Occlusions coronaires chroniques : existe-t-il une spécificité féminine ?

Many differences have been reported regarding gender in angioplasty procedures (PCI), but their potential influence on clinical outcomes after CTO PCI has not been elucidated. Aim of this paper is to analyse these potential differences starting from 2 clinical cases. The basic features found in the two clinical cases presented here, older age and presence of diabetes (that are more frequent in women), are in line with the differences identified in non-CTO studies on angioplasty. Furthermore, CTO in women are generally under-diagnosed and less frequently treated by angioplasty than in men. These features combined to the often atypical clinical presentation could explain why women are generally less frequently enrolled in CTO registries than men. Although data on the impact of gender on this topic are scarce, it appears that, despite a clear outcome difference in patients who have a successful CTO angioplasty and similar success rates, women are still under-referred for a CTO angioplasty. Indeed, CTO angioplasty seems a valid therapeutic option, in women as in men.     

Quels sont les objectifs non médicaux individuels et collectifs ?

INDIVIDUAL NON-MEDICAL OBJECTIVES ARE: Information to patients concerning their past exposure to asbestos and their right to compensation; equity demands that every person potentially eligible should be fully informed. Social recognition. Facilitation of compensation by informing the patient and his physician of the mechanisms. COLLECTIVE NON-MEDICAL OBJECTIVES ARE: Social visibility, contributing to the prevention of occupational cancer. Better balance of the Social Security budget since it is the employers who bear the cost of compensation of occupational diseases. Improved epidemiological understanding of the circumstances of exposure and the most commonly concerned occupations and industries. Evaluation of the mechanisms of management of occupational diseases. PSYCHOLOGICAL IMPACT: It is of the same magnitude as any screening procedure; it should be acceptable and avoid long-term negative psychological effects; it may be useful to implement specific support for the few patients with psychological problems.     

Traitement antiagrégant plaquettaire chez la femme : une spécificité liée au sexe ?

Women is a fragile and complex substet of patients, under-represented in clinical trials, but experiencing growing cardiovascular events, with higher mortality, delayed presentation, higher bleeding complications and undertreatment with antithrombotic therapies, compared to their male counterparts. Female gender has been associated with enhanced basal platelet reactivity, high residual on-treatment platelet reactivity and various responses to antiplatelet agents. Growing concern on gender-specificity has emerged, including potential difference in women compared with men on the benefits and risks of antiplatelet therapy in primary or secondary prevention and according the antiplatelet agent used. We provide here a review of available data on antiplatelet therapy in women.     

Hématome intramural de l’aorte thoracique : traitement médical ou chirurgie ?

Intramural hematoma (IMH) of the aorta is an uncommon entity. This disease shares many characteristics with acute aortic dissection. Treatment of IMH remains controversial. We report the case of a 58 years old man with hypertension disease who was admitted in emergency department with suspicion of acute aortic dissection. Transoesophageal echocardiography showed IMH involving the descending aorta which spred afterwards to the ascending aorta. Patient was treated medically and echocardiographic follow-up showed that aortic hematoma remains stable. Two years later, patient is alive and the last TEE reveals disappearance of hematoma in ascending aorta and decrease of it in descending aorta.     

Faut-il faire un test au méthergin non invasif après un arrêt cardiaque par spasme coronaire ?

A 59-year-old man was admitted after cardiac arrest with successful reanimation. There was no significant coronary lesion. We conclude to the diagnosis of coronary spasm after the occurrence of a chest pain with anterior ST elevation reversible with intravenous nitrates. One month later, non-invasive methylergometrine test was carried out and complicated by a cardiac arrest due to complete heart block and asystole treated by chest compression, molsidomine and epinephrine. No cardiac event occurred within the following six months. Technique (invasive versus not invasive) and indication of methylergometrine test for the follow-up of severe manifestations of coronary spasm should be better specified in international guidelines.     

La consultation médicale après une pré-éclampsie : pourquoi ? Pour qui ? Quand ? Comment ? Pour trouver quoi ?

The internist has a relevant role in the medical assessment which is mandatory after every case of pre-eclampsia. This postnatal visit has to be performed to assert there is no underlying disorder such as chronic arterial hypertension or nephropathy, autoimmune disease or thrombophilia. This visit is also needed to provide information to the woman about what occurred during the pregnancy as well as to consider which would have to be done in case of a subsequent pregnancy. Long-term outcome had also to be taken into account considering risks for cardiac, arterial, renal and metabolic diseases. This visit is of outmost importance after very early-onset pre-eclampsia, and especially if it has already occurred. The postnatal visit after pre-eclampsia represents a very demonstrative example of the role that the internist can afford to the obstetrician in the management of medical disorders occurring during pregnancy and needing a specific expertise as well as a long-term follow-up.