[Echocardiography and connective tissue diseases]. / Echocardiographie et maladies du tissu conjonctif.

The aim of this study is to show the clinical value of the echocardiography in the heritable disorders of connective tissue, within a series of 10 cases, from 7,500 echocardiograms reviewed between 1978 and 1985. Echocardiography visualized an aneurysm of the ascending aorta in three patients, a dilatation of the pulmonary artery in one case, a mitral valve prolapse in six patients associated with an aortic and tricuspid valve prolapse in two cases, and a tricuspid valve prolapse and aortic regurgitation in one case. In two patients, an aortic valve prolapse was isolated. Other echocardiographic features were intracardiac calcifications (4 cases), septal hypertrophy (2 cases) and an incompetent foramen ovale (2 cases). Echocardiographic examination must be performed in all connective tissue diseases because cardiovascular complications are responsible for the vast majority of deaths. Conversely, all the patients with valvular prolapse, dilatation of the great vessels, aneurysm of the sinuses of Valsalva or congenital heart defects type incompetent foramen ovale should be suspected of connective tissue disorders. Such diagnosis is crucial when a surgical intervention is being considered because of the fragility of the tissues.

[Effects of the artificial pancreas on peripheral nerve function in the diabetic]. / Effets du pancréas artificiel sur les fonctions nerveuses périphériques chez le diabétique.

Twenty-one diabetic subjects were studied; all manifested fasting hyperglycemia and elevated Hb A1C. Motor conduction velocity of the median, ulnar and peroneal nerves; F wave of the peroneal nerve; sensory conduction velocity and sensory potential amplitude of the median and ulnar nerves and H reflex were determinated immediately before and after two days of strict glucose control with an artificial endocrine pancreas. A significant and acute improvement of some electrophysiological parameters led us to presume that repair of structural lesions would be unlikely. Only a metabolic disturbance, due to hyperglycemia, can be rapidly corrected.

[Prognosis of generalized scleroderma. A retrospective study of 78 cases]. / Pronostic de la sclérodermie généralisée. Etude rétrospective de 78 observations.

From 1960 to 1984, 78 new patients with progressive systemic sclerosis were followed up: 60 women and 18 men whose ages ranged from 20 to 83 years, with a mean age of 58 years. Twenty nine are known to be dead and 3 were lost of follow-up. Forty six have been followed up to the present time for a mean period of 5 years. The cumulative survival rates were 88 +/- 7 p. 100 at one year, 62,5 +/- 11,5 p. 100 at five years and 50,5 +/- 15 p. 100 at ten years. These figures are significantly different from those found in a matched group from the French general population. Nine features at the time of diagnosis which might influence prognosis were studied. Seven factors apparently have not affected prognosis: sex, age, time elapsed between initial symptom and definitive diagnosis, location of scleroderma, blood pressure, erythrocyte sedimentation rate and creatinine clearance. On the other hand, survival declined significantly faster in the 28 patients with anemia than in the 50 patients without anemia (P less than 0,001). Similarly, the 47 patients with radiological pulmonary involvement or pulmonary function abnormalities were at significantly higher risk for death than the 31 patients without interstitial pulmonary fibrosis. Anemia and pulmonary involvement are predictors of mortality and important prognostic tools in the management of the different drugs that have been recommended for the treatment of patients with systemic sclerosis.

Atenolol induced systemic lupus erythematosus syndrome.

We report the first case of an illness resembling idiopathic lupus erythematosus, with fever, pleuropericarditis, antinuclear antibodies and antidenaturated DNA antibodies after 18 months of treatment with atenolol for hypertension. After withdrawal of atenolol our patient's clinical symptoms disappeared and laboratory test results returned to normal, which strongly suggests the role of atenolol in inducing the syndrome, therefore atenolol should be added to the list of beta blocking agents capable of inducing a lupus-like syndrome.

[Assay of urinary iodides by specific electrodes: its value in dysthyroidism]. / Dosage des iodures urinaires par électrode spécifique: son intérêt au cours des dysthyroïdies.

A simple and reliable electrochemical urinary iodides determination method, using a crystalline membrane specific electrode is proposed. Normal adult values are determined. Determinations performed on 74 patients with an excess iodine induced hyperthyroidism show that urinary iodides determination is a good clinical evolution marker.

[Blink reflex and stimulus detection by the facial nerve in 21 diabetics. Testing before and after precise blood sugar normalization by the artificial pancreas]. / Réflexe de clignement et stimulodétection du nerf facial chez 21 diabétiques. Etude avant et après normalisation glycémique stricte par pancréas artificiel.

Study of the blink reflex and stimulodetection of the facial nerve in 21 diabetics with chronic hyperglycemia (HbA1C: 12.17 +/- 2.34%) shows normal or slightly prolonged R1, R2 and M latent periods in most cases. Forty-eight hour metabolic correction by artificial pancreas produces an overall improvement in the latent periods of the blink reflex, while the motor latent period of the facial nerve remained unchanged. The improvement, also observed in studies of limb responses, points towards a metabolic process directly related to the hyperglycemia.

[Cardiac manifestations of chronic atrophic polychondritis]. / Les manifestations cardiaques de la polychondrite chronique atrophiante.

The authors present a case of chronic atrophic polychondritis with cardiovascular complications, consisting of aortic incompetence due to dilatation of the aortic ring associated with an aneurysm of the ascending aorta and a first degree atrio-ventricular block occurring six months after the onset of the disease. The progression towards heart failure resulted in the replacement of the ascending aorta and of the aortic valve. The authors discuss the cardiovascular complications of this disease.

[Cardiac insufficiency in infectious endocarditis]. / L'insuffisance cardiaque dans l'endocardite infectieuse.

The aim of this study of 101 cases of infective endocarditis was to determine the factors predisposing to cardiac failure, the prognostic factors of this complication and the therapeutic implications. A significant (p less than 0.05) Chi square test was the statistical reference. Fifty-two per cent of patients developed cardiac failure which was biventricular in 48 p. 100 of cases and the presenting symptom in 64 p. 100. The mean age of the patients with cardiac failure was 56.6 years with a clear male predominance. In 48 p. 100 of cases, cardiac failure complicated a pre-existing cardiac lesion which was usually acquired (84 p. 100). The commonest condition was valvular insufficiency of the aortic and mitral valves (70 p. 100 of cases with cardiac failure). Severe cardiac failure was observed more frequently and earlier in aortic than in mitral regurgitation. The commonest infecting organism was the streptococcus (53 p. 100 of cases with cardiac failure) and the most frequent presumed portal of entry was dental (25 p. 100). Arrhythmias were observed in 51 p. 100 of patients in cardiac failure, the commonest being atrial fibrillation (34 p. 100) complicating mitral valve disease in 56 p. 100 of cases; 17 p. 100 of arrhythmias were ventricular. Conduction defects were observed in 26 p. 100 of cases with cardiac failure, 55 p. 100 of which had aortic valve disease. Valvular vegetations were demonstrated by echocardiography in 43 p. 100 of cases with cardiac failure. Valve replacement had to be performed for resistant cardiac failure in 13 p. 100 of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Current aspects of infectious endocarditis. Review of 101 cases]. / Aspects actuels des endocardites infectieuses. Revue de 101 observations.

One hundred and one cases of infectious endocarditis were reviewed, from 1966 to 1982. The mean age of the patients was 56.3 +/- 15 years. There was a marked predominance of men (70.2 p. 100); the commonest portal of entry was dental (45.9 p. 100); the number of iatrogenic portals of entry and cases of endocarditis on prosthetic valves has been increasing in recent years. Blood cultures were positive in 83 p. 100 of cases; the commonest responsible organism was the non-D streptococcus (31 p. 100 of cases) followed by the D streptococcus (18.8 p. 100), the staphylococcus aureus (17.8 p. 100), and the staphylococcus epidermidis (2.9 p. 100). Gram-negative bacilli were isolated in 9.9 p. 100 of cases. Rare and slow growing organisms have been isolated since 1977. Echocardiography was then introduced and helped the diagnostic in 70 p. 100 of cases. Circulating immune complexes were measured in 25 patients and were found to be raised in 14 cases (56 p. 100). The commonest complication was cardiac failure (43 p. 100) which led to valve replacement in the acute phase in 14 p. 100 of cases. The occurrence of cardiac arrhythmias was a poor prognostic factor. The other complications were neurological (15 p. 100), renal (10 p. 100), embolic (19 p. 100), and pulmonary (9 p. 100). The mortality rate in the acute phase was 30 p. 100 and the probability of a five year survival was 54 p. 100.

[Reversible bone marrow hypoplasia in a case of male anorexia nervosa]. / Hypoplasie médullaire réversible au cours d'une anorexie mentale masculine.

The authors report the case of a 17 year old boy with anorexia nervosa and bone marrow hypoplasia. After a 14 kg weight loss, the patient had pancytopenia, morphological abnormalities of the red cells (acanthocytes, schizocytes), without hemolysis, and hypogonadotropic hypogonadism. Bone marrow biopsy showed a marked reduction of hematopoietic cells with striking diffuse interstitial oedema. Clinical recovery, during the next 6 months, was associated with a return of the haematological changes to normal and to a disappearance of hypogonadism. Anorexia nervosa is a rare entity in boys. In all probability, bone marrow hypoplasia is not a well known feature of this disorder. The haematological changes are reversible with improvement of nutritional status.