SummaryA 77-year-old female was admitted in our hospital for uterine prolapse surgery. She developed ventricular tachycardia during induction of general anaesthesia and after initial symptomatic measures, she was transferred to the coronary care unit. Heart failure persisted and electrocardiographic changes mimicking acute myocardial infarction appeared. Coronary angiography was normal and left ventriculography revealed akinesis of the apical region of the left ventricle and apical ballooning during systole, with relative sparing of the base of the heart. Complete recovery of left ventricular function occurred 8 days after the initial onset of symptoms. A diagnosis of Takotsubo syndrome was made on the basis of consistent clinical and laboratory findings, typical echocardiography and angiography findings, and reversible course. This case emphasises the importance of being aware of uncommon causes of cardiac dysfunction in stressful situations, especially during induction of general anaesthesia. Takotsubo cardiomyopathy, or transient left ventricular apical ballooning syndrome, was first described in Japan as acute systolic heart failure caused by transient left ventricle apical akinesis [1]. This syndrome is usually triggered by stressful situations, and mainly affects elderly female patients [2]. The peri-operative period is wellknown to induce stress in patients, and this diagnosis should be considered when a patient presents with left ventricular dysfunction or electrocardiographic changes mimicking acute myocardial infarction in stressful situations [3,4], especially during the induction of general anaesthesia. We report the case of a 77-year-old female with Takotsubo syndrome that revealed itself during the induction of general anaesthesia. Case reportA 77-year-old female was admitted to our hospital for vaginal repair of uterine prolapse. She had a history of facial neuralgia treated by clonazepam, venous insufficiency, previous laparotomy under general anaesthesia and bilateral cataract surgery under peribulbar anaesthesia. There were no anaesthetic complications during these procedures. Pre-operative evaluation including electrocardiography was unremarkable, arterial pressure was 150 ⁄ 80 mmHg, and cardiopulmonary auscultation was normal. The patient decided against spinal anaesthesia, and it was therefore decided to administer a targetcontrolled infusion (TCI) of propofol, combined with regional anaesthesia (bilateral paracervical and pudendal nerve blocks). Before transfer to the operating room, the patient received 50 mg hydroxyzine. In addition to standard monitoring, anaesthesia depth monitoring was performed during surgery to measure bispectral index (BIS). Her arterial pressure was 195 ⁄ 92 mmHg, and heart rate was 70 beats.min )1 . Oxygen saturation was 95% with the patient breathing air. Pre-oxygenation was administered until the expired oxygen reached a fraction of 0.9.

Objectif : Nous décrivons l'intérêt et la bonne tolérance de la ventilation non-invasive lors d'un oedème pulmonaire attribué aux médicaments tocolytiques durant le travail d'une grossesse gémellaire. L 'uTiLiSATioN de la ventilation non-invasive (VNi) comme substitut à l'intubation trachéale est particulièrement indiquée chez les patients pour lesquels la période de support ventilatoire anticipée est courte et pour qui la prise en charge conventionnelle des voies aériennes par intubation semble présenter des risques importants.Les inhibiteurs calciques de la famille des dihydropyridines sont indiqués dans la tocolyse lors des menaces d'accouchement prématuré (MAP). ils ont supplanté les ß2-mimétiques en raison d'une meilleure

The benefits of skeletal myoblast transplantation are limited by the high rate of early cell death which is partly of ischemic origin. We, therefore, assessed whether graft survival could be improved by the additional use of the angiogenic cytokine erythropoietin (EPO). Thirty-five Lewis rats underwent coronary artery ligation and, two weeks later, were randomized to receive in-scar injections of control medium, skeletal myoblasts (5x10(6)) or skeletal myoblasts with EPO started the day before transplantation and continued for two weeks (500 U/kg three times a week). A fourth group was treated by EPO alone without injections. Function was assessed by 2D echocardiography before transplantation and one month thereafter. Compared with controls and hearts treated by EPO-alone, those transplanted with myoblasts yielded a significantly better recovery of LV ejection fraction, irrespective of whether they had received EPO or not. Neither the area of myoblast engraftment, nor angiogenesis differed between the myoblast-alone and the myoblast+EPO groups. Apoptosis was hardly detectable and, therefore, unaffected by EPO therapy. In this model, EPO failed to improve myoblast engraftment and postinfarction LV function. These negative findings justify to pursue the search for alternate cell survival-enhancing strategies.