Corrélation entre les dosages des dérivés methoxylés urinaires et l’index d’apnée-hypopnée dans une population d’hypertendus : étude pilote

Aims

Sleep disorders like obstructive sleep apnea in adults are associated with increased sympathetic activity, which induced high blood pressure and could be associated with resistant hypertension. Some studies have demonstrated that high urinary catecholamine levels in obstructive sleep apnea patients may be decreased with continuous positive airway pressure therapy. However, very few studies have demonstrated a correlation between apnea-hypopnea index and urinary catecholamine levels in hypertension patients.

Methods

In this pilot study, 20 hypertensive patients referred for hypertension work-up including night-time polygraphy and 24 h urinary catecholamine dosage were included.

Results

Mean age was 51 ± 11 years (30–76), 68% were males. Diagnosis of obstructive sleep apnea was confirmed in 13 patients at the end of the work-up. Mean apnea-hypopnea index was 14 ± 9 (2–32). The only urinary catecholamine parameter significantly increased in patients with obstructive sleep apnea was 24 h urinary normetanephrine (1931 ± 1285 vs 869 ± 293 nmol/24 h; P < 0.05). However, this difference was not significant when this parameter was adjusted to 24 h urinary creatinine. We observed a significant positive correlation between AHI and 24 h urinary normetanephine (r = 0.486; P = 0.035).

Conclusion

This pilot study confirms an isolated elevation of 24 h urinary normetanephrine in hypertensive patients with obstructive sleep apnea and shows a significant correlation between sleep disorders expressed by apnea-hypopnea index and urinary catecholamines excretion.     

Dénervation rénale dans le traitement de l’hypertension artérielle résistante : expérience du CHU de Lyon

Aim

We report the first experience of Lyon's university hospital regarding renal denervation to treat patients with resistant essential hypertension.

Patients and methods

Over a one-year period, 17 patients were treated (12 men, 5 women) with renal denervation. Baseline characteristics were as follows: age 56.5 ± 11.5 years, BMI 33 ± 5 kg/m² and ambulatory blood pressure 157 ± 16/87 ± 13 mmHg with 4.2 ± 1.5 anti-hypertensive treatment.

Results

We did not observe per procedural and early complications. After a median follow-up of 3 months and with the same anti-hypertensive treatment, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) decrease respectively of 20 ± 15 (P < 0.001) and 10 ± 13 mmHg (P = 0.014) (n = 17). After six months of follow-up, ambulatory blood pressure (ABPM) decrease of 17.5 ± 14.9 mmHg (P = 0.027) for SBP and of 10.5 ± 9.6 mmHg (P = 0.029) for DBP (n = 6). Among these patients, five of them were controlled (ABPM inferior to 130/80 mmHg) and electrical left ventricular hypertrophy indexes decreased: R wave in aVL lead of 4 ± 3 mm (P = 0.031), Sokolow index of 3 ± 3 mm (P = 0.205), Cornell voltage criterion of 9 ± 7 mm (P = 0.027) and Cornell product of 1310 ± 1104 (P = 0.027).

Conclusion

Our results are in accordance with data from other centers. On average blood pressure decreases significantly but important inter individual variations are observed. The procedure seems safe.     

Fibrose rétropéritonéale idiopathique : évolution à long terme du pronostic rénal dans une série rétrospective multicentrique de 30 cas

Purpose

Idiopathic retroperitoneal fibrosis (IRF) is an inflammatory disorder, affecting the aorta and the surrounding vessels and tissues. The prognosis is mainly driven by the risks of chronic kidney disease and relapse. Our aim was to assess the prevalence of chronic kidney disease at follow-up.

Methods

We retrospectively reviewed the medical records of patients diagnosed for IRF in Seine-Saint-Denis (France) between 1987 and 2011. We collected informations about presentation, radiologic findings and follow-up. Diagnosis of IRF was confirmed when all the following criteria were met: infiltration of the infrarenal aorta or iliac vessels, absence of aneurysmal dilation, lack of clinical suspicion of malignancy.

Results

Thirty patients were identified, with a male/female ratio of 4.9. Mean age was 55 ± 13 years old. The mean creatinine clearance was 66 mL/min/1.73 m² and the mean CRP was 45 ± 36 mg/L. In 24 (80%) patients, the location of IRF was periaortic and periiliac. Eleven patients (37%) underwent a diagnostic biopsy, and 14 (47%) required an ureteral procedure. A mean follow-up of 63 months was available for 29 patients: 69% relapsed, 7 developed chronic renal disease (24%), and one died of urinary sepsis. Older age (P = 0.023), diabetes (P = 0.007), and initial renal insufficiency (P = 0.05) were associated with a risk of chronic renal insufficiency.

Conclusion

The high frequency of relapses and chronic renal disease emphasizes the need of close follow-up in patients diagnosed with IRF.     

Résultats diagnostiques à court terme et pronostiques à long terme chez des patients avec syncopes inexpliquées : résultats d’un série menée en centre hospitalier

Objective

Evaluate the diagnostic and prognostic input of head-up tilt test in the exploration of unexplained syncope.

Method

Between January 2009 and December 2012, all patients undergoing a head-up tilt test for recurrent syncope were studied. Follow-up data were obtained using telephone interviews and medical record reviews.

Results

A head-up tilt test was realized in 77 patients (47.8 ± 20 years, 53% female) for an exploration of syncope. The tilt test elicited syncope or pre-syncope in 57 patients (74%). The positive response included vaso-vagal syncope in 53 patients and psychogenic syncope in 4 patients. After a mean follow-up of 32 ± 11 months (range 6–54 months), 90% of patients had not a recurrence of syncope. Of note, the incidence of recurrence was the same regardless of whether the patients had a positive (n = 5/48; 10%) or a negative head-up tilt test response (n = 2/19; 10%).

Conclusion

The tilt test has a certain diagnostic value in the exploration of unexplained syncope. Recurrence rate of syncope after a tilt test is low. However, our study suggests no correlation between head-up tilt test results and the likelihood of recurring syncope.     

Fibrose(s) rétropéritonéale(s) : stratégie diagnostique,pathologies associées et suivi à long terme d’une cohorte française

Purpose

Retroperitoneal fibrosis (RPF) is a rare disease with an expanding etiologic spectrum. We aimed to analyze non-invasive diagnosis strategy, associated disorders, monitoring, treatment and prognosis.

Methods

Retrospective cohort study in a single tertiary center.

Results

Eighteen RPF cases (11 males) followed between 1996 and 2009 were reviewed. Blood CRP level was high in all cases before treatment. CT scan, associated or not with MRI or 18-FDG PET-scan, confirmed the diagnosis in 15 patients. Histological analysis of a surgical biopsy specimen was performed in only three cases. Ten patients suffered retroperitoneal fibrosis secondary to systemic vasculitis (granulomatosis with polyangeitis, n = 1, Takayasu aortitis, n = 2), systemic fibrosis with Riedel thyroiditis (n = 1) and atheromatous periaortitis (n = 6). Fifteen patients were treated with corticosteroids with a mean treatment duration of 60 months (12–228). Dependency to corticosteroids was recorded in ten patients. Patients with fibrosis related to vasculitis were younger, had a higher CRP level, more frequent corticosteroid dependency and a higher relapse rate. Relapses were successfully treated with steroids. Immunosuppressive treatment was only prescribed in the setting of systemic vasculitis. No patient died, after a 6 ± 2 years follow-up. Late relapses could occur, sometimes years after steroid therapy cessation.

Conclusion

In our study, RPF occurred as a secondary disorder in 60% of the cases. Disease extension, relapse rate and treatment response varied according to the underlying cause of RPF, pleading for an extensive and systematic initial assessment. Since no death or end-stage renal insufficiency was observed, RPF might be considered as a steroid-sensitive and benign disorder.     

Prévalence et facteurs prédictifs du syndrome d’apnée obstructive du sommeil au décours de l’infarctus du myocarde

Background

Obstructive sleep apnea has been implicated in the pathogenesis and aggravation of coronary atherosclerosis. However, it remains underdiagnosed in cardiology practice.

Aim

The aim of this study was to determine the prevalence of obstructive sleep apnea and the predictors of severe sleep apnea in patients admitted for ST elevation myocardial infarction.

Methods

This was a prospective study which has included 120 patients hospitalized for ST elevation myocardial infarction, from April 2011 to March 2012. All patients have undergone an overnight sleep study using a portable polygraphy device, in the 15 days following the acute coronary syndrome. The diagnostic of obstructive sleep apnea was considered as apnea–hypopnea index of ≥ 5 events per hour, severe sleep apnea was defined as apnea –hypopnea index of ≥ 30. Subjective daytime sleepiness was assessed by the Epworth sleepiness scale. All patients have had an oxygen saturation monitoring in the coronary care unit using a pulse oxymeter, before undergoing the sleep study.

Results

The study population was made up of 102 men and 18 women. The mean age was 58 ± 12 years. Smoking was the major cardiovascular risk factor found in 72% of all patients, diabetes and hypertension were represented in 40% and 44% of the population, respectively. Eighty-seven percent of patients were admitted in the first 24 hours of symptom onset. A primary percutaneous coronary intervention was performed in 60% of cases while fibrinolysis was done in 10% of patients. The prevalence of obstructive sleep apnea was 79%. Mean apnea–hypopnea index was 15.76 ± 14.93 and severe form was diagnosed in 16% of all patients. Multivariate analysis showed that Epworth sleepiness score of ≥ 4 and nocturnal desaturation below 82% were independent predictive factors for severe obstructive sleep apnea.

Conclusion

Prevalence of obstructive sleep apnea was very high in patients admitted for acute myocardial infarction. Epworth sleepiness score of ≥ 4 and nocturnal desaturation below 82% were independent predictive factors for severe form of sleep apnea.     

Évaluation départementale des délais de reperfusion des syndromes coronariens aigus avec élévation du segment ST en fonction de la filière de recours aux soins

Introduction

Acute coronary syndrome with ST segment elevation (STEMI) remains a major cause of morbidity and mortality in France, directly correlated with the time management of the patient to achieve reperfusion of the artery as early as possible. But the delay of reperfusion is related to the course that will take the patient to the revascularization.

Methods

To make an observation of departmental practices, we conducted a retrospective monocentric study on the STEMI supported on 4 years in the Departmental Hospital of La Roche-sur-Yon by comparing the time of reperfusion in two groups: patients who used the recommended chain = diRect chain (Call the emergency number–specialist mobile emergency unit–Cardiac intensive care unit or cardiac catheterization laboratory), and patients who used another chain = Long chain.

Results

On 838 patients with STEMI, 356 (42.5%) used the Direct chain. The average time of reperfusion in the Direct chain group is 4.26 hours (±3.12), 6.17 hours (±4.82) in the Long chain group. There is a significant difference between the two groups of 1.9 hours (P < 0.001). Of 186 patients who consulted a general practitioner, 40.3% of patients were not supported by the mobile emergency unit.

Conclusion

These results should lead to improved practices, to carry on continuing medical education with all actors in the chain and patient information to shorten up the time of reperfusion.     

Intérêts et limites de la stratégie invasive coronaire chez les patients nonagénaires

Background

Nonagenarians are systematically excluded from studies of interventional cardiology. Few data exist on the usefulness, safety, and results of coronary angiography (CA) and percutaneous coronary intervention (PCI) in this population.

Purpose

To evaluate the benefits and hazards of CA and PCI in nonagenarians.

Methods

Retrospective study conducted from the database (Cardioreport^®) of the CH de Versailles, from January 2001 to December 2011.

Results

From the 15,806 procedures performed in the center during the period, 107 (0.9%) were done in 97 patients aged ≥ 90 years. Half of them underwent PCI. Median age was 92 ± 2 years (range: 90 to 100), 56% were women. Main indication was an acute coronary syndrome (77%, acute STEMI in 39%). The first group (n = 58) had a single CA leading to strengthen medical treatment, and CABG in one case. The second group (n = 49) had a CA followed by immediate (41) or delayed (8) PCI. The primary success rate of PCI was 90%. Radial route was used in 94% in the period 2009–2011 (51% overall). Failure of arterial access (4%) and difficulties of catheterization (13%) were rare. Severe complications occurred in 19%. They were local (11 hematomas, 6 severe, 4 transfusions, and 1 fatal acute ischemia of a lower limb), and general (1 stroke, 1 death by left main rupture during PCI). Twenty percent of the complications (11% of severe ones) were directly related to the procedure. Overall hospital mortality was 10%.

Conclusions

Angiography is feasible in nonagenarians by radial approach without failures and with a reduced rate of complications. PCI was indicated in about half of the cases. PCI may be proposed in nonagerians with a high success rate, and an acceptable risk of local and general complications.     

Validation de la reproductibilité de la mesure de la surface de l’orifice régurgitant par planimétrie dans l’insuffisance aortique : une étude préliminaire d’échocardiographie trans-œsophagienne tridimensionnelle

Background

Aortic regurgitation is mainly evaluated by trans-thoracic echocardiography using multi-parametric qualitative and semi quantitative tools. All those parameters can fail to meet expectations, resulting in an imperfect diagnostic reliability and assessment of aortic regurgitation severity can be challenging.

Objectives

We sought to evaluate feasibility and intra- and inter-observer reproducibility of aortic regurgitant orifice area measured by planimetry with tridimensional trans-esophageal echocardiography on patients with at least grade 2/4 aortic regurgitation.

Patients and methods

Consecutive patients with at least grade 2/4 aortic regurgitation measured by trans-thoracic echocardiography and referred for trans-esophageal echocardiography for any reason were included. Planimetric reconstructions of regurgitant orifice area were studied and reproducibility indexes between senior and junior observers were calculated.

Results

Twenty-three patients were included in this study. Intra- and inter-observer reproducibility were excellent with an ICC of 0.95 [0.88–0.98], P < 0.0001 and 0.91 [0.79–0.96], P < 0.0001, respectively. Mean length of the measurement was 6.6 ± 0.9 min [CI95% 6.23–7.01].

Conclusion

Planimetric measurement of the aortic regurgitant orifice using tridimensional trans-esophageal echocardiography seems to be feasible and has great intra- and inter-observer reproducibility. Reconstruction durations were compatible with a daily use. There is a need now to investigate the reliability of this measurement as compared with the reference technique.     

Morbimortalité cardiovasculaires en 6 ans des hypertendus noirs du sud algérien

Introduction

Arterial hypertension is a major public health problem not only internationally, but also in our country, and it is the major risk factor for cardiovascular diseases. In south Algeria, the black population is nearly half the population of the oases of the Algerian Sahara.

The objectives of the study

The objectives of the study are to analyze the long-term fate of the black hypertensive subjects in Algerian oases in southern Algeria, in terms of morbidity and mortality, comparing the morphometric profile and cardiovascular complications with the white population of the same oases.

Materials and methods

One thousand four hundred and twenty-five subjects of both sexes were included (811 blacks and 614 white subjects), aged 40 and older, living in the Algerian Sahara and were reviewed after six years of decline. The control consisted of filling a questionnaire oriented on civil status, target organ damage, the number of hospitalizations and mortality. All calculations and statistical analyzes are processed by the SPSS 17.0 and Epi Info6 software.

Results

Mean age for the black population and the white population was 60.3 ± 11.1 and 58.6 ± 10.6 years, respectively. The incidence of hypertension was 50 % among blacks. The main complications observed were: stroke in 3.8 %, heart failure in 3.1 %, myocardial infarction in 1.7 %, hospitalizations related to cardiovascular complications of the black population was around 4.4 %, mortality 5.4 %.

Conclusion

These data on hypertension black subjects emphasize the importance of a policy of adequate local health issues raised, both in terms of the management of hypertension, as in investment in local medical research.     

Análisis del coste del trasplante hepático en un hospital de la comunidad: su relación con el Model for End-stage Liver Disease,un índice pronóstico que prioriza al paciente más grave

Introduction

The aim of the present study was to investigate the impact of the Model for End-stage Liver Disease (MELD) on transplantation costs.

Material and methods

We included all patients who received a liver transplant for end-stage liver disease between 2006 and 2010. The study period encompassed the day of transplantation until hospital discharge. The patients were classified into two groups: those with a MELD score of 6-19 and those with a score of 20-40.

Results

The mean MELD score at transplantation was 19.2 ± 7.0 (mean ± SD). The mean cost per procedure in the study period was USD 33,461 per patient (range 21,795-104,629). The cost of transplantation was USD 30,493 ± 8,825 in patients with a MELD score of 6-19 and was USD 36,506 ± 15,833 in those with a score of 20-40; this difference was statistically significant (P = .04). In a stepwise logistic regression analysis, the only independent predictor of high cost was having a MELD score of 20 (OR 11.8; CI 1.6-87). In the linear regression model, the most important predictor of cost was the length of hospital stay (r² = 43%).

Discussion

Our results demonstrate that the MELD score directly affects transplantation costs. We suggest that reimbursement systems compensate the distinct financing bodies according to the severity of the underlying disease, evaluated with the MELD.     

Le degré de l’insuffisance rénale chronique est associé aux taux de cytokines pro-inflammatoires, à l’hyperhomocystéinémie et au stress oxydant

Aim

To evaluate pro-inflammatory cytokines, homocysteinemia and markers of oxidative status in the course of chronic renal failure.

Patients and methods

One hundred and two patients (male/female: 38/64; age: 45 ± 07 years) with chronic renal failure were divided into 4 groups according to the National Kidney Foundation classification. They included 28 primary stage renal failure patients, 28 moderate stage renal failure, 28 severe stage renal failure and 18 end stage renal failure. The inflammatory status was evaluated by the determination of pro-inflammatory cytokines (tumor necrosis factor-α, interleukin-1β, interleukin-6) and total homocysteine. Pro-oxidant status was assessed by assaying thiobarbituric acid reactive substances, hydroperoxides, and protein carbonyls. Antioxidant defence was performed by analysis of superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase.

Results

Inflammatory markers were elevated in the end stage renal failure group compared to the other groups (P < 0.001). Indeed, an increase in thiobarbituric acid reactive substances, hydroperoxides and protein carbonyls was noted in the end stage renal failure group in comparison with the other groups (P < 0.001), while the levels of antioxidants enzymes activity were decreased in the study population (P < 0.001).

Conclusion

Impaired renal function is closely associated with the elevation of inflammatory markers leading to both increased markers of oxidative stress and decreased antioxidant defense.     

La pancréatite lupique : une série de six cas

Purpose

The occurrence of acute pancreatitis in systemic lupus erythematosus (SLE) is known but rare, and is exceptionally the presenting manifestation. Its pathogenesis is multifactorial, and it is difficult to separate what belongs to vasculitis, thrombotic phenomena in the context of an associated antiphospholipid syndrome, or iatrogenic complications. We report on six cases of lupus pancreatitis.

Methods

This is a retrospective monocenter study of 110 patients with SLE. The diagnosis of lupus pancreatitis was established after exclusion of other causes of pancreatitis.

Results

Five women and one man (5.4%) with a mean age of 36.3 years presented with lupus pancreatitis. In four patients the pancreatitis was concurrent with the diagnosis of SLE and it occurred later during an exacerbation of the disease in the two remaining patients. In all patients, pancreatic manifestations were associated with other organ involvement. Clinical manifestations were: abdominal pain (n = 6), vomiting (n = 3), and fever (n = 3). Elevated pancreatic enzyme was noted in all cases. All patients were treated by high doses of glucocorticoids. The outcome was favorable in five patients, and one patient died.

Conclusion

Pancreatitis may be the presenting manifestation of SLE. Its pathogenesis is often multifactorial. The outcome is usually favorable with corticosteroids.     

La distensión de la región isquémica predice una mayor inducibilidad de fibrilación ventricular tras la oclusión coronaria en el modelo porcino

Introduction and objectives

Distension of the ischemic region has been related to an increased incidence of spontaneous ventricular arrhythmias following coronary occlusion. This study analyzed whether regional ischemic distension predicts increased ventricular fibrillation inducibility after coronary occlusion in swine.

Methods

In 18 anesthetized, open-chest pigs, the left anterior descending coronary artery was ligated for 60 min. Myocardial segment length in the ischemic region was monitored by means of ultrasonic crystals. Programmed stimulation was applied at baseline and then continuously between 10 and 60 min after coronary occlusion.

Results

Coronary occlusion induced a rapid increase in end-diastolic length in the ischemic region, which reached 109.4% (0,9%) of baseline values 10 min after occlusion (P<.001). On average, 6.6 (0,5) stimulation protocols were completed and 5.4 (0,6) ventricular fibrillation episodes induced between 10 and 60 min of coronary occlusion. Neither baseline serum potassium levels nor the size of the ischemic region were significantly related to ventricular fibrillation inducibility. In contrast, the increase in end-diastolic length 10 min after coronary occlusion was associated directly (r=0,67; P=.002) with the number of induced ventricular fibrillation episodes and inversely (r=–0,55; P=.018) with the number of extrastimuli needed for ventricular fibrillation induction.

Conclusions

Regional ischemic expansion predicts increased ventricular fibrillation inducibility following coronary occlusion. These results highlight the potential influence of mechanical factors, acting not only on the triggers but also on the substrate, in the genesis of malignant ventricular arrhythmias during acute ischemia.Full English text available from: www.revespcardiol.org/en     

Complications vasculaires de l’abord artériel fémoral : impact du système de fermeture percutanée Perclose

Introduction

Vascular complications at the femoral access site is an important factor of morbidity. The aims of this study were to evaluate the efficacy and safety of the percutaneous closure device (Perclose) during interventional cardiology procedures.

Patients and methods

All patients with percutaneous closure of the femoral access site by the Perclose system in 2010 were included. We evaluated the indications of the procedures, the success rate of implantation and the bleeding complications according to antithrombotic therapy used.

Results

Three hundred and seventy five patients underwent a percutaneous closure by the Perclose system. Acute coronary syndromes with or without elevation of ST segment were the main indications of procedures (74.9%). The success rate of percutaneous closure of the femoral access site was 97.3%. The rate of minor, moderate, and severe bleeding of the entire cohort according to the GUSTO classification was respectively 4.2%, 0.5% and 1%. Bleeding complications were similar in both groups of patients (2.1% vs 7% P = 0.122). In case of unsuccessful deployment of femoral closure devices, the risk of bleeding complications range from 4.3% to 60% (P = 0.0000036).

Conclusion

The use of the Perclose system is associated with a low rate of severe bleeding at the femoral access site. However, the failures of percutaneous closure increase the risk of bleeding complications.     

Admissions en réanimation des femmes en cours de grossesse ou en post-partum : circonstances et pronostic. Une série rétrospective de 96 cas

Purpose

Very few studies had been published about admission of obstetric patients in French intensive care units (ICU).

Patients and methods

Files of women who had been admitted during pregnancy or the postpartum period to ICU of an academic hospital between January 1st 1997 and 31st December 2006 were analyzed. Diagnosis at admission, severity, main treatments and outcome were studied during two successive periods of 5 years.

Results

There were 96 admissions (0.95% of all admissions to ICU). They included 34 complications due to arterial hypertension (35%), among them 10 cases of pre-eclampsia, eight of eclampsia, seven of Hemolysis-Liver Enzymes-Low Platelet (HELLP) syndrome and two of retroplacental hematoma ; 26 postpartum haemorrhages (27%); and 36 miscellaneous diagnosis including two sepsis, four acute pulmonary oedema, four cardiomyopathy, three pulmonary embolism, and three acute liver steatosis. Mean Simplified Acute Physiologic Score (SAPS II) was 18.5 ± 11.2 and mean Sequential Organ Failure Assessment (SOFA) 2.1 ± 2.3. The main treatments were mechanical ventilation (50% of all cases) and transfusion (32%). The average ICU stay was 5.7 ± 5.4 days. Two maternal deaths were observed (aortic dissection and peripartum cardiomyopathy). The number of patients admitted for postpartum haemorrhage increased from five to 21 over the two successive periods of the study.

Conclusion

The number of women admitted to ICU during pregnancy or the postpartum period is low. Admissions for hemorrhage have increased. Regular monitoring of maternal morbidity and mortality gives relevant clues for assessing the quality of obstetrical care.     

Évolution d’une thrombopénie chronique idiopathique en cours de grossesse (62 grossesses)

Purpose

The aim of this study was to assess the platelet count outcome during a pregnancy occurring in a series of 62 women followed for a chronic idiopathic thrombocytopenia.

Methods

We studied the medical files of women who had a previous history of chronic idiopathic thrombocytopenia persistently below 150 G/L for at least 1 year, and who became pregnant over a 14-year period.

Results

Sixty-two pregnancies (including 41 in women suffering from an immune thrombocytopenic purpura according to updated definition criteria) which occurred in 50 women, were analysed. At the beginning of the pregnancy, platelet count was above 150 G/L in 16% of the cases and lower than 50 G/L in 8%. Platelets decreased by more than 25% for 55% of the pregnancies, remained stable during pregnancy in 33% and improved in 12%. Platelet count remained above 50 G/L in 70% of the pregnancies and higher than 100 G/L in 27%. Mean nadir was 84 G/L at 31 weeks of gestation. A treatment was started in 40% of pregnancies, among them 64% of the cases during the last month only in order to allow locoregional anaesthesia at delivery. Platelet count was below 150 G/L at delivery in 82% of the women (116 ± 56 G/L). No bleeding occurred in 83% of the pregnancies. Neonatal mean platelet count was 225 ± 87 G/L, thrombocytopenia occurred in 17% of the babies (platelet count below 150 G/L), without any serious bleeding.

Conclusion

Pregnancy worsens chronic idiopathic thrombocytopenia outcome in half of the cases, most of the time without any haemorrhagic complications.     

Corrélations entre antécédents d’angioplastie coronaire et mortalité précoce après chirurgie coronaire

Background

In this study, we examine the effect of previous percutaneous intervention on the rate of adverse perioperative outcome in patients undergoing coronary artery bypass graft surgery (CABG).

Methods

Outcomes of 240 CABG patients, collected consecutively in an observational study, were compared. Gp A (n = 35) had prior PCI before CABG and Gp B (n = 205) underwent primary CABG.

Results

Statistically significant results were obtained for the following preoperative criteria: previous myocardial infarction: 48.6% vs 36.6% (P = 0.003), distribution of CAD (P = 0.0001), unstable angina: 45.7% vs 39% (P = 0.04). For intraoperative data, the total number of established bypasses was 2.6 (GpA) vs 2.07 (Gp B) (P = 0.017), with the number of arterial bypass grafts being: 20% vs 13% (P = ns). Regarding the postoperative course, no significant difference in troponine I rate, 24-hour bleeding: 962 ml (Gp A) vs 798 ml (Gp B) (P = 0.004), transfusion (PRBC unit): 3.63 (Gp A) vs 2.5 (Gp B) (P = 0.006). Previous PCI emerged as an independent predictor of postoperative in-hospital mortality (OR 2.24, 95% CI [1.52–2.75], P < 0.01).

Conclusion

Patients with prior PCI presented for CABG with more severe CAD. Thirty-day mortality and morbidity were significantly higher in patients with prior PCI.