[Pure hypertensive nephropathy associated with malignant arterial hypertension in disseminated lupus erythematosus. Case with a favorable outcome]. / Néphropathie hypertensive pure, contemporaine d'une hypertension artérielle maligne au cours d'un lupus érythémateux disséminé. Une observation d'évolution favorable.

The authors report the association of a clinically florid form of lupus with malignant hypertension and renal failure. The renal histology revealed lesions of nephroangiosclerosis, with virtually no signs of lupus proliferative glomerulonephritis. With a follow-up period of 42 months, the renal function has returned to normal, although steroid treatment has been interrupted for 33 months. However, intensive antihypertensive treatment is still required. This unusual case is discussed in the light of previous reports in the literature of the association of disseminated lupus erythematosus and malignant hypertension, which is nevertheless a rare entity.

[Yersinia enterocolitica septicemia occurring in a hospital milieu. A case with septic shock in an immunocompromised patient]. / Septicémie à Yersinia enterocolitica survenue en milieu hospitalier. Une observation avec choc septique chez un malade immunodéprimé.

A case of Yersinia enterocolitica septicemia is reported. This case is unusual as the infection was apparently acquired within the hospital and septic shock occurred during the course. Immunodeficiency, which is nearly consistent in similar observations and was established in the index case, was apparently caused by protein-calorie deficiency, without any of the usual associations reported in the literature.

[Peritonitis encapsulans]. / Péritonite encapsulante.

Encapsulating peritonitis is characterized by the formation of a membrane which encases all or part of the abdominal viscera. It is a fibrous perivisceritis. It may answer to many different causes. Tuberculosis, though often considered, is only infrequently ascertained. Other etiologies are: trauma, colitis, jejuno-ileitis, appendicitis, etc. The clinical presentation is a subocclusive syndrome with, in some instances, a fixed abdominal mass giving a paradoxically resonant percussion note. Roentgenograms show gastroduodenal displacement, signs of stenosis, and agglutinated small bowel loops. The best procedure is excision of the membrane with complete decortication. Subsequently, the main risk is recurrence of bowel obstruction.

[Congestive heart failure due to chronic alcoholism (author's transl)]. / L'insuffisance cardiaque congestive due à l'alcoolisme chronique.

In rare instances, chronic alcoholism leads to the congestive heart failure which is characteristic of alcoholic beriberi with edema. The affected patients is usually a young man with longstanding alcoholic intoxication and often with neurologic features. Onset is often sudden, with dyspnea on exertion, orthopnea, and palpitations. The clinical sings of cardiac failure are unequivocal. Roentgenography shows cardiomegaly mainly due to enlargement of the right cavities and of the pulmonary artery. ECG shows sinus tachycardia and abnormal repolarisation in the precordium. The cardiac output and the cardiac index are increased, as well as the coronary output. Pyruvic acid levels exceed 15 mg/l, the provoked hyperpyruvicemia test is abnormal, thiamine levels are low, and the tryptophane test is normal. The course is variable. Cardiac beriberi progresses by exacerbation and remissions. Prognosis is poor, with a risk of sudden death. However, with adequate treatment combining rest, a low sodium diet, alcohol withdrawal, diuretics, and vitamin B1 (IV) recovery occurs. Our two observations clearly fit this description.

[Professional future after myocardial infarction (author's transl)]. / Devenir professionnel des patients victimes d'infarctus du myocarde (d'après quatre-vingt-six cas).

After a first myocardial infarction, the professional future of 86 patients is studied. 80 men and 6 women are included in the study. The mean age is 50.68 years. Manual workers prevail among affected patients, regardless of their age or of the site of the infarct. 78% of patients under 60 years resumed work, during the first threa months in more than half the cases, without any readjustments. The mean age of patients who resumed work is 47.6 years. Work was more often completely discontinued among office clerks and business managers than among other professions. Difficulties in finding readjusted jobs are greater for manual workers, especially if they belong to a small firm or if they are over 50. From a psychological and professional point of view, rehabilitation should be included in the management of myocardial infarction, even if it's impact on long-term mortality remains unknown.

[Mitral valve prolapse and severe rhythmic trouble (author's transl)]. / Prolapsus mitral et trouble du rythme grave.

Mitral valve prolapse is usually a benign affection, and yet but rather seldom, severe rhythmic troubles and even a sudden death may happen. The authors relate an observation about a seventeen years old young man presenting syncopes caused by ventricular fibrillation fit. The existence of a mitral valve prolapse is demonstrated by phonomecanogram and specially by echocardiogram which shows a telesystolic depression of the small valve. The observation is followed by commentaries about the frequency and clinic of Barlow syndrome. The rhythmic troubles liable to accompany this mitral damage are analysed and so is the evaluation of the risk of a sudden death by ventricular fibrillation.

[Secondary pericarditis after myocardial infarction (author's transl)]. / Les péricardites secondaires à un infarctus du myocarde.

Our study concerns 480 observations about myocardial infarctions. In 10% of the cases, we have found a premature pericarditis diagnosed on the pericardic friction, electric and biologic signes. Some complications such as rythmical troubles, left ventricular dificiency, parietal anevrism are more frequent and increase the prognosis. In 1,2% of the cases, we find a post-infarction syndrom of Dressler, the prognosis of which is mild. The diagnosis is founded on the revival of the thoracic pain, the fever, the pericarditis and an inflammatory syndrom. The corticothérapy is efficient but seems to favour relapses.

[Primary hyperaldosteronism with paroxysmal arterial hypertension. Apropos of 2 operated cases]. / Hyperaldostéronisme primaire avec hypertension artérielle paroxystique. A propos de deux cas opérés.

Primary hyperaldosteronism usually causes moderate hypertension. It is rare to note as in our two patients intermittent attacks of paroxysmal hypertension. The diagnosis of aldosteronism will be suspected on the finding of persistent hypokalemia with acidosis. It will be confirmed by laboratory examinations severe fall in plasma renin activity and rise in aldosterone in the adrenal veins. To determine the affected side, one may carry out adrenal phlebography which is a difficult technic, and/or a scan using iodine cholesterol which is benign and precise. Surgery with removal of the adenomatous hyperplasia in one case and of an adenoma in the other, gave one very good result.

[Ebstein's disease. Study of 5 personal cases]. / La maladie d'Ebstein. Etude de cinq observations personnelles.

Ebstein's disease is a frequently cyanotic form of congenital heart disease. The lesions consist of low implantation in the right ventricle of the tricuspid valves, often associated with an atrial septal defect. Our five cases (two men and 3 women) had a variable clinical presentation depending on the degree of the variable clinical presentation depending on the degree of the lesions. A fairly exceptional fact should be emphasised, which is that 3 of our patients brought to term or almost to term 3 pregnancies and gave birth to live children. Ebstein's disease should be suspected when a large heart with a rugby football shape is discovered on X ray and E.C.G., together with right atrial hypertrophy, frequent elongation of the P-R interval, low voltage and complete right bundle branch block. The diagnosis can be confirmed by angiocardiography and catheterisation. Angiocardiography shows a large right atrium and a distal right ventricle in the form of a small chamber with thin walls. Catheterisation is essential and detects the atrial septal defect in 80% of cases and a pressure gradiant intermediate between atrial and ventricular pressures, revealing ventricular morphology. Surgical treatment will be either palliative (cavo-pulmonary anastomosis) or curative: Hunter's operation (Lillehei-Hardy) implantation of the tricuspid on the atrio-ventricular ring. The prognosis is then worse.