6-h dark period. This could be explained by their different metabolite fate.

Metabolic effects of glucose, medium chain triglyceride and long chain triglyceride feeding before prolonged exercise in rats.

The purpose of this study was to test the hypothesis that oral ingestion of lipids could increase endurance by slowing the rate of glycogen depletion. Trained rats were killed after a 2 h run on a rodent treadmill, following an intragastric infusion of water, glucose, medium chain triglycerides (MCT) or long chain triglycerides (LCT). Glucose and triglycerides were administered in equicaloric concentrations (50 kJ). The results show that oral ingestion of lipids (MCT or LCT) did not reduce glycogen depletion in liver, heart or skeletal muscle after exercise whereas the fat diet increased muscle and heart glycogen stores in resting conditions. In contrast, glucose feeding induced a significant sparing effect on endogenous carbohydrate utilization and reduced physical exercise lipolysis. These data indicated, firstly, that enhanced lipid availability induced by a single lipid meal before exercise was not able to modify the glycogen depletion occurring after exercise and, secondly, that the glucose/fatty acid cycle was not effective in these conditions. The comparison between lipids indicated that the effect on glycogen use of MCT did not differ from that of LCT, and did not seem to be of any particular importance during physical exercise.