Cardiac hydatic cyst is a rare parasitic disease. We reported 45 patients with cardiac hydatid cysts; 33 of the 45 had a primitive, unique cardiac cyst. Altogether, 18 patients of our series were asymptomatic, and 27 patients complained of symptoms (dyspnea, chest pain, palpitations). In 11 cases the cyst was revealed by an acute complication; 3 of the 11 had pulmonary metastatic hydatidosis. The diagnosis was based on a series of test results in which hydatid serology and imaging (echocardiography, computed tomography, magnetic resonance imaging) played a predominant role. Cystopericystectomy is the gold standard procedure but is sometimes unsuitable for particular sites. In that case, a conservative approach (partial pericystectomy) is mandatory to preserve organ function. The operative mortality rate is 5.5%. Two pericardial recurrences were reported during follow-up.

Abstract-Microalbuminuria in diabetes is a risk factor for early death and an indicator for aggressive blood pressure (BP) lowering. We compared a combination of 2 mg perindopril/0.625 mg indapamide with enalapril monotherapy on albumin excretion rate (AER) in patients with type 2 diabetes, albuminuria, and hypertension in a 12-month, randomized, double-blind, parallel-group international multicenter study. Four hundred eighty-one patients with type 2 diabetes and hypertension (systolic BP Ն140 mm Hg, Ͻ180 mm Hg, diastolic BP Ͻ110 mm Hg) were randomly assigned (age 59Ϯ9 years, 77% previously treated for hypertension). Results from 457 patients (intention-to-treat analysis) were available. After a 4-week placebo period, patients with albuminuria Ͼ20 and Ͻ500 g/min were randomly assigned to a combination of 2 mg perindopril/0.625 mg indapamide or to 10 mg daily enalapril. After week 12, doses were adjusted on the basis of BP to a maximum of 8 mg perindopril/2.5 mg indapamide or 40 mg enalapril.

Percutaneous transluminal balloon valvuloplasty was attempted in 92 adult patients with severe calcific aortic stenosis. The mean age was 75 +/- 11 years (range 38 to 91) and 35 patients were more than 80 years old. Most of the patients were severely disabled; 66 were in New York Heart Association functional class III or IV, 27 had syncopal attacks and 21 had severe angina pectoris. Because of unacceptably high surgical risk or contraindication to thoracic surgery, 42 patients could not be considered for valve replacement. Other patients either were in a category of high operative risk or refused the surgical intervention. Valvuloplasty was performed by way of the femoral route (82 patients) or the brachial route (10 patients). Catheters of size 15, 18 and 20 mm were successively placed across the aortic valve and three inflations were usually done with each of them, lasting 80 seconds on average, until a decrease in peak to peak systolic pressure gradient to 40 mm Hg or less was attained, a result considered satisfactory. The inflated balloons were not totally occlusive in most cases and clinical tolerance of inflation was good. Valvuloplasty resulted in a reduction of mean systolic gradient from 75 +/- 26 to 30 +/- 13 mm Hg (p less than 0.001); the final gradient was less than 40 mm Hg in 78 patients. Mean calculated aortic valve area increased from 0.49 +/- 0.17 to 0.93 +/- 0.36 cm2 (p less than 0.001). Immediately after the procedure, ejection fraction increased from 48 +/- 16 to 51 +/- 16% (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)