To explore the mechanisms of the "white coat" phenomenon, the effects of talking, reading, and silence were analyzed. Fifty essential hypertensive patients were randomly allocated to periods of stress talking and relaxing reading, alternating with three periods of silence. While talking, systolic/diastolic blood pressure increased sharply, from 142 +/- 0.7/97.7 +/- 0.5 mm Hg to 159 +/- 0.7/111 +/- 0.5 mm Hg (P < .0001). While reading, systolic/diastolic blood pressure decreased (P < .0001). Moreover, talking and reading had opposite residual effects. The silence and reading periods gave the best approximations of the daytime ambulatory period. The predictive value of clinical blood pressure can be improved if measured during a period without talking, thus decreasing the "white coat" phenomenon.

Background-Balloon coronary angioplasty has been reported to be ineVective in patients treated for end stage renal disease because of a high restenosis rate. Objective-To compare the clinical outcome following coronary angioplasty with provisional stenting in dialysis versus non-dialysis patients. Design-A case-control study. Patients-Of 1428 consecutive patients who underwent coronary angioplasty, 100 (7%) were being treated for end stage renal disease. These were compared with 100 control patients matched for age, sex, coronary lesions, presence of diabetes mellitus, and rate of coronary stenting (40%). Main outcome measures-In-hospital and one year clinical outcome. Results-The rates of procedural success (90% v 93%), in-hospital mortality (1% v 0%), stent thrombosis (0% v 0%), and Q wave myocardial infarction (0% v 1%) were similar in dialysis and non-dialysis patients. One year clinical outcome after coronary angioplasty was similar in the two groups in terms of clinical restenosis (31% v 28%) and myocardial infarction (6% v 2%), but cardiac death was more common in dialysed patients (11% v 2%, p < 0.03). Conclusions-Dialysis does not increase the risk of clinical restenosis after coronary angioplasty with provisional stenting. Coronary angioplasty is a safe and eVective therapeutic procedure in selected dialysis patients with culprit lesions accessible to stenting. However, the one year survival is reduced in this high risk population. (Heart 2001;85:556-560)

Calcific emboli from a calcific aortic stenosis is an uncommon eventA 73-year-old right-handed man had the sudden onset of aphasia and right hemiparesis. He had been treated for hypertension over the previous 10 years. One year earlier, a pulsed Doppler echocardiogram carried out for effort-related cardiac symptoms of angina pectoris, dyspnea, and syncope showed moderately tight CAS. An aortic outlet of approximately 1 cm 2 , with minimal aortic insufficiency and left ventricular hypertrophy, was demonstrated.On admission 3 days after his stroke, right hemiparesis was no longer present. Neurologic examination showed a fluent Wernicke's aphasia, with dysgraphia and dyslexia. Electrocardiogram snowed sinus rhythm and the sequelae of a posterolateral myocardial infarction. Electroencephalogram showed persistent left temporal abnormalities with monomorphic theta waves compatible with an ischFrom the Cliniquc Neurologique, H6pital de La Salpe'triere (G.R., L.M., D.V., M.C., A.A.) and the Clinique Cardiologique, Hdpital Necker-Enfants Malades (A.V.),

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