Unsupported valvuloplasty in children with congenital mitral valve anomalies. Late clinical results.

OBJECTIVE: To analyze late clinical evolution after surgical treatment of children, with reparative and reconstructive techniques without annular support. METHODS: We evaluated 21 patients operated upon between 1975 and 1998. Age 4.67+/-3.44 years; 47.6% girls; mitral insufficiency 57.1% (12 cases), stenosis 28.6% (6 cases), and double lesion 14.3% (3 cases). The perfusion 43.10+/-9.50 min, and ischemia time were 29.40+/-10.50 min. The average clinical follow-up in mitral insufficiency was 41.52+/-53.61 months. In the stenosis group (4 patients) was 46.39+/-32.02 months, and in the double lesion group (3 patients), 39.41+/-37.5 months. The echocardiographic follow-up was in mitral insufficiency 37.17+/-39.51 months, stenosis 42.61+/-30.59 months, and in the double lesion 39.41+/-37.51 months. RESULTS: Operative mortality was 9.5% (2 cases). No late deaths occurred. In the group with mitral insufficiency, 10 (83.3%) patients were asymptomatic (p=0.04). The majority with mild reflux (p=0.002). In the follow-up of the stenosis group, all were in functional class I (NYHA); and the mean transvalve gradient varied between 8 and 12 mmHg, average of 10.7 mmHg. In the double lesion group, 1 patient was reoperated at 43 months. No endocarditis or thromboembolism were reported. CONCLUSION: Mitral stenosis repair has worse late results, related to the valve abnormalities and associated lesions. The correction of mitral insufficiency without annular support showed good long-term results.

Valve repair in children with congenital mitral lesions: late clinical results.

Mitral valve repair may be performed without ring support with advantages related to results and complications. The objective of this study was to analyze the long-term clinical results following surgical repair and reconstruction without the use of rings in cases of congenital mitral lesions in children less than 12 years of age. Twenty-one patients who had undergone surgery during the period from 1975 to 1998 were evaluated. The mean age was 4.6 +/- 3.4 years. Females represented 47.6% of the total. Mitral regurgitation was present in 57.1% (12 patients), stenosis in 28.6% (6 patients), and the mixed lesion group represented 14.3% (3 patients). Perfusion time was 43.1 +/- 9.5 minutes and ischemic time 29.4 +/- 10.5 minutes. Follow-up time was 41.5 +/- 53.6 months for the regurgitation group, 46.3 +/- 32.0 months for the stenosis group, and 39.41 +/- 37.51 months for the mixed lesion group. Echocardiographical follow-up time was 37.17 +/- 39.51 months for the regurgitation group, 42.61 +/- 30.59 months for the stenosis group, and 39.41 +/- 37.51 months for the mixed lesion group. Operative mortality was 9.5% (two cases). There were no late deaths. In the regurgitation group, 10 patients (83.3%) were asymptomatic (p = 0.004). In the echocardiographical follow-up, most of the patients had minimal regurgitation. In the clinical follow-up of the stenosis group all patients were in functional class I (NYHA). The mean transvalvular gradient measured by echocardiography was from 8 to 12 mmHg with a mean gradient of 10.7 mmHg. In the mixed lesion group there was one reoperation at postoperative month 43. There were no cases of endocarditis or thromboembolism. Mitral valve repair in congenital lesions is associated with good late results. The majority of cases in the regurgitation group remain asymptomatic and do not require reoperation. Rings or annular support are not necessary in such cases. Satisfactory repair is more difficult to achieve in cases of mitral stenosis due to valvular abnormalities and the seriousness of the associated lesions.

[Dietary behavior during pregnancy (author's transl)]. / Comportement alimentaire au cours de la grossesse.

A study on dietary behavior during pregnancy was performed between June and December 1975 at the Saint Antoine Maternity Hospital in Paris. In addition to the routine clinical examinations at the 3rd, 6th, 8th and 9th month of pregnancy, the women were systematically questioned on their dietary and tobacco habits. Results show that: (1) the mean caloric intake is constant during the first trimester and then significantly decreases in the last two trimesters (2) the fatter the woman before pregnancy, the lower the caloric intake at the successive examinations (3) the total weight gain is positively related to the caloric intake during the first trimester, but not related to the dietary data observed at the 6th, 8th or 9th examinations (4) birth weight seems to be more related to body size before pregnancy than to weight gain.

[Spontaneous bacteriological course of prolonged rupture of the fetal membranes (author's transl)]. / Evolution bactériologique spontanée des ouvertures prolongées de l'oeuf.

Bacteriologic study of amniotic fluid was undertaken in 300 cases of prolonged rupture of the membranes to evaluate the risk of infection without systematic administration of prophylactic antibiotics to the mother. The rate of amniotic contamination was 8.3 per cent within the first 12 hours following rupture of the membranes, it increased with time to reach 52 per cent, after 48 hours. In 90 per cent of the cases, contamination was caused by streptococci and anaerobes, Streptococcus B alone being responsible for 50% of the contaminations. Antibiotics administered to the mother were effective, but they needed a 6 hour-minimum delay to sterilize a contaminated amniotic fluid. Although the overall percentage of contamination was 23 per cent, infection occurred in only 4 per cent of the infants. The outcome was satisfactory in every case. Those results do not seem to discredit the suppression of prophylactic cover antibiotic therapy following the premature rupture of the membranes.

[Risk of neonatal Streptococcus B infection]. / Risque infectieux néo-natal à streptocoque B.

23 cases of contamination with streptococcus group B have been seen after premature rupture of the membranes. Mothers and fetuses have been affected. The systematic study of swabs or liquor or cervical discharge carried out on the mother since the time her membranes had ruptured show that in 74 per cent of cases studied contamination existed within the first 24 hours. Giving antibiotics to the mother before delivery gave very variable results. These multiple tests, before and around the time of birth, made it possible to detect the children at risk of infection and to start antibiotic therapy with a narrow spectrum antibiotic of the type Penicillin G. The clinical progress of these children, which is usually favourable, gives no reason for postponing prophylactic cover antibiotic treatment when the membranes have ruptured prematurely.

[Preliminary trials of an oral chemical contraceptive for men]. / Premiers essais d'une contraception chimique par voie orale chez l'homme

PIP: R 2323 (13-ethyl, 17 alpha-ethyl, 18-hydroxy-gona-4,9,11-trien-3-one) was administered orally, 50, 75, or 100 mcg/week in 2 or 3 divided doses with or without 3 100 mg testosterone implants to arrest spermatogenesis, to 20 healthy men 25-35 years of age with at least 2 children. There were 3 dropouts, 1 for a high triglyceride level. 7 men became azoospermic within 2-3 months after the combined treatment and 8 after receiving 75 or 100 mg/week of R 2323 only. No abnormal sperm forms appeared. Side effects were weight gain of 2-8 kg chiefly with the combined schedule. Libido declined in 3, erective capacity decreased in 2, and coital frequency fell in 8. 1 case of gynecomastia appeared after 4 months. 1 man had a superficial thrombosis in the left arm at the site of a biopsy for polyadenopathy. Testosterone fell from 5 to .5 ng/ml and follicle stimulating hormone and luteinizing hormone from 5-1 mIU/ml in both groups. The only remarkable change in a biological parameter was an increase in transaminase, especially SGPT, 25-50%. Testosterone and gonadotropins returned to normal within 1 month after stopping steroids, and sperm counts within 3-4 months. The testosterone implants failed to prevent plasma testosterone levels from falling, and seemed to cause more side effects such as weight gain and loss of libido than did R 2323 alone.^ieng

[Acute pancreatitis and pregnancy]. / Pancréatite aiguë et grossesse

When a pregnant woman presented with a syndrome suggesting obstruction and fever together with jaundice and oliguria the authors remembered the difficulty of clinical diagnosis and the biology of pancreatitis. They studied the connection of this condition with pregnancy, its pathogenesis, its prognosis and its treatment, as well as the various factors that were favourable (treatment with diuretics, the right ovarian vein syndrome).

Kasabach-kasabach-. / Problémes pratiques posés par deux cas d'hémangiomes géants avec syndrome de Kasabach Meritt

Giant haemangiomas combined with a haemostasis disorder of the Kasabach-Meritt type are rare and even more rare are the problems posed during labour when vulvo-vagino-uterine sites are involved. Two cases are reported. After summary of the clinical and biochemical studies, the authors report attempts to improve the haemostasis disorder, first with heparin and then with antifibrinolytic preparations, and to improve the angiomas with antifibrinolytic preparations in the hope of stimulating intrasacular thrombosis. In particular, the obstetric and surgical problems are discussed in the context of labour. In one case the outcome of labour was successful only moderate transfusion being required, and in the other the outcome was fatal despite the use of about 100 bottles of blood in the first 24 hours. In both cases the infants were normal.

[Role of varicocele in male sterility]. / Responsabilité effective du varicocèle dans la stérilité masculine

After they had analysed 50 cases of varicocoele the authors decided to put in writing some of their ideas. They conclude that varicocoele is often sub-clinical, localised to the right side, bilateral only in a number of cases. Although neither the sperm count nor the histology of the testes show specific pathological features, treatment of the condition brings worthwhile rewards. About 40% of patients father pregnancies.

[Secretion into the plasma of testosterone and estradiol 17 beta by the human testicle. Value of the study in male sterility]. / Sécrétions plasmatiques de la testostérone et de l'oestradiol 17 beta par le testicule humain

The levels of oestradiol and of testosterone were estimated in the spermatic and in the perpheral veins in two series of 13 subjects. The one was a control group and the other stimulated with 10,000 International Units of chorionic gonadontrophir (II.C.G). The follwing conclusions can be drawn. --the first is that the testis secretes simultaneously testosterone and oestradiol 17 beta --the second is that the level of oestradiol is significantly raised after the administration of II.C.G. whereas the level of testosterone hardly alters. This leads on to the supposition that oestradiol does not arise from the same source in the testis as testosterone.