Hend Keskes

ANÉVRYSME AORTIQUE D'ORIGINE SYPHILITIQUE : À propos d'un cas

: The incidence of tertiary syphilis has declined in recent years owing to the early recognition of the disease and use of antibiotics. As a result, syphilitic aortic aneurysms are rarely encountered nowadays. We report the case of a 65 years old man, who was admitted to our hospital in June 2004 for dyspnea, cough and chest discomfort. On physical examination, blood pressure was 130/80 mmHg with no significant laterality, pulse rate was 70 per minute and there was a decrease of breath sounds over the right lung. Laboratory findings revealed a slight elevation of the erythrocyte sedimentation rate. Serological studies for syphilis showed a positive venereal disease laboratory test (VDRL) at 1/32 and a positive Treponema pallidum hemagglutination test (TPHA) at 1/2560. The chest radiography showed a right para cardiac opacity measuring 16 x 12 cm. Fiber optic bronchoscopy showed an extrinsic compression of the right upper lobar bronchus. Gadolinium-enhanced magnetic resonance angiography and 16 multidetector-row spiral computed aortography showed a huge partially thrombosed saccular aneurysm of the ascending aorta measuring 132 mm in diameter. The circulating lumen measured 53 mm in its largest diameter. This aneurysm involved the innominate artery. There was no other arterial involvement. The patient was given a three week course of intravenous penicillin followed by a successful surgical procedure in September 2004 with ascending aortic replacement and innominate artery reimplantation. This case illustrates well a formerly common, but now extremely rare disease.

201: Are QT intervals correlated to apnea-hypopnea index in obstructive sleep apnea?

Introduction Several studies proved that obstructive sleep apnea (OSA) is associated with cardio-vascular diseases such as cardiac arrhythmia. QT duration and dispersion reflect the heterogeinity of ventricular repolarization and are considered as precursors of ventricular arrhythmia Aim The aim of this study is to assess the relation between the severity of OSA parameters as apnea hypopnea index and QT intervals. Methods Forty patients (18 men and 22 women) who were diagnosed with OSA by overnight polysomnography were included in this prospective study. The mean age was 56±10 years old. They were all in sinus rhythm. Before initiating continuous positive airway pressure therapy, we calculated on a 12 lead ECG : QT duration (QTend) corrected to Bazett formula and QT dispersion (QT end max -QT end min). Results Twenty four patients had severe OSA (AHI >30), 4 had moderate OSA (AHI between 15 and 30) and 12 had a mild OSA (AHI between 5 and 15). There was a significant positive correlation between QT dispersion and AHI (r=0.48, p=0.001) Conclusion The severity of OSA seems to be correlated with ventricular repolarization heterogeinity These results suggest that the higher is the AHI the higher is the risk of ventricular arrhythmia occurence. Further studies are needed to validate these results.

203: Correlation between P wave variables and apnea-hypopnea index in obstructive sleep apnea

Introduction Obstructive sleep apnea (OSA) is associated with several cardio-vascular abnormalities as atrial fibrillation (AF). AF occurrence in OSA increases the risk of stroke which worsens the prognosis of these patients. P wave dispersion (Pd) and maximal P wave duration (P max) are simple electrocardiographic parameters which reflect atrial conduction abnormalities and have been reported to be predictors of atrial fibrillation Aim the aim of this study is to determine the correlation between apnea-hypopnea index (AHI) and P wave dispersion and maximal P wave duration. Methods Forty patients (18 men and 22 women) who were diagnosed with OSA by overnight polysomnography were included in this prospective study. The mean age was 56±10 years old. They were all in sinus rhythm. Before initiating continuous positive airway pressure therapy, we evaluated on a 12 lead ECG P wave duration and P wave dispersion (P max - P min). Results Twenty four patients had severe OSA (AHI >30), 4 had moderate OSA (AHI between 15 and 30) and 12 had a mild OSA (AHI between 5 and 15). Mean P max duration was 119±21 ms. P wave dispersion was 93±6 ms. There was a significant positive correlation between P max and AHI (r= 0.45, p=0.001) and between P wave dispersion and AHI (r=0.42, p=0.001) Conclusion The severity of OSA seems to be correlated with the importance of atrial conduction abnormalities. These results suggest the higher is the AHI the higher is the risk of AF occurrence in OSA. Further studies are needed to validate these results.