Search

Résumé: Le thalidomide est une molécule ayant connu un grand succès commercial en 1957 en Europe, comme sédatif non barbiturique et antiémétique chez les femmes enceintes. Cependant, elle a été rapidement retirée du marché en raison de ses effets tératogènes majeurs. L'avancée des connaissances de ses propriétés immunomodulatrices et anti-angiogéniques a redonné un regain d'intérêt thérapeutique à cette molécule. Elle est indiquée actuellement dans diverses pathologies tumorales et inflammatoires, telles que l'aphtose sévère liée à la maladie de Behçet. Par ailleurs, de nombreux effets indésirables peuvent entraver le cours du traitement par le thalidomide. Certains sont fréquents et bien connus des cliniciens. D'autres complications ne sont rapportées qu'occasionnellement, notamment la survenue d'une bradycardie symptomatique. Nous rapportons ici le cas d'un jeune homme suivi pour maladie de Behçet, chez qui un traitement par thalidomide a été indiqué pour une aphtose buccale sévère résistante aux thérapeutiques habituelles, et ayant présenté une bradycardie symptomatique comme effet secondaire amélioré après l'arrêt du traitement. Cela nous amène à mettre le point sur la nécessité de restreindre la prescription du thalidomide aux formes d'aphtoses sévères et résistantes en utilisant la dose efficace la plus faible associée à une vigilance extrême. Thalidomide is a molecule that had a great commercial success in Europe in 1957 as a non-barbiturate sedative agent and antiemetic in pregnant women. However, it was quickly taken off the market because of its major teratogenic effects. The advanced knowledge of its immunomodulatory and anti-angiogenic properties, has given a new therapeutic interest to this molecule. It is currently indicated in various tumoral and inflammatory pathologies such as severe aphtosis related to Behçet's disease. Otherwise, many adverse effects appear to hinder the course of treatment with thalidomide. Some are common and well known to clinicians. Other complications are reported only occasionally including the occurrence of symptomatic bradycardia. We report here the case of a young man with Behçet's disease. He was treated with thalidomide for a severe oral aphtosis resistant to the usual therapies. Who presented a symptomatic bradycardia as a side effect improved after stopping treatment. This allows us to highlight the need to reserve the prescription of thalidomide to severe and resistant forms of aphtosis using the lowest effective dose with extreme vigilance. [ABSTRACT FROM AUTHOR]

Copyright of Médecine et Santé Tropicales is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: La fréquence des bradycardies observées en période néonatale impose de surveiller attentivement le rythme cardiaque mais également d’appréhender ses mécanismes intrinsèques dont l’état d’équilibre et de réactivité du système nerveux autonome. C’est par l’étude de la variabilité cardiaque et du baroréflexe spontané qu’il est possible d’appréhender au mieux un état de dysrégulation autonomique de la commande cardiorespiratoire, possiblement en cause dans la survenue de malaises graves ou de mort inattendue du nourrisson. En pratique clinique, les bradycardies néonatales ne justifient pas la poursuite d’un monitorage si, mêmes nombreuses, elles sont isolées, asymptomatiques, brèves (<10 s) et suivies d’une accélération cardiaque rapide témoignant d’une réponse sympathique adaptée. Une évaluation complémentaire du ű capital Ƈ et de la ű réactivité Ƈ autonomique des nouveau-nés est possible après analyse de la complexité des rythmes cardiaques et respiratoires et de leur variabilité. Cela permet de mieux repérer les enfants à haut potentiel de malaise au décours d’une hospitalisation. L’évaluation en temps réel de la régulation autonomique pourrait devenir un outil précieux au service de la clinique. [ABSTRACT FROM AUTHOR]

Goal : Take stock of the practice of LRA at the University Hospital Center of Point G from January 2004 to December 2008. Materials and method : Retrospective analysis of 1261 cases, assessing the practice of regional anesthesia. Demographics, the surgery, the technical characteristics of the gesture made, the type of local anesthetic used, adverse events were evaluated. Results : The ALR was involved 1261 patients, 8.30%. The American Society of Anesthesiology (ASA) was evaluated for scheduled surgery, patients were class 1 (50.40%) and Class 2 (49.60%). The main surgical procedures were: 26.20% prostatectomy, caesarean section fistulorraphie 23.80% and 19.04%. The ALR techniques performed were: spinal anesthesia, 87.60%, epidural anesthesia, 12%. Three hundred three adverse events (24%) have been reported, three (1%) have resulted in the death of the patient. The incidence of hypotension was 94.40%, bradycardia 4.6%. The three heart attacks were fatal (0.024‰). Patients operated under spinal anesthesia and patients aged 60 years or more had presented more adverse events with 20% and 10.38% for p <0.05 respectively. Sixty eight failures (5.4%) were observed. Conclusion: The practice of regional anesthesia at the University Hospital of Point G is characterized by adverse events and a low number of deaths. Patients operated under spinal anesthesia and patients aged 60 years and older are at greatest risk of adverse events. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Indications for fetal blood sampling (FBS) are getting more limited. In this context, we aimed to evaluate fetal loss and morbidity associated with FBS and to precise the predictive parameters for fetal complications. More than a retrospective evaluation of our practices, the final end point of our study was to better inform the patients coming to our centre. Patients and methods: Retrospective monocentric cohort (Canadian Task Force classification II-2) of the 99 FBS performed between April 2004 and June 2010 on 80 fetuses, after excluding the procedures done for termination of pregnancy. The main clinical outcome was a composite outcome criteria for fetal tolerance including cesarean section for abnormal non stress test within the 24hours, or any event responsible of a modified obstetrical management during the 14day following FBS. Results: Mean maternal age at FBS was 30years±5.13 SD and parity was 2.49±1.38SD. FBS was performed by an experienced operator in 86.5% of cases (CI 95%, 78–92.6); with a single insertion in 83.3% of circumstances (CI 95%, 74.4–90.2). The mean duration was 11min±6.37 SD. The total rate of intrauterine death, in our series, was 7.1% (CI 95%, 2.9–14), including all reported fetal demise within the 14 days after FBS, whatever the relation with the procedure. Our study demonstrated a 9.1% occurrence of post-FBS altered CTG fetal testing (CI 95%, 4.2–16.6), half of it with spontaneous resolution. The rate of severe complications (main clinical outcome) was 11.1% (CI 95%, 5.7–19) including one fetal death liable to FBS and 10 emergency caesarean sections: 5.1% for fetal bradycardia (CI 95%, 1.7–11.4), 2% for placental abruption (CI 95%, 0.2–7.1), 2% for premature preterm rupture of membranes (CI 95%, 0.2–7.1) and 1% for significative umbilical cord bleeding (CI 95%, 0–5.5). Univariate factor analysis highlights 4 parameters for impaired fetal tolerance; a prolonged procedure, presence of low fetal platelets (<30.109/L); and FBS performed for fetal anaemia during Parvovirus B19 infection or allo-immune thrombocytopenia. Discussion and conclusion: FBS remains a tricky procedure with a substantial risk of fetal loss or complications especially when performed on high-risk fœtuses. The length of the procedure should be shortened as much as possible (trained operator, postponed procedure when all favourable condition are not available). Fetal thrombocytopenia is a meaningful risk factor encouraging carefulness when exploring allo-immune fetal thrombocytopenia. [Copyright &y& Elsevier]

Copyright of Archives of Cardiovascular Diseases Supplements is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases Supplements is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: A 10-year-old child was hospitalized for bradycardia during a viral infection with chikungunya. His history showed unexplored episodes of bradycardia. Cardiologic explorations revealed cardiac sinus node dysfunction (SD). Mutational screening of the SCN5A gene showed that this case was a compound heterozygote for p.Ala735Val and p.Asp1792Asn missense mutants. Five years later, the child underwent a pacemaker insertion after an electrophysiological study performed during an atrial flutter access. [ABSTRACT FROM AUTHOR]

Abstract: Nerium oleander is potentially lethal plants after ingestion. We report a case of poisoning by these plants. Our patient complained of nausea, vomiting, and diarrhoea. He had bradycardia during first twelve hours. He was discharge after 3 days. All parts of these plants are toxic and contain a variety of cardiac glycosides including oleandrin. In most cases, clinical management of poisoning by N. oleander involves administration of activated charcoal and supportive care. Digoxin specific Fab fragments are an effective treatment. [Copyright &y& Elsevier]

Summary: Introduction: An 88-year-old woman suffered a cerebrovascular accident and was found on the floor of her cold house. Materials and methods: At the time of admission to our division, the patient was unresponsive with a rectal temperature of 28°C, blood pressure of 120/80mmHg, and a heart rate of 40 bpm. The cerebral CT revealed a hypodense lesion in the temporal region. The ECG showed sinus bradycardia, prolonged PR and QTc intervals, and a classic “J” (Osborn) wave that was most pronounced in the lateral and inferior leads. The patient presented a low respiratory rate, hypoventilation, severe acidosis (both respiratory and metabolic), hyperkalemia, elevated liver enzymes, mild anemia, hyporeflexia, and sluggish pupil responses. Results: During rewarming with thermic blanket and heated intravenous fluids, the respiratory condition improved, and the ECG alterations disappeared. Twenty-four hours later, however, the patient died suddenly due to cardiac asystole. Discussion: This report analyses the effects of hypothermia and its clinical manifestations and provides a brief discussion of the electrophysiologic mechanisms underlying Osborn waves and the other electrocardiographic changes associated with hypothermia. [Copyright &y& Elsevier]

Abstract: Introduction: Pregnancy can precipitate or exacerbate cardiac arrhythmias. Management of those arrhythmias is not very different from that in non-pregnant women. Objective: In this review we tried to specify factors which favour arrhythmias in pregnant women and to show their specific management. Methods: We carried out a search through PubMed using as keywords: pregnancy, cardiac arrhythmias, antiarrhythmics. Results: Hemodynamic perturbations, direct electrophysiological effects of hormones and underlying heart disease are potential factors that can promote arrhythmias in pregnancy. Usually, no drug therapy is needed for the management of supraventricular or ventricular premature beats but potential promoting factors should be eliminated. In paroxysmal supraventricular tachycardia, vagal maneuvers should be tried firstly. Adenosine could be used if vagal maneuvers are ineffective. In pregnant women with atrial fibrillation, the goal of treatment is the conversion to sinus rhythm or the control of ventricular rate. Ventricular arrhythmias are usually uncommon during pregnancy and often occur in the absence of structural heart disease and are responsive to drug therapy. Symptomatic bradycardia rarely complicates pregnancy and its management does not differ from that in non-pregnant women. [Copyright &y& Elsevier]

Abstract: Prematurity apnea remains a major clinical problem that requires treatment choices which are sometimes difficult. Prematurity apnea occurs in most infants of gestational age at birth less than 33 weeks. It is a developmental disorder which usually reflects a “physiological” immaturity of respiratory control. However, neonatal diseases may be associated and play an additive role, resulting in an increased incidence of apnea. Careful screening should therefore be performed in order to make sure that no other factor than immaturity is involved in the occurrence of apnea. Short apnea (less than 10s, without hypoxemia and bradycardia), due to immaturity, are not clinically relevant. More prolonged apnea, that last for more than 15 or 20s, and / or apnea associated with bradycardia or oxygen desaturation, results in short-term disturbances of cerebral haemodynamics and oxygenation, which may negatively impact on neurodevelopmental outcome. Evaluating the immediate severity of apnea and the risks that apnea may affect long-term outcome remains a challenge. The choice of treatments is based on a few evidences. Caffeine citrate, which reduces the incidence of apnea, has been used for decades. However, a thorough evaluation of risks and benefits of this medication has been performed only recently. Caffeine citrate was found to be safe and resulted in unexpected benefits. In treated infants, compared with controls, indeed, a decreased incidence of the following complications was recorded: bronchopulmonary dysplasia at 36 weeks of conceptional age, patent ductus arteriosus, cerebral palsy at 18 months of age. Nasal CPAP can be used in association with caffeine citrate, when the latter is not effective enough. [Copyright &y& Elsevier]

Abstract: Anaphylaxis is a relative uncommon event in pregnancy that can have serious implications for both mother and foetus. Two cases of grade 3 anaphylactic shock occurring at the end of the third trimester of pregnancy are reported; the causal agents were respectively amoxicilline and suxamethonium. Maternal and foetal outcome was good after adequate resuscitation and caesarean section performed in both cases because of severe bradycardia. A review of the literature confirms the good maternel outcome; neurologic damage in the newborn is frequent. On the basis of physiologic findings degranulation of placental mast cell is evoked in the genesis of birth asphyxia. [Copyright &y& Elsevier]

Abstract: Diphemanil methylsulfate (Prantal®) is a quaternary ammonium with parasympathicolytic properties. It is used in premature and term neonates with bradycardias related to vagal hyper reflectivity (HRV). Objectives: To assess the use of Prantal® in the French neonatal and intensive care units: its indications, its modalities of use, its side effects and the number of patients treated during 1 year (2004) in France. Methods: A questionnaire was electronically sent to all neonatology units and all neonatal intensive care units in France. Results: Among 202 units, 121 (60%) answered the questionnaire. Prantal® was reporded to be used in 51 (42.1%) units. Among them, 38 (31.4%) actually treated 169 patients in 2004 with a mean number of patients treated by unit of 4. The diagnostic of HRV was supported by: a history of malaise (84.3%), bradycardia (94.1%), oculocardiac reflex (74.5%), cardiac Holter (76.4%), cardiorespirographic recording (19.6%), esophageal pHmetry (35.2%) and esophageal fibroscopy (21.5%). The mean starting dosing was 4.7 mg/kg/d, the mean maximal dosing was 9 mg/kg/d and the mean daily intakes were initially 2.3 and secondary 2.9. Prantal dosing was adjusted to weight in 54.9%, every month in 85.7%. Treatment was stopped at the mean post-natal age of 6 months, mostly in a progressive manner and without monitoring help. Conclusion: Prantal® was seldom used in 2004 in France for different reasons: HRV is an uncertain entity, the efficacy of Prantal® has not been validated and atropinic side effects can be encountered. [Copyright &y& Elsevier]

Abstract: Objective: To review the most recent and relevant issues concerning paracervical block in obstetrics since 1975 when Jägerhorn described the superficial technique that has become a standard. Data sources: Extraction from Pubmed® database of articles issued from 1975 to 2005. Data selection: The collected articles were selected on the basis of the use of the superficial injection method. The more recent data were selected. The keywords were: paracervical, labour, childbirth, and neonate. Data synthesis: Paracervical block (PCB) is routinely used over the world despite the risk of foetal bradycardia. Bradycardia occurring immediately after the performance of block is short lasting. The reports of few cases of foetal or neonatal deaths have caused many physicians to question its safety. The incidence of bradycardia has dramatically decreased (less than 10%) due to the Jägerhorn superficial injection method. In case of healthy neonate the occurrence of bradycardia is harmless but its mechanism is still imprecise. The intensity an duration of analgesia is poor in comparison with epidural anaesthesia. PCB is a viable alternative to epidural in selected cases. [Copyright &y& Elsevier]

Abstract: Objectives. – To analyse neonatal effects after in utero betablockers exposure and the pertinence of recommendations delivered by our team. Population and methods. – We report 44 pregnancies exposed to betablockers during the late pregnancy including the period of delivery about which the Regional Pharmacovigilance Center of Tours (CRPV) was questionned. Results. – Among the 39 children for whom we know the follow up, 22 had neonatal adverse effects of which 19 could be explained by in utero exposure to betablockers i.e. an hypoglycaemia (11 times), a bradycardia (six times), a bradycardia and hypoglycemia (one time) and an hypotension (one time). A drug-related effect was retained for eleven newborns (27%) and another etiology could be evoked in the eight others. The risk of neonatal adverse effects seems to increase in newborns exposed to labetalol (5/11), to betaxolol (1/2) or to propranolol (2/6) or when the dose is high. The eight newborns who had intrauterine growth retardation were generally more often exposed to atenolol than eutrophic newborns. Four babies had malformations. Conclusions. – Our recommendation was an hospitalization 44 times (100%) to monitor heart rate, blood pressure and glycemia. When the follow-up is known, hospitalization was performed in 88% of the cases. Glycemia, heart rate and blood pressure were monitored in all the hospitalized children and in three of the five not hospitalized children. Our recommendation seems particularly justified with regard to hypoglycemia which is often asymptomatic but whose consequences can be severe. Atenolol often provider of intrauterine growth retardation and labetalol more often at the origin of neonatal adverse effects are probably to avoid during pregnancy. [Copyright &y& Elsevier]

In an adult population, the prevalence of sleep apnea is 4% for men and 2% for women. Generally, nasal positive pressure ventilation is the best therapeutic option. To date, and in spite of the possible presence of marked brady-arrhythmias during sleep apnea, there is no recognised indication for Pacemaker implantation. However, recent data show the potential benefit of permanent cardiac stimulation in these patients. Increasing heart rate (using atrial pacing) improves cardiac output, and reduces pulmonary congestion and pulmonary vagal afferent nerves are no longer stimulated. The incidence of central sleep apnea is thereby reduced. Excessive nocturnal vagal tone increases snoring and sleep apnea, because of excessive relaxation of the oropharyngeal muscles. In patients with bradycardia, atrial stimulation may oppose increased vagal tone, by stimulating the sympathetic system or maintaining it at a minimal level. It is therefore possible that cardiac stimulation will become part of the treatment of sleep apnea in patients with documented bradycardia and/or heart failure. [Copyright &y& Elsevier]

We conducted a case control study during six and a half years with the objective to analyse the risk factors for NEC.Population and methods – All cases of confirmed NEC matched to controls for identical gestational age and period of hospitalization; apnoeas-bradycardias prospectively counted.Results – Forty-five cases were compared to 89 controls. The isolated risk factors were: an intra-uterine growth retardation (OR = 3,65, 95% confidence interval {CI} 95%: 1,54-8,63); a birth weight < 1000 g (OR = 8,16, CI 95%: 1,17–56,62), compared to a weight ≥ 1500 g; a triple antibiotherapy (OR = 6,15, CI 95%: 1,16-32,45); an umbilical venous catheterization (OR = 2,64, CI 95%: 1,09–6,44); a number of simple apnoeas-bradycardias ≥ 3rd tercile (n = 27) (OR = 4,54, CI 95%: 1,29–15,93), or severe (stimulated or with hypoxia) apnoeas-bradycardias ≥ 3rd tercile (n = 8) (OR = 6,15, CI 95%: 1,59-23,75); an haemoglobin level lower than the 1st tercile (95 g/L) (OR = 5,90, CI 95%: 1,20-20,13); and milk thickening by Gumilk® (OR = 2,78, CI 95%: 1,11–6,90).Conclusion – In the present practices, anoxo-ischemic factors during the first week of life do not represent an important risk of NEC; a great vigilance must be exercised for indications of the triple antibiotherapy and the treatment of apnoeas-bradycardias. [Copyright &y& Elsevier]

The aim of the study was to present data investigating vagal reactivity in a population of premature infants reaching term, using the oculo-cardiac reflex.Patients and methods. – Ninety three premature infants, free of any disease, near full term at the moment of testing, were prospectively investigated at a time close to discharge from neonatal unit. After an all-night polygraphic recording, a standardized oculo-cardiac reflex test was performed during quiet sleep. Data were classified in relation to both chronological and postconceptional ages. Simple liner regression analyses were performed on the selected variables.Results. – The results showed heterogeneity of the vagal response in this population: longest asystolia (1049 ms±540 ; 95th percentile=1894 ms) ; maximal percentage of deviation between two successive RR intervals (88%±90; 95th percentile=200%); and duration between the beginning of decrease in heart rate and return to mean heart rate (14 s±10; 95th percentile=30s).Conclusion. – Our healthy premature infants at time of discharge exhibited a wider range of vagal reactivity than previously reported for the full term newborns. Considering our findings, we recommand caution before proceeding with treatment of vagal bradycardia in a similar premature infant population. [Copyright &y& Elsevier]

Résumé: Le choc neurogénique traumatique est une complication rare, mais grave, des traumatismes du rachis. Il associe une bradycardie et une hypotension artérielle causées par un traumatisme médullaire. Il met en jeu le pronostic vital du patient et aggrave le déficit neurologique. Une immobilisation stricte et une évaluation rapide du niveau lésionnel sont nécessaires dès la prise en charge préhospitalière. Le traitement initial requiert l’instauration précoce d’amines vasopressives associée au remplissage. La corticothérapie n’est pas recommandée. La chirurgie précoce est préconisée en cas de déficit incomplet vu dans les six premières heures. Nous rapportons le cas d’un choc spinal secondaire à une luxation C6/C7 pris en charge en préhospitalier. [ABSTRACT FROM AUTHOR]

Abstract: Acute pancreatitis is frequently associated with electrocardiographic abnormalities, including arrhythmias and repolarization. We briefly describe a male patient with a severe acute pancreatitis who presented several bradycardias during his hospitalization in our intensive care unit. The aim of this case report is to underline the probability of severe arrhythmias during acute pancreatitis, which can increase morbidity of this pathology. Despite many publications or reports, causes of increased EKG abnormities during severe pancreatitis remained unclear and are probably multifactorial. To prevent accidents or complications, patients with severe acute pancreatitis should have a continuous EKG monitoring. [Copyright &y& Elsevier]

Abstract: A chronically depressed 44-year-old man was rescued by the French medicalised ambulance service four hours after the ingestion of Nerium oleander leaves in a suicide attempt. Cardiotoxicity was evidenced by the presence of bradycardia with mental confusion and vomiting. The patient was empirically treated in the prehospital phase with a single dose of digoxin-specific Fab antibody fragments (Digidot®). In spite of this treatment, the patient presented a new episode of important bradycardia (25 b/minute). Thereafter, the patient''s rhythm stabilized and neurological signs and vomiting resolved. The patient recovered uneventfully and was discharged from the intensive care unit two days later. [Copyright &y& Elsevier]

Competing Interests: Les auteurs déclarent n’avoir aucun lien d’intérêts.

Objectives: Evaluate the influence of rupture of membranes (spontaneous or artificial) on fetal heart rate. Secondary objectives were to compare spontaneous and artificial ruptures and to investigate the risk factors associated with the occurrence of abnormalities of fetal heart rate (FHR)., Methods: This is a monocentric retrospective study (Lille, France) from January to March 2018. All low-risk pregnancies with cephalic presentation, spontaneous labor, gestational age more than 37 weeks of amenorrhea, singleton pregnancy, absence of maternal or fetal pathology were included. The elements sought were the occurrence of bradycardia, tachycardia, decelerations (early, late, typical variable, atypical variable, prolonged) and abnormal variability. FHR was analyzed one hour before and one hour after rupture. The groups with and without abnormalities of FHR were compared according to the type of rupture., Results: Two hundred and thirty-three patients were included. A total of 44.54% (n=129, P<0.001) showed abnormalities of FHR after rupture of membranes. In the fetal heart rate time study after the rupture event, prolonged decelerations were more frequent in the first quarter hour compared to the second quarter hour. There was significantly more risk of abnormalities of fetal heart rate if the fetal heart rate before the rupture of membranes was already pathological, as well as if the time between rupture and delivery was short. The type of rupture, artificial or spontaneous, was not a risk factor., Conclusion: The rupture of membranes increased the occurrence of abnormalities of FHR. However, there is no more deleterious impact of one type of rupture than the other., (Copyright © 2020. Published by Elsevier Masson SAS.)