Modalités ou charge de réentraînement : quelle modalité choisir pour améliorer l’aptitude aérobie du patient coronarien en seulement 4 semaines ?

Objective

The aim of this study was to compare the effects of 4 weeks of CT and AT, which training impulse (total external workload and perceived exertion), are similar on power associated at VO₂peak (pVO₂peak) and cardiorespiratory responses of patient with CAD.

Method

Eighteen male with CAD (62 ± 7 years, 175 ± 2 cm, 84 ± 16 kg, fraction of ejection = 0.49 ± 0.16) performed 4 weeks of CT (n = 9) or AT (n = 9). pVO₂peak, maximal and first ventilatory threshold values of oxygen uptake (VO₂peak, VO₂-vt) and heart rate (HRmax, HR-vt) were measured before and after training session. Total training impulse (exercise rehabilitation and other paramedical actions) were evaluated and harmonized between AT and CT according to Foster et al. formula (1996)

Results

No significant difference were found in training impulse between AT and CT (3650 ± 220 vs 3497 ± 190 U, P = NS). VO₂pic increased after AT (16.9 ± 4.4 vs 18.9 ± 4.9 mLO₂/min/kg, P < 0.05) and remained unchanged after CT (17.7 ± 7.8 vs 17.8 ± 7.2, P = NS). Four weeks of training induced significant increase in pVO₂peak, VO₂-vt and FC-vt, expressed in absolute or relative value (P < 0,05), without any difference between AT and CT modalities (P = NS).

Conclusions

Improving pVO₂pic following an exercise training does not necessarily preclude an improvement in coronary VO₂pic. pVO₂ peak was not improved with the same cardiorespiratory adaptations between AT and CT. Thus, there seems important to measure gas exchanges of subject with CAD during the incremental test and identify the respective part of muscular and cardiorespiratory functions in exercise exhaustion.     

Surveillance des cancers coliques opérés à visée curative : faut-il revoir les recommandations de la conférence de consensus ?

Colorectal cancer is one of the most common human malignancies. Surgical resection remains the primary treatment but cancer recurrences (locoregional or distant) are associated with a poor prognosis. Follow-up is of particular importance in the three-years after surgery and various strategies have been purposed in the surveillance of patients after curative resection for colorectal cancer. The objective is to diagnose a recurrence at the earliest possible stage, enabling a second curative treatment. Optimal strategy for follow-up remains controversial. Results from randomized trials comparing low intensity programs and intensive programs of colorectal cancer surveillance are insufficient to recommend a follow-up strategy. To update recommendations for surveillance of colorectal cancer, larger prospective randomized studies are required.     

Pleuroscopie virtuelle de la plèvre diaphragmatique: mythe ou réalité ?

PURPOSE: Evaluate the feasibility of the virtual pleuroscopy (VP) in the detection of the pleural plaques. METHOD AND MATERIALS: Twenty consecutive patients, having asbestos exposure, explored by unenhanced multidetector CT-scan (Siemens, Sensation 16). The imaging parameters were as follows: beam width, 12 mm; beam pitch, 1; and reconstruction thickness, 1mm every 0.8mm at 120 kV and 180 mA. The image display used a surface-rendering algorithm and produced perspective red-scale images with a matrix of 512 x 512. Each VP image simulated a coned-down view, with a variable cone angle to explore the diaphragmatic pleura. The camera was placed 1 to 2 cm above the diaphragmatic dome. Four views are studied by diaphragm: craniocaudal, lateral tangential, anterior and posterior. The observed virtual pleura aspect was classified in 5 groups (gr): gr 1: Rib band, gr 2: lobulated pleural thickening, gr 3: spicular, gr 4: plaques and gr 5: nodules. The results were compared to the other MDCT images using multiplanar reformatting. RESULTS: The visualization of each diaphragm was optimal (35/40; 87.5%), limited (3/40; round atelectasis and asbestosis) or impossible (2/40; asbestosis). The classifications of the studied 38 diaphragmatic pleura were: gr 1 (n=15), gr 2 (n=5), gr 3 (n=11), gr 4 (n=7), gr 5 (n=0). The MDCT analysis showed normal pleura for both gr 1 and gr 2, a confirmed or beginning of fibrosis for gr 3 and confirmed the presence of pleural plaques on the diaphragmatic pleura in all cases of gr 4. CONCLUSION: The virtual pleuroscopy is a reality. It is a feasible technique. Other studies are necessary to confirm these preliminary results.     

Quel est l’intérêt de rechercher un hypogonadisme chez un patient présentant des ulcères de jambe récidivant depuis l’âge de 20 ans ?

Androgen replacement therapy has been reported to have a beneficial effect in patients with Klinefelter's syndrome or perforating plantar ulcers. We report the case of a 55-year-old man with a 35-year history of leg ulcers and venous insufficiency. His leg ulcers healed 4 months after a management scheme including vascular rehabilitation (intermittent pressure therapy, ankle mobilization, multiple layer compression bands on the lower limbs), skin grafts and foam sclerotherapy of the great saphenous vein. The ulcers recurred 1 month later. This recurrence and the unusually young age for development of venous leg ulcers led to a search for a rare cause. The diagnosis of anterior pituitary failure was established. Sclerotherapy and androgen replacement therapy led to complete healing without recurrence at the 1-year follow-up visit. A link between androgen deficiency and fibrinolysis, protein synthesis deficiency, inflammation and trophicity is well documented in the literature. A search for hypogonadism may be useful in young patients presenting a longstanding history of leg ulcers or in patients with suspected andropause irrespective of age.