Unsuccessful lung scan due to major right-to-left shunt through a sinus venosus septal defect.

In a patient with a prior history of cerebral abscess and cerebral ischemia, an unsuccessful perfusion lung scan led to a radionuclide angiocardiogram using an arm vein injection. This showed a total right-to-left (R-L) shunt from the superior vena cava (SVC) to the left atrium. Repeat radionuclide study, through a leg vein, demonstrated a moderate R-L shunt and an interpretable lung scan could be obtained. Catheterization and contrast cineangiogram did not provide the exact diagnosis, the preoperative conclusion being anomalous drainage of the SVC into the left atrium, with atrial septal defect (ASD) and partial anomalous pulmonary venous connection to the SVC. The operative diagnosis was high atrial (sinus venosus) septal defect. This example of major but clinically unsuspected R-L shunt emphasizes the value of performing a perfusion lung scan, preferably in conjunction with radionuclide angiocardiography in patients with a prior history of unexplained cerebral abscess or systemic ischemia. Implications of the site of an ASD on quantitation of L-R shunts by radionuclide methods are also discussed.

Attempted suicide by insulin injection treated with artificial pancreas.

An elderly woman with longstanding insulin dependent diabetes tried to commit suicide by injecting 400 units of insulin subcutaneously (usual total daily dose 56 units). She was admitted to hospital within the hour and treated with the aid of an artificial pancreas. This avoided the usual difficulty of the physician having to cope with rapid and substantial fluctuations in blood glucose concentrations and 67 hours after the overdose insulin was reinstituted. Using an artificial pancreas in insulin overdose is an important advance in management and may avoid the need for surgical intervention such as excising the site of injection.

[Two dimensional echocardiography. Its main clinical applications (author's transl)]. / L'échocardiographie bidimensionnelle. Principales applications cliniques.

The authors, who have experience of more than 1500 bidimensional echocardiographic recordings, underline the rapidity, safety and value of the method in cardiovascular disorders. The two-dimension echo provides better evaluation of the mitral area, right cavities and tricuspid valves. It is very sensitive in detecting mitral valve prolapse, pericardial effusion, intracavitary tumours and dissecting aneurysms and permits a detailed study of abnormal segmental contractions in ischaemic heart disease. Spatial and dynamic visualization coupled, if required, with contrast echocardiography is also of considerable help for the diagnosis of congenital cardiopathies.