[Anti-arrhthmic effects of injectable amiodarone in resuscitation during cardiovascular surgery, 2 cases].
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Biomedical subjects
Publications and source records attributed to C Cabrol.
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A clinical and cytogenetic investigation carried out in a special institution for mentally retarded patients revealed 82 cases of oligophrenia, amongst whom were found 56 normal karyotypes (68.3%). Out of 25 karyotypes with chromosome anomalies or variants there were 18 cases of trisomy 21 and 7 others: one case of mosaicism with balanced translocation, 46,XX/46,XX,6p+,17q-; one case of partial trisomy, 46,XX,11q+; one case of pericentric inversion, 46,XY,inv(1) (p13,q21); one case with 8% chromosome breaks; three cases of marker chromosomes, of which one was of karyotype 46,XX,1qh+, and two (oligophrenic sisters) 46,XX,21p+. Moreover, there was an interesting case of testicular feminisation in a 9-year-old girl with karyotype 46,XY. The authors' results corroborate those obtained in several important previous studies based on much larger numbers of patients. Amongst the 56 cases where the karyotype was shown to be normal, there were 15 for whom a probably exogenic cause of the oligophrenia could be established, occurring mainly during the perinatal period. The authors were also able to confirm that the genetic factor plays an important role in the incidence of mental retardation, since in 22 examined patients, i.e. 26.8% of all cases, the condition was of familial type. Some interesting observations of idiopathic oligophrenia are reported, as well as several cases with well-known syndromes (Crouzon's and Cornelia de Lange's syndromes, hypothyroidism). Two cases of incest between father and daughter, which had produced children with serious oligophrenia associated, in one case, with deaf-mutism, microphthalmia, microcephaly and sclerocornea, are also discussed. The data show that mental retardation can frequently have a genetic cause, either of mendelian, chromosomal or multifactorial origin.
The usual distribution of the coronary arteries of the heart as its appears from the study of 60 casts of these vessels is the following:--the right coronary artery gives three right atrial branches, the superior (sinus node artery) medium and inferior branches and three kinds of right ventricular branches : anterior, marginal and inferior. It divides into the posterior descending branch and the posterior left ventricular branch. Its territory is postero-septal.--the left coronary artery divides into 2 branches. The anterior descending artery gives right ventricular, left ventricular (diagonal) and septal branches for the antero-septal territory. The left circumflex gives three left atrial branches, the superior, medium and inferior branches and 1 or 2 left ventricular (lateral) branches for the corresponding lateral territory of the left ventricule.
On thirty cadaveric dissections, we studied the so-called "phreno-gastric" ligament. In fact, it appears that there is an adhesion between the fundus and the posterior wall in only 60 % of the cases. This adhesion is always very loose, easily cleaved and in no case is there a real fibrous suspensory ligament. Moreover, in 40 % of the cases, the posterior surface of the fundus is entirely covered by peritoneum and is free in the bursa omentalis. In that case, the posterior surface of the stomach is connected with the diaphragm by a very short meso extending on the right to the meso esophagus and on the left to the gastrosplenic ligament.
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A series of 80 heart dissections, compared with a survey of the literature shows that:--both coronary ostia are usually in the right anterior and in the left posterior position, in the commissural plane, at the level of the corresponding sinus of Valsalva (the left one being often superior in size to the right one).--anatomic variations of the coronary ostia (especially variations of the left coronary ostium) may be summed up into 3 patterns: Variations in number : sometimes, there is only one aortic coronary ostium, usually owing to a left coronary artery originating from the pulmonary artery; a common aortic ostium for a single coronary artery is not frequent. Multiple ostia are the most common variations : an accessory artery may arise from a separate ostium (often the "third coronary artery" from the right aortic sinus; sometimes the anterior descending and the circumflex arteries may originate from separated orifices). Variations in origin remain few, affecting most often the left ostium. Variations in size reflect the corresponding coronary plexus preponderance.
An anatomic study of the main left coronary artery is reported : important anatomic variations may occur:--sometimes, the main left coronary artery is missing (1 % of the cases),--its origin may be unusual (from the pulmonary artery),--its average length is 11 mm; but, it may be longer (35 mm) and sometimes very short (less than 8 mm in 15 per cent of the cases) : this last aspect has to be taken in account by the surgeon during aortic valve surgery if a coronary perfusion has been decided.--At last, its division into two branches (anterior descending and left circumflex) is the most usual (65 or 70 per cent of the cases). A third branch of division may exist (diagonal or lateral branch) in about 20 to 30 per cent of the cases. The left coronary artery may also divide into four (or even five) branches in 5 to 10 per cent of the cases.
We have reported the study of a young girl aged 19 suffering from a gonadal dysgenesis the chromosomal complement of which is 45,X/46,XXp-. The analysis of the transmission of Xg group was insufficient to demonstrate with certainty the origin of the pathological X. The tests indicating the ability to discriminate colours (Ishihara's test and anomaloscopy) showed a protanopia, probably of paternal origin. Hence, the Xp- probably comes from the mother.
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The case is reported of an 8 year old child who had a 1/1 atrio-ventricular conduction by the bundle of Kent after accidental surgical division of the bundle of His; this "accessory" pathway conducted satisfactorily over a period of 12 years. At the age of 20, the patient had a complete conduction block of the bundle of Kent, causing a complete atrio-ventricular block; this indicated the definitive insertion of a pacemaker.
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The favourable clinical results of cardiac transplantation merit wider application of this therapeutic measure in the management of non-obstructive primary cardiomyopathies and diffuse myocardial fibrosis secondary to coronary artery disease and in its terminal phase, in the absence of any absolute contraindication (pulmonary resistance too high, diabetes, gastrointestinal disorder, infection, patient too old.). Close cooperation between departments of cardiology and surgical transplantation centres, with systematic study of the patients pre-operatively and the setting up of a waiting list of recipients, will make possible in the future the improvement of the already encouraging results of cardiac transplantation.