[Mitral prolapse and sudden death. A case report]. / Prolapsus mitral et mort subite : à propos d'un cas.

The association between the mitral valve prolapse and the sudden Cardiac Death remains controversial, the high prevalence of this valvulopathy contrasting with the low incidence of sudden death in this population. We report the case of a 54-year-old woman admitted for a sudden cardiac death, revealing a bi-prolapse with low-grade leakage, leading to the implantation of a subcutaneous automatic defibrillator. Combined echocardiography and cardiac MRI can identify the mitral annular disjunction, the rolling motion of the posterior face of the mitral annulus towards the myocardium, and the myocardial fibrosis of the inferolateral wall induced by streching forces of the sub valvular apparatus, that may lead to ventricular arrhythmias. More than the conventional clinical parameters (young woman, ventricular premature beats with a right bundle branch block morphology, mitral bi-prolapse), mitral annular disjunction and myocardial fibrosis are to be considered as powerful markers of the rhythmic risk of mitral prolapse and must be systematically sought and integrated into the prognostic evaluation of these patients. In the absence of randomised trials, therapeutic management is difficult especially in primary prevention, and needs Heart Team advice.

Prevalence of genital human papillomavirus among Lebanese women.

PURPOSE: The purpose of this study was to determine the prevalence of human papillomavirus (HPV), and more specifically of HPV 16, in a group of Lebanese women. MATERIALS AND METHODS: Type-specific prevalence of cervical HPV and the presence of cytological abnormalities were determined in a cohort of Lebanese women. The population included 1,026 women, 18-76 years, seeking routine gynecological care at a tertiary care center. Demographic and behavioral data were collected. HPV DNA was detected in cervical scrapes by polymerase chain reaction using consensus primers. Cervical cytological abnormalities were identified by Papanicoleau (Pap) smears. RESULTS: The mean age of our population was 40 +/- 11.3 years. General HPV DNA was detected in 50 patients (4.9%). The high-risk HPV type 16 DNA was detected in 31 patients (3%). Patients with HPV 16 were more likely to have an abnormal pap smear than those with negative tests (6.6% vs 1.6%, p < 0.05), and more likely, but not significantly, to be smokers (21.4% vs 18.4%, p = 0.5). The age-specific prevalence of HPV increased with age and peaked at 60-69 years. CONCLUSIONS: The prevalence of HPV in this small group of Lebanese women is similar to its prevalence in the Mediterranean countries. The presence of HPV, its known association with the development of cervical neoplasia, and the lack of a universal screening program for cervical cancer in our country should be used to enforce implementation of proper screening programs.

Case report and review of literature: leptomeningeal relapse in epithelial ovarian cancer.

The diagnosis of leptomeningeal relapse in a patient with epithelial ovarian cancer was confirmed by the presence of malignant ovarian cells in the cerebrospinal fluid. There was no clinical evidence of tumor spread elsewhere. Therapy, including intrathecal methotrexate and whole-brain irradiation led to transient clinical improvement. International literature review revealed only 13 other cases of leptomeningeal carcinomatosis in epithelial ovarian cancer; all died within 15 months following the diagnosis of leptomeningeal spread.

A pelvic retroperitoneal Schwannoma presenting as an adnexal mass.

Solitary nerve sheath tumors such as benign schwannomas arising in the pelvic retroperitoneum are infrequently reported. We report a case of a benign retroperitoneal pelvic schwannoma that presented with pelvic pain and an adnexal mass. Complete surgical excision was achieved only after transection of the S1 nerve root on the left side. The adjacent vascular and urinary channels sustained no injuries and the patient had minimal neurologic deficit.

High-velocity penetrating wounds of the gravid uterus: review of 16 years of civil war.

OBJECTIVE: To evaluate the value of selective laparotomy in pregnant women with penetrating abdominal injuries. METHODS: A retrospective survey was carried out at our center over 16 years of civil war, extending from 1975 to 1991. Fourteen pregnant women had uterine injuries secondary to high-velocity abdominal penetrating trauma. The corresponding management was evaluated carefully with respect to maternal and fetal outcomes. RESULTS: Two maternal deaths occurred, neither resulting solely from intra-abdominal injuries. Visceral injuries were present when the entrance of the missile was in either the upper abdomen or the back. When the entry site was anterior and below the uterine fundus, visceral injuries were absent in all six women upon surgical exploration. Perinatal deaths occurred in half of the cases and were due to maternal shock or uteroplacental or direct fetal injury. Immediate cesarean delivery was performed because of either limited surgical field exposure, fetal injury, or distress. Three patients explored were managed by delaying delivery. All later delivered vaginally with successful fetal outcomes in all three. CONCLUSION: Selective laparotomy may be considered in pregnant women with anterior penetrating abdominal trauma, as the likelihood of intra-abdominal injuries may be predicted based on the location of the penetrating wound.

Maternal mortality in the American University of Beirut Medical Center (AUBMC) 1971-1982.

Maternal deaths were reviewed at the American University of Beirut Medical Center (AUBMC) during an 11-year period, 1971-1982. There were 35,058 live births and 45 deaths making a maternal mortality rate of 128 per 100,000 live births. Hemorrhage, sepsis and toxemia were the main direct obstetric causes of death. The most important indirect causes were cerebrovascular accidents and heart disease. In this review, an analytic discussion of the direct and indirect causes of maternal death in Lebanon are presented and preventive measures are discussed.

PIP: Maternal deaths were reviewed at the American University of Beirut Medical Center during an 11 year period, 1971-82. There were 35,058 livebirths and 45 deaths, making a maternal mortality rate of 128/100,000 livebirths. Hemorrhage, sepsis, and toxemia were the main direct causes of obstetric death. The most important indirect causes were cerebrovascular accidents and heart disease. In this, review, an analytic discussion of the direct and indirect causes of maternal death in Lebanon are presented and preventive measures are discussed.

Alanine transport across in vitro rabbit vagina.

Transmural flux of alanine across the vaginal epithelium of the rabbit is a specialized mechanism. There is a net serosal to mucosal translocation of the amino acid in the absence of a concentration gradient. Changes in reproductive cycle do not influence this mechanism but, in castrated animals, it is abolished. Transport properties of vaginal epithelium is important because of increasing utilization of intravaginal contraceptives.

Partial hypopituitarism in a patient with a pituitary stone.

A case of sexual infantilism was found to have calcification within the sella turcica. Endocrine evaluation revealed partial hypopituitarism involving gonadotrophin and growth hormone secretion.

Ovarian biopsy in the evaluation of amenorrhea.

Endoscopic ovarian biopsies were performed on 78 amenorrheic patients in an attempt to determine the etiology of their amenorrhea and predict its prognosis, correlating the histologic examination with physical findings, endocrine patterns and cytogenetic studies. Ovarian follicles were present while gonadotropins were high in 14 cases (6 primary, 8 secondary) and there were no follicles in 4 cases (3 primary, 1 secondary) whose gonadotropins were low. Secondary sex characteristics were well developed without prior estrogen stimulation in 5 cases of primary amenorrhea who had no follicles and whose gonadotropins were either low, 3, or high, 2. The mere presence of ovarian follicles was not enough to make them responsive to gonadotropin stimulation whether endogenous or exogenous; a phenomenon that had to do with the quality and quantity of germinal follicles available. The histologic examination of ovarian tissue for the evaluation of amenorrhea has been made feasible and relatively safe through recent advances in endoscopic techniques.

Bromocryptine therapy in cases of amenorrhea-galactorrhea.

Of 28 patients presenting with amenorrhea-galactorrhea, pituitary tumors were confirmed in eight. Six patients had occult hypothyroidism and the rest had an endocrine profile suggestive of pituitary tumor or of an idiopathic etiology. Treatment with bromocryptine resulted in suppression of the inappropriate lactation and restoration of regular menstrual function. In five cases, however, the galactorrhea was only diminished and in four of these cases, normal ovarian function did not return. Of the 19 patients that were seeking fertility and continued the medication for at least 20 days, nine pregnancies resulted. A similar response to bromocryptine was observed regardless of the underlying cause of the amenorrhea-galactorrhea.

PIP: 28 women with amenorrhea-galactorrhea were investigated endocrinologically and treated with bromocryptine 2.5 mg twice daily, ranging from 18 to 150 days. These women were classified into 6 with hypothyroidism, having prolactin (PRL) over 30 ng/ml, thyroid stimulating hormone (TSH) over 8 mcU/ml, luteinizing hormone (LH)6-20 mlU/ml and greater than follicle stimulating hormone (FSH); 8 with radiologically diagnosed pituitary tumors, LH, FSH, and increased PRL; 9 with similar endocrine profiles and suspected pituitary tumors; and 3 with high PRL considered idiopathic. 5 of the hypothyroid group were followed, and achieved ovulation, reduced TSH, PRL, and lactation, and 3 became pregnant. Of the 8 with tumors, 5 menstruated, 4 ovulated, 3 conceived, 3 had reduced lactation, 2 had reduced PRL, and 1 failed to respond clinically; 9 with suspected tumors took bromocryptine for at least 20 days, resulting in 4 pregnancies and 3 with regular menses. The 3 idiopathic cases showed lower PRL and regular ovarian function, 1 pregnancy, yet 1 developed pseudocyesis and recurrent galactorrhea. 2 women had to stop bromocryptine because of vomiting. This drug is longer-acting than L-dopa and safer than estrogen-progestagen combinations in cases of pituitary tumors. Bromocryptine reduces galactorrhea and associated hypothyroidism temporarily.

Varicocele and infertility in men.

Varicocele is an important cause of infertility in men. The exact mechanism by which varicocele depresses spermatogenesis is unknown but probably the retrograde flow of blood rich in catecholamines into the testes plays a major role. Because subfertile semen qualities are present in a large percentage of men with varicocele and because the response to surgical procedures is very good, high ligation of the left internal spermatic vein is recommended in men with varicocele and infertility.

Ovarian refractoriness to gonadotropins in cases of inappropriate lactation: restoration of ovarian function with bromocryptine.

In ten patients with amenorrhea-galactorrhea who had hyperprolactinemia, ovulation could not be induced clomiphene citrate or exogenous gonadotropins. Treatment with bromocryptine in eight of these patients resulted in suppression of PRL in all, cessation of galactorrhea and ovulation in seven and conception in five.

Abnormality in metabolism of 15N-labeled nitrate in toxemia.

The urinary excretion of 15N-labeled ammonium nitrate was studied during the last few weeks in patients with normal pregnancy and in those with toxemia. Marked diminution of the 15N label was found consistently in patients with toxemia in the urinary fraction consisting of nitrogenous compounds other than urea and ammonia. The possible significance of this finding is discussed.

Active transport system in human spermatozoa.

The presence of potassium influx into human spermatozoa was investigated through the use of radioactive K42 and Rb86. A gradient of potassium and sodium has been found between the spermatozoal midpiece-tail region and seminal plasma. The influx of potassium seemed to correlate with spermatozoal motility.