Biomedical subjects
Publications and source records attributed to G Rousseau.
A case of carpal tunnel syndrome with skin ulcerations and osteolysis is reported. Such cases are unusual. There was a sensory and motor deficit with chronic ulcerations on the palmar surface of the third phalanx of the medius. The distal phalanx of the forefinger had been lost due to osteolysis. Surgical treatment is said to be followed by a healing of the ulcerations.
The authors present a case of acute renal ischemia resulting from embolism of its main artery on the occasion of the transient interruption of anticoagulant treatment for dental extraction, in a patient bearing a Björk-Shiley valvular prosthesis in the mitral position. Its progression is marked by the complete repermeabilisation of the artery under heparin therapy with complete recuperation of renal function. This classically exceptional observation suggests that the delay occurring between the initial obstruction and repermeabilisation does not alter the degree of renal distress, the estimation of which is unpredictable. The relative resistance of the kidney to ischemia and the occurrence of efficacious fibrinolysis suggests the possibility of therapy other than surgery. Prevention demands the maintenance of coagulants under guarantee of local hemostatic processes.
This study compares two groups of patients: Group I with 44 patients who suffered recent acute myocardial infarction and Group II: 40 control subjects. In both groups, 2D Doppler echocardiography was performed to detect carotid atheroma, to determine the respective roles of vascular risk factors for two sites of atherosclerosis. Carotid atheroma affected 73 p. 100 of subjects in Group I and 22.5 p. 100 in Group II. Carotid stenosis of more than 40 p. 100 was found mainly in hypertensive patients who presented with acute myocardial infarction, and in patients with left ventricular hypertrophy. Smoking was more frequent in Group I than in Group II (p less than 0.001) irrespective of the frequency of carotid atheroma (p less than 0.05). Hypercholesterolaemia only favoured carotid atherosclerosis after acute myocardial infarction (p = 0.01). We did not find any difference in the incidence of diabetes mellitus in the two groups of patients. Age analysis indicated that carotid atheroma occurred earlier in Group I than in Group II. An association between a dominant risk factor for coronary disease (smoking or hypercholesterolemia) was found in 9 patients, all of whom had severe bipolar atherosclerosis with multivessel coronary lesions and carotid stenosis.
A prospective study of carotid artery atheroma by vascular echotomography and spectral analysis was performed in 40 patients with myocardial infarction and 40 control subjects. Carotid artery atheroma was commoner in the group of patients with myocardial infarction (72.5% +/- 6.8%), earlier (9 years), more commonly bilateral (37.5% +/- 7.6%) and more stenotic (32.5% +/- 7.4%) than in the control group (p less than 0.000a, p less than 0.0001 and p less than 0.002, respectively). The severity of carotid artery atheroma correlated with the site of coronary artery disease; the following significant relationships were found: stenosing 40% and/or bilateral carotid atherosclerosis and left anterior descending disease (p less than 0.02); carotid atherosclerosis and double or triple vessel disease (p less than 0.05). The authors conclude that detection of carotid artery atheroma after myocardial infarction is valuable for two reasons: it gives an indication as to the severity of the coronary disease; carotid endarterectomy may be considered at the same time as coronary artery bypass surgery.
A typical case of advanced obstructive cardiomyopathy in a young subject was revealed by Streptococcal mitral valve endocarditis and was diagnosed by one and two dimensional echocardiography, which revealed a pedunculated vegetation on the large mitral valve and rupture of the chordae of the small mitral valve. This was complicated by biventricular heart failure, peripheral arterial embolism in the leg due to migration of the vegetation which disappeared on the repeat echocardiography and pulmonary embolism with arterial clot emboli due to heparin-induced thrombocytopenia. This condition resolved without requiring cardiac surgery. Patients with obstructive cardiomyopathy should be treated routinely with prophylactic antibiotics, particularly when dental treatment is required. Echocardiography has become an essential examination in the diagnosis of this disease and its complications, especially in cases with infectious endocarditis.
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One hundred and twelve patients with atrial fibrillation of different causes were treated with fenoxedil chlorhydrate. Sinus rhythm was restored in 81 cases (72.3 p. 100). The best results were obtained in the following conditions: hypertensive heart disease (77.6 p. 100), ischemic heart disease (75 p. 100), idiopathic atrial fibrillation (76.4 p. 100), senile lone fibrillation (78.2 p. 100). The results were average in valvular heart disease (57.1 p. 100) and in hyperthyroidism (40%). Age did not appear to be a deciding factor, the overall results being comparable in patients under 70 years of age (70.8 p. 100) and over 70 years of age (73.4 p. 100). Although recent atrial fibrillation was reduced more easily (83.3 p. 100), the results were satisfactory in chronic arrhythmias (over 3 years) (77.7 p. 100). The success rate was 76.3 p. 100 when the cardiothoracic index was over 0.60, and 66.6 p. 100 when less than 0.60. The antiarrhythmic effect of fenoxedil chlorhydrate is related to its electrophysiological properties as it depresses sinus node activity and atrioventricular conduction. No arrhythmic or conduction complications were observed during a short period (maximum 5 days) of close monitoring. However, lengthening of the QT and PR intervals was a common phenomenon. The advantages of fenoxedil chlorhydrate over electrical cardioversion (atraumatic, possibility of associating digitalis) and the results obtained whilst respecting the prescribing advice, justify its adoption as a method of converting atrial fibrillation.
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Cardiac involvement in the course of familial Portuguese amyloidosis, as apart from the other primary amyloidosis, is characterised by the early and wide-spread intracardiac conduction disorders, and the contrasting late presentation of the clinical signs. A case is presented of Portuguese amyloidosis which was typical from the viewpoint of the neurological disorders, the familial characteristics, and the positive biopsy; the main conduction defects found in primitive amyloidoses are also recalled. The patient described had for many years suffered from first degree heart block, and then presented with lipid changes with syncopal attacks which led to electrophysiological investigation of the conduction defect, no similar example of which has been found in the literature. The severity and widespread nature of the disorders which were found, together with the localisation of a sub-His block led us to implant the pacemaker. We have only found two other patients who had implants for disorders of conduction secondary to cardiac amyloidosis. Emphasis has been laid on the importance of this investigation which, when it leads to the positioning of a pacemaker, should avoid the onset of syncopal attacks and sudden death which together constitute one of the primary causes of mortality in primary amyloidosis. The length of follow-up in our case has been 14 months (April 1977).
The authors report a case of thrombosis of the left popliteal artery in a man aged 20 years, secondary to repeated minimal trauma from contact with a hypertrophied internal gemellus muscle. A bifurcation abnormality was also present. They review the anatomical variations seen at the end of the femoro-popliteal trunk and define the clinical and angiographic characteristics of popliteal thrombosis due to adjoining muscle hypertrophy.
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