[Hospital production cost of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression].

Background: Repetitive transcranial magnetic stimulation (rTMS) is an effective and well-tolerated treatment in resistant depression with mild to moderate intensity. This indication has not yet been approved in France. The cost and medico-economic value of rTMS in psychiatry remains unknown.

[Aortic insufficiency in certain so-called systemic diseases].

The authors present a retrospective study of all the patient followed up for systemic disease in the rheumatology Department of Bichat hospital between 1975 and 1984 in whom aortic regurgitation developed. Only rare or previously undescribed associations were retained: two MacDuffie syndromes, one adult form of Still's disease, one Takayashu's disease, one association of rheumatoid arthritis and Takayashu's disease, one rheumatoid arthritis, one Cogan's syndrome and two cases of disseminated lupus erythematosis. The authors use these cases and a review of the literature to discuss the possible physiopathological mechanisms of the aortic regurgitation.

[Right intraventricular tumors. Apropos of a case].

The authors report a case of right ventricular tumour in a 16 year old girl who presented with dyspnoea on effort, chest pain on exertion and loss of consciousness. The diagnosis was made on the basis of abnormal right intraventricular echoes on two dimensional echocardiography and was confirmed by angiography. The patient was operated with success.

[Aorto-septal angulation: a new cause of disorder in left ventricular ejection? (a 2-dimensional echocardiographic study apropos of 66 cases)].

Aorto-septal angulation is defined as an acute angled connection between the anterior aortic wall and the interventricular septum. It is quite a common 2D-echo finding. Does it correspond to a simple anatomical curiosity or is it associated with certain well defined diseases? Could it be a cause of obstruction to left ventricular ejection? To try to answer these questions, 66 consecutive cases of aorto-septal angulation were analysed; the echocardiographic and clinical data were correlated.

[Clinical study of the action of dobutamine in acute cardiac insufficiency].

78 patients were treated with dobutamine for a severe episode of heart failure at a mean dose of 9.51 micrograms . kg-1 .

[Treatment with intracoronary streptokinase in the acute phase of myocardial infarct. Preliminary results apropos of 20 cases].

Twenty patients with primary myocardial infarction (mean age 55 years +/- 6) were treated with intracoronary streptokinase in the acute phase. The mean interval between the onset of chest pain and treatment was 4 hours 30 minutes (extremes, 30 minutes and 6 hours). The total quantity of streptokinase required to obtain coronary revascularisation varied from patient to patient and with the technique used, but it was less than 350,000 units in all cases.

[Visualization by bidimensional echocardiography of the trunk of the left coronary artery. Affirmation of its integrity before coronary angiography].

The aim of this study was to visualise and analyse the status of the main left coronary artery by 2D echocardiography before coronary angiography. Fifty two patients were studied. The recordings were performed from the left parasternal position on video cassettes and played back frame by frame for each patient, to analyse the left main coronary artery and its bifurcation.

[Intracoronary thrombolytic treatment in the acute phase of myocardial infarction (author's transl)].

Thrombolysis by intracoronary injection of streptokinase was attempted in 18 patients with recent myocardial infarction. Streptokinase was administered by continuous i.v.

[Predictive value of the ajmaline test for the diagnosis of distal paroxysmal atrioventricular block (author's transl)].

An ajmaline test was conducted in 120 patients with a history of disorders of consciousness : Adams-Stokes syndrome (n = 49), loss of consciousness (n = 42), or lipothymia (n = 29). Four types of response were observed after ajmaline : VH less than 80 ms (n = 63); VH between 80 and 100 ms (n = 19); VH greater than 100 ms (n = 17); distal block (n = 21). One hundred and fifteen of these patients were followed-up for from three to six years (mean 56 months).

[Identification of the sino-atrial potential in the dog by epicardial electrocardiography].

The electrical activity of the sino-atrial node has been recorded in the dog through a thoracotomy and using both unipolar and bipolar electrodes. Amiodarone was used to establish that the pre-artial potential which was registered was indeed originating in the sinus, as it allowed us to produce various degrees of sino-atrial block in a reliable and reproducable manner. The fact that the sinus potential can be recorded in the presence of intermittent abnormalities of the surface P wave suggests that the abnormalities may be associated with intra-sinus displacement of the pacemaker and not with ectopic depolarisation of the atrium.

[The treatment of myocardial infarct with streptokinase].

The current situation concerning the use of Streptokinase in the treatment of recent myocardial infarction does not make it possible to draw any definite conclusions with regard to its therapeutic value:--mortality would not appear to be significantly modified in the majority of series;--the occurrence rate of major complications during the acute phase is not notably altered but it seems possible that the electrocardiographic course of the necrosis is more favourable under the influence of Streptokinase when treatment is begun early. The long term course cannot be assessed. Finally, it is certain that the tolerance of Streptokinase therapy has been good in all the published series.

[Recording of the electrical activity of the sino-atrial node area during an experimental sinoatrial block in dogs. Arguments in favor of its sino-atrial origin].

The electrical activity of the sino-atrial node appears to be difficult to detect, and has not until now been recorded from the heart in situ. Recording of the electrical activity from the area of the sino-atrial node area was carried out in the dog after thoracotomy, using a unipolar electrode placed in the epicardium at the cavo-atrial junction area; it enabled us to demonstrate a slow potential, of low amplitude, preceding the atrial deflection. The particular relationships between this slow potential and atrial activity under differing degrees of sino-atrial block have led us to believe that this potential does indeed originate in the sinoatrial node.