Intestinal intussusception in elderly patients.

Intussusception is the most common cause of bowel obstruction in children, but it is a very rare cause of bowel obstruction in the elderly. Diagnosis is based on a high index of suspicion, complete anamnestic recall, physical examination, and imaging modalities. We find abdominal CT scans to be highly sensitive and accurate for making the diagnosis. Treatment of intussusception in adults is always surgical. Segmental bowel resection must be performed. The extent of resection should include any nonviable bowel as well as the leading point of the intussusception. We present a case of an 82-year-old patient with ileo-cecal intussusception, followed by a discussion of the diagnostic and therapeutic options.

Chlamydia preumoniae in ischemic heart disease.

BACKGROUND: Previous work has suggested an association between Chlamydia pneumoniae infection and coronary artery disease. The infection was demonstrated by titers of antibodies--enzyme-linked immunosorbent assay or immunofluorescence, and polymerase chain reaction--and by the findings of C. pneumoniae in the atherosclerotic plaque. OBJECTIVES: To evaluate the association between chronic infection with C. pneumoniae, as measured by a high titer of IgG antibody, and CAD. Our study was designed to explore the relationship between seropositivity to C. pneumoniae and serious coronary events, and to assess whether or not there may be an additional association between established cardiovascular factors and infection with this organism. METHODS: The serum of 130 patients with proven CAD was tested for the presence of IgG antibodies to C. pneumoniae using an ELISA test. A titer < or = 1:64 using the microinfluorescence method, the recognized "gold standard," correlates with a positive result when using the ELISA method. The mean age was 57 (40-65 years). The patients, 82% male and 18% female, had either myocardial infarction (n = 109) or unstable angina (n = 21) 6 months before the investigation (range 3-24 months). The serum for the control group was obtained from 98 blood donors from the same area matched for age 52 (40-58 years) and sex. The donors had no known cardiac history. RESULTS: In the CAD group 75% of patients were positive for C. pneumoniae compared to 33% in the control group (P = 0.001). No increased correlation could be demonstrated between traditional risk factors and C. pneumoniae infection, except in those patients with diabetes mellitus. We found a lower prevalence of IgG antibody to C. pneumoniae in the diabetes subgroup than in other subgroups (P < 0.006), but a higher prevalence than in the control group. CONCLUSIONS: We demonstrated a more than twofold increase in seropositivity to C. pneumoniae among patients suffering serious coronary events, and this trend was independent of gender, age or ethnic group. These findings suggest that chronic C. pneumoniae infection may be a significant risk factor for the development of CAD, but this correlation should be investigated further.

[Intraoperative evaluation of mitral valve reconstruction using two-dimensional contrast echocardiography]. / Evaluation per-opératoire de la plastie mitrale par l'échocardiographie bidimensionnelle de contraste.

20 patients who underwent reconstructive surgery for mitral regurgitation were peroperatively investigated by contrasted bidimensional echocardiography using intraventricular injection of 20 ml of physiologic saline. Before the valvuloplasty, the peroperative quantitation of mitral leakage was in all cases closely correlated with the data obtained preoperatively. After the mitral reparation, three groups of patients could be observed: group I (12 cases): absent or minimal regurgitation (0-+); group II (5 cases): moderate mitral regurgitation (++); group III (3 cases): marked regurgitation ( - +) necessitating an immediate ECC. In two cases it was possible to improve successfully the valvular function, in the third case valvular replacement was necessary. The correlation between the data of peroperative contrasted echography at one hand and the clinical examination and the postoperative paraclinical investigations on the other hand was excellent in all cases. Thus the contrasted bidimensional peroperative echocardiography represents a reliable method for predicting the immediate results of mitral reconstructive surgery.

[Abnormalities of left ventricular contraction in the mitral valve prolapse syndrome]. / Les anomalies de la contraction ventriculaire gauche dans le syndrome du prolapsus de la valve mitrale.

Left ventricular contraction was studied in 20 patients with mitral valve prolapse presenting with chest pain and/or palpitations. In this group of symptomatic patients systolic abnormalities were observed in 11 patients (55 p. 100): segmental hypokinesis was observed in 5 patients, hyperkinetic motion in 3 patients and an association of hyperkinetic and hypokinetic pareital motion was observed in the other 3 cases. Abnormalities of ventricular relaxation were found in 80 p. 100 patients. In all, 90 p. 100 patients in this selected group demonstrated systolic and/or diastolic abnormalities of the left ventricular myocardium. Symptoms (anginal chest pain, palpitations, neurotic symptoms) appear to be more frequent and more troublesome in patients systolic abnormalities. Hyperkinetic movement may be related to increased levels of circulating catecholamines. Segmental hypokinesis may be the result of focal ischaemia secondary to an abnormality of the coronary microcirculation. Both these abnormalities may be dependant on dysfunction of the autonomic nervous system. Further study is necessary to define the role of the autonomic nervous system in the myocardial abnormalities observed in this valvular syndrome.

[Arrhythmias following closure of atrial septal defects. Apropos of 300 cases]. / Les troubles du rythme après fermeture des communications inter-auriculaires. A propos de 300 cas.

In a series of 300 cases whose atrial septal defects were closed (268 with ostium secundum, 27 with ostium primum, and 5 cases with both), arrhythmias were found in 60%. These were usually slow supraventricular arrhythmias caused by substitution (51%), and less commonly rapid supraventricular arrhythmias (27%), extra-systoles (16%), disorders of atrio-ventricular conduction of second and third degree and disorders of the auricle (6%). Conduction disorders were significantly more common (p less than 0.001) after closure of ostium primum (37%) than after closure of an ostium secundum (4.5%). Arrhythmias are most common during the first week (56%), and are usually of the slow type, and during the three succeeding weeks are markedly less frequent (31%) with a higher proportion (p less than 0.001) of the rapid type. No one anatomical type of ASD was complicated with arrhythmia more than the others. The slow type of arrhythmias occurred in the high ASDs, and the fast type especially amongst elderly patients. Longterm follow-up showed arrhythmias in 28% of patients with an ostium secundum defect. The factors influencing arrhythmias were age, cardiac enlargement, and the mean pulmonary arterial pressure. Arrhythmias were just as common in cases with a small shunt.