Thyroid hypokalemic periodic paralysis.

An unusual presentation of thyrotoxicosis resulting in hypokalemic periodic paralysis is reported here. The patients with this disorder have very low serum potassium levels during the active phase of the disease. Very often, several months pass before the diagnosis is made. Once recognized and the thyrotoxicosis is treated, the patient does well.

[On the use of the gastroepiploic artery in myocardial revascularization]. / De l'utilisation de l'artère gastro-épiploïque droite dans la chirurgie de revascularisation myocardique.

Between 1985 and 1992, the gastroepiploic artery was used for coronary bypass surgery in 80 consecutive patients. Revascularisation was totally arterial in 62.5% of cases, the gastroepiploic being associated with single or double internal mammary artery grafts. The gastroepiploic graft was used to revascularise the inferior myocardial regions. The postoperative morbidity was essentially due to respiratory complications: 6 patients had objective pulmonary complications and 11 patients had relative transient postoperative hypoxia. The early gastrointestinal complications were related to ulceration (5 patients) complicated by haemorrhage in 2 patients. This morbidity was responsible for a significant increase in the period of intensive care. The hospital mortality was 6.2%, observed mainly in the first third of the author's experience and in patients with preoperative poor prognostic factors. These relatively high morbidity and mortality rates have led to a cautious use of the right gastroepiploic artery for coronary bypass surgery in patients over 70 years of age, in those with unstable angina operated as an emergency and in those with associated pathology, especially respiratory problems. The choice of a complex surgical option should not be synonimous with an increased postoperative mortality.

[Implantable defibrillator using epicardial and endocardial leads. Results of 36 implantations]. / Défibrillateur implantable par système épicardique et endocardique. A propos de 36 implantations.

The authors report their experience of implantable defibrillators over a 5 year period. Between February 1988 and July 1992, 36 patients (25 men, 11 women, average age 51 +/- 11 years, range 18 +/- 71 years) underwent implantation of an automatic defibrillator with epicardial (n = 13, Group I) or endocardial leads (n = 23, Group II) without patch electrodes (n = 7), with subcutaneous patch electrodes (n = 12) or epicardial patch electrodes (n = 4). Three serious early complications were observed: 2 cardiogenic shocks in Group I, one of which died on Day 1 and one case of infection which required explanation of the defibrillator on Day 23 in Group II. Late complications in Group I included one case of disactivation of the defibrillator, 2 losses of output, one of which required replacement of the defibrillator and 2 increases of threshold treated by implantation of an endocardial lead. In Group II, 2 patients had inappropriate shocks due to overdetection (n = 1) and double counting (n = 1). During an average follow-up period of 28.5 +/- 9 months in group I and 13 +/- 6 months in Group II, 4 patients died, 2 from sudden death. Ninety seven shocks were delivered in 19 patients (56%), 5.1 shocks per patient. In the 17 patients with an antitachycardia function, 14 (82%) developed 947 episodes of VT treated successfully by antitachycardia pacing in 917 cases. This retrospective study confirms the efficacy of implantable defibrillators in the treatment of malignant ventricular arrhythmias. The efficacy of endocardial and epicardial leads seems to be the same but there seems to be a lower immediate mortality and morbidity with the endocardial system.

Bilateral adrenal myelolipomas with Cushing's syndrome.

A 24-year-old woman with non-pituitary dependent Cushing's syndrome was found to have bilateral adrenal myelolipomas at surgery. These benign tumors consist of bone marrow and fat and are uncommon incidental findings that are discovered by computed tomography. Myelolipomas have rarely been associated with Cushing's syndrome, but the cause of the syndrome has not always been defined, because the reports preceded modern diagnostic methods. Careful examination of the adrenal glands from our patient showed a fusion of myelolipoma elements and adrenal cells without distinct adenomas or the typical nodular pattern of adrenal hyperplasia. This report suggests that adrenal myelolipomas and atypical hyperplasia of the zona fasciculata may be anatomically and functionally related.

Hypergonadotropic hypogonadism with congestive cardiomyopathy: an autosomal-recessive disorder?

We report on two sisters with ovarian dysgenesis and secondary hypergonadotropic hypogonadism and congestive cardiomyopathy. Their parents are first cousins. It is suggested that these are the main manifestations of a previously unreported autosomal-recessive syndrome.