Correction of selenium deficiency in hemodialyzed patients.

Selenium is an essential trace element important for glutathione peroxidase activity. Selenium deficiency has been found in association with skeletal and cardiac myopathy and may increase the risk for cardiovascular diseases and for cancer. We studied 39 hemodialysis patients and 15 control subjects. Plasma selenium, plasma glutathione peroxidase activity and erythrocyte glutathione peroxidase activity were lower than in controls (38 +/- 14 vs. 88 +/- 17 micrograms/liter (P less than 0.01); 153 +/- 32 vs. 334 +/- 41 IU/liter (P less than 0.01), 19 +/- 4 vs. 26 +/- 4 IU/g Hb (P less than 0.01), respectively). Plasma selenium and plasma glutathione peroxidase activity were strongly correlated with duration of dialysis. There was no correlation between plasma selenium and protein or calorie intakes. Plasma selenium was lower in patients dialyzed with highly permeable membranes (P less than 0.01). The total muscle mass, assessed by anthropometry, was lower in the patients who had the lowest plasma selenium (P less than 0.01) and plasma glutathione peroxidase activity (P less than 0.05). Interventricular septum hypertrophy, documented by echocardiography, was greater in patients with the lowest plasma selenium and plasma glutathione peroxidase activity (P less than 0.01). Twenty hemodialysis patients had oral supplementation of 500 micrograms/day of sodium selenite for three months, and then, 200 micrograms/day for the next three months. Plasma selenium increased as early as the first week and reached a plateau similar to the control levels after three weeks. Plasma glutathione peroxidase activity increased after two months but remained below controls. Erythrocyte glutathione peroxidase activity reached a higher value than controls after one month.(ABSTRACT TRUNCATED AT 250 WORDS)

[Correction of selenium deficiency in patients with renal failure undergoing hemodialysis]. / Correction du déficit en sélénium chez des insuffisants rénaux hémodialysés.

Plasma selenium levels (p Se) as well as glutathione peroxidase activity in plasma (p GPx) and in erythrocytes (e GPx) were measured in 39 haemodialysis patients. Glutathione peroxidase is a selenium-dependent enzyme which protects cells against oxidation. The mean level values obtained were significantly lower in patients than in controls: p Se: 38 +/- 14 versus 88 +/- 17 micrograms/l; p GPx: 15 +/- 32 versus 334 +/- 41 IU/l; e GPx: 19 +/- 4 versus 26 +/- 4 IU/g Hb. These values were found to correlate significantly with the duration of dialysis and with the type of membrane utilized. The total muscular mass was significantly smaller in patients with the lowest p Se or p GPx values. At echocardiography, septal hypertrophy correlated with both p Se and p GPx. Twenty patients were supplemented with sodium selenite administered orally at the end of each haemodialysis session during 6 months. After this period, muscular mass and septal hypertrophy were decreased and the echocardiographic contractility parameters were improved, albeit not significantly.

[Tumor of the tricuspid valve operated on with success. Apropos of a case simulating cyanotic heart disease]. / Tumeur de la valve tricuspide opérée avec succès. A propos d'un cas simulant une cardiopathie cyanogène.

The case of a 36 year old woman with a calcified tumour of the tricuspid valve is reported. The clinical signs suggested tricuspid stenosis with a right to left shunt via a patent foramen ovale simulating a cyanotic heart lesion. Preoperative diagnostic investigations were discordant. Echocardiography showed a stenotic tumoural tricuspid valve. Catheterisation and selective right ventriculography were more suggestive of dominant tricuspid incompetence. The patient was referred for surgery because of the severity of her shortness of breath and cyanosis, and tumoral involvement of the three tricuspid leaflets was found. This was removed and replaced by a bioprosthesis with good results 27 months after surgery. 17 other cases of tricuspid tumours have been previously reported. Their clinical presentation was usually that of a right ventricular tumour with stenosis of the right failure, positional syncope and pericardial effusion in the malignant forms. Signs of tricuspid stenosis with cyanosis and polycythaemia are very rare. The relative diagnostic values of angiography and echocardiography are discussed.

[Cardiac manifestations of the hypereosinophilic syndrome. The value of 2-dimensional echography (12 cases)]. / Manifestations cardiaques du syndrome hyperéosinophilique. Intérêt de l'échographie bidimensionnelle (12 observations).

The prognosis of the hypereosinophilic syndrome (HS) depends mainly on the development of endomyocardial fibrosis (EMF). This complication may be overlooked at an early stage, although its presence is an indication for steroid or antimitotic therapy of the HS. Even at an advanced EMF and associated intracardiac thrombi may not be visualised by angiography. This study was undertaken to assess the diagnostic value of 2D echocardiography in 12 patients. The patients were all men (12 of them) aged 22 to 64 years with unexplained eosinophilia 1 500/mm3 for over 6 months, and visceral lesions. The patients were divided into 3 clinical groups. Group A comprised 4 "allergic" patients with chronic asthma and a significant elevation of IgE; Group B comprised 5 "myeloproliferative" patients with splenomegaly and/or hepatomegaly and a significant elevation of serum B12 levels. The 3 remaining patients who could not be allocated to either Group A or B formed the third group (Group C). 2D echocardiography was carried out on average 30 months after diagnosis of the HS and six planes of examination were used systematically (two parasternal, two apical, one extreme apical and one subcostal). Right and left ventriculography was performed in 6 patients (less than one month before or after 2D-echo). Anatomical studies were obtained in 4 cases (2 operations, 3 autopsies). Echocardiographic signs of EMF were observed in 8 cases. Four patients had a restrictive cardiopathy associated to a large LV thrombus in 2 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Sclerodermic cardiomyopathy : prospective study employing phonocardiography and echocardiography. Value of diastolic parameters of ventricular function (author's transl)]. / Cardiomyopathie sclérodermique. Etude prospective utilisant des explorations non traumatisantes (phonocardiographie, échocardiographie). Intérêt des paramètres diastoliques de fonction ventriculaire.

A prospective study in 30 patients with systemic sclerosis included phonocardiographic (PCG) recordings in all cases and an echocardiogram (ECHO) in 18 patients. A specific diagnosis of myocardial fibrosis was established in 2 cases, based on anatomical criteria, and was suspected in 5 patients from combined clinical, electrical, and radiological findings. Ventricular diameters, the slope of mitral valve closure, and systolic parameters of ventricular function (haemodynamic quotient, left ventricle ejection fraction, and mean rate of circumferential shortening) were rarely abnormal, and did not correlate with possible myocardial fibrosis. Diastolic pick-up (PCG) was abnormal in 30 p. cent of the cases but this is not specific to myocardial fibrosis. Total myocardial relaxation interval, as measured by PCG, was significantly increased to 146 +/- 23 ms (mean +/- one standard deviation) in relation to a control group (p less than 0.001). A relaxation interval (measured by PCG and/or ECHO) superior to 150 ms is suggestive of myocardial fibrosis. The rate of thinning of the left ventricular posterior wall was diminished in the 14 cases in which it was measured. These results are in favour of a myocardial relaxation disorder during scleroderma.