[Double mitral orifice. Apropos of a case]. / Double orifice mitral. A propos d'une observation.

The authors report a case of Double Mitral Orifice (DMO), existing in isolation and type 3 by the Floch Prigent classification. This rare anomaly is often associated with another congenital malformation, dominated by intra-atrio-ventricular defect. Two-dimensional echocardiography is the essential diagnostic factor. Hemodynamic consequences may be nil, but mitral insufficiency and/or stenosis may complicate this malformation. Treatment may be summarised as abstention, surgical repair or valve replacement, according to the severity of lesions.

False positive diagnosis of arterial hypertension: the diagnostic errors and their avoidance.

Arterial hypertension is a risk factor both for morbidity and mortality. The diagnosis usually depends on the auscultation method using the cuff and the mercury manometer, which remains the international reference method. However, this indirect method is the source of numerous errors, sometimes important, which are related variously to the equipment used, the observer, the conditions under which the measurement is taken and sometimes to the patient. Such errors can in turn lead to therapeutic overdosage and to unnecessary treatment, which may be dangerous. "Pseudohypertension" is a typical example of the problems. Various means have been proposed to improve the reliability of measurements, above all the physician must adhere strictly to the correct routine. The use of self-registering equipment, provided it is scientifically assayed, can be considered for incidental measurements or for ambulant use. The ambulant measurement of arterial pressure promises to be of diagnostic, therapeutic and prognostic value, but further experience is required to confirm these impressions.

[Recent advances in the investigation of the renin-angiotensin and cardiac natriuretic systems in patients with chronic heart insufficiency]. / Progrès récents dans l'exploration du système rénine-angiotensine et du système cardiaque natriurétique chez des patients en insuffisance cardiaque chronique.

The renin-angiotensin and cardiac natriuretic systems were studied by measuring plasma renin activity, plasma concentrations of active renin, angiotensinogen, atrial natriuretic hormone and urinary cyclic GMP in 37 patients with moderate to severe cardiac failure. The plasma sodium and osmolality were chosen as markers of hydroelectrolytic imbalance and plasma concentrations of préalbumin and retinol-binding protein as indicators of the degree of hepatocellular dysfunction. Plasma renin activity (PRA) plasma concentration of active renin, atrial natriuretic hormone and urinary cyclic GMP were higher in patients in NYHA Class IV than in those in Classes II-III, whilst plasma sodium, angiotensinogen, prealbumin and retinol-binding protein concentrations were lower in Class IV patients than in patients in Classes II-III. The plasma angiotensinogen concentrations were negatively correlated with PRA (r = -0.41, p less than 0.02), active renin (r = -0.45, p = 0.005), the atrial natriuretic factor (r = -0.36, p less than 0.05) and positively correlated with prealbumin (r = 0.54, p less than 0.001) and retinol-binding protein (r = 0.60, p less than 0.0001). In NYHA Class IV patients the decreased circulating renin substrate led to an underestimation of plasma concentrations of active renin by measurement of PRA. On the other hand, direct radio-immunometric measurement of active renin allows true estimation of circulating active renin, independently of plasma angiotensinogen concentrations and thereby reliably reflects activation of the renin system. The serum sodium was negatively correlated with active renin (r = -0.66, p less than 0.0001) in these patients not receiving converting enzyme inhibitors.(ABSTRACT TRUNCATED AT 250 WORDS)

[Neurologic complications of cocaine abuse]. / Accidents neurologiques liés à l'usage de la cocaïne.

Cocaine is increasingly used by drug addicts. It is considered harmless, but numerous, varied and often serious complications due to its abuse have been published. Among these, neurological complications are in the forefront. They include generalized or partial epileptic seizures, ischaemic or haemorrhagic cerebral vascular accidents, visual loss caused by optic neuropathy or by retinal artery occlusion, headaches and exacerbation of tics. Infections of the central nervous system are possible via endocarditis or septicaemia of venous or nasal origin. Neurological disorders may also occur as a consequence of a major cardiovascular complication induced by cocaine (myocardial infarction and/or dysrhythmia, aortic dissection). These neurological complications are unpredictable, and they weigh heavily on the functional and sometimes vital prognosis in habitual or occasional cocaine abusers.

[Magnetic resonance imaging in the diagnosis of pheochromocytoma]. / L'imagerie par résonance magnétique dans le diagnostic des phéochromocytomes.

The diagnosis of pheochromocytoma is biological. If ultrasound enables the visualization of certain adrenal tumours or hepatic metastasis, in fact two tests enable the topographic diagnosis, the screening of ectopic localizations and metastasis. They are IMBG scintigraphy and tomographic scanning. The place of magnetic resonance imaging is not yet specified. However, it has many advantages: absence of irradiations, good anatomic precision, meticulous screening of ectopic forms, of metastases and of adenopathies, study of the tissue characterization, good definition of the tumour relation with the vascular pedicles and the neighbouring structures.

[False and true hypertension in the aged subject. Diagnostic errors and potential solutions]. / Fausses et vraies hypertensions artérielles du sujet âgé. Les erreurs diagnostiques et leurs solutions potentielles.

Arterial hypertension has the same definition in elderly people as in young adults. Epidemiologically, it has clearly been demonstrated that in the elderly it is a risk factor of morbidity and cardiovascular mortality. The international reference method for measuring blood pressure is by auscultation and mercury manometer. However, this indirect measurement is the source of many errors due to the material or the observer, or inherent in the method. A typical example of this is pseudohypertension in the elderly. Several solution are offered to improve the reliability of indirect blood pressure measurement, the most convincing one being the use of scientifically validated autonomous instruments relying on the oscillometry system. Ambulatory blood pressure measurement is interesting, being of diagnostic, therapeutic and probably prognostic value, but all this has to be confirmed in elderly subjects.

[Mycotic aneurysms]. / Les anévrysmes mycotiques.

Mycotic aneurysms are aneurysms infected by bacteria or fungi. These may be secondary to an endocarditis, or they may be primary, and then are developed from a septicemia or bacteremia. The diagnosis, often difficult, is sometime only made during complications, the most severe of which is rupture. This diagnosis must be aided by new imaging techniques such as ultrasonography, tomodensitometry, magnetic resonance imaging. The treatment is medical (antibiotics) and surgical.

[Bronchial cancer with extension into the heart. Apropos of a case with magnetic resonance imaging]. / Cancer bronchique avec extension intracardiaque. A propos d'une observation avec imagerie par résonance magnétique.

The authors report a case of a 64-year-old patient with an adenocarcinoma of the bronchus with mediastinal involvement. The echocardiography and CT scan showed the existence of involvement of the left auricle. Confirmation and the extent of the intra-cardiac involvement were provided by nuclear magnetic resonance imaging which confirmed the diagnosis here and was particularly helpful. The authors further recall that the place of nuclear magnetic resonance as a standard investigation in assessing staging in bronchial cancer remains to be determined in relation to CT scanning.

[Experience at an Internal Medicine service in the postoperative follow-up of 403 patients operated on at a cardiovascular surgery service]. / Expérience d'un service de Médecine Interne dans les suites postopératoires de 403 patients opérés dans un service de Chirurgie Cardio-vasculaire.

Over the last 3 years, 403 patients operated in the Department of Cardiovascular Surgery of Broussais Hospital have been transferred to a Department of Internal Medicine for secondary postoperative care. A total of 245 non-cardiac complications (64%) and 134 cardiac or vascular complications (36%) were observed in 321 of these 403 patients (80%). Infections accounted for 26% of non-cardiac complications (63/245). They included 9 cases of mediastinitis, 2 cases of septicemia, 6 endocarditis, 6 wound infections, and 40 other infections (ENT, gastrointestinal, pulmonary, urogenital). The non-cardiac, non-infectious complications comprised mainly delayed healing (39 cases) and pleuropulmonary (29 cases), ENT (9 cases), gastrointestinal (31 cases), urogenital (12 cases), hematological (17 cases) and neuropsychiatric (9 cases) complications; and, finally, 37 inflammatory syndromes. The cardiac complications were pericarditis with or without tamponade (24 cases), arrhythmias or conduction disturbances (50 cases), haemodynamic (54 cases) and vascular (6 cases complications. These very varied complications sometimes occurred late and could be latent. They resulted in prolongation of the duration of hospitalization, so increasing the overall health costs.

[Spontaneous dissection of the renal artery]. / Dissection spontanée de l'artère rénale.

In this paper we describe a case involving spontaneous dissection of the renal artery (DRA) successfully treated with an aorto-renal venous graft. DRA is a rare disorder which strikes men especially. Hypertension is the most frequent sign of its presence, which is usually of sudden onset, and with major adverse impact on the eye and brain. Arteriography is the key diagnostic examination. The most typical image is that of "cuffing". Treatment is surgical in nearly 50% of cases and should be as conservative as possible since these lesions may be bilateral.

[Infectious complications, delayed wound healing and inflammatory syndromes as late complications of cardiovascular surgery]. / Complications infectieuses, retards de cicatrisation et syndromes inflammatoires dans les suites retardées de la chirurgie cardiovasculaire.

Four-hundred and three patients were admitted to an internal medicine unit for late complications of cardiac or vascular surgery; 321 of these patients (80 per cent) had a total of 379 complications or intercurrent disease, 147 (40 per cent) of which were infections (71 cases), delayed healing of the operative wound (39 cases) or inflammatory syndromes (37 cases). Such complications are notable for their immediate or secondary severity, the diagnostic problems sometimes raised by their latency, their repercussions on the length of hospitalization and cost of surgery, and the thoughts they inspire concerning the minimal stay in hospital required after this type of surgery.