[Latero-cervical thyroid tissue and congenital hypothyroidism revealed in adult age]. / Tissu thyroïdien latéro-cervical et hypothyroïdie congénitale révélée à l'âge adulte.

It is generally admitted that in front of tissues of thyroid origin found in latero-cervical position, the clinician should look for the presence of an occult thyroid carcinoma. This position is therefore against the diagnosis of lateral aberrant thyroids or benign metastatic thyroidosis that have been evocated in the past. We present the case of a 59 yr old woman in whom the diagnosis of benign latero-cervical mass of thyroid origin was made in association of an undiagnosed congenital hypothyroidism due to an ectopic thyroid gland in a sub-lingual position. This observation as well as recent published observations are in contrast with the current medical practices which should be discussed according to the location of the cervical mass and to precise histopathological features.

[Left bundle-branch block and chest pain of simultaneous occurrence during exercise]. / Bloc de branche gauche et douleur thoracique d'apparition simultanée à l'effort.

The authors report a new case of left bundle branch block with pain during exercise, with arteriographically normal coronary arteries. Clinical findings and the course of the condition are reviewed. Pathophysiological mechanisms are discussed, with attribution of first place to an ischemic theory.

[Maximal effort, maximal heart rate and serum lactic acid in exercise electrocardiography. A comparative study]. / Effort maximal, fréquence cardiaque maximale et lactacidémie en électrocardiographie d'effort. Etude comparative.

In exercise stress testing the quantification of effort on which the value and significance of the test depend is based on two simple and practical criteria: theoretical maximal heart rate for age (MHR) and serum lactic acid levels 3 minutes after exercise. Usually only MHR is used, 85% of MHR being the common cut-off point between "interpretable" maximal or "inframaximal" effort and useless effort. Our study was based on 1 000 exercise stress tests performed over a two year period with the same protocol and equipment. Initially, we determined our values of MHR and serum lactic acid in undoubted maximal effort stress tests, as shown by a levelling out of the heart rate during the last load increments, the last stage of exercise being sustained for at least 1.5 minute. The application of both criteria to all the investigations showed significant differences in the evaluation of the exercise obtained when the maximal measured heart rate was between 85 and 95% of MHR. This was also true, to a lesser extent, in patients over 60 years of age or under 30 years of age with maximal measured heart rate of 85% or less than MHR. A discussion of the theoretical basis of the two criteria helps explain this divergence, attributing it to the inaccuracy and unreliability of the MHR. The only obstacle to the use of serum lactate as the preferential indicator of maximal effort is the need for laboratory facilities and the delay in obtaining the result.(ABSTRACT TRUNCATED AT 250 WORDS)