[Interstitial lung disease and pancreatic cancer: Series of two cases]. / Pneumopathie infiltrante diffuse et cancer du pancréas : présentation de deux cas.

INTRODUCTION: Pancreatic cancer is often not diagnosed until at a metastatic stage at which point the prognosis is very poor. Pulmonary metastases are pleomorphic, often present at the time of diagnosis and can lead to the discovery of an asymptomatic primary disease. CASE REPORT: We describe two cases aged 60 and 74 years, where imaging identified what was thought to be an interstitial lung disease but which was actually metastasis from pancreatic cancer. In the first case, CT showed multiple excavated pulmonary nodules but the presentation with medullary compression led rapidly to pathological diagnosis on bone lesions. In the second patient, a history of rheumatoid arthritis and the lack of abdominal symptoms led to an initial search for disease related to the rheumatoid disease. Histopathology, from lung and bone biopsies, enabled a correct diagnosis to be achieved. CONCLUSION: Where atypical interstitial lung disease occurs, biopsy should be considered in order not to delay a diagnosis of cancer, especially pancreatic cancer.

[Complementary value of the isoprenaline test and high-amplification ECG in the diagnosis of arrhythmogenic dysplasia of the right ventricle]. / Valeur complémentaire du test à l'isoprénaline et de l'ECG à haute amplification dans le diagnostic de la dysplasie arythmogène du ventricule droit.

Arrhythmogenic dysplasia of the right ventricle is a common cause of ventricular arrhythmia. It is important to reach a diagnosis, due to the risk of sudden death, particularly as this may be the first sign of the disease. Diagnosis is based on the angiographic demonstration of a morphological or structural abnormality of the right ventricle, and non-invasive tests are relatively insensitive. From a case investigated in 1984, the authors carried out a prospective determination of the diagnostic value of the isoprenaline test in 61 patients suffering from arrhythmogenic dysplasia of the right dysplasia confirmed by angiography. High concentrations (8-30 micrograms/min) of isoprenaline were continuously infused over a period of 3 minutes, regardless of the heart rate achieved. In a control group of 50 subjects with no myocardial disorder, isoprenaline induced monomorphic wave-burst arrhythmia in only one patient (2%). In the subjects affected by right ventricular arrhythmogenic dysplasia, isoprenaline induced one or more episodes of wave-burst ventricular arrhythmia in 52 patients (85%): one triplet in four patients, several episodes of wave-burst arrhythmia in 31 patients and prolonged ventricular tachycardia in 17 patients. Polymorphic arrhythmia occurred in 80% of cases, but left lag forms predominated. High-amplification ECG demonstrated late potentials in 66% of cases, i.e. in 80 and 62% of patients with and without prolonged VT respectively. The isoprenaline test or high-amplification ECG gave abnormal results in 58 of the 61 patients, with a cumulative sensitivity of 95 percent.

[Apropos of a rare cause of torsades de pointe: hypokalemia caused by dietary deficiency]. / A propos d'une cause rare de torsade de pointe: hypokaliémie par carence d'apport alimentaire.

The authors report a case of wave burst arrhythmia in a young immigrant woman of Laotian origin aged 32. The main cause of the arrhythmia was related to potassium deficiency of dietary origin. Some contributory factors may have had a promoting effect: theophylline treatment, beta-mimetics and adrenaline (epinephrine). This case can therefore be related to the cases of wave burst arrhythmia and hypokalemia previously reported in anorexic subjects. This case suggests that special attention should be paid to the diet of some ethnic groups who have been displaced by economic causes. Their very unusual dietary habits may induce or aggravate hypokalemia, which may also be promoted in some cases by drugs. Some treatments should therefore be introduced with caution in this context due to the potential risk of inducing severe arrhythmia.

[Major tricuspid insufficiency and absence of systolic valvular coaptation. Echocardiographic study. Apropos of 6 cases]. / Insuffisance tricuspidienne majeure et absence de coaptation valvulaire systolique. Etude échocardiographique. A propos de 6 observations.

In a retrospective series of 960 cases of tricuspid regurgitation studied by two-dimensional echocardiography 6 patients presented a systolic defect of valvular coaptation. The origin of this defect varied: one case was due to carcinoid, two to rheumatic cardiopathy, two to papyraceous right ventricle and one to sclerodermia associated with pulmonary arterial hypertension. The mechanism of the lacking coaptation varies according to the etiology: valvular retraction in carcinoid cardiopathy, right-ventricle dilatation, dilatation of the tricuspid ring and altered kinetics of the right ventricle in the other cases. Changed contractility of the right ventricle is the only element allowing to distinguish tricuspid regurgitation with and without a coaptation defect. Clinically this abnormality always points to an advanced stage of severe tricuspid regurgitation.