[Left atrial thrombus in multiple myeloma treated with thalidomide].

The occurrence of a left atrial thrombus without a haemodynamic predisposing factor (arrhythmia, mitral valvulopathy, severe left ventricular dysfunction) is a rare event. We report a case during the progression of refractory myeloma, four months after stopping treatment with thalidomide. The promoting haemodynamic factors for left atrial thrombosis in sinus rhythm, described in the literature, had been excluded.

Low molecular weight heparins: a guide to their optimum use in pregnancy.

The incidence of pulmonary embolism (PE) and venous thromboembolism (VTE) is higher in pregnant patients than in non-pregnant patients. The incidence of thrombosis in all pregnancies is reported to be between 0.05 and 1%, and an incidence as high as 3% may be present in women after caesarean section.

[Inflammatory abdominal aortic aneurysm].

A 58-years-old man, with no medical past history, was examined for abdominal pain and weight loss. An enlarged kidney could be palpated, and abdominal echography showed left hydronephrosis due to ureteral compression by abdominal aortic aneurysm. Laboratory data showed an inflammatory syndrome.

[Venous thromboembolism in pregnancy].

Unlabelled: A DUAL CHALLENGE: Pregnancy is a physiological state favoring the development of venous thromboembolism and sometimes discloses a coagulation disorder. Due to the presence of the fetus, suspected venous thromboembolism in a pregnant woman raises a dual challenge for the clinician: confirmation of the clinically suspected diagnosis using imaging techniques exposing the fetus to as little radiation as possible, and adapted anticoagulant therapy taking into account the teratogenic risk.

Mild To Moderate Disease: Excepting exceptionally severe cases, the only validated long-term treatment is continuous infusion heparin.

[Acute complication of a composite graft replacement of the aortic root].

A 78-year old man operated for an acute aortic dissection 8 years ago was hospitalized for an unusual clinical presentation with acute cor pulmonale and superior vena caval syndrome. He had poorly controlled high blood pressure, and coronary artery disease with aorto-coronary by-pass 10 years ago. He underwent Bentall procedure 2 years later for type I acute aortic dissection, with vein graft reimplantation on the valvular conduit.

[Youthful popliteal aneurysm].

Popliteal artery aneurysms are not so clinically frequent but are the most common site of peripheral aneurysms. They usually affect men aged over sixty and are caused by atherosclerosis. Whenever they concern younger men, other more unusual aetiologies such trauma, infection, inflammatory arteritis or popliteal entrapment are responsible.

[Post-traumatic vena cava thrombosis].

Background: Post-traumatic thrombotic events are exceptional in the caval system. We report a case of inferior vena cava thrombosis in a traffic accident victim.

Case Report: A 53-year-old male victim of a traffic accident suffered multiple trauma including blunt trauma of the abdomen.

[Non-invasive management of a serious acute pulmonary embolism].

Prompt diagnosis of a large pulmonary embolus is essential in order to initiate appropriate treatment early. We report a case of a large pulmonary embolus in which management was aided solely by noninvasive investigations. Transthoracic echocardiogram showed elevated right heart pressures which together with the patient symptoms suggested a major pulmonary embolus.

[Treatment of amiodarone-induced hyperthyroidism by carbimazole with maintenance of amiodarone].

The authors report the case of a patient treated with amiodarone for syncopal ventricular tachycardia complicating idiopathic dilated cardiomyopathy in whom symptomatic hyperthyroidism led to a discussion of the different therapeutic options available in this type of case. Neomercazole treatment was prescribed with success enabling maintenance of the antiarrhythmic drug. The reputation of inefficacy of carbimazole should be reconsidered ; high dose therapy should probably be tried in patients with hyperthyroidism when withdrawal of the antiarrhythmic drug does not seem to be possible.

[Superior vena cava syndromes of benign etiology].

Superior vena cava syndromes are uncommon and usually caused by malignant diseases. In about 20% of the cases however, the cause is benign. Besides chronic mediastinitis, a growing number of cases are reported of thrombosis resulting from endovenous devices (central catheters, pacemaker leads.

Sudden death as a presenting symptom of hypertrophic cardiomyopathy: treatment with an implantable cardioverter defibrillator.

Aborted sudden death as the presenting manifestation of hypertrophic cardiomyopathy in a 14-year-old child is reported. Documented ventricular fibrillation was the cause of cardiac arrest. No ventricular arrhythmia was induced during programmed electrical stimulation.

[Atresia of the left coronary artery: a case in a marathon runner. Review of the literature].

The authors report the case of a very rare coronary malformation: atresia of the left main coronary artery. This anomaly was discovered in a marathon runner who presented effort angina with a positive exercise stress test. At coronary angiography, it was not possible to catheterise the left coronary artery and only a minuscle dimple could be visualised.

[Bone marrow aplasia related to ticlopidine].

The authors report two cases of bone marrow aplasia observed 2 months after initiation of a treatment with ticlopidine. The outcome was favorable after discontinuation of therapy. The frequency of this severe drug-induced complication seems to have been underestimated.

[Acute ischemic liver].

Ischaemic hepatitis, a condition to be distinguished from cardiac liver or stasis cirrhosis, can occur as an acute episode in patients with advanced stage congestive heart failure. The mechanism is massive necrosis in the central lobules resulting from acute hypoxia when low cardiac output reduces oxygen supply further aggravating the underlying condition of congestion due to poor venous outflow. We report 4 cases which illustrate the difficulties in diagnosis and treatment.

[Non-calcified chronic constrictive pericarditis. Diagnostic difficulties and contribution of complementary tests].

The authors report a case of noncalcified chronic constrictive pericarditis, in which the diagnosis was delayed due to an associated mitral stenosis. The diagnostic value of various invasive and noninvasive complementary investigations is discussed.

[Medical phlebitis. A rational approach of the etiological evaluation].

One-hundred and four records of ambulatory deep venous thrombosis were studied retrospectively to determine the usefulness of an aetiological evaluation based on a rational approach. Among these 104 patients, 27 were known to have a cancer at the time of admission, and 77 had a presumably idiopathic deep venous thrombosis. The discovery of 10 cancers in the second group (13 percent) confirmed that the aetiological research was useful.

[Myocarditis of pseudo-infarctoid onset].

The authors report two cases of myocarditis in young individuals in whom clinical and electrocardiographic findings during the acute phase could have led to an erroneous diagnosis of myocardial infarction. The problem in such cases is that of a differential diagnosis with infarction with normal coronary arteries. Few clinical or paraclinical arguments are of diagnostic value, endomyocardial biopsy remaining the reference investigation.

[Isolated pericardial metastasis of digestive cancer disclosed by tamponade].

The authors report a case of a single secondary tumour of the pericardium presenting as tamponade and occurring three years after sigmoidectomy for an adenocarcinoma of the colon. Gastrointestinal investigations confirmed the absence of any local tumour recurrence. The originality of this case lies in the presentation and isolated nature of this metastasis.

[Severe pulmonary embolism and thrombus of the right atrium. Success of the thrombolytic treatment combining Rt PA and streptokinase].

The authors report the case of a patient with a serious recurrence of pulmonary embolism with echocardiographic evidence of a floating serpentine thrombus of the right atrium. The outcome was rapidly satisfactory with disappearance of signs of acute cor pulmonale and lysis of the right atrial thrombus after infusion of two thrombolytic agents: Rt PA and streptokinase. There is no evidence in the literature to indicate that one form of treatment, i.

[Subxiphoid pericardiostomy and pericardioscopy. Value and indications apropos of a series of 25 cases].

An experience of 25 subxiphoid pericardial windows with pericardioscopy in eleven cases is reviewed and presented. The operative indications in pericardial effusions result from hemodynamic compromise or from the need for etiologic criteria. Validated in its technical simplicity, its safety, its etiologic findings, its efficacy on immediate and delayed no recurrence of pericardial effusion, the low rate of late constrictive changes, this operative procedure is worth listing in the therapeutic know-how of a general surgeon.

[Myocardial infarction and coronary artery aneurysm].

Two cases of aneurysm of the right coronary artery are reported. These atheromatous aneurysms not associated with tight coronary stenosis were responsible for myocardial infarctions treated by early intravenous thrombolysis with a resultant limited area of necrosis. According to the literature, coronary aneurysms associated with stenosis are not rare.

[Myocardial infarction with normal electrocardiogram].

These two cases concern myocardial infarcts where the electrocardiogram (ECG) was within normal limits at admission and throughout the period of hospitalisation, the diagnosis of an infarct being made secondarily on the basis of raised CPK. Both cases involved infarcts limited to the lateral wall due to occlusion of the first marginal artery of the left border. Several recent studies have evaluated the diagnostic value of the ECG in infarcts and have shown its lack of sensitivity in lateral infarcts.