Pneumococcal endocarditis.

Among 369 patients with native valve infective endocarditis observed during a 14-year period, 17 were related to S: pneumoniae. Fourteen of them were observed in the last 7 years. At the time of admission 13 exhibited purulent meningitis, 6 of them being comatose. An apparent portal of entry was present in 13 patients including Pneumonia (n = 11) and otitis media (n = 2). Major alcoholism was present in 6 cases. The mean delay between the onset of fever and the discovery of the cardiac murmur was 15 days (range 1 to 60). Twelve patients exhibited congestive heart failure with acute pulmonary oedema in 9. The aortic valve was involved in 12 and the mitral valve in 7 (in 2 patients both mitral and aortic valves were involved). Myocardial and/or annular abscesses were found in 7 patients. Nine patients underwent surgical procedure (3 died) whereas 6 comatose patients were not operated on and died. The overall mortality was 59%. Although antibiotics are effective, the severity of anatomical lesions leads to prompt surgical treatment. The high mortality is mainly due to purulent meningitis.

[Herpes encephalitis in adults and interferon (author's transl)]. / Synthèse d'interféron au cours des encéphalites herpétiques de l'adulte.

In 10 adult patients with herpes encephalitis type I interferon synthesis was detected in the cerebrospinal fluid at the onset of the disease, but not in serum collected the same day as the CSF. In 20 controls with various non-herpetic infections associated with neurological disorders, type I interferon was found neither in CSF samples nor in sera. The early intrathecal synthesis of type I interferon during adult encephalitis therefore strongly support the assumption of a herpetic origin. The role of CSF interferon in the pathogenesis of the disease and the absence, or presence in small amounts, of serum interferon are discussed. These findings raise queries about the treatment of herpes encephalitis with parenteral interferon combined with nucleoside analogues.

[Severe pneumococcal infections of adults. 100 cases collected in three years (Claude Bernard Hospital, Paris) (author's transl)]. / Formes graves de l'infection pneumococcique chez l'adulte. Statistique de la Clinique de Réanimation médicale à propos de 100 cas observés en trois ans à l'Hôpital Claude Bernard (Paris).

After retrospective in intensive care unit of 100 severe cases of pneumococcal infection in three years, the authors analyse the circumstances of onset (occurring in autumn of winter), the general status (without evident high risk population), the symptomatology (84% of meningitis, 30% of pneumonia), the origin of infection (essentialy otitis media in meningitis). The case fatality rate is 39%. Frequency of multiple visceral localisations and of bacteremias is emphasized.

[Traumatic rupture of the aortic valve. Echocardiographic aspects. Apropos of a case]. / Rupture traumatique de la valve aortique. Aspect échocardiographique. A propos d'un cas.

The appearance of a diastolic murmur in a pyrexial patient 15 days after trauma was suggestive of infectious endocarditis. This diagnosis was excluded, especially by echocardiography, and the aortic incompetence was attributed to the trauma. The value of echocardiography and the features of other reported cases are discussed with referrence to this case.

[Risks and long-term results or tricuspid monovalvular replacement, using a ball or disk prosthesis. Apropos of 21 cases]. / Risques et résultats éloignés du remplacement monovalvulaire tricuspidien par une prothèse à bille ou à disque. A propos de 21 cas.

21 patients (15 with stage IV and 6 with stage III symptoms by the NYHA classification) underwent monovalvular tricuspid replacement with a ball or disc prosthesis for varying tricuspid pathology, bacterial endocarditis in half the cases, between June 1964 and July 1973. Hospital mortality was 29 p. 100 (6 patients), medium-term mortality, nil. There were 23 survivors (62 p. 100) with an average follow up of 7 years (range 5 years to 10 years 4 months), 12 of whom recovered to stage I disability by the NYHA classification after the first postoperative year. 12 patients are on long-term anticoagulant therapy and 3 on diuretic or digitalo-diuretic therapy. The main complications observed were 2 prosthetic thromboses and 3 haemorrhages for 1095 patient-months. The results are to be compared with those bioprostheses, which, not requiring anti-coagulant therapy, may tend to supplant ball and disc prostheses.

[Closure of ventricular septal defects. Comparison of 2 technics]. / La fermeture des défauts septaux interventriculaires.Comparaison de deux techniques

To be correctly done, closure of a ventricular septal defect must be sound, and must also avoid damage to the conducting tissue. These two essentials are somewhat contradictory, since in order to avoid the bundle of His in its position along the postero-inferior edge of the ventricular septal defect (VSD) in the membranous septum, the sutures inserted into this region must be superficial, and therefore weak. It is for this reason that the published series continue to show evidence of a significant number of post-operative shunts and atrio-ventricular blocks, as much in the closure of isolated VSDs as in the treatment of Fallot's tetralogy. This paper compares two techniques of suturing the prosthetic material which is used to close the VSD: the classical technique, in which it is intended to avoid the bundle of His by working below it, on the right side of the interventricular septum, and a different technique in which the sutures are applied directly to the free edge of the interventricular communication.