[Mitral prolapse and sudden death. A case report]. / Prolapsus mitral et mort subite : à propos d'un cas.

The association between the mitral valve prolapse and the sudden Cardiac Death remains controversial, the high prevalence of this valvulopathy contrasting with the low incidence of sudden death in this population. We report the case of a 54-year-old woman admitted for a sudden cardiac death, revealing a bi-prolapse with low-grade leakage, leading to the implantation of a subcutaneous automatic defibrillator. Combined echocardiography and cardiac MRI can identify the mitral annular disjunction, the rolling motion of the posterior face of the mitral annulus towards the myocardium, and the myocardial fibrosis of the inferolateral wall induced by streching forces of the sub valvular apparatus, that may lead to ventricular arrhythmias. More than the conventional clinical parameters (young woman, ventricular premature beats with a right bundle branch block morphology, mitral bi-prolapse), mitral annular disjunction and myocardial fibrosis are to be considered as powerful markers of the rhythmic risk of mitral prolapse and must be systematically sought and integrated into the prognostic evaluation of these patients. In the absence of randomised trials, therapeutic management is difficult especially in primary prevention, and needs Heart Team advice.

The gender gap in mental health service use.

PURPOSE: This study examines why men engage less in mental health service use, by studying how gender is performed in interactions, following the doing gender perspective. We hypothesize that seeking help for mental illness may constitute a gendered role conflict among men since help seeking is associated with femininity. Therefore, we expect that men will recommend reliance on self-care options to other men, and in cases in which professional treatment is recommended, they will prefer medication to psychotherapy. We also expect that men will report greater stigmatizing attitudes. METHODS: The survey Stigma in a Global Context-Belgian Mental Health Study (2009) conducted interviews of a representative sample of the Belgian general population (N = 743). The vignette technique, depicting depressive and schizophrenic symptoms, was used. Multiple linear and logistic models were estimated in SPSS. RESULTS: In male vignettes, self-care is more likely to be recommended, both by male and female respondents. Men are less likely to acknowledge the helpfulness of psychotherapy and women rate psychotherapy as less helpful when judging a man compared to a woman. Men rate tranquilizers as more helpful for other males than that women do for other females. Furthermore, male respondents seem to ascribe more shame and blame to the situation. CONCLUSIONS: The gender gap in mental health service use is due not only to men and their negative attitudes toward help seeking, but also to structured social norms that are reconstructed in interactions. Women also contribute to the maintenance of masculinity norms.

Medicalizing versus psychologizing mental illness: what are the implications for help seeking and stigma? A general population study.

PURPOSE: This study contrasts the medicalized conceptualization of mental illness with psychologizing mental illness and examines what the consequences are of adhering to one model versus the other for help seeking and stigma. METHODS: The survey "Stigma in a Global Context-Belgian Mental Health Study" (2009) conducted face-to-face interviews among a representative sample of the general Belgian population using the vignette technique to depict schizophrenia (N = 381). Causal attributions, labeling processes, and the disease view are addressed. Help seeking refers to open-ended help-seeking suggestions (general practitioner, psychiatrist, psychologist, family, friends, and self-care options). Stigma refers to social exclusion after treatment. The data are analyzed by means of logistic and linear regression models in SPSS Statistics 19. RESULTS: People who adhere to the biopsychosocial (versus psychosocial) model are more likely to recommend general medical care and people who apply the disease view are more likely to recommend specialized medical care. Regarding informal help, those who prefer the biopsychosocial model are less likely to recommend consulting friends than those who adhere to the psychosocial model. Respondents who apply a medical compared to a non-medical label are less inclined to recommend self-care. As concerns treatment stigma, respondents who apply a medical instead of a non-medical label are more likely to socially exclude someone who has been in psychiatric treatment. CONCLUSIONS: Medicalizing mental illness involves a package deal: biopsychosocial causal attributions and applying the disease view facilitate medical treatment recommendations, while labeling seems to trigger stigmatizing attitudes.

Attitudes toward community mental health care: the contact paradox revisited.

Contact with people with mental illness is considered to be a promising strategy to change stigmatizing attitudes. This study examines the underlying mechanisms of the association between contact and attitudes toward community mental health care. Data are derived from the 2009 survey "Stigma in a Global Context-Belgian Mental Health Study", using the Community Mental Health Ideology-scale. Results show that people who received mental health treatment themselves or have a family member who has been treated for mental health problems report more tolerant attitudes toward community mental health care than people with public contact with people with mental illness. Besides, the perception of the effectiveness of the treatment seems to matter too. Furthermore, emotions arising from public contact are associated with attitudes toward community mental health care. The degree of intimacy and the characteristics of the contact relationship clarify the association between contact and attitudes toward community mental health care.

Elevated left atrial pressure estimated by Doppler echocardiography is a key determinant of mitral valve tenting in functional mitral regurgitation.

BACKGROUND: Functional mitral regurgitation (FMR) may occur in patients with reduced or preserved left ventricular ejection fraction (LVEF) and has been associated with excess valvular tenting only in patients with reduced LVEF. This study aimed at identifying the predictors of FMR and to determine whether or not they are different in patients with reduced versus preserved LVEF. METHODS: 190 consecutive patients free of congenital or primary valvular disease had a comprehensive echocardiographic assessment of LV remodelling and function, diastolic function and FMR severity. RESULTS: 112 patients had depressed LVEF (<50%) and 78 had preserved LVEF. FMR was present in 30 patients with preserved LVEF and in 65 with reduced LVEF. Higher E/Ea, E/A and larger mitral tenting were independent predictors of FMR regardless of LVEF. The mitral tenting area was an independent predictor of FMR severity in patients with reduced or preserved LVEF (p = 0.04 and p = 0.0045) in addition to E/A (p = 0.0007), E/Ea (p = 0.004) in patients with reduced and preserved LVEF, respectively. Higher E/Ea was independently associated with larger mitral tenting in patients with reduced and preserved LVEF. Mitral tenting area was linearly related to E/Ea (r = 0.30, p<0.0001) and E/A (r = 0.43, p<0.0001) and LA enlargement (r = 0.54, p<0.0001) after having paired 96 patients with and without FMR on indices of LV remodelling. CONCLUSIONS: In both patients with preserved and reduced LVEF, mitral tenting that leads to FMR is mainly determined by both mitral tethering forces-that is, displacement of papillary muscles and by pushing forces-that is, increased left atrial pressure. This study underscores that LV preload is a key determinant of FMR.

Identification of essential amino acids in the active center of thyroidal NAD+ glycohydrolase.

1. Purified thyroidal NAD+ glycohydrolase has been subjected to the action of a number of group specific reagents in order to gain information concerning its mode of action. 2. Modification of histidyl residues with diethylpyrocarbonate strongly suppresses the NAD+ glycohydrolase activity. Inactivation with this reagent can be reversed to some extent by subsequent treatment with hydroxylamine. 3. NAD+ and ADP-ribose partially protect against inactivation with similar efficiencies. 4. The incomplete reactivation with hydroxylamine after diethylpyrocarbonate treatment and the selective inactivation by 2,4-pentanedione indicates that apart from one or more essential histidyl residue(s) also lysyl residues are important for activity. NAD+ and to a smaller extent ADP-ribose again protect against inactivation by 2,4-pentanedione. 5. The sensitivity of the enzyme towards N-ethyl-5-phenyl-isooxazolium-3'-sulfonate further points to the importance of carboxylate containing side chains. 6. The mechanistic implications of these results are discussed.

[Pregnancy after treated breast cancer. Results of a case-control study]. / Grossesses après cancer du sein traité. Résultats d'une étude cas-témoins.

Sixty-eight cases of pregnancy after carcinoma of the breast were collected during a survey conducted by the Société Française de Gynécologie: 27 patients had one or several pregnancies interrupted at an early stage; 41 patients had at least one uninterrupted pregnancy. The fate of these patients was compared to that of 136 controls similar in all respects, except for the absence of post-cancer pregnancy. There was no significant difference in survival curves: the 10-year survival rate in our 68 patients was 71% (90% in those with N- cancer; 71% in those with N+ cancer, with no significant difference between cases and controls in each group). The patients whose pregnancies were interrupted had the same prognosis as those who delivered at term. The survival of 14 patients who conceived within 6 months of the breast cancer treatment was not significantly different from that of the corresponding controls. Pregnancy after breast cancer does not seem to alter the prognosis of the disease. In women with good prognosis cancer, the survival rate is excellent whatever the delay between cancer and pregnancy, and women should not be discouraged from having children; in women with poor prognosis cancer (N+), the outcome is not modified by pregnancy, and it remains lethal in about 50% of cases.

[Pregnancy following surgery for cancer of the breast]. / Grossesses après cancer du sein opéré.

Twenty-tree cases of pregnancy subsequent to mastectomy for carcinoma of the breast were observed. This association accounts for 8% of cases of breast carcinoma in potentially fertile women under 40. The overall prognosis is good, with a crude survival of 89% at 5 years and 70% at 10 and 15 years, superior to the figures observed in a control group matched for age, stage and date of treatment. Nevertheless, after elimination of the "selection effect" (pregnancy is more likely to occur in patients with a prolonged survival and no evidence of disease), no evidence of a biological effect of pregnancy was found: the prognosis in cases in which the delay from cancer to pregnancy is short is not different from the prognosis of the matched group. However, the disease free interval was longer in the pregnancy group.

[Surgery's place in the treatment of ovarian cancer]. / Cancers de l'ovaire: place de la chirurgie dans le traitement.

Surgery must remain in first place as it allows for: --biopsy by direct access, --the assessment of the peritoneal and visceral extensions, --a cytological pre-operative study of the liquid of the peritoneal lavage which might lead the surgeon to suspect otherwise unnoticed extensions--a frozen section examination of the lumbar nodes or of the other apparently normal ovary. But surgery is, above all, indispensable in order to achieve "tumoral reduction", as large as possible by total hysterectomy with the ablation of both annexae as well as of the epiploon. Nevertheless the surgeon is often obliged to leave cancerous centers impossible to remove and he also fails to recognize the mini-centers grafted on the peritoneum and the viscera; he therefore has an imperative need of the complementary actions of polychemo--or radiation therapy in order to sterilise or neutralize these centers. A routine "second look" after chemotherapy must be done even if laparoscopy is negative; this makes it possible to judge whether treatment can be discontinued; it seems capable of significantly increasing the chances of treatment in the case of a limited recurrence of a slightly developed tumor; it can make possible secondary exeresis of certain originally inoperable forms. Combined treatment and secondary controls, in particular by means of a re-intervention appear to be a serious hope of improving the results thanks, above all, to the recent contribution of chemotherapy.

[Surgical treatment of intestinal radio-lesions. 53 patients operated, out of 171 radio-lesions among 7301 irradiated (author's transl)]. / Traitement chirurgical des radio-lésions intestinales. 53 opérés sur 171 radio-lésions parmi 7301 irradiés.

Results of a complete and homogenous series by the Medical Team of the Centre Anti-Cancéreux.--2,45% of abdomino-pelvic irradiations among 6516 cases,--but only 0.78 are serious and need surgery (i.e. 1/3 of the radio-lesions). The study concerned 65 cases;--during the same period, medical treatment alone controlled 51 cases of rectitis and 51 stenoses. The interval after irradiation is variable: 33 times, it was shorter than 1 year, in 32 cases, it was longer, up to 13 years. The plan for therapy is to continue the medical treatment as well as possible and to operate only in case of absolute need, but before obstruction;--to prefer immediate resection to internal derivation. The 27 resections resulted in 18 recoveries and 9 cases of peritonitis. In spite of the serious nature of the initial irradiated lesion, followed by this complicated radio-lesion, we observed: 28% of 5-year survivals, and over 10 years in 9 cases.

[Intrathoracic chemodectomas. A report on four observations (author's transl)]. / Les chémodectomes intra-thoraciques. A propos de quatre observations.

Intrathoracic chemodectomas are extremely rare tumours, the number, published up to the present time being less than 50. We wish to report here four personal cases, all resected. The diagnosis was never made before surgery but solely by histopathology. The course was benign in two cases and malignant with slow progression in one case and malignant with rapid progression in the other. On the basis of these four cases, a general review is undertaken of this particular site on the basis of publications in the literature.