[Malignant mediastinal schwannoma in Recklinghausen's disease presenting as cardiac tamponade. Report of two cases]. / Tamponnade cardiaque révélatrice de schwannome malin médiastinal au cours de la maladie de Recklinghausen. A propos de deux observations.

The authors report two cases of Recklinghausen's disease admitted for cardiac tamponade. Two-dimensional echocardiography showed a pericardial tumour in addition to a compressive pericardial effusion. After pericardial drainage, the outcome was rapidly fatal. Histological examination confirmed the diagnosis of a malignant intrapericardial schwannoma. A review of the literature revealed the scarcity of mediastinal malignant schwannoma. Associated with Von Reckinghausen's disease in 2 to 13% of cases, the prognosis is poor. The presentation of malignant mediastinal schwannoma with cardiac tamponade remains very rare.

[Primary hyperaldosteronism. Apropos of 2 cases]. / Hyperaldostéronisme primaire. A propos de 2 cas.

Primary hyperaldosteronism (PHA) represents less than 1 to 2% of all causes of hypertension (HT). We report 2 cases of primary hyperaldosteronism which emphasize the difficulty of distinguishing neoplastic PHA from idiopathic PHA, observed in a 60-year-old woman and a 42-year old woman, respectively. In both cases, the diagnosis of PHA was suggested by marked hypokalaemia with inappropriate potassium excretion and was confirmed by hyperaldosteronaemia and low and poorly stimulated renin activity. In the first case, computed tomography showed nodular hyperplasia of the 2 adrenal glands. The patient was treated with spironolactone and calcium channel blockers which controlled blood pressure and serum potassium. In the second case, computed tomography and magnetic resonance imaging revealed an adrenocortical adenoma confirmed by pathological examination after the operation. The diagnosis of primary hyperaldosteronism is based on three steps: detection, positive diagnosis and aetiological diagnosis. Detection is essentially based on demonstration of hypokalaemia. Positive diagnosis is based on demonstration of elevated aldosterone secretion with inhibited renin secretion. The aetiological diagnosis is dominated by the differentiation between Conn's adenoma and bilateral adrenal hyperplasia, which has therapeutic implications.

[Endomyocardial fibrosis of the right heart in Behçet disease]. / Fibrose endomyocardique du coeur droit au cours de la maladie de Behçet.

Cardiac involvement is rare in Behçet's disease. Endomyocardial fibrosis of the right heart is exceptionally rare and is associated with right ventricular thrombosis. The authors report the case of a 27 year old man who died of a massive pulmonary embolism and who suffered from right-sided endomyocardial fibrosis with intraventricular thrombi. The diagnosis was made at autopsy. Behçet's disease was diagnosed on the finding of bipolar aphthous ulcers and skin hypersensitivity. The authors support previous workers in stating that Behçet's disease should be considered as a possible cause of endomyocardial fibrosis of the right heart.

[Survey on the practice of antibiotic prophylaxis of infective endocarditis by dentists]. / Enquête sur la pratique de l'antibioprophylaxie de l'endocardite infectieuse par les dentistes.

The authors undertook an enquiry among 287 dentists to assess their practice of prophylactic antibiotic therapy against infectious endocarditis. Of the 227 dentists who replied, most (90%) knew that a dental extraction required prophylactic antibiotic therapy. They correctly prescribed antibiotics to prosthetic valve patients (84%) and to those with post-rheumatic cardiac disease (87%). Many dentists considered that coronary bypass (66%), mitral valve prolapse without mitral regurgitation (65%) or chronic myocardial infarction (68%) also required antibiotic prophylaxis, contrary to published recommendations. Only 21% of dentists used the recommended 3 gram dose of amoxicillin; the others prescribed a lower dose or another antibiotic. Approximately half the dentists started treatment 1 to 3 days too soon and less than 5% used the recommended single dose of antibiotic. These results show that dentists do not adhere strictly to the rules of prophylaxis on infectious endocarditis defined by different working groups. The authors make several suggestions to improve the prevention of infectious endocarditis and to remedy the problems shown up by this study.

[Imaging in cardiac hydatid cyst. Apropos of a case]. / Apport de l'imagerie dans l'hydatidose cardiaque. A propos d'un cas.

Cardiac hydatid disease is rare. Its dificult diagnosis is based on a series of arguments in which hydatid serology and imaging play a predominant role. A young patient with multiple cardiac hydatid cysts was investigated by 2D echocardiography, transoesophageal echocardiography and magnetic resonance imaging. This case illustrates the value of the various noninvasive imaging techniques in the diagnosis of cardiac hydatid disease and emphasizes the importance of surgical treatment before the development of complications.

[Cardiac tamponade disclosing systemic lupus erythematosus]. / Tamponnade cardiaque révélatrice d'un lupus érythémateux systémique.

Cardiac tamponade secondary to systemic lupus erythematosus is rare and has a very serious prognosis. The authors report a case of cardiac tamponade confirmed by echocardiography, which constituted the presenting sign of systemic lupus erythematosus in a 20-year-old patient, who required emergency pericardial aspiration. The diagnosis of systemic lupus erythematosus was established on the basis of the combination of pericardial involvement, non-erosive arthritis, leukopenia with lymphopenia, presence of LE cells and anti-native DNA antibodies and positive antinuclear antibody titre of 1/2560. The clinical course was favourable in response to 3 months of corticosteroid treatment. The possibility of SLE should be considered in any case of cardiac tamponade in a young patient in which the aetiology is not explained.

[Mediastinal malignant schwannoma disclosed by pericardial tamponade in von Recklinghausen disease]. / Schwannome malin médiastinal révélé par une tamponnade péricardique au cours de la maladie de von Recklinghausen.

The authors report a case of a 47-years-old patient with Von Recklinghausen's disease. He was admitted with pericardial tamponade. 2D echocardiography showed, in addition to the compressive pericardial effusion, an enormous intrapericardial tumor compressing the left cardiac cavities. The patient died soon after pericardial drainage. The post-mortem examination revealed the diagnosis of malignant schwannoma of the left costo-vertebral gutter with an anterior intrapericardial development. A review of the literature showed that malignant schwannomas are seldom localized in the mediastinum, are associated with Von Recklinghausen's disease in 2 to 13% of cases, and have a poor prognosis. Pericardial tamponade is an exceptional presenting sign of mediastinal malignant schwannoma.

[Bacterial endocarditis in Morocco]. / L'endocardite bactérienne en milieu marocain.

This retrospective study was based on 157 cases of infectious endocarditis observed in the Cardiology department of Ibn Rochd Hospital in Casablanca between January 1983 and December 1994. The mean age of the patients was 27.5 years (11 to 65 years) with a male predominance (62.8%). Infectious endocarditis was secondary to rheumatic valvular heart disease in 63.% of patients and was primary in 29.9% of cases. Mitral or mitro-aortic valve involvement was clearly predominant. A portal of entry of the infection was identified in 63% of patients. It was dental in 64% of cases. Blood cultures were positive in 42% of cases with a predominance of unclassifiable Streptococci (37.8%) and coagulase-negative Staphylococci (25.7% of cases). Echocardiography was very useful, particularly in the presence of negative blood cultures. It demonstrated specific lesions of infectious endocarditis in 73.2% of cases and revealed very large, mobile vegetations in every case complicated by systemic embolism. The clinical course was complicated by heart failure (47.8%), renal failure (14.6%) or neurological lesions (11.5%). The global mortality was 28.7%, related to refractory heart failure in most cases.

[Cardiac manifestations of diffuse systemic scleroderma. Apropos of 4 cases]. / Manifestations cardiaques de la sclérodermie systémique diffuse. A propos de quatre observations.

Based on a series of four cases and a review of the literature, the authors describe the lesions of the various cardiac tissues in the course of systemic scleroderma. Pericardial involvement presents in the form of either acute pericarditis or chronic pericarditis. Pericardial tamponade is exceptional. Sclerodermal cardiomyopathy is frequent and serious and can be responsible for heart failure. Arrhythmias are frequent and may be either ventricular or supraventricular. Involvement of the conduction tissue often requires implantation of a pacemaker. Endocardial and valvular involvement is very rare. Lastly, coronary involvement appears to be fairly rare and responsible for vasospastic episodes in the coronary artery territory.

[Cardiovascular manifestations of hereditary dysplasias of connective tissue]. / Les manifestations cardio-vasculaires des dysplasies héréditaires du tissu conjonctif.

The purpose of this study was to demonstrate the special features of cardiovascular effects in connective tissue disorders through a group of fifteen cases observed over a period of ten years. The group consisted of eleven cases of Marfan syndrome (or Marfan-like syndrome), two cases of pseudoxanthoma elasticum and two cases of Ehlers-Danlos disease. The cardiovascular lesions were as follows: 1) dissection of the ascending aorta which was confirmed and had been treated surgically in 2 cases; 2) aneurysmal dilatation of the ascending aorta in 5 cases; 3) moderate mitral valve prolapse, which was isolated in 2 other cases; 4) distention of the mitral valve in 2 cases; 5) mitral valve prolapse combined with tricuspid valve prolapse in 1 case; the mitral incompetence was severe and made it necessary to carry out mitral valve replacement; 6) moderate aortic valve prolapse combined with tricuspid prolapse in a case of type-I Ehlers-Danlos disease; 7) Fallot's tetralogy combined with Marfan's syndrome and treated surgically in one case; 8) severe hypertension with abnormalities of the iliac and renal arteries in one case of elastic pseudoxanthoma elasticum. In three cases complications occurred leading to death, extension of the dissection of the abdominal aorta and global recalcitrant heart failure respectively. The outcome in the other 12 cases, with a mean follow-up time of 3 and one half years (range: 3 years to 7 years) was not marked by complications.

[Use of brachial venous grafts in coronary bypass surgery]. / Emploi de greffons veineux brachiaux dans la chirurgie de pontage coronaire.

From May, 1975, to December, 1988, 30 patients (pts), 26 men and 4 women, aged 36 to 79 (average age: 58) underwent one or several aortocoronary bypass (ACB) operations requiring the use of veins from the upper limbs (VUL). Sixty operations (2.0 ACB/pt) were performed, involving the anterior interventricular artery in 27 cases, the right coronary artery in 14 and the other left vessels in 19. The grafts used were a VUL in 45 cases, an internal mammary artery in 13, a great saphenous vein in one case and a 4-mm polyurethan tube in one case. The indications for the use of a VUL included bilateral stripping in 23 patients, repeated phlebitis in one, bilateral varices in 2, and the previous use of the saphenous veins in 4 patients. The coronary lesions were a three-vessel involvement in 17 cases, a two-vessel involvement in 9 and a single-vessel involvement in 4. An additional procedure was required in two patients for the resection of a left ventricular aneurysm and for the plication of an akinetic area of the left ventricle. No intraoperative complication was observed. Perioperative mortality was of two cases (6.6%). The postoperative myocardial infarction rate was of one case (3.3%). A complication directly associated with the type of graft used (massive bleeding due to graft tearing) caused cardiac arrest in one case. Two patients presented with local disorders caused by the removal of veins from the upper limbs, including hypoesthesia of the forearm in one case and anesthesia associated with regressive muscle enfeeblement in the other.(ABSTRACT TRUNCATED AT 250 WORDS)