Influence des leucocytes sur la réserve coronaire, la fonction systolique ventriculaire gauche, et les complications hospitalières, dans l’infarctus antérieur aigu traité par angioplastie primaire

Objective

To assess the relationship between leukocyte count, non invasive coronary flow reserve (CFR), left ventricular systolic function, and in-hospital adverse events in acute anterior myocardial infarction (AMI) treated by primary angioplasty.

Methods

Leukocyte count at admission and within 24 h after angioplasty, and differential count at admission were obtained in 72 consecutive patients with a first AMI (mean age 56 ± 12 years) successfully treated by primary angioplasty. Transthoracic Doppler echocardiography was performed within 24 h after angioplasty and 3 months later to assess the CFR (using intravenous adenosine), in the left anterior descending artery (LAD), left ventricular ejection fraction (LVEF) and the wall motion score index using the nine segments assigned to the LAD territory (WMSi-lad). In hospital events were defined as death, heart failure (Killip ≥ 2) and reinfarction.

Results

Leukocyte count was higher before and after angioplasty in patients with impaired acute CFR (< 1.7), when compared to patients without such impairment (P ≤ 0.01), and a significant correlation was found between CFR and leukocyte, neutrophil and monocyte count (P < 0.05). Leukocyte (before and after angioplasty), and neutrophil count, were lower in patients with recovery of global and regional LV function (P < 0.05). A significant correlation was found between leukocyte count before and after angioplasty, and, initial and follow-up LVEF, and WMSi-lad (all, P ≤ 0.01). Leukocyte (before and after angioplasty) and monocyte count were higher in patients with in-hospital events (n = 14), by comparison to patients without events (all, P < 0.01). In multivariate analysis, leukocyte count after angioplasty was an independent predictor of CFR, and in-hospital events, and neutrophil count of WMSi-lad at follow-up (all, P < 0.05).

Conclusion

In the first AMI treated successfully by primary angioplasty, leukocyte count is inversely correlated to CFR, and global and regional LV systolic function at follow-up. These links are higher after than before reperfusion. And, leukocyte count after angioplasty is an independent predictor of in-hospital adverse events.     

Difficult necks. Diagnosis and treatment. Retrospective study of 145 cases using the method of Feldman

To identify a neck as difficult seems an easy thing. Nevertheless, we must admit that various clinical situations are represented under this single designation. A clinical and anatomical classification is proposed regarding the surgical strategy presented in this paper. Predominant tissue laxity and predominant fat accumulation are presented as progressive forms. Short platysma muscles and low hyoid bones are presented as constitutional. According to this classification, 145 patients among 438 facial rejuvenations were designated as difficult necks. The surgical strategy was intended, in each case, to address the underlying anatomical features, using a short incision system. A combination of wide skin undermining, fat removal under direct vision and corset platysmaplasty was performed in the 145 patients between November 2003 and May 2008. The average age was 59 years old and medium follow-up at 22 months. There was only 2% of secondary touch up for aesthetic reasons. Difficult necks, as described in this article, responded adequately to the present protocol. The postoperative results on the neck were consistent with the rest of the rejuvenated face and stood the test of time.