5-Fluorouracil-induced cardiotoxicity mimicking myocardial infarction: a case report

BACKGROUND: Severe cardiotoxicity is a documented, but very unusual side-effect of intravenous 5-fluorouracil therapy. The mechanism producing cardiotoxicity is poorly understood. CASE PRESENTATION: A case of 5-fluorouracil-induced cardiotoxicity, possibly due to coronary artery spasm, and mimicking acute anterolateral myocardial infarction is presented and discussed. Electrocardiographs highlighting the severity of the presentation are included in the report along with coronary angiograms demonstrating the absence of significant coronary atherosclerosis. CONCLUSION: Severe 5-fluorouracil-induced cardiotoxicity is rare, but can be severe and may mimic acute myocardial infarction, leading to diagnostic and therapeutic dilemmas. Readministration of 5-fluorouracil is not advised following an episode of cardiotoxicity

Study of the interaction between plant and aphid in a proteomic approach and research of elicitors of plant defence mechanisms in Myzus persicae saliva.

La salive des insectes joue un rôle important dans la mise en place des mécanismes de défense chez les plantes et encore peu d’études se sont intéressées à l’identification d’éliciteurs dans la salive de pucerons. Pour cette étude, trois volets sont investigués. Premièrement, une approche protéomique a été développée afin d’analyser les protéines exprimées différentiellement suite à différentes périodes d’infestation de Myzus persicae chez Arabidopsis thaliana. Nous avons également effectué des mesures de pH et de burst oxydatif sur une suspension cellulaire de tabac afin de démontrer le pouvoir éliciteur de la salive. Une approche génomique a également été développée afin de cloner un gène codant pour une glucose oxydase (GOX). En effet, cet éliciteur, connu notamment chez les Lépidoptères, a été identifié dans la salive de M. persicae. Le but est donc de démontrer l’activité élicitrice de la protéine recombinante. A l’issue de ce travail, nous avons observé une expression protéique différentielle chez A. thaliana suite à l’infestation de M. persicae. L’identification des protéines n’ayant pas encore été réalisée, nous ne connaissons pas encore la nature de ces protéines induites. Nous avons également remarqué que l’ajout de diète contenant de la salive de puceron pouvait provoquer, chez les cellules de tabac, une modification de pH similaire à celle observée avec la surfactine, éliciteur de référence. Cependant la réponse est peut-être la conséquence d’un effet tampon dû au pH basique de la diète. Enfin, nous avons réalisé le clonage d’un gène codant pour une GOX mais l’expression de la protéine d’intérêt dans E. coli est faible. Les protocoles d’expression et de purification de la protéine recombinante doivent être optimisés, de manière à pouvoir procéder à des tests (mesure de pH, burst oxydatif) sur cellules de tabac

Prognostic significance of silent exertional myocardial ischaemia in symptomatic men without previous myocardial infarction.

A total of 360 consecutive male patients with complaints of chest pain and documented coronary artery disease underwent a maximal exercise test combined with thallium myocardial scintigraphy. Patients with a history of previous myocardial infarction were excluded. During follow-up (46 months; from 12 to 96) 27 patients died and 26 had a first non-fatal myocardial infarction. The 6-year survival rate and the 6-year event-free rate were 81 and 71%. Four variables contributed independently to the prognosis (Cox Model): the number of diseased vessels, the angiographic ejection fraction, the age and a multivariate score of the exercise test. From these patients, 227 had an abnormal response to exercise (ST-segment depression greater than or equal to 0.1 mV); in 138 patients, angina pectoris was induced during exercise while 89 patients had no pain during exercise (silent ischaemia). These 89 patients with silent exertional ischaemia were matched to 89 patients with exertional angina pectoris, according to the above-mentioned four prognostic predictors. The two groups of patients had similar signs of ischaemia during exercise (ST-segment depression and thallium perfusion score). The 6-year survival rates (81 and 81.5%) and the 6-year event-free rates (71 and 70.5%) were similar in the two groups. Thus, in men without previous myocardial infarction, silent exertional ischaemia bears the same prognosis as exertional ischaemia attended by angina pectoris

Unusual atrial pro-arrhythmic effect of flecainide : a contemporary review

The authors report the case of a patient with drug-resistant atrial fibrillation, who developed, for more than 2 hours, a well-tolerated attack of palpitations, after taking 500 mg of flecainide acetate. The Holter monitoring demonstrated atrial flutter with 1:1 AV conduction and a ventricular rate at 220 bpm. This atrial pro-arrhythmic effect is rare and the mechanism is discussed

Additional prognostic value of exercise testing and thallium-201 scintigraphy in catheterized patients without previous myocardial infarction.

To determine whether exercise testing and thallium scintigraphy provide additional prognostic information in symptomatic patients undergoing catheterization, we studied 432 consecutive male patients without a previous myocardial infarction by means of an exercise test, thallium scintigraphy and catheterization. The follow-up period was 46 +/- 24 months (from 12 to 96). Events were defined as death (27 patients), nonfatal myocardial infarction (occurring in 27 patients) or late (greater than 60 days after test) surgery or dilatation (needed in 45 patients). The 5 year survival rate was 89% and the event-free rate was 72%. History, noninvasive and invasive variables were submitted to a stepwise Cox regression analysis. By multivariate analysis, the significant variables related to death were the number of diseased vessels and exercise workload; the selected variables for all cardiac events were the number of diseased vessels; the score at thallium exercise testing and exercise workload. Among the subgroups of 337 coronary patients, the predictive variables for death were exercise workload and the number of diseased vessels. For all cardiac events, the selected variables were the number of diseased vessels, the score of defects during thallium exercise and exercise workload. Thus, in patients without a previous myocardial infarction, noninvasive variables do provide prognostic information which is not available either from the history or from catheterization