[Glycyrrhizine poisoning (apropos of 3 cases)].
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Biomedical subjects
Publications and source records attributed to H Warembourg.
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The action of the contrast material over the various contractility indices was assessed five minutes after left ventriculography. There was an increase of the contractility index in normal subjects. On the contrary, in coronary patients, the contractility function remained unchanged or was depressed, related to the presence or not, of signs of cardiac failure. Depression of the various indices was noted in subjects with primary cardiomyopathy. After recalling the mechanism of action of the contrast products on the cardiovascular haemodynamic parameters, the following practical conclusions were drawn in relation with a series of 65 cases of coronary heart disease: the late diastolic left ventricular pressure remained lower than 20 mmHg after ventriculography in the subjects with a normal ejection fraction; it incraeased between 20 and 30 mmHg in most of the subjects with an ejection fraction ranging from 0.4 and 0.6, finally it was constantly found above 35 mmHg in the subjects with severely disturbed ventricular contraction with an ejection fraction lower than 0.4. These results underline the interest of this simple test, easy to perform, consisting in measuring the left ventricular late diastolic pressure before and 5 minutes after left ventriculography.
Three cases of aneurysm of the membranous septum were diagnosed in vivo. The fourth case was discovered at post-mortem examination in a patient who had a conductive disorder. These four cases give us reason to review the anatomical, clinical, radiological and haemodynamic features of this condition.
An anatomical study of the conducting pathways was carried out in a case of Steinert's disease complicated by a complete atrio-ventricular block with syncope. Electrical study of the potentials in the bundle of His located the block within and below the bundle. When the patient died, an anatomical study of the conducting pathways was carried out. There were foci of fibrosis mainly within the conducting system, but these changes were moderately marked only, and seemed to be the final stage of a disorder which was not itself visible optically. The basic underlying pathological process is probably biochemical, and the lesions seen microscopically are simply a late sign of the disorder.
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A histological study of the conduction pathways was performed by serial sections in two patients who died with atrio-ventricular block in the course of rhumatoid arthritis. In the first case, the conduction disturbance was preceded by attacks of supra-ventricular paroxysmal tachycardia. The His-Tawara system was wholly infiltrated by a cast of lympho-plamocytes starting from rhumatoid nodules located at the base of both mitral and tricuspid valves and at the root of the aorta. The sinus node was the seat of a common fibrosis. In the second case, the atrio-ventricular block was secondary to amylosis which predominated in the central fibrous node and in the adjacent small coronary vessels. The His-Tawara system was completely destroyed down to its bifurcation. The sinus node was normal.
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