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Introduction : Ralentir la progression du surpoids et de l’obésité infantile est un des enjeux majeurs dans notre société actuelle puisque connu comme facteur de risque cardiovasculaire. Le rôle du médecin généraliste, de par sa place au sein de la famille, est primordial dans le diagnostic et la prise en charge du surpoids chez les enfants. Son diagnostic repose essentiellement sur l’IMC, et sur l’utilisation des courbes de percentiles présentes dans le carnet de santé. Matériel et méthode : Cette étude qualitative a été effectuée par entretiens semi dirigés auprès de 10 médecins généralistes du Var, à l’aide d’un guide, divisé en cinq grands thèmes.Résultats : Les médecins généralistes sont conscients de l’importance du calcul de l’IMC pour le diagnostic du surpoids. Or, celui-ci est finalement un outil trop peu utilisé et le médecin traduit un sentiment d’inefficacité dans sa prise en charge. Les principales difficultés qu’ils rencontrent sont : un manque de temps ou de formation, mais surtout le rapport, parfois difficile, avec les parents qui freine la prise en charge de l’enfant. Les pistes d’amélioration proposées par les médecins sont d’essayer de casser les habitudes de vie trop sédentaires afin de retrouver un équilibre alimentaire, de pratiquer une activité physique régulière et d’avoir une prise en charge psychologique adaptée.Conclusion : Le médecin généraliste de par son rôle de médecin de famille est au cœur de la prise en charge du surpoids infantile. Ayant une relation de confiance avec l’enfant et sa famille, il devrait pouvoir modifier les habitudes de vie des familles concernées par le surpoids. La mise création de protocoles pour les consultations obligatoires pourrait être une des solutions, pour aider les médecins dans leur pratique courante.

This investigation was aimed at increasing both accuracy and performance of systems used to obtain and measure V(max) (dV/dt(max)), an important yet underevaluated physiological parameter. A method is presented to correct measured V(max) (V(mes)) based on an algorythm adapted to 2 tested systems: IOX and DataPac. We also investigated 89 rabbit Purkinje fibres (before and 30 min following drugs effective on ventricular repolarization) to derive experimental electrophysiological correlations. In fact, no method may be reliable without knowing its accuracy over a large scale of representative physiological values. This is why it is essential to estimate accuracy, precision and fidelity of systems aimed at action potential recording before pharmacological or pathophysiological investigations are performed, even more if therapeutical consequences might ensue. A formula is presented to obtain real V(max), based on V(mes) [V(max)=V(mes)/1 - (tau.V(mes)/APA)(2.p)], where tau=49.64 µs, p=0.72 and APA=action potential amplitude. This formula is reliable up to V(max) values of 1000 V/s which may be seen in rabbit Purkinje fibres, a classical model for in vitro studies. Using this formula may have practical implications in cellular electrophysiology which may impact on safety pharmacology and therapeutics.

Resume L’objectif de cette etude est d’ameliorer la justesse des systemes d’acquisition de potentiels d’action en ce qui concerne les calculs de Vmax (dV/dtmax) pour rendre de maniere plus fiable cette donnee physiologique importante generalement sous-evaluee. La methode presentee ici permet d’effectuer une correction selon un algorithme adapte a chaque systeme. Nous avons etudie 2 systemes : IOX et DataPac. Nos resultats comparatifs portent sur une etude de 89 fibres de Purkinje de lapin (avant et 30 min apres la superfusion de molecules agissant sur la repolarisation ventriculaire). Il serait critiquable d’utiliser une methode de mesure sans en connaitre l’exactitude dans une gamme de valeurs representatives d’une situation physiologique. Lors d’experiences qui visent a mettre en evidence des effets pharmacologiques ou physiopathologiques (encore plus si cela entraine des consequences therapeutiques), il est essentiel de connaitre auparavant la justesse, la fidelite et la precision de son systeme de mesure au risque de fausser les resultats. Une formule ici presentee pour corriger la Vmax mesuree peut avoir une application pratique en electrophysiologie.

Extension of the duration of electric systol in the acute phase of coronary thrombosis can be analysed in satisfying conditions whatever the physiological frequencies by the measurement (formula; see text) represents the average QT measurement of three non-consecutive complexes in five derivations (DI, DIII, aVF, VI and V6). This extension is of prognostic value when the QTc is greater than 44 c/s. Out of 1 255 acute phase thrombosis patients, 18 Out of 20 cases of ventricular fibrillation revealed a QTc greater than 44 c/s in the 24 hours preceding sudden death. Therapeutic intervention with anti-andrenergic drugs such as bretylium tosylate or beta-blocking agents appears to reduce the QTc of these patients and thus prevent sudden death.

Recent reports have drawn attention to the association between long QT intervals and sudden death in myocardial infarction and certain congenital syndromes. This study was undertaken to determine the relationship between lengthening of the QT interval and primary ventricular fibrillation in acute myocardial infarction. Thirteen cases were chosen out of a total of 21 cases of primary ventricular fibrillation (5.09% of 412 cases of myocardial infarction hospitalised during this period). Ten other cases of myocardial infarction with the same features apart from the arrhythmia were used as controls. Three series of electrocardiogrammes recorded under the same technical and chronological conditions (2 before and 1 after ventricular fibrillation) were analysed. The average QT interval was corrected for heart rate (RR) with Bazett's formula. The average QTc in acute myocardial infarction was longer than the theoretical QTc (p less than 0.05). The graph showing this increase reached a peak at the 48th hour. The average QTc in patients with primary ventricular fibrillation was longer than in the control patients (p less than 0.05) and significantly longer than the theoretical value (p less than 0.001). The average QTc in survivors of ventricular fibrillation was not significantly longer than that of the control group but was longer than the theoretical value (p less than 0.01). These results justify the strict surveillance of the length of electrical systole in the first hours of the acute phase of myocardial infarction. In this series, values greater than 440 ms were associated with a high risk of ventricular fibrillation in the first week after myocardial infarction.

The authors have treated 48 unstable knees by lateral and medial ligament plasties using the Hughston technique. 36 patients were athletes who had to cease their sport because of anteromedial or anterolateral instability. 8 had previously had a menisectomy. Forty-three patients were reviewed with a follow up of 15 to 60 months. 30 patients who had both an active and a passive ligament plasty were able to undertake sporting activities but only 12 at top level. There were 13 failures.

Intramuscular injection of levomepromazine (0.5 mg/kg) 30 min before intravenous injection of 10 mg/kg pentobarbital sodium induces a good surgical anaesthesia in dogs artificially ventilated with 50% N2O and 50% O2 and given 0.01 mg/kg atropine and 0.1 mg/kg pancuronium intravenously before left thoracotomy. This protocol is suitable for the study of the arrhythmogenic effects of acute one-stage coronary artery ligation in anaesthetized dogs. In fact, minor interference with the autonomic nervous system appears to be involved since heart rate is maintained slow and mean aortic pressure is kept within normal limits, as pH, PaO2, anc PaCO2 during subsequent periods. Acute circumflex coronary arterio-venous pedicle ligation close to the left main trunk division resulted in this model in a high incidence of ventricular fibrillation (10 out of 15 dogs) early (7 +/- 4 min) after occlusion. Specific interventions aimed at reducing the incidence of early post-ischemic life-threatening ventricular arrhythmias might be tested in this model.

The white coat effect (WCE) has been known for many years. Its diagnosis is made difficult by the multiple blood pressure measurements to be carried out (in clinic and outpatient). In addition, its cardiovascular influence is poorly understood. In this context, we have developed a concept of office white coat effect tail (OWCET), making it possible to reduce the number of blood pressure measurements to be carried out (in clinic only). It is well correlated with the WCE and less with white coat hypertension. Its cardiovascular impact is significant, especially in women, making EBBR a full-blown cardiovascular risk factor. The recommendations should better understand the WCE to improve its management in clinical practice., L’effet blouse blanche (EBB) est un phénomène connu depuis de nombreuses années. Son diagnostic est rendu difficile par les mesures multiples de pression artérielle à réaliser (en consultation et en ambulatoire). De plus, son influence cardio-vasculaire est mal connue. Dans ce contexte, nous avons développé un concept d’effet blouse blanche résiduel (EBBR), permettant de diminuer le nombre de mesures de pression artérielle à réaliser (en consultation seulement). Il est bien corrélé à l’EBB et moins à l’hypertension blouse blanche. Son impact cardio-vasculaire est important notamment chez la femme, faisant de l’EBBR, un facteur de risque cardio-vasculaire à part entière. Les recommandations doivent mieux appréhender l’EBB afin d’améliorer sa prise en charge en soins courants.

viii, 88 p. ill.