[Unexplained pulmonary edema: demonstration of obstruction to pulmonary venous return by transesophageal echocardiography. Apropos of 4 cases]. / Oedèmes pulmonaires inexpliqués: mise en évidence d'une gêne au retour veineux pulmonaire par échocardiographie transoesophagienne. A propos de quatre observations.

The usual causes of pulmonary edema are left ventricular dysfunction, mitral valve disease or left atrial myxoma. Obstruction to pulmonary venous drainage is a rare and unrecognised diagnosis which should be considered when the usual investigations are unproductive. The authors report four cases in which transesophageal echocardiography showed pulmonary edema to be due to compression of one or more pulmonary veins by a mediastinal mass (2 cases), by the false lumen of dissection of the aorta (1 case) and postoperative stenosis of the pulmonary veins (1 case). These cases underline the diagnostic value of this technique which rapidly provides diagnostic information with privileged visualisation of the pulmonary veins and abnormalities of acceleration of blood velocities in the Doppler mode due to obstruction.

[Amiodarone and hyperthyroidism]. / Amiodarone et hyperthryroïdie.

22 cases of hyperthyroidism occurring during or following treatment with amiodarone are reported and compared with more than 15 cases in the literature. The specific clinical features of these cases of hyperthyroidism are presented and the problems in interpretation of the laboratory thyroid function tests are discussed. A study of the course of these cases reveals a number of prognostic factors. Finally, the authors describe the practical management of this form of hyperthyroidism.

[Venous homografts as femoro-popliteal bypasses or as vascular access routes in chronic hemodialysis]. / Les homogreffes veineuses comme pontages fémoro-poplités ou comme abords vasculaires pour l'hémodialyse itérative.

Saphenous vein homografts preserved by freezing at 40 degrees C in the presence of antibiotics for periods of as much as six months were implanted as part of a clinical evaluation program. Candidates included one requiring femoro-popliteal reconstruction with two separate bypass procedure and reoperations for thrombosis and false aneurysm in the left limb as well as 23 maintenance hemodialysis patients (32 arteriovenous blood access shunts for a total of 424 patient-months). Explanted veins used as femoro-popliteal bypasses were examined after collection incidental to reoperations and autopsy. In-vivo dwell time varied between 7 and 51 months. The femoro-popliteal by-passes exhibited calcification and sclerosis. The dialysis access shunts had average service lives of about a year; 21 were replaced because of thrombosis, 10 were stenosed, 7 had aneurysms and necrosis was present in six. Although this implant provides a workable alternative approach to vascular reconstruction, the rapid degeneration of such veins in vivo is a limitation.

[Automatic retroversion of the femur neck during fasciculated nailing of pertrochanteric fractures by the Ender method]. / La rétroversion automatique du col fémoral lors de l'enclouage fasciculé selon Ender des fractures per-trochantériennes.

The shape of the standard Ender nail may result in malunion in external rotation in intertrochanteric fractures treated with this device. The nail is curved in one plane, and is usually introduced into the femur without making allowance for the bowing of the diaphysis and the anteversion present in the neck. We have measured radiographically the anteversion of the femoral neck in three groups of patients after operation using Ender nails, and also assessed the anteversion of the unoperated hip for comparison. In Group I normal Ender nails were used. The operated hip showed an average of 12 degrees of retroversion compared with the opposite side. In Group II the nails were bent anteriorly at their upper end, but an average retroversion of 14 degrees was produced compared with the other hip. In Group III the nails were bent to produce anterior bowing as well as proximal anteversion. The group showed retroversion of only 1 degree compared with the normal side. We therefore recommend that Ender nails be bent in this manner in order to reduce rotatory malunion when used for intertrochanteric fractures of the neck of the femur.

[False images of foreign bodies of plant matter in the limbs of children. Apropos of 3 case reports]. / Masque trompeur des corps étrangers végétaux des membres chez l'enfant. A propos de trois observations.

Vegetal foreign bodies in the limbs cannot be demonstrated by X-ray examination and may lead to erroneous diagnosis. The answer should be given by surgical exploration, however, and this is particularly true for mobile foreign bodies in the joint, a high degree of suspicion is necessary at surgery. Three observations are presented in this paper which emphasize practical recommendations to perform without delay the simple efficient surgical procedure consisting in removal of the foreign body.

[Effect of metoclopramide in a subject at risk for Huntington's chorea]. / Effet de la métoclopramide chez un sujet à risque de chorée de Huntington.

Because of vomiting, a 15 years old girl inserted one metoclopramide suppository. Her mother has Huntington's chorea. She had a transient choreiform syndrome. Could latent Huntington's chorea be revealed by this drug?

[Value of herniography in the therapeutic management of inguinal hernias in young girls. Apropos of 148 cases]. / Intérêt de la herniographie dans la conduite thérapeutique des hernies inguinales de la fille. A propos de 148 observations.

The authors report a study on 148 female children demonstrating clinical evidence for inguinal hernias. The diagnosis was evaluated using Ducharme-Bensoussan's procedure for herniography hernia was documented in 143 cases, so which 44% revealed genital tract content. Eight cases produces unrelated pathological findings, especially crural hernia, nephro-uropathy diaphragmatic hernia. However, the main interest of the procedure is in evaluating the controlateral inguinal canal. Whereas three infants presented with bilateral symptoms, bilateral hernia was proven in 66 cases (46,2%) by herniography. In this way, the procedure is a sure way to ensure that hernia is really unilateral and to prevent any controlateral recur in the coming months.

MR patterns of dialysis arthropathy.

Ten patients (average age 51 years) on long-term hemodialysis (average duration 13.5 years) were examined by magnetic resonance (MR) (all cases) and CT (five cases) for cystic radiolucencies of the wrist, shoulders, and hips. MR and CT revealed more lesions of smaller size than plain films and both showed a constant communication with the joint space. Synovial hypertrophy was generally absent or very mild even in the case of large osseous erosions. The MR analysis of the content of the lesions in the wrist was quite variable: low signal on T1- and T2-weighted images (12 of 24), low signal on T1- and high signal on T2-weighted images (10 of 24), and high signal on T1- and T2-weighted images (2 of 24). The patterns of transplanted (four cases) or ungrafted (six cases) patients were indistinguishable. These results suggest an articular origin of the lesions, but different from synovial processes such as rheumatoid arthritis, and confirm their probable multifactorial pathogenesis.

[Right coronary-cardiac fistulae. Anatomic and clinical study, course and therapy. Apropos of 3 new cases]. / Les fistules coronaro-cardiaques droites. Etude anatomo-clinique evolutive et thérapeutique. A propos de trois nouveaux cas.

Three cases of coronary-cardiac fistulae diagnosed in the Cardiologic Unit of the Dijon University Hospital are reported. With reference to these cases current knowledge on this rare condition is reviewed. Symptomatology is variable, with sometimes only a systolic and diastolic murmur on the sternal border, usually with good functional tolerance. A thorough investigation, including left angiography, ascertains diagnosis and shows the exact nature of the lesions. Surgery is almost always advocated as it often ensures good results and avoids delayed complications, which are mainly heart failure by coronary insufficiency, and infectious endocarditis.