This is a case report of a 16-year-old male with moderate mitral disease, probably rheumatic, and with severe tricuspid insufficiency, which at surgery appeared to be a congenital malformation of the tricuspid valve (absence of the anterior leaflet). A tricuspid heterograft was successfully inserted. The symptoms of congenital tricuspid insufficiency are discussed, and this entity is differentiated from other causes of tricuspid insufficiency.

Adolescent↗

PubMedDate not supplied

Relationship of blood coagulation and fibrinolysis to vital exhaustion.

OBJECTIVE: Acute physical and psychological stressors affect blood coagulation and fibrinolysis, but little is known about hemostatic factors associated with chronic psychological stress. Prolonged psychological stress may end in a state of vital exhaustion, which has been shown to be a risk factor for first myocardial infarction and recurrent events after coronary angioplasty. The present study tested the hypothesis that vital exhaustion resulting from chronic psychological stress is associated with impaired fibrinolytic capacity and increased coagulation factors. METHODS: On the basis of a validated questionnaire and subsequent structured interview, a well-defined group of otherwise healthy exhausted men was recruited (N = 15) and compared with age-matched not-exhausted controls (N = 15). Fibrinolytic measures included tissue plasminogen activator (TPA) antigen and plasminogen activator inhibitor (PAI-1) activity, and as coagulation factors we examined factors VIIc, factor VIIIc, and fibrinogen. Control variables were: blood pressure, smoking status, triglycerides, cholesterol, and standard hematological measures. Samples were collected twice to correct for intraindividual fluctuations. Statistical analyses were performed using 2 x 2 mixed model analysis of variance with subsequent univariate testing. RESULTS: Vital exhaustion was associated with significantly elevated levels of PAI-1 activity (p = .023). The higher PAI-1 activity in exhausted subjects (median = 13.0 U/ml vs. 6.0 U/ml) was not accounted for by smoking status or serum lipids. No significant differences were observed in TPA antigen, factor VIIc, factor VIIIc, and fibrinogen. The groups did not differ in blood pressure, smoking status, triglycerides, cholesterol, or standard hematological measures. CONCLUSION: These data suggest a reduced fibrinolytic capacity in exhausted individuals. Therefore, the relationship between vital exhaustion and risk of myocardial infarction may be mediated in part by an imbalance between blood coagulation and fibrinolysis.

Adult↗

PubMedDate not supplied

Congenital ventricular diverticula of the heart: two cases.

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Child, Preschool↗

PubMedDate not supplied

[Radiological aspects of aneurysms of the membranous septum (author's transl)].

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Adolescent↗

PubMedDate not supplied

[Agenesia of the pulmonary valves manifested by ventilation disorders. In the newborn].

Agenesia of the pulmonary valves is often responsible for severe disorders of ventilation by bronchial compression in newborns. This may be involved in case of respiratory distress, with a double murmur, expressing the stenosis of an avalvulated pulmonary ring and the massive pulmonary regurgitation. The bad tolerance is due to the association with an interventricular dilatation of the pulmonary artery, which characterizes this malformative complex. The prognosis is severe and the treatment is disappointing since all surgical attempts failed at this age.

Airway Obstruction↗

PubMedDate not supplied

[Thalidomide with or without dexamethasone for refractory multiple myeloma].

It was shown in 1999 thalidomide could induce a therapeutic response in patients with refractory multiple myeloma. Between March 2000 and January 2002, we treated 21 patients with refractory multiple myeloma with thalidomide (Thalidomide) at initial dose of 400 mg a day. Response rate (Intergroupe Francophone du Myélome criteria) was 33 percent and median progression-free survival estimated to 15 months. All patients suffered from drowsiness and constipation requiring lowest doses. Five patients developed a sensitive neuropathy. Eight refractory patients were treated by a combination of their prior maximally tolerated dose of thalidomide and monthly dexamethasone (Soludécadron) alone (n = 4) or associated to cyclophosphamide (Endoxan) and étoposide (Etopophos) (n = 4). Six patients on 8 were responders. Our results suggest that the combination thalidomide/dexamethasone should be compared to thalidomide alone in a prospective, randomized study in patients with refractory multiple myeloma.

Adult↗

PubMedDate not supplied

[Angiocardiographic study after complete correction of interventricular communications treated by banding of the pulmonary artery. 20 cases (author's transl)].

An angiographic study after complete correction in twenty children who had previously undergone banding of the pulmonary artery revealed a certain number of complications. The considerable percentage of residual V.S.D, the persistance of notable narrowing in the region of the zone of banding, and infundibular hypertrophy are mainly due to surgical difficulties. Two cases of pulmonary valve incompetence were detected with the appearance of thickened valves, which were isolated or associated with a "domeshaped" valve appearance. Kowledge of these complications enables reduction as far as possible of the indications for banding of the pulmonary artery.

Angiocardiography↗

PubMedDate not supplied

[A comparative prospective study of an edrophonium test and an esophageal balloon distension test in 78 patients with non-coronary angina and 12 healthy controls].

UNLABELLED: The aim of this study was to compare the most current tests used for the diagnosis of esophageal angina-like pain: manometry, balloon distension, edrophonium provocation. METHOD: 78 patients with angina-like pain, who had normal coronary arteriograms, and 12 healthy controls were prospectively evaluated with esophageal manometry, esophageal balloon distension, according to Barish's method (2), edrophonium provocation and 3 h pH-monitoring. Provocation tests were considered positive if they reproduced the angina-like pain. RESULTS: basal manometry was abnormal in 23 patients (29%); nutcracker esophagus; 8, achalasia; 1, diffuse esophageal spasm: 1, hypertensive LES: 2, non specific motility disorders: 5, It was abnormal in 1 healthy control (1 nutcracker esophagus). Edrophonium provocation was positive in 19 patients (24%) and in none of the controls. Balloon distension was positive in 33 patients (42%) and none of the controls, but 3 controls experienced a back pain at 7, 9 and 9 cc. Balloon distension was more sensitive than edrophonium provocation (p less than 0.001). There was no correlation between the results of the basal manometry and those of balloon distension and no correlation between pH monitoring and balloon distension. 1) Balloon distension is the most sensitive test and should be used at first. 2) If balloon distension is negative edrophonium provocation can be useful because the pain mechanism is different. 3) Some controls can experience a back pain without irradiation, then balloon distension must be considered positive only if it strictly reproduces the spontaneous angina-like pain.

Adult↗

PubMedDate not supplied

[Systemic artery-pulmonary vein fistula. Apropos of a case].

Fistulas between a systemic artery arising from the aorta and the pulmonary vein with absence of a branch of the pulmonary artery and without abnormality of the bronchial tree are very seldom. We report the case of a child which had a continuous vascular murmur with heart failure secondary to a left-left shunt. A left inferior lobectomy was performed. The inferior lobe was the site of a huge arterio-venous fistula between an artery arising, from the aorta and the pulmonary veins.

Adolescent↗