[Blood pressure variability and morbidity]. / Variabilité tensionnelle et morbidité.

In a previous study (resting blood pressure profile, Dinamap) we have confirmed the correlations between blood pressure and left ventricular mass (myocardial hypertrophy being one of the morbidity criteria in Hypertension) and we have demonstrated the absence of significant difference (Fisher's z Test) with the results of ambulatory recordings found in literature. Furthermore, we have showed a weaker correlation between absolute variability (AV) and left ventricular mass (LVM). If indeed there exists a cause-effect relationship between the AV increase and the LVM increase, a relative independence between VA and blood pressures mean (mBP) should still be demonstrated. In order to do that we have used the factorial analysis (main components analysis) with which a small number of independent factors can be isolated from a large number of correlated variables. A resting blood pressure (Dinamap, 8AM-8PM, one reading every 15 minutes) has been recorded among 551 patients (259 females, 292 males; 109 normotensive WHO, 442 hypertensive WHO) and an echocardiogram TM and two-dimensional in order to measure the interventricular septum thickness (IVST), the posterior wall thickness (PWT) and the left ventricular internal diameter (LVID) with which we can calculate the myocardial mass (MM, Devereux formula) and the myocardial mass index (MMI) using the body surface (BS). The blood pressure variables are the means of the recordings (mBP): systolic (mSBP), diastolic (mDBP), mean (mMBP) and their standard deviations (SSD, DSD, MSD) corresponding to the AV. We have studied the heart rate (HR) with its standard deviation (HRSD) and age.(ABSTRACT TRUNCATED AT 250 WORDS)

[Relationship between heart mass and semi-ambulatory pressure profiles]. / Relation masse cardiaque et profils tensionnels semi-ambulatoires.

This work was undertaken with 420 patients (90 normotensives: casual blood pressure less than or equal to 140/90 mmHg and 330 hypertensives) in which was recorded a semi ambulatory blood pressure profile (Dinamap 8AM-8PM, a reading every fifteen minutes). On the same day an echocardiogram was performed. We have correlated the left ventricular mass, the left ventricular mass index, the interventricular septum, the left ventricular cavity volume and the left ventricular posterior wall with casual blood pressure, average daily blood pressure standard deviation and variation coefficient for mean blood pressure, systolic blood pressure and diastolic blood pressure. Analysis by sex, left ventricular mass index and blood pressure level (normotensive, hypertensive): we observe a left ventricular hypertrophy in normotensive males (18 p. 100) and hypertensive ones (39.8 p. 100), in normotensive females (15 p. 100) and hypertensive ones (33.3 p. 100). Overall in 420 patients: excellent correlation (p less than 0.001) between average daily blood pressure, casual blood pressure and the four echocardiographic parameters except for left ventricular cavity volume. But correlation is better (z test of Fisher) with average daily blood pressure than with casual blood pressure. No difference exists between results obtained in women (194) and men (226). Concerning variability, four observations: there exists a correlation between standard deviation, left ventricular mass index, interventricular septum, left ventricular posterior wall (only for standard deviation of MBP). No correlation with coefficient correlation except for the MBP with septum in women. The correlation for the standard deviation are weaker than with average daily blood pressure. They are better with the septum than with other echocardiographic parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

[Blood pressure variation]. / Etude de la variabilité tensionnelle.

A blood pressure profile at rest was recorded in 2,000 patients (1,069 females, 931 males) by DINAMAP 845 (from 8 AM to 8 PM. a record every fifteen minute). The limit between normotensive and hypertensive patients in this settled by WHO (BP = 160/95 mmHg). The analysis of percentage of pathological values (BP greater than 160/95 mmHg) allowed us to identify eight type of recordings. Normal (295), Border line hypertension less than or equal 20 p. 100 of pathological values (573), Paroxysmal hypertension (58), hypertension with predominance (963) of whom 484 with systolic predominance and 479 with diastolic predominance, Isolated systolic hypertension (15), Isolated diastolic hypertension (47), hypertension without predominance (15) and Permanent hypertension (82). The variability of blood pressure was studied by using the coefficient of variation = p. 100 of standard deviation/mean.(ABSTRACT TRUNCATED AT 250 WORDS)

[Analysis of 1,400 blood pressure profiles]. / Analyse de 1,400 profils tensionnels.

Hypertension may be defined by 3 criteria obtained by indirect, non invasive, automatic measurement of blood pressure using the DINAMAP device analyses the profile obtained over a 12 hour period (one recording every fifteen minutes): percentage of abnormal values (BP greater than 160/95 mm Hg), average values of systolic, diastolic and mean BP, variability (standard deviation of means), The analysis was based on 1,400 profiles recorded from 174 normotensive and 1,226 hypertensive patients. The following observations were made: the largest group was that of patients with predominantly diastolic hypertension under 60 years of age (81.3 p. 100 vs. 18.9 p. 100 systolic hypertension) and predominantly systolic hypertension over 60 years of age (68.9 p. 100 vs. 31.1 p. 100 diastolic hypertension), borderline hypertension (between 1 and 20 p. 100 of pathological values) is observed in 34.5 p. 100 of hypertensive patients under 60 years of age, and 21.8 p. 100 of patients over 60 years of age. This form of hypertension may be managed without drug therapy but requires a control blood pressure profile at least once a year, the other groups of patients were much smaller: pure diastolic hypertension (4.8 p. 100 in the under 60's, 0.6 p. 100 in the over 60's); pure systolic hypertension (1/1,226 cases of hypertension), permanent hypertension (5.7 p. 100 in the under 60's and 4.4 p. 100 in the over 60's), paroxysmal hypertension (2.1 p. 100 in the under 60's and 5.6 p. 100 in the over 60's).(ABSTRACT TRUNCATED AT 250 WORDS)

[Congenital esophagotracheal fistulas without esophageal atresia in children]. / Les fistules oeso-trachéales congénitales sans atrésie de l'oesophage chez l'enfant.

Ten cases are reported of children presenting isolated, congenital esophagotracheal fistulae without esophageal atresia, or "H-type-fistula" of Anglo-Saxon authors. The malformation is rare, of difficult diagnosis and often associated with other malformations. Respiratory symptomatology is sometimes dramatic, but diagnosis is based on data from radiologic imaging of the esophagus and from esophageal and tracheobronchial endoscopy. Treatment is surgical by a cervicotomy approach due to the almost constant high localization of the lesion.

[Malignant chemodectoma of the intrapetrous facial nerve]. / Chémodectome malin du nerf facial intrapétreux.

A 30 year old man presented with a tumor of the intrapetrous portion of the facial nerve, found to be a malignant chemodectoma on investigation. Possible relations with tumors of the APUD system, as well as pathogenic and therapeutic aspects are discussed.

[A median craniofacial malformation: schizoprosopia. Apropos of 4 cases]. / Malformation cranio-faciale médiane: la schizoprosopie. A propos de quatre cas.

Four cases of a median craniofacial malformation, schizoprosopia, are reported. This rare but compatible with life anomaly is included within the group of neurocristopathies of the nasofrontal bud. Patients affected present signs of more or less severe mediofacial division with, in some cases an associated encephalocele or cranial bone defect. The possible presence of an associated hypopituitarism must be investigated routinely, and substitutive hormone therapy combined with surgical treatment of the various malformations when results are positive.

[Suprapetrosal approach to the anterosuperior surface of the petrous bone. Its importance for the treatment of rare lesions of the sphenoid bone, trigeminal nerve and internal carotid artery]. / Abord de la face antéro-supérieure du rocher par voie sus-pétreuse. Son intérêt pour le traitement des lésions rares intéressant le sphénoïde, le nerf trijumeau, l'artère carotide interne.

The anterior suprapetrosal approach provides access to the anterior part of the middle cerebral fossa and its various openings: small round, oval and large round foramina. Trephination of the floor of the cerebral fossa reveals the Eustachian tube, the intrapetrosal portion of the internal carotid artery, the pterygomaxillary fossa, and possibly a particularly markedly developed recess of the sphenoidal sinus. This new surgical approach can resolve certain rare but classical therapeutic problems, particularly of excision of tumors in this region: neurinomas of V developing anteriorly, meningioma.

[Spontaneous rupture of the esophagus]. / Les ruptures spontanées de l'oesophage.

Two rare (as they were cervical) cases of so-called spontaneous rupture of the esophagus are reported, and similar cases treated in the C.H.U. Rennes, over the last 8 years reviewed. The historical background and pathogenic mechanism of this affection are recalled, and its difficult diagnosis emphasized, the latter being the result of the almost total lack of precise symptoms, which associate thoracic, abdominal, and cervical features to varying degrees. Therapy is difficult and the prognosis poor.

[Cerebral aneurysms complicating bacterial endocarditis. Seven cases (author's transl)]. / Les anévrysmes cérébraux des endocardiites bactériennes. A propos de sept cas.

The authors report seven cases of cerebral aneurysms complicating bacterial endocarditis. The evolution was good in three cases, two of which without sequelae. The bacteries involved were staphylococcus, streptococcus, and enterobacter. The cardiopathy was mitral in four cases. Two patients presented an isolated focal neurological impairment, while the other five presented a severe coma either isolated (one case) or associated with focal neurological deficits (four cases). An intracerebral hematoma was diagnosed in five cases (four died). Only one patient was not operated. The surgical treatment was as follows: one carotid ligation (good result), two evacuations of intracerebral hematomas (both died), two evacuations of intracerebral hematomas with clipping of the aneurysms (one died, one had a fair result in despite of residual hemiplegia), one clipping of aneurysm (good result). Repeated cerebral angiographies should be systematically performed in cases of bacterial endocarditis in order to disclose and follow up cerebral aneurysms which may occur in this condition. Except in cases of emergency, surgery should be differed, in particular, in cases of proximal or multiple aneurysms. Aneurysms of the peripheral cortical arteries are more accessible to treatment and may be operated in the acute phase.

[Unilateral Moebius syndrome associated with Poland's abnormality in a 25-year-old woman (author's transl)]. / A propos d'un syndrome de Moebius unilatéral associé à une anomalie de Poland chez une femme de 25 ans.

The authors present a case of unilateral Moebius syndrome associated with Poland abnormality in a 25-year-old woman. The patient had a complete left peripheral facial paralysis associated with involvement of both VI. In addition, there was microdactyly, syndactyly of the left hand, absence of the pectoralis major, of the mammary gland and nipple adding up to Poland syndrome. Surgery was envisaged with the aim of performing a hypoglossofacial anastomosis. Operation revealed muscles of normal appearance with a somewhat thin digastric and total absence of the facial nerve both at the point of its emergence through the stylomastoid foramen as well as in the parotid.