Chronic atrial fibrillation in adults: direct current cardioversion or medical cardioversion

To study cardioversion modalities of atrial fibrillation, we had a look to 100 cases hospitalized in Mongi slim cardiologic department during the period lasting from January 1993 to July 2001. Medical cardioversion (with amiodarone) was performed in 47 patients and electrical cardioversion in 53 patients. Atrial fibrillation was 17 months old. Vavular heart disease was the main etiology (65%). The primary success rate of medical cardioversion (73%) was equivalent to electrical cardioversion (70%). Oldness of atrial fibrillation was the only predictive factor of failure of cardioversion.     

Gemcitabine plus carboplatin combination therapy as second-line treatment in patients with relapsed breast cancer

This study was designed to determine the safety and efficacy of the combination therapy of gemcitabine plus carboplatin when used as a second-line treatment in patients with metastatic breast cancer (MBC). From February 2002 to May 2003, 30 previously treated patients with adenocarcinoma of the breast received gemcitabine 1000 mg/m2 on days 1 and 8 plus carboplatin to an area under the curve (AUC) of 5 on day 1. The carboplatin dose was changed to an AUC of 4.5 because of toxicity, with cycles repeated every 3 weeks. Among 30 patients enrolled, 25 were assessable for response rate (RR). There was no complete response; 9 patients (30%) had partial response, for an overall RR of 30%. The median time to progression for the study group was 20.47 weeks (range, 8-46 weeks). Treatment-related toxicities included grade 3/4 neutropenia in 50% of patients (20% of whom had febrile neutropenia), grade 3/4 anemia in 26.6% of patients, and grade 3/4 thrombocytopenia in 30%. Eleven patients (36.67%) had grade 1 alopecia, and 1 patient (3.33%) had grade 2 alopecia. Moderate nausea was observed in 8 patients (26.67%), and vomiting occurred in 7 patients. Four patients had asthenia and 3 (10%) experienced stomatitis. Three patients discontinued treatment because of hematologic toxicity (thrombocytopenia) and 2 patients are still receiving treatment. Carboplatin plus gemcitabine is an active combination for patients with MBC despite significant but manageable hematologic toxicity.     

Congenital coronary aneurysm. Three case reports

Congenital coronary aneurysms are an unusual anatomical entity. Their prognosis appears to be particularly dependent on the presence or absence of aneurysm thrombosis. We report three cases of congenital coronary aneurysms, diagnosed in one case after myocardial infarction. Two patients were treated successfully by an exclusion of the aneurysm and coronary bypass and the third patient was treated medically. The aim of this study is to discuss the clinical features, prognosis and management of this disease.     

Spontaneous contrast of the left atrium in mitral valve stenosis

The left atrial spontaneous contrast is uncommon finding during transthoracic échocardiography. Transesophageal echocardiography provides superior imaging of the left atrium and left spontaneous contrast has been detected more frequently by this technique in rheumatic mitral stenosis. In order to analyze the significance of spontaneous contrast, we have studied 100 patients with mitral stenosis. Trans thoracic and transesophageal echocardiography were performed in all patients. Left atrial spontaneous echo contrast was detected in 60 patients (group A) and was absent in 40 patients (group B) The mean of mitral valvular area was 0.9 10.2 mm in group A and 48 9.5 mm in group B (p < 0.001). Ther was a high incidence of atrial fibrillation in group A; 63% VS 12% in group B (p < 0.001). A systemic embolization was noted in 20% of patients in group A; No one of group B has presented this complication (p < 0.001).     

Evaluation of thoracic aortic atherosclerosis by transesophageal ultrasonography: value and limits as predictive factor of coronary disease

Atherosclerotic disease in the aorta is associated with a high risk of cardiovascular events. This prospective study was conducted to correlate the presence of aortic plaques in the thoracic aorta detected by transesophageal echocardiography (TEE) and angiographically significant coronary artery disease. The presence of aortic plaques on TEE had a sensitivity of 97%, a specificity of 80% and positive and negative predictive values of 89% and 94%. Univariate logistic regression revealed that aortic plaques were the most significant independent predictor factor of coronary artery disease compared to other risk factors. This study reveals that the thoracic aortic plaques detected by TEE is a strong predictor of the presence and the severity of coronary artery disease.     

Treatment of acute hepatitis C with interferon alpha-2b: early initiation of treatment is the most effective predictive factor of sustained viral response

AIM: To evaluate the efficacy of early interferon alpha-2b in non-post-transfusion acute hepatitis C virus: a prospective study with historical comparison. PATIENTS: Group A: 28 patients prospectively treated for acute hepatitis C virus with daily regimen of interferon 5 million units for 2 months. Group B: historical series of 16 patients with untreated acute hepatitis C virus. RESULTS: There was no significant difference between the two groups with regard to gender, age, icterus, alanine aminotransferase, or genotypes. In group B, hepatitis spontaneously resolved in three of 16 (19%) patients (follow-up 1-7 years). In group A, 21 of 25 patients became sustained viral responders (75%; P = 0.0003 vs. group B). Factors include not predictive of sustained viral response: age, gender, sources of infection, presence of icterus, alanine aminotransferase peak, bilirubin peak, incubation period, presence of hepatitis C virus antibodies at presentation, or genotypes. The time from presentation to the start of therapy was, however, significantly shorter in sustained viral responders (43 +/- 31 days) than in relapsers or non-responders (88 +/- 52 days) (P = 0.016). CONCLUSIONS: Early treatment of acute hepatitis C virus with interferon prevents chronicity. A short waiting time from presentation to treatment appears as the most relevant predictive factor for sustained response.     

New indications for cardiac pacing

Over the past decades, the pacemakers have become the standard treatment for patients with symptomatic sinus node disease or high grade atrioventricular block. With the development of pacemaker technology, attempts have been made to apply pacing to the treatment of problems other than symptomatic bradycardia. These problems include pacing to prevent atrial arrhythmia, improve hemodynamic function and to prevent neurocardiogenic syncope. The aim of modern pacing is not only reducing mortality but also improving quality of life and reducing morbidity. Ongoing studies will help to identify better the patient population that benefits most of this treatment.