Le point sur l'ergométrie en 2012 dans le diagnostic de la maladie coronarienne.

Background In patients presenting with acute cardiac symptoms, abnormal ECG and raised troponin, myocarditis may be suspected after normal angiography. Aims To analyse cardiac magnetic resonance (CMR) findings in patients with a provisional diagnosis of acute coronary syndrome (ACS) in whom acute myocarditis was subsequently considered more likely. Methods and results 79 patients referred for CMR following an admission with presumed ACS and raised serum troponin in whom no culprit lesion was detected were studied. 13% had unrecognised myocardial infarction and 6% takotsubo cardiomyopathy. The remainder (81%) were diagnosed with myocarditis. Mean age was 45615 years and 70% were male. Left ventricular ejection fraction (EF) was 58610%; myocardial oedema was detected in 58%. A myocarditic pattern of late gadolinium enhancement (LGE) was detected in 92%. Abnormalities were detected more frequently in scans performed within 2 weeks of symptom onset: oedema in 81% vs 11% (p<0.0005), and LGE in 100% vs 76% (p<0.005). In 20 patients with both an acute (<2 weeks) and convalescent scan (>3 weeks), oedema decreased from 84% to 39% (p<0.01) and LGE from 5.6 to 3.0 segments (p¼0.005). Three patients presented with sustained ventricular tachycardia, another died suddenly 4 days after admission and one resuscitated 7 weeks following presentation. All 5 patients had preserved EF. Conclusions Our study emphasises the importance of access to CMR for heart attack centres. If myocarditis is suspected, CMR scanning should be performed within 14 days. Myocarditis should not be regarded as benign, even when EF is preserved.

La fibrose rétropéritonéale, une maladie inflammatoire méconnue. Observations cliniques et revue de la littérature [Retroperitoneal fibrosis, an unrecognized inflammatory disease. Clinical observations and review of the literature]

Retroperitoneal fibrosis (RF) is a rare disease, typically with an insidious clinical course. The peak incidence is seen in patients 40 to 60 years of age and mostly in man. The characteristic finding in this disease is a periaortic fibrous mass that often surrounds the ureters. Although usually regarded as an obstructive uropathy, there has been growing recognition of the condition as a generalized disease. It may have a wide variety of manifestations including mediastinitis, thyroiditis and sclerosing cholangitis. The most common mode of presentation remains abdominal or flank pain with uremia, anemia and a high sedimentation rate. Although ultrasound and renal scintigraphy may contribute to the general evaluation of patients with RF, CT-scanner is the preferred imaging method. The multiplanar imaging capability of magnetic resonance may facilitate assessment of disease extent. The pathogenesis of the disease remains unknown. Steroids and, more recently tamoxifen, appear to be effective in the treatment of the RF. In most instances, RF does not lead to long-term morbidity or affect survival. The three cases of RF reported herein illustrate the varied mode of presentation and the response to the treatment.

Pseudomonas aeruginosa et maladie broncho-pulmonaire chronique obstructive [Pseudomonas aeruginosa in chronic obstructive pulmonary disease].

The role of Pseudomonas aeruginosa isolated in sputum cultures from adults with obstructive chronic pulmonary disease (COPD) is not well known. However, this pathogen has many factors of virulence and is responsible for several clinical manifestations in this setting. Isolation of a new strain of Pseudomonas is associated with a significant risk of exacerbation of the COPD and its prevalence depends on the severity of the COPD. The role of Pseudomonas among patients with COPD apart from exacerbations is less clear, but it could be responsible for an ignition for the airways and progression for the disease. Currently, the relevance of a prophylactic antibiotic therapy has not yet been demonstrated in COPD holders of Pseudomonas.

Mycobactéries non tuberculeuses maladie pulmonaire: quoi de neuf [Non tuberculous mycobacteria pulmonary disease: what's new?].

The incidence of NTM (non tuberculous mycobacteria) pulmonary disease is increasing. The diagnosis must be established in the presence of clinical, radiological and microbiological findings. Groups at risk to contract pulmonary disease due to NTM are patients with underlying structural lung disease. Treatment of NTM is long and requires multiple drugs combinations. Relapses and re-infection are not rare. Our understanding in many matters of NTM pulmonary disease is incomplete. Further research is necessary in order to understand the host's defense mechanisms against NTM, and the factors that influence the evolution to lung disease.

Le cancer est-il une maladie nouvelle? A propos du diagnostic des maladies tumorales dans le De Medicina de Celse [Is cancer a new disease? Apropos of diagnosis of tumor diseases in De Medicina by Celsus]

Cancer is a particularly common disease in modern societies. Moreover, epidemiology considers it typical of contemporary pathology. Nevertheless, the abundant ancient literature-in the De Medicina by Celsus, among others-leads us to believe that numerous benign and malignant tumours were observed if not identified as such. Hence, it is possible that both the change in medical conceptualization and the real increase in the prevalence are responsible for the actual importance of cancer

Analyse de la prescription, de l'efficacité et de la tolérance des inhibiteurs de l'acétylcholinestérase dans la maladie d'Alzheimer

Résumé En suisse, trois inhibiteurs de l'acétylcholinestérase sont disponibles pour le traitement symptomatique de la maladie d'Alzheimer légère à modérée. Il s'agit du donépézil (Aricept®), de la galantamine (Reminyl®) et de la rivastigmine (Exelon®). Leur prescription est maintenant largement répandue, sur la base d'études ayant confirmé leur efficacité et leur tolérance. Le but de la présente étude a été d'évaluer si de tels résultats se retrouvent dans notre hôpital. Nous avons analysé les dossiers hospitaliers et interviewé les proches et les médecins traitants de 103 patients chez qui un tel traitement a été proposé ou initié dans notre centre de gériatrie, entre janvier 2001 et juillet 2003. Nos résultats montrent que le donépézil fut la molécule la plus fréquemment prescrite (50,6% des cas), suivie par la galantamine (44,2%). Après une année de traitement, seulement 54% des patients (n = 51) prenaient encore leur traitement. Une faible majorité des patients (52% selon les médecins traitants, 62% selon les proches) a favorablement répondu au traitement. Nos résultats confirment l'efficacité de ces molécules mais dans une proportion moindre que celle publiée dans la littérature et sans dégager de supériorité d'une molécule sur une autre. Sur le long terme (une année), le pourcentage d'abandon a été élevé et supérieur aux données de la littérature. Nous estimons que le grand âge des patients de notre collectif explique en partie cette discordance de résultats.