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Resume Introduction L’hypertension arterielle (HTA) essentielle, affection frequente, est une cause majeure de maladie cardiovasculaire. L’hyperactivite sympathique peut etre incriminee dans l’HTA essentielle. Ce travail se propose de comparer essentiellement les reponses sympathiques, obtenues lors de l’etude du profil autonomique cardiovasculaire, chez les patients ayant une HTA essentielle avec celles des sujets normotendus. Materiels et methodes Cette etude prospective avait concerne un groupe de patients hypertendus (n = 120, d’âge moyen 54 ans), compare avec un groupe temoin (n = 120, d’âge moyen 52 ans) de sujets normotendus. Les tests d’etude autonomique avaient inclus la respiration profonde ou deep-breathing (DB), l’exercice de la contraction isometrique ou hand-grip (HG) et l’echo de stress (ES). Les valeurs, representees en moyenne ± ecart-type(SE), obtenues chez les deux groupes equilibres pour l’âge et le sexe, etaient compares suivant le t-test de Student, p Resultats La reponse sympathique alpha-adrenergique mesuree par la methode de ES a ete de 20,0 % ± 9,8 dans le groupe HTA et de 15,2 % ± 8,6 dans le groupe temoin (p Conclusion Chez l’hypertendu compare au normotendu, la reponse de la stimulation sympathique, aussi bien centrale que peripherique, est significativement plus elevee, alors que celle de la stimulation vagale l’est significativement moins.

Resume Le syndrome de tachycardie orthostatique idiopathique (TOI) est une pathologie mal connue car son diagnostic ne repose pas sur les methodes d’investigation conventionnelles. Le test orthostatique permet d’en faire aisement le diagnostic. L’objectif de cette etude est de determiner les reflexes cardiovasculaires de 70 patients atteints de la TOI. Les tests d’exploration du systeme nerveux autonome pratiques sont en plus du test orthostatique, le test de la respiration profonde, la pression manuelle et le stress mental. L’analyse du test orthostatique a montre que l’augmentation de la frequence cardiaque, relative a l’etat d’hyperactivite sympathique « β » peripherique se produisait avant la deuxieme minute chez 80 % des patients. La TOI a ete jugee majeure chez 43 % des patients et s’etait compliquee d’une chute brutale et severe de la pression arterielle systolique (PAS) inferieure a 70 mmHg chez quatre patients, apres la cinquieme minute du test. L’analyse des differents tests avait montre une hyperactivite vagale chez 63 % des malades au test de respiration profonde, chez 93 % au test de pression manuelle, et chez 100 % au test orthostatique. L’activite sympathique centrale « α » etait augmentee dans 76 % des cas et « β » etait elevee dans 83 % des cas. Une hyperactivite « α » peripherique a ete observee chez 63 % des malades au test de pression manuelle et chez 44 % au test orthostatique. L’analyse des reflexes autonomiques cardiovasculaires chez les patients atteints de TOI permettant la determination de leur profil autonomique, contribuera probablement a une meilleure comprehension de cette pathologie et a une meilleure orientation de sa prise en charge.

The objective of this study was to determine both the prevalence of white-coat effect and white-coat hypertension (WCH) and which selected clinical variables were predictors of WCH. A total of 2462 patients underwent ambulatory blood pressure monitoring either in borderline hypertension (group 1) or for assessment of antihypertensive treatment (group 2) or for hypotension (group 3). In the overall population 33.0% of patients showed WCH, 32.8% in group 1 and 37.0% in group 2. In multivariate analysis, sex and grade of hypertension were independent predictors of WCH in groups 1 and 2.

Resume La regurgitation aortique secondaire a une atteinte inflammatoire non specifique de l’aorte est relativement rare. Elle est consideree comme l’un des principaux facteurs de mortalite dans la maladie de Takayasu. La chirurgie de remplacement est la seule alternative therapeutique pour la valve aortique au cours de cette affection. L’association d’un anevrisme de l’aorte ascendante a une fuite aortique est assez rare dans le cadre de cette maladie. La gestion chirurgicale est particulierement difficile du fait de la nature inflammatoire chronique et du potentiel evolutif imprevisible. La corticotherapie perioperatoire est indispensable pour eviter les complications postchirurgicales. Nous rapportons l’observation de deux patientes marocaines âgees respectivement de 32 et de 36 ans ayant presente une fuite aortique massive associee a une dilatation anevrismale de l’aorte ascendante avec des lesions subocclusives des principales branches des troncs supra-aortiques. Nous avons remplace donc la valve aortique par une prothese mecanique, puis l’aorte ascendante par une prothese interposee en position sus-coronaire. L’examen histologique a montre une atteinte inflammatoire non specifique en faveur de la maladie de Takayasu. L’evolution postoperatoire apres 32 mois est favorable. Nous rapportons ces deux cas rarissimes au Maroc, en signalant les difficultes therapeutiques rencontrees.

Hyperhomocyteinemia (HHcy) is a risk factor for coronary artery disease (CAD), and methylenetetrahydrofolate reductase (MTHFR), methionine synthase (MTR), and methionine synthase reductase (MTRR) polymorphisms may contribute to plasma total homocysteine (tHcy) variation. We investigated the association of polymorphisms 1298A--C in the MTHFR gene, 2756A--G in the MTR gene, and 66A--G in the MTRR gene with tHcy levels and with CAD in patients undergoing coronary angiography.CAD patients (n=151) and control subjects (n=79) were compared regarding the prevalence of the polymorphisms, risk factors, and biochemical parameters.The mean tHcy concentration was significantly higher in CAD patients than in control subjects (P0.001). HHcy (tHcy/=15 mumol/l) conferred an OR of CAD of 4.1 (95% CI 2.2-7.5, P0.001). In both cases and controls, smokers had a higher tHcy level than non-smokers and demonstrated a markedly increased risk for CAD (OR=2.5, 95% CI 1.7-3.3, P0.001). The allele frequencies of the MTHFR 1298A--C, MTR 2756A--G, and MTRR 66A--G mutations were 36.7%, 15.7%, and 36.6%, respectively. The 1298C allele frequency was significantly higher in the CAD group than in controls (P0.05) and showed a significant association with CAD in heterozygote carriers. There was no statistically significant difference between cases and controls in the frequencies of the A2756G alleles/genotypes in the MTR gene and of the A66G alleles/genotypes in the MTRR gene. The contributions to tHcy levels of the three common mutations were statistically significant. The heterozygosity of the MTHFR 1298AC genotype, MTR 2756G allele, and MTRR 66G allele yielded an OR of 3.4, 2.0, and 2.1, respectively, for having HHcy.We suggest that HHcy confers a risk for CAD, and smokers with tHcy are at a greatly increased risk. Our finding supports an important role of the MTHFR gene in CAD and provides evidence of polygenic regulation of tHcy.

Resume Objectif Le test de respiration profonde (« Deep-Breathing » : DB) presente un interet majeur dans la determination de la reponse vagale (RV). L’objectif de ce travail est d’evaluer au moyen de ce test et par comparaison a un groupe de sujets controle sains, la reponse vagale chez un groupe de patients presentant des signes fonctionnels neurologiques, cardiovasculaires et digestifs mais dont l’examen clinique et paraclinique est normal. Patients et methodes Les groupes suivants ont ete selectionnes : un groupe controle C ( n = 50), un groupe de patients symptomatiques S constitue de trois sous-groupes (S1, S2, S3) comptant chacun 50 patients : S1 : tachycardie orthostatique idiopathique (POTS), S2 : hypertension arterielle (HTA) ; S3 : ni POTS ni HTA. La reponse vagale a ete exprimee en pourcentage de variation des intervalles RR 100 × [( RR max – RR min )/ RR min ] et, avant toute comparaison, correlee a l’âge et au sexe dans le Groupe C. Resultats Dans le groupe C, la reponse vagale evaluee par le DB etait egale a 31.0 % ± 8.2. Celle-ci etait negativement correlee avec l’âge ( r = −0.42 ; p = 0.003) et il n’y avait pas de difference significative entre les hommes (31.2% ± 5.7) et les femmes (30.9% ± 9.0) ( p = 0.12). Comparee au groupe C, la reponse vagale etait de 51.6% ± 20.4 dans le sous-groupe S1 ( p p p Conclusion La reponse vagale n’est pas influencee par le sexe mais diminue avec l’âge. Par comparaison a un groupe controle, elle est significativement plus elevee chez les patients ayant un POTS et significativement moins elevee chez les hypertendus.

International audience; Background - Chronic kidney disease (CKD) is frequent in individuals infected with human immunodeficiency virus (HIV). Progression to end-stage renal disease can be slowed by appropriate medical management. Methods - To assess whether active promotion of guidelines improves CKD management, we conducted a cluster randomized controlled trial within the French Hospital Database on HIV (FHDH-ANRS CO4). We randomized 46 centers participating in the FHDH to either simple information on guideline availability or active promotion with a multifaceted and repeated intervention comprising reminders and audit feedback and targeting of local opinion leaders carried out between April 2009 and April 2010. Outcome measure was CKD management adequacy assessed before and 2 years after the beginning of the intervention in HIV-infected patients with moderate to severe CKD. CKD management was considered adequate in case of referral to a nephrologist or if proteinuria, blood pressure, low-density lipoprotein cholesterol level, and glycemia had been measured during the previous year and medications had been prescribed when necessary. Results - Three hundred six patients were enrolled, of whom 238 (78%) completed the 2 years of follow-up. During the study period, the percentage of patients receiving adequate CKD management improved from 64.1% to 70.4% (+6.3%) in the active arm and from 68.3% to 75.6% (+7.3%) in the control arm (adjusted mean difference, -0.7 percentage points [95% confidence interval: -9.2 to 7.9]; P = .95). The biggest impact of active promotion was on the management of proteinuria and blood pressure. Conclusions - Adequate compliance with CKD management guidelines improved slightly between 2009 and 2011, with no difference between the simple information and active promotion arms. Clinical trials registration - CCTIRS 10.150 and CNIL DR-2010-379.

Resume Objectifs. – Notre etude a pour but d'illustrer par cinq observations originales, les differentes situations ou le stenting du tronc commun peut etre propose en alternative au pontage aortocoronaire, avec des resultats encourageants a court et a long terme. Materiel et methodes. – Il s'agit d'une analyse retrospective des dossiers de cinq patients presentant une stenose du tronc commun traitee par la mise en place d'une endoprothese, entre 1996 et 2002 au service de cardiologie A du CHU Avicenne de Rabat, avec : stenting sur tronc commun non protege dans deux cas, sur tronc commun protege dans deux autres cas, et un stenting en urgence pour dissection iatrogene du tronc commun. Resultats. – Le stenting a ete realise avec succes chez les cinq patients ; sans complication hospitaliere majeure. Au cours du suivi, avec un recul de 29 mois en moyenne, nous n'avons pas rapporte de deces, aucun geste de revascularisation sur le tronc commun n'a ete necessaire (avec un tronc commun permeable sur trois controles coronarographiques). Conclusion. – A la lumiere de ces resultats, et en se fondant sur les donnees de la litterature, nous concluons que le stenting du tronc commun peut etre propose comme une alternative a la chirurgie dans des cas particuliers chez des patients « selectionnes » (refus ou contre-indication de la chirurgie, tronc commun protege, occlusion aigue spontanee ou accidentelle du tronc commun).

Resume Introduction. – Le syndrome de Lutembacher associe une communication interauriculaire congenitale et un retrecissement mitral. Cette condition releve habituellement d'un traitement chirurgical de remplacement valvulaire mitral et fermeture de la communication interauriculaire. Materiel et methodes. – Entre 1993 et 2003, quatre patientes porteuses d'un syndrome de Lutembacher congenital ont ete traitees par commissurotomie mitrale percutanee sans fermeture du defect septal interauriculaire dans notre institution. Les quatre patientes etaient en insuffisance cardiaque droite evoluee et presentaient une dyspnee classe III a IV de la NYHA. Resultats. – La procedure s'est deroulee avec succes pour nos quatre patientes. La surface mitrale est passee en moyenne de 0,87 a 1,97 cm2 ; la pression de l'oreillette gauche a diminue de 28,2 a 12,7 mmHg et le gradient transmitral moyen est passe de 15,5 a 3,9 mmHg. Une nette amelioration fonctionnelle et clinique a ete observee dans tous les cas. Durant un suivi moyen de 55 ± 29 mois, nos quatre patientes sont restees peu symptomatiques sous traitement medical. Conclusion. – Le traitement percutane du syndrome de Lutembacher est actuellement une alternative possible a la chirurgie chez les patients ayant une anatomie favorable a la procedure.

Elevated plasma total homocysteine (tHcy) is increasingly being recognized as a risk factor for coronary artery disease (CAD) and other defects. Recent genetic studies have characterized molecular determinants contributing to altered homocysteine metabolism. Our objectives were therefore to confirm the relationship of tHcy with CAD and to examine the importance of genetic influence on tHcy in the coronary angiograms and conventional cardiovascular risk factors recorded in 230 subjects. We also determined the genotype frequencies distribution of the A2756G transition of the B12-dependent methionine synthase (MTR) gene and the A66G mutation of the methionine synthase reductase (MTRR) gene.Patients with CAD (n=151) had significantly higher tHcy concentrations than control subjects (15.49 +/- 2.75 micromol/l vs. 11.21 +/- 3.54 micromol/l, P0.001). Hyperhomocysteinaemia (tHcyor =15 micromol/l) was a risk factor for CAD [RR = 4.07, 95% CI: 2.21 - 7.47, P0.001]. The homocysteine concentrations were significantly different between smokers and non-smokers, at 15.63 +/- 3.10 vs. 12.45 +/- 3.84 micromol/l, P0.05. In addition, smokers with hyperhomocysteinaemia demonstrated a markedly increased risk of CAD (OR = 2.50, 95% CI: 1.67 - 3.32, P0.05) compared with non-smokers with normal homocysteine.The 2756G and the 66G allele contribute to a moderate increase in homocysteine levels (P = 0.008 and P = 0.007, respectively), but not to CAD (P0.05). Combined MTR and MTRR polymorphisms, the 2756AG + 66AG and the 2756AG + 66GG were the combined genotypes that were a significant risk factor for having hyperhomocysteinaemia (14.4 +/- 2.8 micromol/l, OR = 2.75, IC 95% = 1.21 - 6.24, P=0.016 and 17.9 +/- 4.1 micromol/l, OR = 6.28, IC 95% = 1.46 - 12.1, P = 0.021, respectively). Statistic analysis using the UniANOVA test shows that these two polymorphisms have an interactive effect circulating homocysteine levels (P0.05).Our data suggest that moderately elevated tHcy levels are prevalent in our population and are associated with an increased risk for CAD. This study provides evidence that the MTR A2756G and MTRR A66G polymorphisms significantly influence the circulating homocysteine concentration. In addition, the MTR and MTRR genes may interact to increase the risk for having hyperhomocysteinaemia.

Resume Objectif. – Un dysfonctionnement du systeme nerveux autonome (SNA) est implique dans la genese et la persistance de la crise migraineuse. L'objectif de ce travail etait de comparer le profil autonomique d'un groupe de patients migraineux en dehors de la crise a celui d'un groupe de sujets temoins en se fondant sur les tests de la reactivite cardiovasculaire. Patients et methodes. – Les sujets ayant une migraine diagnostiquee selon les criteres de l'IHS 2004 etaient selectionnes pour l'etude. Apres la prise de la pression arterielle (PA) de base a 30 minutes, les tests pratiques etaient, la respiration profonde ou le deep-beathing (DB), le hand-grip , (HG) 15 secondes, et trois minutes, la manœuvre de Valsalva, l'echostress (ES) et le tilt test ou test d'inclinaison (TT). Les resultats de ces derniers sont compares a ceux d'un groupe temoin d'âge comparable constitue de 44 sujets dont 37 etaient de sexe feminin (84,1 %) en utilisant le t -test de Student avec un p Resultats. – Trente-deux patients etaient explores (27 de sexe feminin, 84,38 %) dont l'âge etait compris entre 16 et 51 ans avec une moyenne de 40,4 ± 7,8 ans. Les mesures de PA avaient montre que la PA systolique a 30 minutes etait inferieure a 94 mmHg chez 22 patients (69 %), la PA diastolique etait inferieure a 60 mmHg chez 25 patients (78 %). Par comparaison au groupe temoin, chez les migraineux, la reponse a la stimulation vagale etait significativement plus elevee ( p p Conclusion. – La reactivite cardiovasculaire chez le migraineux est a type d'hyperactivite vagale et de deficience du systeme alpha sympathique. Cela conduit a des etudes d'essai de nouvelles therapeutiques.

Resume Le systeme nerveux autonome controle toutes les fonctions de l’organisme. Son dereglement, appele dysautonomie, s’accompagne de manifestation fonctionnelle polymorphe. Son exploration peut reveler les anomalies responsables du tableau clinique. L'objectif de ce travail est d'essayer de relier les signes fonctionnels essentiellement cardiovasculaires aux anomalies autonomiques. Un groupe de patients hypertendus est inclus volontairement. Methodes. – Les patients presentant des signes fonctionnels sans anomalie aux examens conventionnels sont retenus pour l'exploration. Les manœuvres pratiquees sont la respiration profonde, le hand grip , l’echo de stress, la manœuvre de Valsalva et le test d’inclinaison. Resultats. – Deux cent quatre-vingt-quatre patients sont explores, 70 % de sexe feminin, d'âge moyen 44 ans (extremes 9 et 81 ans). Les syndromes objectives sont essentiellement, l’hypoTA orthostatique, 88 patients chez lesquels l'activite sympathique peripherique alpha est diminuee alors que l'activite vagale est elevee, le postural tachycardia syndrom « POTS » 123 patients, lesquels rapportent une symptomatologie orthostatique et dont l'activite sympathique beta est augmentee, la syncope neurocardiogenique, quatre patients chez lesquels l'activite vagale est elevee et l'anomalie des barorecepteurs (115 patients) de degre variable. Le groupe avec HTA essentielle (137), presente une activite sympathique alpha augmentee (elevation de la PA de 38,5 % en moyenne apres stimulation) et une activite vagale diminuee. Douze patients diabetiques ont une activite vagale reduite (variation de RR sur l'ECG de 8 %, en moyenne). Le traitement, fonction de l'anomalie objectivee (mesures hygienodietetiques, ethylephrine, fludrocortisone, phenobarbital, clonidine, maproptyline, inhibiteur de recapture de serotonine) a permis d’ameliorer l'etat fonctionnel des patients. Conclusion. – L'etude du profil autonomique permet de solutionner l'etiologie d'une symptomatique fonctionnelle, ressentie par les patients, et non expliquee par un examen clinique et paraclinique conventionnel.

UNLABELLED The autonomic nervous system controls all body functions. Dysregulation of this system, called dysautonomia, is responsible of polymorphic functional symptoms. Its exploration can reveal abnormalities which explains the clinical symptoms. The objective of this work is to try to find a connection between functional signs, mainly cardio-vascular and autonomic abnormalities. We also consider the autonomic profile of a group of patients with primary hypertension. METHODS Patients with functional symptoms and normal clinical and paraclinical examinations underwent autonomic profile study. The following tests were performed: deep breathing, hand grip, echo stress, Valsalva maneuver and tilt test. RESULTS Two hundred and eighty four patients were included in this study, females 70%, mean age 44 years (extremes 9 and 81). In this group of patients, the main autonomic syndromes found were: orthostatic hypotension, 88 patients in whom the alpha peripheral sympathetic activity is decreased and the vagal one is increased, postural orthostatic tachycardia syndrome (POTS), 123 patients who describe orthostatic symptoms and in whom beta sympathetic activity is high, the neurocardiogenic syncope, four patients in whom vagal activity is high, and the baro-receptor abnormality (115 patients) of variable degree. In patients with primary hypertension (137), the alpha sympathetic activity is high (mean increase of blood pressure of 38.5%), meanwhile the vagal one is low. Twelve patients having diabetes showed a low vagal activity, (mean EKG RR variation of 8%). The treatment, depending on the autonomic abnormality (hygienodietetic measures, ethylephrine, fludrocortisone, phenobarbital, clonidine, maproptyline, serotonine recapture inhibitor) showed an improvement in the functional state of the patients. CONCLUSION Autonomic profile study helps to explain the causes of symptoms described by the patients whose clinical and conventional paraclinical examinations are normal.

Among 1146 patients undergoing percutaneous mitral valvuloplasty for symptomatic mitral stenosis, 8 (4 men and women) were at high risk for surgery on the basis of the New York Heart Association functional class IV ( n =8), severe pulmonary hypertension ( n =5). All these patients aged 30±23.6 years had signs of right heart failure, high echocardiographic score (9.6±3.6) and low mitral valve area (0.50±0.19 cm 2 ). The procedure resulted in an increase in mitral valve area (1.55±0.17 cm 2 ) with a concomitant reduction in pulmonary artery systolic pressure (58.7±9.9 mm Hg) and decrease in tricuspid regurgitation. At follow-up (mean 14±3 months), one patient with renal failure… presented with a mitral restenosis is scheduled for mitral valve replacement, two patients with severe tricuspid regurgitation required tricuspid annuloplasty. In conclusion, percutaneous mitral valvuloplasty is feasible and safe in patients at high surgical risk and can be considered as an acceptable alternative to surgery.

Objectives The present study was performed to determine the outcome of emergent balloon mitral valvotomy (BMV) in patients with refractory pulmonary edema. Methods Of 1776 patients undergoing BMV between 1986 and 2004, 17 patients presented with refractory pulmonary edema to medical treatment underwent emergent BMV. Results Age (mean+/−SD) 29+/−10.5 years, incidence of atrial fibrillation (30%), pulmonary artery systolic pressure (PAsP) (79+/−17 mm Hg), mitral valve (MV) score (8.6+/−2.9) and MV area (0.7+/−0.19 cm 2 ). After the procedure, minimal mitral regurgitation occurred in 20%, and mortality rate was 11%. Follow-up of 4.5+/−2 years was available in 14 of 15 survivors, of whom 11 were asymptomatic. The gain in MV area and the decrease in transmitral gradient (TMG) and PAsP persisted during the follow-up period. Conclusion Emergent BMV is safe and feasible in patients with symptomatic mitral stenosis and severe pulmonary edema refractory to medical therapy. Survivors have excellent clinical and hemodynamic status at follow-up.

Introduction Le nombre de patients en dialyse apres echec de transplantation augmente. La survie des patients et la technique de dialyse semble equivalente entre dialyse peritoneale (DP) et hemodialyse (HD) dans cette situation. Cependant, le niveau de preuve dans la litterature reste actuellement faible. Materiels et methodes Dans cette etude retrospective et multicentrique, nous avons inclus 328 patients inscrits dans le Registre de dialyse peritoneale de langue francaise et debutant la DP apres echec de transplantation (groupe Tx) entre le 1er janvier 2002 et le 31 decembre 2012. Ils ont ete matches chacun sur le sexe et l’âge a 2 patients en DP sans antecedent de transplantation renale (groupe temoin). La survie des patients et de la technique de DP ont ete analysees. Resultats La survie des patients etait identique entre les deux groupes (p = 0,34). La duree mediane en DP etait plus courte dans le groupe Tx : 17 mois [14–20] contre 21 mois [19–23] dans le groupe temoin (p = 0,003). La cause principale de transfert etait liee a une inadequation de dialyse (p = 0,047). Les 3 variables associees a un risque accru de transfert en HD etaient : l’antecedent d’echec de transplantation (HR = 1,6 [1,30 a 1,95], p Discussion La survie de patients et le risque d’infection peritoneale sont similaires entre patients avec et sans antecedents de transplantation renale mais la survie de la technique de DP significativement inferieure dans le groupe de patients avec antecedents de transplantation renale. En effet, ces patients sont plus transferes en HD compares aux patients non transplantes. Les causes de ce transfert sont imprecises. Il semble necessaire de caracteriser les patients a haut risque de transfert en HD et d’identifier des facteurs pronostiques pejoratifs pour mieux les preparer a un transfert en HD. Conclusion La survie des patients en DP n’est pas influencee par l’antecedent de transplantation renale. En revanche, la survie de la technique est significativement plus courte chez les patients en DP apres echec de transplantation.

We study the magnetic susceptibility of mixed-valent La${}_{2\ensuremath{-}x}$Sr${}_{x}$CoO${}_{4}$ single crystals in the doping range of $0.5\ensuremath{\leqslant}x\ensuremath{\leqslant}0.8$ for temperatures up to 1000 K. The magnetism below room temperature is described by paramagnetic Co${}^{2+}$ in the high-spin state and by Co${}^{3+}$ in the nonmagnetic low-spin state. At high temperatures, an increase in susceptibility is seen, which we attribute to a temperature-induced spin-state transition of Co${}^{3+}$. The susceptibility is analyzed by comparison to full-multiplet calculations for the thermal population of the high- and intermediate-spin states of Co${}^{3+}$.

From December 1994 to May 1999, 487 patients underwent percutaneous transvenous mitral commissurotomy according to the Inoue balloon technique for tight mitral stenosis. In three cases, the Inoue balloon technique was not possible because the catheter balloon could not enter the mitral orifice and the double-balloon technique was performed instead. In two cases, a flow-guided balloon catheter met the mitral orifice and the double-balloon technique was effective. In the third case, passing the valve with a flow balloon catheter was impossible, a 0.032 Terumo straight wire crossed the valve, which was dilated with a single balloon the first time and a double balloon the second time. The mitral valve area increased in the three cases from 0.8 to 1.8 cm2, from 0.7 to 1.6 cm2, and from 0.5 to 1.5 cm2, respectively. There were no complications. (J Interven Cardiol 2001; 14:17–19)

From January 1994 to July 1998, percutaneous mitral commissurotomy was performed in 520 patients. Of these patients, 7 (4 men and 3 women aged 31 ± 5.6 years) were dilated in an emergency situation of intractable pulmonary edema caused by severe mitral stenosis. Three patients required mechanical ventilatory support. Percutaneous mitral commissurotomy was performed with the Inoue balloon. The dilatation of the valve was undertaken even though the echocardiographic score of the valve was high. Percutaneous mitral commissurotomy resulted in an increase in the mitral valve area from 0.72 ± 0.18 cm2 to 1.95 ± 0.18 cm2 (P = 0.011) with a concomitant reduction in pulmonary artery systolic pressure from 82.5 ± 16.4 mmHg to 46.7 ± 11.6 mmHg (P = 0.018). One patient died (he had two cardiac arrests before the dilatation). During follow-up (mean 18 months), one patient presented with a restenosis, one an aggravation of mitral insuflciency grade, and four were in NYHA functional Class II. Thus, percutaneous mitral commissurotomy can be considered as a treatment of choice in patients with intractable pulmonary edema caused by severe mitral stenosis.

The objective of this study was to determine both the prevalence of white-coat effect and white-coat hypertension (WCH) and which selected clinical variables were predictors of WCH. A total of 2462 patients underwent ambulatory blood pressure monitoring either in borderline hypertension (group 1) or for assessment of antihypertensive treatment (group 2) or for hypotension (group 3). In the overall population 33.0% of patients showed WCH, 32.8% in group 1 and 37.0% in group 2. In multivariate analysis, sex and grade of hypertension were independent predictors of WCH in groups 1 and 2.

Using $\mathrm{Co}\mathrm{\text{\ensuremath{-}}}{L}_{2,3}$ and $\mathrm{O}\mathrm{\text{\ensuremath{-}}}K$ x-ray absorption spectroscopy, we reveal that the charge ordering in ${\mathrm{La}}_{1.5}{\mathrm{Sr}}_{0.5}{\mathrm{CoO}}_{4}$ involves high spin ($S=3/2$) ${\mathrm{Co}}^{2+}$ and low spin ($S=0$) ${\mathrm{Co}}^{3+}$ ions. This provides evidence for the spin-blockade phenomenon as a source for the extremely insulating nature of the ${\mathrm{La}}_{2\ensuremath{-}x}{\mathrm{Sr}}_{x}{\mathrm{CoO}}_{4}$ series. The associated ${e}_{g}^{2}$ and ${e}_{g}^{0}$ orbital occupation accounts for the large contrast in the Co-O bond lengths and, in turn, the high charge ordering temperature. Yet, the low magnetic ordering temperature is naturally explained by the presence of the nonmagnetic ($S=0$) ${\mathrm{Co}}^{3+}$ ions. From the identification of the bands we infer that ${\mathrm{La}}_{1.5}{\mathrm{Sr}}_{0.5}{\mathrm{CoO}}_{4}$ is a narrow band material.

Spin correlations in La2-xSrxCoO4 (0.3 0.3 exhibits incommensurate spin ordering with the modulation closely following the amount of doping. These incommensurate phases strongly resemble the stripe phases observed in cuprates and nickelates, but incommensurate magnetic ordering appears only at larger Sr content in the cobaltates due to a reduced charge mobility.

Exposure of a mixture of the title azine (1) and triethylamine (1:2 molar ratio) to daylight gives as major products, triethylamine hydrochloride and the Δ2-azetine CF3 CCHCH(NEt 2 )N NCClCF3 (3), together with trifluoroacetonitrile and tar; a single electron transfer (SET) mechanism is proposed involving the intermediacy of the enamine Et2NCHCH2. In contrast the reaction of azine (1) with tri-n- propylamine in light affords the amine hydrochloride, the substituted azine CF3CClNNC(NPrn2)CF3 (14) and tar. Treatment of the heterocycle (3) with diethylamine results in replacement of Cl by NEt2 to give the azetine (6) which is also formed when the azine CF3CClNNC(NEt2)CF3 (7) is heated with triethylamine.

Using Co-L2,3 and O-K x-ray absorption spectroscopy, we reveal that the charge ordering in La1.5Sr0.5CoO4 involves high spin (S=3/2) Co2+ and low spin (S=0) Co3+ ions. This provides evidence for the spin-blockade phenomenon as a source for the extremely insulating nature of the La2-xSrxCoO4 series. The associated e{g}{2} and e{g}{0} orbital occupation accounts for the large contrast in the Co-O bond lengths and, in turn, the high charge ordering temperature. Yet, the low magnetic ordering temperature is naturally explained by the presence of the nonmagnetic (S=0) Co3+ ions. From the identification of the bands we infer that La1.5Sr0.5CoO4 is a narrow band material.

We present a combined study of the thermal expansion and the thermal conductivity of the perovskite series $R{\text{CoO}}_{3}$ with $R=\text{La}$, Nd, Pr, and Eu. The well-known spin-state transition in ${\text{LaCoO}}_{3}$ is strongly affected by the exchange of the $R$ ions due to their different ionic radii, i.e., chemical pressure. This can be monitored in detail by measurements of the thermal expansion, which is a highly sensitive probe for detecting spin-state transitions. The Co ions in the higher spin state act as additional scattering centers for phonons, therefore suppressing the phonon thermal conductivity. Based on the analysis of the interplay between spin-state transition and heat transport, we present a quantitative model of the thermal conductivity for the entire series. In ${\text{PrCoO}}_{3}$, an additional scattering effect is active at low temperatures. This effect arises from the crystal-field splitting of the $4f$ multiplet, which allows for resonant scattering of phonons between the various $4f$ levels.

The magnetic correlations in the charge and orbital ordered manganite ${\text{La}}_{1/2}{\text{Sr}}_{3/2}{\text{MnO}}_{4}$ have been studied by elastic and inelastic neutron scattering techniques. Out of the well-defined charge exchange (CE)-type magnetic structure with the corresponding magnons, a competition between CE-type and ferromagnetic fluctuations develops. Whereas ferromagnetic correlations are fully suppressed by the static CE-type order at low temperature, elastic and inelastic CE-type correlations disappear with the melting of the charge-orbital order at high temperature. In its charge-orbital disordered phase, ${\text{La}}_{1/2}{\text{Sr}}_{3/2}{\text{MnO}}_{4}$ exhibits a dispersion of ferromagnetic correlations, which remarkably resembles the magnon dispersion in ferromagnetically ordered metallic perovskite manganites.

Spin correlations in La2-xSrxCoO4 (0.3or = xor = 0.6) have been studied by neutron scattering. The commensurate antiferromagnetic order of La2CoO4 persists in a very short range up to a Sr content of x = 0.3, whereas small amounts of Sr suppress commensurate antiferromagnetism in cuprates and in nickelates. La2-xSrxCoO4 with x0.3 exhibits incommensurate spin ordering with the modulation closely following the amount of doping. These incommensurate phases strongly resemble the stripe phases observed in cuprates and nickelates, but incommensurate magnetic ordering appears only at larger Sr content in the cobaltates due to a reduced charge mobility.

figuration 10Dq= 1.2 eV, eg= 1.4 eV, and t2g = 0.2 eV. The spectral weight of the lowest absorption feature at 1 – 2 eV changes by a factor of 2 as a function of temperature, which can be attributed to the change of the nearest-neighbor spin-spin correlation function across the Neel temperature TN = 133 K. Interpreting LaSrMnO4 effectively as a Mott-Hubbard insulator naturally explains this strong temperature dependence, the relative weight of the different absorption peaks, and the pronounced anisotropy. By means of transmittance measurements, we determine the onset of the optical gap opt = 0.4– 0.45 eV at 15 K and 0.1– 0.2 eV at 300 K. Our data show that the crystal-field splitting is too large to explain the anomalous temperature dependence of the c-axis lattice parameter by thermal occupation of excited crystal-field levels. Alternatively, we propose that a thermal population of the upper Hubbard band gives rise to the shrinkage of the c-axis lattice parameter.

Treatment of the title azine (1) with phenyl-lithium results in initial replacement of chlorine by phenyl to give the monophenylazine (4) and then the diphenylazine (5) , but this is followed by successive replacement of fluorine in one CF 3 group to afford first the 3,4-diazahexa-1,3-diene CF 3 CPh 2 NNCPhCXY (6) (XYF), then (7) (XF,YPh) and finally (8) (XYPh).

High blood pressure (BP) is a major cause of cardiovascular disease and primary hypertension is a frequent pathological condition. Sympathetic hyperactivity may be involved in primary hypertension. The purpose of this study was mainly to evaluate sympathetic activity when performing cardiovascular autonomic profile examination in patients with primary hypertension in comparison with normotensive subjects.This prospective study included one group of hypertensive patients (n=120, mean age 54 years) compared with a control group (n=120, mean age 52 years) of normotensive subjects. Autonomic tests included deep-breathing (DB), hand-grip (HG) and echostress test (ES). Comparison tests between the two groups, similar in age, were expressed as mean+/-SE and made using the t Student test, p0.05 was considered significant.Alpha-adrenergic sympathetic response using ES method produced a BP response of 20,0%+/-9,8 in hypertensive patients group and 15,2%+/-8,6 in the control group (p0.001). Alpha-adrenergic sympathetic response using three minutes HG test was of 16,7%+/-7,5 in hypertensive patients group and 13,3%+/-6,5 in the control group (p0.001). Vagal stimulation in hypertensive group after DB showed that electrocardiographic: ECG (EKG) waves R (RR) interval variation was of 30,2%+/-8,1 meanwhile in the control group this RR variation was of 46,1%+/-21,1 p0.001, and the one of HG of 15 seconds was 17,6%+/-10,2 versus 32,5%+/-12,7 p0.001.Hypertensive patients had a significantly higher sympathetic response to central and peripheral stimulations and a significantly lower parasympathetic response when compared to normotensive controls.

The Deep-Breathing (DB) test is of major importance in the evaluation of the vagal response (VR). We applied this test to assess the VR in a group of subjects with functional (neurological, cardiovascular or digestive) symptoms unexplained by standard cardiac examination and to compare it with the VR measured in a group of healthy controls.The following groups were considered: a C-Group of healthy controls (n=50), and three groups each consisting of 50 symptomatic patients (S1, S2, S3). Subjects in the S1-Group had a postural orthostatic tachycardia syndrome (POTS), while members of the S2-Group had arterial hypertension, and members of S3-Group had neither POTS nor arterial hypertension. The VR was expressed as a percentage variation of RR intervals 100x[(RR(max)-RR(min))/RR(min)], and was correlated with age and sex in the C-Group before any comparison.In controls the VR was 31.0%+/-8.2. It was negatively correlated with age (r=-0.42, p=0.003) and there was no significant difference between males (31.2%+/-5.7) and females (30.9%+/-9.0) (p=0.12). Compared to the C-Group, the VR was 51.6%+/-20.4 in the S1-Group (p0.001), 26.9%+/-11.3 in the S2-Group (p0.001), and 47.2%+/-22.7 in the S3-Group (p0.001).The VR was independent of sex but was negatively correlated with age. In comparison with healthy controls, it was significantly increased in the patients with POTS and significantly decreased in hypertensives.

Postural orthostatic tachycardia syndrome (POTS) is an inadequately understood pathology because its diagnosis is not based on the conventional methods of investigation. The orthostatic test allows to make the diagnosis easily. The objective of this study is to determine cardiovascular autonomic reflexes of 70 patients having POTS. The tests of exploration of the autonomic nervous system practised are: deep breathing, hand grip, mental stress and orthostatic test. The analysis of orthostatic test showed that the increase of the cardiac frequency, relative to the state of "beta" peripheral sympathetic hyperactivity occurred before the 2nd minute in 80% of patients. The POTS was considered "florid" in 43% of patients and had complicated of a rough and severe fall of systolic blood pressure inferior to 70 mmHg in four patients, after the fifth minute of the test. The analysis of the different tests had shown vagal hyperactivity in 63% of patients on deep breathing, in 93% of patients on hand grip and in 100% on orthostatic test. The "alpha" central sympathetic activity was increased in 76% of the cases and "beta" central sympathetic activity was high in 83% of cases. The "alpha" peripheral hyperactivity was observed in 63% of patients on hand grip, and in 44% on orthostatic test. The analysis of cardiovascular autonomic reflexes in patients affected by POTS allowing the determination of their autonomic profile, will contribute probably to a better understanding of this pathology and to a better orientation of its care.

Increased plasma total homocysteine (tHcy) levels have been shown to be a risk factor for coronary artery disease (CAD). The common methylenetetrahydrofolate reductase C677T (MTHFR C677T) polymorphism has been reported to be a strong predictor of mild hyperhomocysteinaemia (HHcy). We assessed whether this mutation was associated with increased risk of CAD and plasma levels of tHcy. We also evaluated interactions between this polymorphism, mild elevated tHcy levels and conventional risk factors of CAD.Method. Using PCR-RFLP analysis, we studied the frequency of the C677T genotypes and its effect on CAD and on tHcy concentrations in 400 subjects without and with CAD angiographically confirmed. There were 210 subjects with CAD and 190 subjects without CAD.Results. The frequencies of the C677T genotypes were 53%(59.5%in controls versus 48.1%in cases), 34.8%(32.1 in controls versus 37.1 in cases), and 11.8%(8.4%in controls versus 14.8%in cases), respectively, for 677CC, 677CT, and 677TT. The genotype frequencies were significantly different between case and control groups (P<.05). The 677T allele enhances the risk of CAD associated to HHcy (P<.01). In multivariate analysis models, MTHFR C677T polymorphism effect on CAD was masked by other risk factors. HHcy was only and independently influenced by MTHFR polymorphism and smoking habits, and it is a strong predictor of CAD independently of conventional risk factors.Conclusion. Our data suggest that HHcy is strongly and independently associated to CAD risk increase; and MTHFR C677T polymorphism and smoking habits were the main predictors of tHcy levels. The CAD risk increase is mainly associated with mild HHcy in 677TT, whereas in 677CT and 677CC it is mainly associated with the conventional risk factors.

The purpose of our study is to illustrate by five original observations the various situations where the stenting of the left main coronary artery can be proposed in alternative to aortocoronary bridging with encouraging results in short- and long-term.We report a retrospective study relating to five cases with left main disease treated by stenting between 1996 and 2002 at our institution. In two cases the left main stem was unprotected. In two other cases, the left main trunk was protected. And the last case was an emergency stenting for an iatrogenic dissection of the left main coronary artery.The stenting was carried out successfully among the five patients without major in-hospital complication. During the follow-up of 29 months at mean, no death was deplored, and no target lesion revascularization was required on the left main coronary artery (with a left main trunk permeable on three coronarographic controls).In the light of these results, and basing on the published data, we conclude that stenting for the left main coronary disease may be a safe and effective alternative to coronary artery bypass surgery in particular cases among "selected" patients (refusal or surgical contraindication, protected left main coronary artery, spontaneous or iatrogenic acute occlusion of the left main coronary artery).

The magnon dispersion in the charge, orbital, and spin ordered phase in La1/2Sr3/2MnO4 has been studied by means of inelastic neutron scattering. We find excellent agreement with a magnetic interaction model based on the CE-type superstructure. The magnetic excitations are dominated by ferromagnetic exchange parameters revealing a nearly one-dimensional character at high energies. The strong ferromagnetic interaction in the charge or orbital ordered phase appears to be essential for the capability of manganites to switch between metallic and insulating phases.

Lutembacher syndrome refers to the rare combination of congenital atrial septal defect and acquired mitral stenosis. This condition is usually treated surgically by mitral valve operation with concomitant closure of the atrial septal defect.Between 1993 and 2003, 4 patients with congenital Lutembacher syndrome had percutaneous mitral commissurotomy without closure of the atrial septal defect at our institution. The 4 patients were very symptomatic with right-sided heart failure signs and NYHA functional class III-IV.The procedure was carried out successfully for the four patients. Mitral valve area increased from 0.87 to 1.97 cm2 at mean; left atrial pressure decreased from 28.2 to 12.7 mmHg and the mean valve mitral gradient was reduced from 15.5 to 3.9 mmHg. Functional and clinical improvement was observed in all the cases. During a mean follow up of 55 +/- 29 months, our 4 patients remain pauci symptomatic under medical treatment.The percutaneous treatment of the Lutembacher syndrome is currently a possible alternative to the surgery among patients having an anatomy favourable to the procedure.

The magnon dispersion in the charge, orbital, and spin ordered phase in La1/2Sr3/2MnO4 has been studied by means of inelastic neutron scattering. We find excellent agreement with a magnetic interaction model based on the CE-type superstructure. The magnetic excitations are dominated by ferromagnetic exchange parameters revealing a nearly one-dimensional character at high energies. The strong ferromagnetic interaction in the charge or orbital ordered phase appears to be essential for the capability of manganites to switch between metallic and insulating phases.

Coxiella Burnetii endocarditis is very rare. It is the main complication of the chronic form of Q fever. Blood cultures are negative and clinical presentation very variable and diagnosis is essentially based on indirect immunofluorescence serum analysis. The authors report the case of a 19 year old patient with a history of rheumatic aortic regurgitation admitted for an episode of left ventricular failure in a context of long-term pyrexia without valvular vegetations or mutilation. The antiphase I Ig G antibody levels were significant. Treatment with doxycycline and fluoroquinolone was initiated. The clinical improvement was spectacular. Three months later, the patient underwent aortic valve replacement and histological examination of the valve showed subacute endocarditis on chronically fibrotic valvular disease. This is an interesting case by its rarity and its diagnostic and therapeutic problems.

Strong resonant enhancements of the charge-order and spin-order superstructure-diffraction intensities in La1.8Sr0.2NiO4 are observed when x-ray energies in the vicinity of the Ni L2,3 absorption edges are used. The pronounced photon-energy and polarization dependences of these diffraction intensities allow for a critical determination of the local symmetry of the ordered spin and charge carriers. We found that not only the antiferromagnetic order but also the charge-order superstructure resides within the NiO2 layers; the holes are mainly located on in-plane oxygens surrounding a Ni2+ site with the spins coupled antiparallel in close analogy to Zhang-Rice singlets in the cuprates.

Strong resonant enhancements of the charge-order and spin-order superstructure-diffraction intensities in La1.8Sr0.2NiO4 are observed when x-ray energies in the vicinity of the Ni L2,3 absorption edges are used. The pronounced photon-energy and polarization dependences of these diffraction intensities allow for a critical determination of the local symmetry of the ordered spin and charge carriers. We found that not only the antiferromagnetic order but also the charge-order superstructure resides within the NiO2 layers; the holes are mainly located on in-plane oxygens surrounding a Ni2+ site with the spins coupled antiparallel in close analogy to Zhang-Rice singlets in the cuprates.

The autonomic nervous system controls all body functions. Dysregulation of this system, called dysautonomia, is responsible of polymorphic functional symptoms. Its exploration can reveal abnormalities which explains the clinical symptoms. The objective of this work is to try to find a connection between functional signs, mainly cardio-vascular and autonomic abnormalities. We also consider the autonomic profile of a group of patients with primary hypertension.Patients with functional symptoms and normal clinical and paraclinical examinations underwent autonomic profile study. The following tests were performed: deep breathing, hand grip, echo stress, Valsalva maneuver and tilt test.Two hundred and eighty four patients were included in this study, females 70%, mean age 44 years (extremes 9 and 81). In this group of patients, the main autonomic syndromes found were: orthostatic hypotension, 88 patients in whom the alpha peripheral sympathetic activity is decreased and the vagal one is increased, postural orthostatic tachycardia syndrome (POTS), 123 patients who describe orthostatic symptoms and in whom beta sympathetic activity is high, the neurocardiogenic syncope, four patients in whom vagal activity is high, and the baro-receptor abnormality (115 patients) of variable degree. In patients with primary hypertension (137), the alpha sympathetic activity is high (mean increase of blood pressure of 38.5%), meanwhile the vagal one is low. Twelve patients having diabetes showed a low vagal activity, (mean EKG RR variation of 8%). The treatment, depending on the autonomic abnormality (hygienodietetic measures, éthyléphrine, fludrocortisone, phenobarbital, clonidine, maproptyline, sérotonine recapture inhibitor) showed an improvement in the functional state of the patients.Autonomic profile study helps to explain the causes of symptoms described by the patients whose clinical and conventional paraclinical examinations are normal.

The objective of this study was to test the hypothesis that apo E (RFLP, HhaI) and/or angiotensin-converting enzyme (ACE) (ins16del) are associated with higher risk for coronary heart disease. We investigated 250 patients who underwent complete cardiac examination comprising coronary angioplasty and biological analysis (CT, HDLc, LDLc, TG, apo A and apo B). Prevalence of the alleles of apo E and ACE was assessed by molecular analysis. Patients without stenosis or with non-significant stenosis (50% of the vascular lumen) were used as reference group (141 patients). Those presenting a significant stenosis of the coronary artery (. 50% of the vascular lumen) were considered as cases (109 patients). The relative frequency of the e 4 allele was significantly higher in cases than in reference group (p0.02). A strong association have been found between coronary heart disease and apo E polymorphism (2 = 8.91; p0.05). The presence of the e 4 allele increase the risk of atherosclerosis (RR = 2.71; IC95%: 1.25-5.90; p0.02) compared to e 3 allele. Also, subjects with D allele were more frequent in cases than in reference group (p0.001). A significant association was noted between ACE polymorphism and coronary heart disease (2 = 42.15; p0.001). This relationship was positive (rho de Spearman = 0.39; p0.01). With D/D homozygotes patients, the RR for coronary heart disease was 19.10 (p0.001), while The RR with I/D heterozygotes was 6.91 (p0.001) compared to I/I homozygotes. A significant interaction have been shown up between D/D genotype and arterial hypertension (HTA) (2 de Wald = 16.10; p0.001). The multivariate analysis showed that the chronic smoking, diabetes, hypoapolipoproteinemia A, interactive effects between D/D and HTA, I/D and obesity, and between D/D and hypertriglyceridemia were the major significant factors to take into consideration in our population. We also note that subjects with both D and e 4 alleles were presenting a high risk to coronary heart disease (RR = 5.93; IC95%: 2.00-17.55; p0.01). Thus, those two alleles (4 and D) appears to be important cardiovascular risk factors in the moroccan population.

Dysfunction of autonomic nervous system (ANS) is implicated in the genesis and persistence of migraine. The objective of this study was to compare autonomic nervous system (ANS) profile of migraineurs during headache-free periods to a group of normal subjects based on cardio-vascular reactivity.Patients with migraine according to the criteria of IHS 2004 were selected for the study. After a 30 min resting blood pressure (BP), the following standard tests were performed: deep-breathing (DB), hand grip (HG) of 15 s and 3 min, valsalva maneuver, echo stress, (ES) and tilt test (TT). Results were compared to 44 normal subjects, age similar, 37 female, (84.1%) using the Student test, with P0.005 as significant.Thirty-two patients (27 female (84.38%), 16-51 years, mean 40.41 +/- 7.8) were studied. Twenty-two patients (69%) had systolic blood pressure below 94 mmHg and 25 patients (78%) had diastolic blood pressure below 60 mmHg. Compared to normal, migraineurs exhibited a significantly higher vagal response (P0.001) and a significantly lower alpha sympathetic response, central by using ES as well as peripheral by using HG of 3 min (P0.001).Autonomic cardiovascular reactivity of patients with migraine showed a vagal hyperactivity and a deficiency of the alpha sympathetic system. This leads to further studies with new therapeutical approaches.

The aim of our study was assess anatomical and functional results of renal artery angioplasty with and without stenting in 25 hypertensive patients (8 female and 16 male, 42.6 and 61.6 years old respectively) with significative renal artery stenosis (RAS) (atherosclerotic: 22; fibrodysplastic: 3). Eleven patients had simple angioplasty and 13 had stenting. The rate of angioplasty success was 96%. In the stent group, the anatomical result was better: 2% of residual stenosis versus 24% in the other group (p0.001). Restenosis occurred in 2 patients. Immediately after revascularisation arterial blood pressure decreased from 195/105 +/- to 150/85 +/- mmHg in-group without stent (p0.001) and from 190/100 to 145/85 mmHg in the group (p0.001). The value of serum creatinine concentration in patient with renal failure didn't change after revascularization.

Pregnancy is one of the most important factors known to destabilize valvular heart disease. In particular, pregnancy is a major cause of aggravation in the clinical course of women with mitral stenosis (MS). Surgical treatment of MS during pregnancy may be hazardous for both mother and foetus. In this context, percutaneous mitral valvuloplasty using the Inoue balloon may constitute a particularly attractive alternative to surgery. We report the results of percutaneous mitral valvuloplasty achieved in a series of 11 pregnant women.

We demonstrate 100 GHz-spaced 40/spl times/43 Gb/s WDM transmission over 2540 km of SMF fibre in a terrestrial configuration, with combined erbium and Raman amplification and a standard NRZ format. All channels perform better than the enhanced FEC limit.

Summary Authors present the case of a 58 years old man with acute pylephlebitis and liver abscess. Several blood cultures yielded Streptococcus anginosus. Complicated appendiceal inflammatory disease had been eliminated. There was no evident initial focus leading to infection of portal system and liver. Early and prolonged antibiotic therapy led to recovery. This case put emphasis on unidentified initial focus.

A fully broadcasting 128/spl times/128 cross-connect with an all-optical switching fabric has been designed and a managed, rack-mounted prototype based on commercially available technologies has been developed for testing. System architecture and experimental results are reported, and 512/spl times/512 feasibility is demonstrated.

Our data suggest that the hyperhomocysteinemia and/or increased plasma level of lipoprotein Lp(a) are risk factors for coronary heart disease. We investigated 178 patients who underwent complete cardiac examination comprising coronary angiography and biological analysis (CT, HDL-c, LDL-c, TG, and apoAI, apoB, homocysteine and Lp(a)). Patients presenting a significant stenosis of the coronary artery ( 50% of the vascular lumen) were considered as cases (113 patients). Those without stenosis or with non-significant stenosis (50% of the vascular lumen) were used as controls (65 subjects). Homocysteinemia was significantly higher in cases than in control subjects (8.26 mol/L (2.34 versus 17.85 (2.34, p0.001). A strong association between coronary heart disease and homocystein has been found (Eta(2) = 0.76). The OR were 0.16 when homocystein level was lower than 15 mol/L, and 27.78 when homocysteine level was upper than or equal to 15 mol/L. The RR was 5.16 (95% IC = 3.66-6.66, p0.001). Even though there was a significant correlation between tabagic impregnation and homocysteinemia (Spermann's rho = 0.37, p0.05), there was no interactive effect between these two factors and coronary disease (Wald khi2 = 0.086, p0.05). Therefore, no association was found between homocyteinemia and other coronary heart disease risk factors. The Lp(a) levels were significantly higher in cases than in controls subjects (188 (84 mg/L in control subjects versus 590 (199 in cases, p0.001). A stronger relationship was noted between coronary heart disease and Lp(a) (Eta (2) = 0.66). The OR were 0.09 when lipoprotein (a) levels were lower than 350 mg/L, and 5,88 when Lp(a) levels were higher than or equal to 350 mg/L. The estimate RR was 6.47 (95% IC = 4.39-8.55, p0.001). The level of Lp(a) was positively correlated with the severity of coronary heart disease (Spermann's rho = 0.95, p0.001). A weak correlation between Lp(a) and LDL-c was observed (Spermann's rho = 0.12, p = 0.048). But the multivariate analysis didn't show interactive effect between these two factors and coronary disease (khi2 de Wald = 0.264, p0.05). No association was noted between Lp(a) and the others risk factors. Moreover, a positive correlation between the levels of homocysteine and those of Lp(a) was found (Spermann's rho = 0.54, p0.001). In contrast their effect on coronary heart disease seems to be independant (Wald khi2 = 2.957, p0.05). Thus, these two parameters appear as independant risk factors for coronary heart disease.