[Alcohol dependence in primary care : a clinical approach by the GP]

Clinical care to patients with alcohol dependence by GP's is described in this article. First, we have to destigmatize these patients and their illness. Diagnosis approach is specified. Therapeutic approach is first a motivational approach; subsequently it's like pedagogy : it's coping. Care is both physical and psychological. Empathy all along therapeutic relationship is a priority and how establishing a therapeutic alliance is described. A psychiatrist, a psychologist, a care network, self-help associations have also to be called on when needed. Physicians education creates new opportunities since 2016-2017 : in particular SSMG (Scientific Society of Primary Care) and three Belgian universities (UCL, ULB and ULiège) introduced a special study program called «?certificat interuniversitaire d'alcoologie?». Let's hope this new clinical rewarding approach for GP's contribute to reduce the treatment gap as far as clinical care of patients with alcohol dependence is concerned.

Idiopathic dilatation of the pulmonary artery: report of four cases

Idiopathic dilatation of the pulmonary artery (IDPA) is a rare congenital disease which is usually detected fortuitously on chest x-ray, thus radiologists must be aware of this clinical entity. This report describes four cases to which Magnetic Resonance Imaging (MRI) played a major role in diagnosing IDPA and in detecting the concomitant findings observed in this disease. MRI is a non-invasive procedure with many advantages for the accurate and reproducible measurement of artery structures, which makes it the preferred option for combined use with echocardiography in the diagnosis and follow-up of patients with IDPA.

Angiosarcomas of the interatrial septum mimicking atrial myxomas

Angiosarcoma of the heart is a rare tumor. This tumor is most frequently located in the right atrium and pericardium. Localization of a tumor in the interatrial septum usually suggests atrial myxoma. We report two cases of angiosarcoma originating from the interatrial septum, one extending into the right atrium and the other into the left atrium, mimicking atrial myxomas. Transesophageal echocardiography allowed the diagnosis and comprehensive assessment of compromised structures.

Mediastinal and pericardial complications after heart transplantation. Not-so-unusual postoperative problems?

Of a total of 133 patients who underwent heart transplantation, 16(12%) had pericardial and mediastinal complications. Non-infectious pericardial complications, pericardial effusion and constriction were noted in ten patients, and infectious pericarditis or mediastinitis in six. Cardiac echocardiography, catheterization and magnetic resonance imaging were useful in assessing these problems. All patients underwent surgical treatment, pericardial drainage, pericardectomy or muscle flap closure. Twelve (75%) of these 16 patients are long-term survivors. In conclusion, pericardial and mediastinal complications are common after heart transplantation, and aggressive surgical treatment is most often effective in their control.

Asymptomatic heterotopic thyroid tumour in the right ventricular infundibulum

An asymptomatic thyroid cardiac tumour was discovered in the right ventricular infundibulum of a 63-year-old female investigated for angina. The results of the investigation are presented: coronary angiography, echocardiography, magnetic resonance imaging, resting radioactive 201-thallium scintigraphy, dipyridamole-thallium scintigraphy, nuclear isotopic ventriculography. The tumour was successfully removed at surgery for coronary bypass. Anatomopathological description is also included.

Pseudoaneurysm after Bentall repair: magnetic resonance imaging assessment

The prevalence and natural history of pseudoaneurysms (PA) following Bentall procedure has not been established. To determine the follow-up of PA in patients, the authors report their experience with magnetic resonance imaging (MRI) since 1988. Spin-echo technique suspected PA in 19 of the 27 patients who underwent aortic valve and ascending aortic replacement between 1980 and 1991. Mean PA diameter was less than 4 cm in 13 patients (group 1) and at least 4 cm in six patients (group 2). Two patients in group 1 were lost at follow-up while two others in this group died after first spin-echo examination (one death was related to PA formation). Repeated MRIs were thus possible in nine patients in group 1 and in all patients in group 2, averaging 2.2 +/- 1.1 examinations per patient for group 1 and 1.8 +/- 1.1 for group 2. PA assessed in six group 1 patients and one group 2 patient suggested thrombosed PA or postoperative hematoma. PA remained stable in two group 1 patients and one group 2 patient. One patient from group 1, in whom PA increased at follow-up, died suddenly. Four patients in group 2 required correction of PA, which had increased in diameter. Recently, addition of cine MRI has allowed visualization of turbulent flow within PA, thus increasing MRI specificity for PA diagnosis. In conclusion, MRI constitutes a reliable noninvasive imaging technique for diagnosis and follow-up of PA after Bentall repair.

Assessment of left ventricular function using digital angiography

We have demonstrated that selective digital left ventricular angiography using small amounts of contrast material minimized both symptoms and hemodynamic alterations and provided good images for assessment of regional ventricular function. However, comparisons of ejection fraction (EF), end-systolic volume (ESV), and end-diastolic volume (EDV) from digital angiography, at 10 frames per second, with measurements derived from conventional angiography, showed only a fair correlation between the two methods. Using a new generation of digital equipment and an acquisition time of 30 frames per second, we studied the correlation between digital and conventional angiography in 29 patients with coronary artery disease for a wide spectrum of left ventricular functions. Ventricular volumes and EF were calculated by computer using the area-length method. The correlation coefficient (r) between both the methods was 0.93 for EF, 0.95 for ESV and 0.89 for EDV. Thus digital left ventricular angiography provides an accurate evaluation of left ventricular function and can with advantage replace conventional angiography for this purpose.

Usefulness of digital subtraction left ventriculography in patients with ischemic heart disease: comparison with cineangiography

Digital subtraction and computer enhancement of left ventriculography allow the injection of small amounts of contrast medium into the left ventricle. Image quality measurements of cardiac volumes, and ejection fraction and evaluation of regional wall motion were compared following digital subtraction and cine ventriculography in 30 patients undergoing coronary arteriography for suspected or proven ischemic heart disease. At concentrations of 13% to 19% (iodine contents: 2.0 to 5.0 g) meglumine sodium diatrizoate used for digital subtraction ventriculography, no alterations of ventricular pressures were noted; premature ventricular contraction and cineventriculography in 30 patients undergoing coronary arteriography for suspected wall motion by two independent observers showed complete agreement between digital and cineventriculography in 141 of 150 segments (94%), including 114 normal segments; digital ventriculography led to underestimation of four segments and to overestimation of five. Left ventricular ejection fraction and volumes calculated using both techniques correlated relatively well (ejection fraction: r = 0.86; end systolic volume: r = 0.88; end diastolic volume: r = 0.665). Thus, intraventricular injection of low concentrations of contrast medium provides good digital angiographic images and may eventually replace cine ventriculography for invasive assessment of left ventricular performance. However, ECG gating and shorter exposure times will be required for accurate measurement of ventricular volumes and ejection fractions.

Comparison of digital and radionuclide left ventriculography in patients at risk from conventional left ventriculography

In this study, two alternative methods of assessing left ventricular (LV) sequential wall motion and ejection fraction (EF) were used in 28 consecutive patients in whom an unstable clinical condition (unstable angina pectoris or severe LV dysfunction) precluded the use of high volume contrast cineventriculography. A new approach, direct small volume contrast digital ventriculography, was compared to radionuclide blood pool ventriculography considered as a "standard" and reliable technique. The qualitative analysis of regional LV contraction by three independent observers showed a complete agreement in 64% of segments studied in the left anterior oblique (LAO) projection and in 69% in the right anterior oblique (RAO) projection; a one-degree disagreement was observed in 13% and 19% respectively, and a discrepancy of two degrees or more in 23% and 12% respectively. Left ventricular ejection fraction calculated from both techniques correlated relatively well (r = 0.82). The radionuclide examination still remains the fastest, easiest and most objective way to appraise global LV function in high risk patients. However, optimal analysis of segmental wall motion requires invasive digital contrast left ventriculography. In future, a more general use of non-ionic contrast media including their intravenous injection and the advent of portable digital devices should permit their widespread use as a safe, rapid and reliable procedure even in the intensive care unit.

Clinical experience with ioxaglate (Hexabrix) in selective coronary arteriography

This prospective nonrandomized study was performed to evaluate the safety and efficacy of, as well as patient tolerance for, a new low osmolality contrast medium, ioxaglate (Hexabrix), in 90 adult patients of both sexes who were referred to our cardiac catheterization laboratory for angiocardiography including selective coronary arteriography. Ioxaglate did not cause any major adverse effects; side effects were rare and mild. Hemodynamic changes were minimal, even in patients with severe coronary artery disease, and no arrhythmias were seen. The radiographic quality of angiograms was scored as good to excellent for each examination, and was equal to that of films performed using a conventional contrast medium. Ioxaglate may be the contrast medium of choice for angiocardiography, especially in patients at high risk, i.e., those with severe coronary artery disease or severe left ventricular dysfunction.

Value of a cinefluoroscopic assessment of the Lillehei-Kaster prosthetic heart valves

In order to assess the functioning of the pivoting disc of the Lillehei-Kaster prosthetic valve, a cinefluoroscopic technique using multiple angulations was developed. The disc was detected in 240 (99%) of the 242 valves studied (126 aortic, 107 mitral, and nine tricuspid valves). The maximal-opening angle of the disc was measured in 75% of the aortic but only 20% of the mitral valve prostheses in the 182 valve studies in which this was attempted. Prosthetic dysfunctions were suspected clinically in three aortic and three tricuspid valves and confirmed with the cinefluoroscopic technique. This cinefluoroscopic approach constitutes a rapid, noninvasive, and sensitive evaluation of the function of the Lillehei-Kaster prosthetic valve in the aortic position.