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[Conduction disorders in chronic parietal endocarditis or endomyocardial fibrosis. 170 cases at the Cardiology Institute of Abidjan].

The authors have conducted research on conduction disturbances in the endomyocardial fibrosis, synonymous with chronic parietal endocarditis, about 170 cases at the Institute of Cardiology in Abidjan, from January 1977 to June 1991. The anatomical and/or angiographic examination have permitted to describe 64 cases of right fibrosis, 24 cases of left fibrosis and 82 cases of bilateral fibrosis. Conduction anomalies have been observed among 42.9% of the patients. Among 92 anomalies recorded, the most frequent has been the first degree heart block (43.5%) and the incomplete right bundle branch block (30.4%). The old age of the patients and the right localization were the factors associated with conduction disturbances in endomyocardial fibrosis (difference not significant). Yet, fibrosis surgery, especially the decortication of the fibrous endocardium of the right ventricle, have generated one or many conduction anomalies among most of our operated patients. The right branch of the fasciculus of the His has been the most injured by the fragmented techniques of METRAS who had, therefore, the merit to have minimized the incidence of the complete post-operative heart blocks still high in European and Brazilian series. In term of prognosis, no conduction disturbance has directly caused a patient's death, even if those anomalies cannot be totally ruled out in the 16 cases of sudden death.

Adolescent↗

[Short and long-term prognosis of intraventricular conduction disorders in the acute stage of myocardial infarct].

The short- and long-term prognosis of acute intraventricular (iv) conduction defects is analyzed in 59 patients admitted to the coronary care unit with acute myocardial infarction. In-hosptial mortality of patients with iv conduction disturbances was more than twice (30%) the mortality of patients without iv conduction defects (13%; p less than 0.001). Mortality was very high among patients with all forms of incomplete trifascicular block or complete right bundle branch block. Among survivors of the group with conduction defects, the late death rate was significantly higher than in survivors of the group without conduction disturbances (25% and 8% respectively: p less than 0.001). The short- and long-term prognosis of acute conduction defects in myocardial infarction depends on the extent of necrosis. Permanent endocardial pacing is therefore indicated only among patients whose death risk is related to conduction disturbances.

Acute Disease↗

[Hypotension controlled with ATP in orthopedic surgery: incidence of atrio-ventricular conduction disorders].

Adenosine triphosphate (ATP) has been effectively used for induced hypotension in man. Atrio-Ventricular (A-V) conduction disturbances have been observed after adenosine bolus injection and during continuous ATP i.v. infusion. The present perspective investigation was designed to determine the incidence of A-V conduction disturbances during ATP-induced hypotension. Thirty-five normotensive healthy patients (ASA I-II) with no preoperative therapy were subjected to the same anesthetic technique for orthopedic surgery. Premedication consisted of diazepam and atropine. Anesthesia was induced with thiopental and fentanyl followed by atracurium for intubation. The maintenance anesthesia consisted of isoflurane (1.5% inspired)-N2O (60%) in oxygen and incremental doses of fentanyl; the lungs were mechanically ventilated. Dipyridamole (0.15 mg kg-1) was given 15 min prior to ATP-infusion. ATP was administered by an infusion pump at a dosage of 0.025-0.05 mg kg-1 min-1. The ECG was recorded with a Mingograph 34 tape-recorder using 3 pregelled electrodes positioned to give an effective V6 lead pattern. MAP was reduced by 25% and HR increased by 6%. The mean duration of ATP-induced hypotension was 75 min +/- 50 and the mean dose of ATP infused was 200 mg +/- 161. Six patients (17%) showed A-V conduction disturbances. There was a I A-V Block (AVB) in 2 cases, a II AVB in 2 cases and a III AVB in 2 cases. In every case the arrhythmia disappeared spontaneously or after ATP-infusion suspension.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗

Conduct disorder with and without mania in a referred sample of ADHD children.

OBJECTIVE: To test the hypothesis that dysphoric and non-dysphoric types of CD could be distinguished from one another in their patterns of familiality, adversity, and comorbidity. METHODS: We examined 140 ADHD and 120 normal controls at baseline and 4 years later using assessments from multiple domains. We compared ADHD subgroups with and without conduct (CD) and bipolar (BPD) disorders on psychiatric outcomes at a 4-year follow-up, familial psychopathology and psychosocial functioning. RESULTS: We found that ADHD children with both disorders had higher familial and personal risk for mood disorders than those with CD only, who had a higher personal risk for antisocial personality disorder. Among ADHD probands, having both CD and BPD was associated with poorer functioning and an increased risk for psychiatric hospitalization. DISCUSSION: Although preliminary, our findings suggest that the distinction between dysphoric and non-dysphoric CD may be clinically meaningful. If confirmed, our findings could have important diagnostic and therapeutic implications for the management of antisocial youth.

Attention Deficit Disorder with Hyperactivity↗

Reading, spelling, and vigilance in attention deficit and conduct disorder.

A group of 51 male children, average age 9.1 years, presenting at a child psychiatric clinic because of attention and conduct problems were investigated for reading and phonetic spelling ability, vigilance, and intellectual level. Each child was given a DSM-III diagnosis prior to being tested. The Boder Test of Reading and Spelling patterns was used to obtain scores for reading age, number of syllables read correctly in the word list at the child's reading level, and number of phonetically correct syllables spelled in the known and unknown word lists, at and just above the child's reading level. A factor analysis with varimax rotation produced two significant factors, a Reading factor with high loadings for verbal and reading scores, aand a second Vigilance factor. Phonetic spelling ability loaded separately from reading into the Vigilance factor. The Vigilance factor was significantly related to the diagnosis of moderate and severe attention deficit disorder with hyperactivity (ADDH). The correlation of short-term working memory with vigilance in moderate to severe ADDH children is discussed.

Achievement↗