[Cardiac findings in bilharziasis without pulmonary arterial hypertension]. / Les signes cardiaques dans la bilharziose en dehors de toute hypertension artérielle pulmonaire.

1. A systematic search was made for cardiac abnormalities (clinical, radiological and ECG) and haemodynamic disorders (catheterisation of the right side of the heart and pulmonary artery) in 37 cases of confirmed biharziasis. It was generally found that:--14 patients (37.8%) had no symptoms;--8 patients (21.6%) had pulmonary hypertension (PH) with the corresponding cardiac signs (these will be reported separately);--15 patients (40.5%) had cardiac signs with no PH; these are studied in this paper. 2. Iatrogenic myocarditis was noted on the ECG. It was found in 3 of the 37 cases (8.1%). This points to the importance of careful monitoring of treatment. There was also ECG evidence of anaemyic myocardial changes in 5 cases of the 37 (13.5%). In 3 of these 5 cases this was found to be due to bleeding. Hypertensive myocardial disease was found in 1 case (2.7%), a patient with renal disease. Myocardial signs were also found in 3 cases because of coexistant disease. 3. Three cases (8.1%) remain in whom there were ECG changes, but without PH and without any other definable cause. These could have been due to bilharzia myocarditis; the authors review the experimental and clinical evidence for such a possibility. The real incidence of this condition remains to be determined. 4. Although there was no such case in this series, the authors suggest that bilharziasis might cause endomyocardial fibrosis (EMCF). 5. The authors put forward the hypothesis that the pulmonary arteritis is a tissue immunological reaction, and also that the myocarditis (and possibly the EMCF) is a manifestation of circulating antibodies.

[Myocardial infarct complicating thrombopenia induced by pentosan polysulfate]. / Infarctus myocardique compliquant une thrombopénie induite par le polysulfate de pentosane.

The authors report a case of thrombopenia induced by pentosane polysulfate (PSP), complicated by a myocardial infarction. Biological tests showed a platelet pro-aggregating effect of PSP and an IgG immunoglobulin fixed to the platelets. A review of the literature shows that PSP-induced thrombopenias must be known as well as those induced by heparins and that they have similar complications. The thrombopenia may persist with an inappropriate substitution with heparin and the clinical picture may be aggravated. It is desirable to carry out systematic screening for a cross-allergy and prevent it by using anti-vitamin K.

[Pheochromocytoma and hyperthyroidism caused by amiodarone]. / Phéochromocytome et hyperthyroïdie à l'amiodarone.

The authors report, in a 66 y. old patient, a case of pheochromocytoma, interesting in that its initial clinical picture is one of amiodarone-induced hyperthyroidism with orthostatic hypotension, and a persisting severe weight loss in spite of the improvement of the thyroid work-up is the indication of an adrenal tumor discovered on tomodensitometry. The accidental combination of these two endocrine diseases delays the already unusual manifestation of this pheochromocytoma and emphasizes the role of radiographic (tomodensitometry) and/or isotopic (MIBG) imaging in the "discovery" of these tumors.

[Vectorcardiography in the diagnosis of the association of inferior necrosis--left intraventricular conduction disorders]. / Apport du vectocardiogramme au diagnostic de l'association nécrose inférieure--troubles de conduction intraventriculaire gauche.

The authors study 53 vectorcardiograms (VCG) which demonstrate the association of inferior myocardial necrosis with left intraventricular conduction disturbances (LIVCD) consisting of 44 left anterior hemi-blocks (LAHB), 2 left posterior hemi-blocks (LPHB) and 7 complete left branch blocks (CLBB). In the presence of LAHB, the ECG and VCG diagnosis concur in 37 cases, with a more obvious appearance on the VCG in 16 cases. In 7 cases, only the VCG provided the diagnosis of this association. In the presence of LPHB, the ECG, in one case, only showed signs of necrosis and only the VCG revealed the hemi-block; in the other case, the ECG showed signs of LPHB, but the Q waves did not present the criteria of necrosis. Once again, only the VCG provided the diagnosis of the association. Finally, in the presence of CLBB, the diagnosis were in agreement in only 3 cases. In two cases, only the VCG revealed the necrosis, in one case, the ECG was superior and in the remaining case, the ECG and the VCG were equally ineffective in confirming the inferior necrosis which was nevertheless definitely present. On the basis of these findings, the authors discuss the ECG criteria of the association of inferior necrosis and LIVCD.

[Treatment of persistent cardiac failure by ultrafiltration]. / Traitement de l'insuffisance cardiaque réfractaire par ultrafiltration.

Ultrafiltration, a method of extra renal filtering, which accomplishes an iso-osmotic removal of water an sodium from the plasma, was used in twelve patients. It is reserved for terminal persistent heart failures. In one case, it preceded a heart transplant. Simple to carry out, this technique is well tolerated when the pulmonary pressure is elevated, respecting an ultrafiltration output inferior or equal to 500 ml/h. Immediate improvement of the patients is spectacular. A new treatment failure may impose long-term ultrafiltration sessions. Failure of the medical treatment, impossibility of heart transplant, must be an indication for ultrafiltration which improves the comfort, and most likely the life expectancy of patients with persistent heart failure.

[Heart and schistosomiasis (author's transl)]. / Coeur et bilharziose.

The review is based on three studies previously reported and involving the clinical, epidemiological and hemodynamic aspects of this problem. Schistosomasis may give frequently (21.6 p. 100) an arterial pulmonary hyperpressure related to the development of granulomas and arteriolitis. A myocarditis may be suspected but is rarely proved. Anemia and specific treatment are also responsible for myocardial deficiency. The parasitic changes of the urinary tract may give a systemic hypertension. Some very rare cases of acute pulmonary heart insufficiency have been reported and the responsibility of schistosomiasis in constrictive fibrous endomyocarditis is still questionned.

[Diseases of the shipwrecked: apropos of 3 cases]. / Pathologie du naufragé: à propos de trois cas.

Three men (31, 34, 36 yr old) were rescued after they had drifted for 50 hours on their wrecked catamaran. While their apparent clinical condition was not worrying, besides multiple bruises, marked dehydration, epigastralgias, mild hypothermia in one patient and 50, severe biological disorders were present in all four: haemoconcentration, functional renal insufficiency, metabolic acidosis, severe rhabdomyolysis, hepatic cytolysis. After intravenous rehydration for 24 hr hydroelectrolytic and acid-base anomalies were corrected. Pathophysiology of shipwreck casualties is recalled. Initial management in ICU is necessary. Psychological and emotional aspects should not be underrated.

[Oxygen supply in war times. Current perspectives]. / L'alimentation en oxygène en temps de guerre. Perspectives actuelles.

The authors report their experience of the use of various sources of oxygen feeding in wartime: a classical feeding by liquid oxygen or by extractive oxygen cylinders; a new type of feeding by oxygen condensers or chemical oxygen. According to their practical experience, each source finds its role in wartime, this role being determined by war conditions.

[Ambulatory colonoscopy under systemic general anesthesia. Our experience apropos of 500 cases]. / Colonoscopie sous anesthésie générale systématique en ambulatoire. Notre expérience à propos de 500 cas.

The authors report a retrospective study of 500 colonoscopies performed on outpatients under general anaesthesia. Anaesthesia protocol associated diluted propofol in continuous titrated infusion and alfentanil. The doses used were relatively low and no serious adverse effects were observed. Therefore this method appears to be appropriate for most outpatients undergoing a colonoscopy provided that usual security rules are respected.

[Study of a protocol of intra-articular analgesia after arthroscopy of the knee]. / Etude d'un protocole d'analgésie intra-articulaire après arthroscopie du genou.

The purpose of this study was to assess the analgesic effects of intra-articular injection of a morphine-bupivacaine combination following knee arthroscopy. 47 patients were evaluated. Knee arthroscopies were all performed under general anaesthesia, using propofol, alfentanil, isoflurane and nitrous oxide. Analgesic effects were evaluated by a visual analogic pain scale. Serum bupivacaine was measured during the first 8 postoperative hours. Analgesia was good in the immediate postoperative period, with minimal side effects. The serum bupivacaine levels were low. However the analgesic efficacy of intra-articular injection of morphine-bupivacaine should be corroborated through a double blind study.

[Systematic cardiologic study in 37 schistosomiasis patients]. / Etude cardiologique systématique chez 37 malades bilharziens.

1) A systematic search was made for cardiac abnormalities (clinical, radiological and EKG) and for haemodynamic disorders (catheterisation of the right side of the heart and pulmonary artery). It was generally found that: -- 14 patients (37.8%) had no symptoms; -- 8 patients (21.6%) had pulmonary arterial hypertension (PAHT) with the corresponding cardiac signs; -- 15 patients (40.5%) had cardiac signs with no evidence of PAHT. 2) The 8 patients with PAHT (21.6%) had precapillary type of PAHT with an arteriocapillary gradient. The symptoms were those of PAHT and of the right ventricular failure; but this desorder could be latent. PAHT can be in relation with inflammatory lesions. In these 8 patients, S. Mansoni was to blame in 6 cases and 5 S. Hematobium in 2. 3) In 9 patients (24.3%), cardiac signs were connected indirectly with bilharziasis by anemia, iatrogenic injury or hypertensive myocardial disease of renal origin. 4) In 3 patients (8.1%), cardiac signs were found because of coexistant disease. 5) In 3 patients (8.1%), cardiac signs could have been due to bilharzia myocarditis. The authors reviewed the experimental and clinical discussions for such a possibility.

[Unusual aspects of Burkitt's disease in Mauritania]. / Aspects particuliers de la maladie de Burkitt en Mauritanie.

The authors report on four observations on Burkitt's lymphoma fro Mauritania: three nodes lymphoma and one abdomen tumor. Mauritania climatic conditions are far from climatic conditions suitable to Burkitt's lymphoma development. Classical monochemotherapy (cyclophosphamide or methotrexate) were inefficient. Therefore, the authors suggest to utilise a polychemotherapy including cyclophosphamide, adriamycin, VM 26, and prednisone.