[Jewish Doctors in Luxembourg: A misunderstood minority]. / Médecins juifs au Luxembourg Cheminement d'une minorité incomprise.

After an outline on the hypocrisy of the Catholic Church towards jewish doctors, the author list some arguments to explain why Jewish doctors were that sought after. He then concentrates on the situation in Luxembourg - on indigenous doctors and migrants, finishing with a parallel between asylum seekers from yesterday and today.

[Hemangioma of the interventricular septum simulating right obstructive cardiomyopathy. Apropos of a case and review of the literature]. / Hémangiome du septum interventriculaire simulant une cardiomyopathie obstructive droite. A propos d'un cas et revue de la littérature.

The authors report a case of haemangioma of the interventricular septum, a rare cardiac tumour (2.8% of all primary cardiac tumours) simulating right obstructive cardiomyopathy. Based on a review of the literature, they emphasize the diversity of the clinical expression of this disease and the uncertain medium and long-term outcome of operated and nonoperated tumours.

[Determination of the optimal atrioventricular timing by impedance plethysmography in patients with cardiac pacing; correlations with left ventricular filling]. / Détermination du délai auriculo-ventriculaire optimal par pléthysmographie d'impédance chez des patients stimulés; corrélations avec le flux de remplissage ventriculaire gauche.

The stroke volume (SV) was measured by the change in the impedance in thirteen patients with dual chamber pacemakers at different atrioventricular delay (AVD) intervals: 31 to 219 ms or 75 to 220 ms. The mitral inflow was also recorded by Doppler echocardiography at each AVD with measurement of the duration of mitral flow (MFD) and the velocity time integral (VTI). All thirteen patients were studied in the DDD mode; in addition, 5 patients were studied in the atrial sensing ventricular stimulation VDD mode. The SV measurement by impedance plethysmography was reproducible with an average variability of 3.5%: the optimal AVD was determined by this method in 11 patients with DDD and 4 patients with VDD pacing: in 3 patients (2 in DDD and 1 in VDD mode) 2 optimal AVD were obtained. The optimal AVD was 123 +/- 31 ms (63 to 156 ms) in DDD mode and 91 +/- 17 ms (63 to 110 ms) in VDD mode. The analysis of left ventricular filling showed that changes in AVD led to similar changes in mitral VTI. The MFD increased as the AVD was shortened to a constant value at the optimal AVD. In all patients, the optimal AVD was obtained when the MFD became maximal and constant. Measurement of MFD is a simple and rapid means of assessing optimal AVD at rest in patients with dual chamber pacing systems.

[Infectious endocarditis on permanent endocavitary pacemakers: value of echocardiography and review of the literature]. / Endocardites infectieuses sur sondes de stimulation endocavitaire permanentes: intérêt de l'échocardiographie et revue de la littérature.

Infectious endocarditis around indwelling pacemakers is rare (0.15% of all implantations). They have a gloomy prognosis with a global mortality rate of nearly 34% as emerges from this review of the literature concerning 58 cases of infectious endocarditis published within the past 16 years. On the basis of the 6 cases which the authors report, they stress the importance and sometimes difficulty of using ultrasound in a positive diagnosis. Cardiographic ultrasound, which can determine the size and emboligenic nature of vegetations is capital in choosing how to remove the pacemakers. Percutaneous ablation by simply pulling or by catheterization currently gives the best results, but it may be necessary to resort to surgery involving right atriotomy if emboligenic vegetations are present. By combining antibiotic treatment and ablation of the intracavitary material, a cure is obtained in 92% of cases. These figures should be compared with the lack of success of using antibiotic treatment alone which results in a high level of mortality (84%).

[Delayed angioplasty for residual stenosis following thrombolyzed infarction: arterial permeability and left ventricular function after 6 months]. / L'angioplastie différée de la sténose résiduelle après infarctus thrombolysé: devenir à 6 mois de la perméabilité artérielle et de la fonction ventriculaire gauche.

At medium term, the results of delayed angioplasty (DA) following intravenous thrombolysis (IVT) in terms of arterial permeability but particularly of left ventricular function (LVF) is still poorly understood and is the subject of this prospective study. Over 18 months, 76 patients underwent DA for the residual stenosis on day 8 +/- 5 with complete and partial success rates of 88.2% and 11.8% respectively. Rapid reocclusion (< 48 hours) was documented in 9.2% of cases. After 6 months, there had been no deaths and no recurrence of infarction but a recurrence of angina in 23.7% of cases. Angiographic monitoring, carried out in 56 cases (73.7%) after 6 +/- 2.4 months identified 21 restenosis (37.5%) and 6 re-occlusions (10.7%). 12 of the restenosis were successfully re-dilated. The effect on LV function was investigated in 50 patients. In the absence of reocclusion, the ejection fraction and the kinetics of the infarcted territory were improved; significant restenosis (> 60% by digital densitometry) did not appear to offset these improvements. In addition to the maintenance of arterial permeability, the possibility of functional recovery appears to be conditioned by the degree of contractile abnormality observed during the initial ventriculography. Despite the absence of restenosis after 6 months, the occurrence on day 6 of akinesia or above all of dyskinesia reduces the chances of contractile improvement with as a corollary more marked LV changes.

[Pulsed echo-Doppler evaluation of regurgitant fraction in mitral valve insufficiency]. / Evaluation par écho-Doppler pulsé de la fraction de régurgitation des insuffisances mitrales.

The aim of this study was to evaluate the validity of Doppler echocardiographic evaluation of the regurgitant fraction in pure mitral insufficiency. The Doppler echocardiographic measurement of systemic flow was made at the level of the aortic ring, and the mitral flow by the method of integration of instantaneous flow proposed by Touche. In a preliminary study, we demonstrated a close correlation between forward aortic and mitral flow in 20 normal subjects (r = 0.94; SD = 0.31 l/mn; y = 0.98 x -0.004). We then studied a group of 38 patients with pure isolated mitral regurgitation. Five patients were excluded because of the poor quality of the echocardiographic documents. The hemodynamic regurgitant fraction was determined by measuring pulmonary flow by thermodilution and the left ventricular outflow by digitised angiography. The average Doppler and hemodynamic regurgitant fractions were 46.6 +/- 18% and 42 +/- 17% respectively. There was a close correlation between the Doppler and hemodynamic values (r = 0.91; SD = 7.8%; y = 0.97 x + 5.7). The correlations were also good between Doppler regurgitant fraction and the four angiographic grades of regurgitation (r = 0.88). A statistically significant difference was observed between the Doppler regurgitant fractions of Grades I and II and of Grades III and IV (p less than 0.001). In addition, the ratio of mitral VTI/aortic VTI gave a useful index of regurgitation in pure mitral insufficiency. When the ratio was greater than 1.3 the regurgitant fraction was over 40% with a sensitivity of 79% and a specificity of 86%. Finally, this study shows that pure, isolated mitral regurgitation can be evaluated by Doppler echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

[Noninvasive measurement of cardiac output by pulsed Doppler echocardiography. Correlation with thermodilution]. / Mesure non invasive du débit cardiaque par échocardiographie Doppler pulsé. Corrélation avec la thermodilution.

Cardiac output was measured simultaneously by pulsed Doppler echocardiography and thermodilution in 22 patients, 18 of whom also underwent atrial pacing at different rates to give a total of 42 different measurements. The aortic diameter was measured firstly at the aortic ring at the level of insertion of the aortic cusps and then at the point of maximum separation of the valve cups in the left parasternal long-axis view. The aortic velocities were recorded in the apical 5-chamber view immediately below the level of the aortic valve. The correlations obtained at the aortic ring (R1) and at the point of maximum separation of the valve cusps (R2) were 0.77 (y = 0.67x + 1.17: standard error = 0.81 l/m) and 0.64 (y = 0.56x + 0.87; standard error = 1.01 l/mn) respectively. The correlations were much better when 7 technically unsatisfactory measurements were excluded (R2 = 0.76: y = 0.59x + 0.74: standard error = 0.79 l/mn) (R1 = 0.87: y = 0.72x + 1.04: standard error = 0.65 l/mn). THe correlations of stroke volume measured at aortic ring level also improved from r = 0.82 (y = 0.75x + 7.29: standard error = 8.9 ml) to r = 0.89 (y = 0.78x + 7.38: standard error = 7.3 ml). The measurement of cardiac output by pulsed Doppler echocardiography in the aortic root seems to be reliable. The correlations of the values of stroke volume and cardiac output with the thermodilution method are good, allowing detection of beat-to-beat variations of cardiac output, in suitable patients in the hands of experienced operators.

[Pathology and clinical aspects of retarded child development. Diagnosis and therapy of defective development]. / Pathologie und Klinik der retardierten Kindesentwicklung. Diagnose und Therapie der Mangelentwicklung.

21 cases of "small for date" pregnancies were analysed. Serial ultrasonic tracings and determinations of total estrogen excretion in the 24-hour-urine and of serum HPL concentration were carried out. The fetal heart rate was measured by cardiotocogram. Retrospectively, the patients were divided into 3 groups according to birth weight. All patients were treated with a combination of Complamin, Calciparin and Partusisten. Fetal growth retardation could not be stopped by this treatment; there was, however, definite fetal weight gain following long term therapy. Results of HPL and total estrogen determinations were inconclusive; in most cases, however, a fall of concentrations was observed. Following long term therapy a rise in concentration up to almost normal values was seen. The positive effect of therapy was best shown by serial cardiotograms.

[Topography of a reference plane for ultrasonic thoracometry (author's transl)]. / Zur Topographie einer Referenzebene für die Ultraschallthoracometrie

A method of ultrasonic thoracometry is reported which uses the veins of the fetal liver as landmarks. The fact that the umbilical vein running from the anterior abdominal wall to the "sinus venae portae" is visible in B-scan display is the given presupposition. In a study about topography of the vein system of the fetal liver in 50 cases the description of a so called "sinus-plane" for sonar thoracometry is given. This reference plane is shown to be identical with the "lower apertura of the fetal thorax" recommended by Hansmann and co-workers since 1971. Thereby the nowadays well established method of thoracometry in obstetrical routine work gets a more accurate definition in regard to it's topography. This is not only of theoretical interest but will improve the conditions for more accuracy and reproducibility of the method.