[Sulmazole: a new positive inotropic agent]

Sulmazol (AR-L 115 BS) is a new positive inotropic agent with arterial and venous vasodilator properties. The authors studied the effects of a 24 hours intravenous infusion (an injection of 0.5 mg/kg over 1 minute, followed by an infusion of 1.4 mg/min) on the major haemodynamic parameters of 17 patients with heart failure: 10 patients with chronic decompensation (group I) and 7 patients with heart failure as a result of acute myocardial infraction (group II). The haemodynamic criteria of inclusion were a cardiac index less than or equal to 2.5 l/min/m2 and a pulmonary capillary pressure greater than or equal to 18 mm Hg. After 6 hr of the infusion, the cardiac index increased in both groups (45%, p less than 0.001 and 40%, p less than 0.001 respectively); the pulmonary capillary pressure decreased (32%, p less than 0.001 and 30%, p less than 0.001) and the right atrial pressure decreased (51%, p less than 0.005 and 31%, NS). The total systemic resistance was also decreased (32%, p less than 0.001 and 34%, p less than 0.001), but there was no significant change in the systolic blood pressure. The heart rate increased only in group II (17%, p less than 0.001). These beneficial hemodynamic effects lasted for the 24 hours of the infusion. Sulmazol was therefore found to be very effective in the treatment of acute and chronic heart failure; its long term tolerance still needs to be demonstrated.

Effect of labetalol on preload in acute myocardial infarction with systemic hypertension

We assessed the effects of labetalol on pulmonary wedge pressure (PWP) and other hemodynamic variables in 18 patients with acute myocardial infarction (AMI) and systemic hypertension (systolic blood pressure greater than 150 mm Hg). According to the initial value of PWP, the patients were separated into two groups of nine patients each: Group 1 (PWP greater than or equal to 15 mm Hg) and Group 2 (PWP less than or equal to 12 mm Hg). Labetalol was infused at increasing rates to lower systolic blood pressure below 130 mm Hg; this optimal rate (mean rates for Groups 1 and 2: 1.8 and 2.1 mg/min, respectively) was maintained for 1 h. Hemodynamic variables were measured before and after 1 h of infusion. Labetalol normalized blood pressure in both groups by a significant decrease in total systemic resistance [22% (p less than 0.001) and 13% (p less than 0.02)] and in cardiac index [17% (p less than 0.005) and 12% (p less than 0.02)]. While the hemodynamic responses were rather similar in both groups, the PWP decreased significantly (from 22 to 15 mm Hg, p less than 0.01) in Group 1, but did not change significantly in Group 2 (from 7 to 10 mm Hg, NS). The possible mechanisms behind these different responses are discussed. We conclude that labetalol is an effective drug for treating systemic hypertension in AMI which acutely decreases total systemic resistance and preload in patients with moderate left ventricular failure.

Hemodynamic effects of dobutamine in patients below and over 65 years, with left heart failure secondary to an acute myocardial infarction

The cardiac response to sympathomimetic agents has been reported to be reduced in the elderly. We studied the hemodynamic effects of dobutamine in two groups of patients with acute myocardial infarction (AMI) and left heart failure: group A included 10 patients aged 65 years or less and group B 10 others older than 65. After a 1-hour infusion the increase in cardiac index was highly significant in both groups (27%, p less than 0.001 and 25%, p less than 0.001), and the decrease in pulmonary wedge pressure was greater in group A (42%, p less than 0.001 and 17%, p less than 0.02). The increase in double product was similar in both groups (14%, p less than 0.001 and 18%, p less than 0.005); nevertheless the 4 patients developing angina pectoris during dobutamine infusion were over 65 years. We conclude that dobutamine remains effective in the elderly with AMI and left heart failure but is less well tolerated.

Hemodynamic and clinical response to three-day infusion of sulmazol (AR-L 115 BS) in severe congestive heart failure

Sulmazol (AR-L 115 BS) is a new positively inotropic drug with arterial and venous vasodilating properties. We studied the effects of sulmazol (three-day infusion) on clinical tolerance, hemodynamics, and blood gas levels in ten patients with severe chronic heart failure. The hemodynamic monitoring included a Swan-Ganz catheter in the pulmonary artery and a radial catheter. Blood gas levels were determined on samples of arterial and mixed venous blood. After 24 hours of infusion, there was a significant increase in cardiac index (2 to 2.5 L/min/sq m; p less than 0.005) and a significant decrease in pulmonary wedge pressure (28 to 19 mm Hg; p less than 0.001) and in right atrial pressure (7 to 4 mm Hg; p less than 0.001) without significant changes in heart rate and systolic blood pressure. These beneficial effects lasted during the three days of infusion. Oxygen delivery was significantly increased (350 to 443 ml/min/sq m; p less than 0.005) without significant change in arterial oxygen tension. The side effects included nausea, vomiting, anorexia, and mild thrombocytopenia. We conclude that sulmazol is a potent drug which may improve severely deteriorated left and right ventricular function in patients with chronic refractory heart failure without affecting the heart rate and the systolic blood pressure.

The effective plasma concentrations of sulmazol (AR-L 115 BS) on haemodynamics in chronic heart failure

Sulmazol (AR-L 115 BS) is a new inotropic drug which has arterial and venous vasodilating properties. We used it in seven patients with severe refractory heart failure to determine the effective plasma concentration levels and the most effective bolus dose on haemodynamics. The haemodynamic monitoring included a Swan-Ganz catheter in the pulmonary artery and a radial catheter. Haemodynamic measurements and plasma concentration determinations were performed before sulmazol injection and at 5, 10 and 30 min after a bolus 0.25, 0.50, 0.75 mg/kg. We observed a gradual increase in cardiac index and decrease in pulmonary wedge pressure when plasma concentration levels rose but the beneficial effects were mainly observed for sulmazol plasma concentrations above 1 microgram/ml. A bolus injection of 0.75 mg/kg was effective in all cases: a significant increase of cardiac index (1.9 to 2.5 1 min-1 m-2; P less than 0.001) and a significant decrease in pulmonary wedge pressure (30 to 25 mm Hg; P less than 0.005) and right atrial pressure (13 to 10 mm Hg, P less than 0.01) were observed. In these patients sulmazol improved the severely deteriorated left ventricular function without affecting heart rate and blood pressure.

Treatment of hypertension in acute stage of myocardial infarction. Haemodynamic effects of labetalol

Labetalol was used to treat systemic hypertension (systolic blood pressure above 150 mmHg) in 11 patients with acute myocardial infarction; its haemodynamic effects and tolerance were studied. Increasing doses of labetalol were infused to lower systolic blood pressure to less than 130 mmHg; the optimal rate was then maintained for one hour (mean rate: 2.3 mg/min). Haemodynamic variables were measured before, during, and after labetalol infusion. Labetalol lowered blood pressure in all patients; this effect was related to a decrease both in total systemic resistance (17.7 to 14 IU) and in cardiac index (3.1 to 2.7 1/min per m2); the stroke index remained unchanged and the heart rate was reduced (94 to 81 beats/min). There was no significant change in the mean pulmonary wedge pressure; it was decreased, however, in the six patients with an initial pressure greater than 15 mmHg. The double product was greatly decreased (16 497 to 8598 mmHg x beats per min), which is favourable in acute myocardial infarction. We conclude that labetalol is a drug of choice to treat hypertension in acute myocardial infarction because it is very effective; its haemodynamic effects are likely to reduce myocardial oxygen requirements and suggest that labetalol administration does not worsen moderate left sided heart failure. The drug, however, may reduce the cardiac output.

[Ataxia-opsoclonus-myoclonus syndrome]

The ataxia-opsoclonus-myoclonus syndrome that was well individualized by Kinsbourne is mostly observed in young children (less than three years old in 90 percent of the cases). From six personal cases, and from a review of ninety cases of the literature, the clinical and etiological features, as well as the evolution of the syndrome, are studied. Prodromes (infectious and digestive manifestations) and comportmental changes usually precede the sudden onset of the clinical triad. Neurologic complementary investigations are typically normal during the acute phase. The frequent association (46 percent of the cases) of this syndrome to a neuroblastoma (usually thoracic) makes it very particular from the etiological point of view. The evolution is identical whatever the type ("isolated" or "tumoral"). Corticotherapy (ACTH or corticoids) is efficient in 60 percent of the cases. But recurrences and cerebral sequelae (mental deficiency and speech disorders) are frequent.

[Gluten enteropathy in children from south-eastern France (author's transl)]

Between 1969 and 1979, 123 cases of gluten-induced enteropathy were diagnosed in south-eastern France. The overall incidence of the disease was estimated at approximately one for 4 600 births. The mean age of the patients was 3.2 years. At the time of diagnosis, 71 children (57,7%) were less than 2 years old, and 52 children (42,3%) were above that age. There was a strong predominance of girls (60%) and North-Africans (48%). Children younger than 2 years presented with the usual malabsorption syndrome, whereas growth retardation, often isolated, was the main feature in older children. The relative increase observed since 1976 in the number of patients of the latter group despite a lower incidence of the disease was probably due to the withdrawal of infants' foods containing gluten. In 58 children followed up dietetic measures resulted in rapid clinical improvement, but healing of the mucosal lesions was much slower (19 months on average). In 28 patients who could be followed for longer periods, reintroducing gluten into the diet regularly led to histological relapse. These patients, however, had been selected for particular reasons. The true incidence of transient intolerance to gliadin is difficult to determine, since most subjects in perfect health refuse control biopsies.

[Diagnostic aspects of cerebral arterial occlusion in infants and children (author's transl)]

The authors have studied the bases of the clinical and CT diagnosis of cerebral arterial occlusion in children from a series of 16 cases. The sequential evolution of the CT appearance seems characteristic depending on the time elapsed since the onset. Contrast enhancement, concerns mainly the grey matter, is maximum during the second and third weeks and should be looked for during this period. The aetiology remains usually hypothetic. Some data, including the angiographic aspect of "endarteritis" may suggest an infectious pathogeny.

Clinical and hemodynamic effects of dobutamine in acute myocardial infarction with left heart failure

We studied the clinical and hemodynamic effects of dobutamine infused for 24 hr into 10 patients with acute myocardial infarction (less than 4 days) complicated by left heart failure (pulmonary wedge pressure greater than 15 mm Hg, cardiac index less than 3.0 liters/min/m2). We measured pulmonary arterial pressures, pulmonary wedge pressure, right atrial pressure, and intravascular systemic blood pressures. The thermodilution method was used for determinations of cardiac output, and the electrocardiogram was followed with a computerized arrhythmia monitoring system. After 1 and 3 hr of infusion with the optimal dose (averaging 8 micron/kg/min), there was a very significant increase of cardiac index (29%) and a decrease of pulmonary wedge pressure (37%) with a moderate increase of heart rate (20%) an without significant changes in blood pressure. After 24 hr of dobutamine infusion, much of the improvement in left ventricular function was lost. This may be attributed either to a decrease of drug action or to an unfavorable evolution of the clinical status. We conclude that infusion of dobutamine is an effective, potent, and well-tolerated short-term procedure in the management of left heart failure during the acute stage of myocardial infarction.

Partial trisomy 4 resulting from a complex maternal rearrangement of chromosomes 2, 4, and 18 with interstitial translocation

A woman presented a complex chromosome rearrangement with translocation between chromosome 2 and 4 in addition to an insertion of the band 4q12 leads to q13 in the long arm of chromosome 18. The authors present a case study of the daughter who displayed the abnormal chromosome 18 and trisomy of band 4q12 leads to q13.

[Evaluation of one year experience with cerebral tomodensitometry in pediatric neurology]

Cerebral tomography allows the delineation of areas modified by edema or necrosis, the visualization of calcifications undetectable by standard x-ray examination, extra- or intra-cerebral blood effusions and neoformations of the cerebrum or of its envelopes. It also reveals slight or localized cerebral atrophies that other neuro-radiologic techniques sometimes failed to detect. It appears therefore worthwhile to reconsider pediatric neurology according to this new type of investigation. Its sole difficulty in young children, is the requirement of a half hour immobility, best obtained by general anesthesia. However, the rapid improvements of this technique will probably permit to overcome this slight drawback.

Computerized tomography in the study of West's syndrome

37 children presenting with West's syndrome were studied by computerized tomography scanning. An abnormality consisting of diffuse cerebral atrophy, predominating in the fronto-temporal region, was demonstrated in 30 cases. The abnormality was sometimes associated with calcification (tuberous sclerosis) or malformation (agenesis of the corpus callosum). The aetiology of the atrophy and its relationship to clinical and electroencephalographic signs is discussed. Computerized tomography scanning is recommended for children with West's syndrome in order to distinguish between primary and secondary cases, and for greater prognostic accuracy.