[Facial dog bite injuries in children: retrospective study of 77 cases]. / Morsures de chien à la face chez l'enfant: étude rétrospective de 77 cas.

INTRODUCTION: The face is the area most vulnerable for dog bites in children. Surgical management is an emergency to prevent infection, functional and aesthetic outcomes. The aim of this study was to define a new gravity scale, and to determine a prevention policy. PATIENTS AND METHODS: In our maxillofacial and plastic surgery department, we conducted a retrospective study from 2002 to 2010, including 77 children under 16 years old, victims of facial dog bite. We analyzed epidemiological, clinical data, surgical outcomes. RESULTS: The mean age was 5.36 years. Dogs were principally represented by class I and II dogs; 27,7% of them had ever bitten before. In almost all the cases, the dogs belong to the family or closers. Twenty-one percent of children belong to an unfavourable social environment; 71.43% of dog bites interested the central area of the face. The bites were deep in 77% of cases with amputation or extensive loss of substance in 31% of cases. The healing time was 10.54 months. Nearly a third of patients required several surgeries; 41.56% of patients had aesthetic and functional sequelae; 35.1% of children had psychological problems afterward. CONCLUSION: Facial children dog bites require a multidisciplinary approach, and a long-term follow-up. We propose a new classification of dog bite severity, more appropriate to the face.

[Anatomic study of the right ventricular inferior wall. Search for the optimal site for implanting epicardial pacing electrodes]. / Etude anatomique de la paroi inférieure du coeur limitée au ventricule droit. Recherche du meilleur emplacement pour l'implantation des électrodes épicardiques de stimulation cardiaque.

The inferior wall of the right ventricle was studied to determine the optimal site of implantation of epicardial pacing electrodes. The hearts of 10 patients without cardiac disease, aged 57 to 84 years, who died in Broussais hospital, were studied. The hearts were washed, weighed (300 to 550 g) and placed in a formol solution to which was added half its volume of Larsen's solution. They were then examined and cut in sections about 0,8 cm thick, perpendicular to the long axis of the heart. Each section was drawn and the thickness of the inferior right ventricular wall measured. The inferior wall of the right ventricle is shaped like a right angled triangle limited medially by the inferior interventricular groove, posteriorly by the atrioventricular groove (containing the right coronary artery), and laterally by the right free border. The surface area of the triangle varies between 14 and 34 cm2, a fatty border is always observed, and, in 5 out of 10 cases, vessels (arteries and veins) run in a randomised fashion across its surface. The inferior wall is very irregular on section, appearing craggy and cavernous with sudden variations of 1 to 10 mm in thickness due to the many 2nd and 3rd order trabeculations. In the muscular zone near the interventricular septum, the thickness varies from 2 to 10 mm, but only 10 out of 70 measurements were less than 4 mm. In the middle and central zones, only 34 out of 182 measurements were less than 4 mm thick. On the other hand, at the apex and right border of the heart, the values fell to 7 mm and parts of the anterior right ventricular wall was as thin as 0,5 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

[Severe postoperative heart blocks appearing late. 16 cases]. / Blocs cardiaques postopératoires de haute gravité et de survenue tardive. 16 observations.

Sixteen patients, aged 4 to 42 years, operated for congenital heart disease, presented, months or years after surgery, complete atrioventricular (11 cases) or sinoatrial block (5 cases). Six patients had transient complete atrioventricular block in the immediate postoperative period, the maximum duration of which was less than 30 days. The late postoperative period was defined as at least 6 months after surgery. The period between surgery and the implantation of a pacemaker varied from 9 months to 19 years, average 6,3 years. Analysis of long term electrocardiographic studies distinguished three types of progression: --group I: alternation of sinus rhythm and conduction defect until definitive block, sometimes presenting with syncope; --group II: sudden, severe conduction defect after a long period of sinus rhythm; --group III: progressive lengthening of the PR interval. Seven patients developed syncope; 4 had dizziness, 2 were short of breath; only 3 were asymptomatic. All underwent permanent pacing. The incidence of late conduction defects appears to be 1 to 2% of operated patients. The causes include progressive fibrosis, slow sclerosis extending over conduction pathways which are congenitally fragile. Most late blocks are of an advanced degree. Some may be responsible for unexplained sudden death. It is therefore desirable to avoid this complication by the judicious and considered implantation of a cardiac pacemaker. Some authors mention the following factors in deciding on the indications for pacing: --complete, transient atrioventricular block during the operation or the immediate postoperative period; --ECG appearances of right bundle branch block and left anterior hemiblock, or trifascicular block; --His bundle studies.(ABSTRACT TRUNCATED AT 250 WORDS)

[Incidence of hyperuricemia in atrioventricular block. Systematic study of 158 cases which required implantation of an isotopic cardiac pacemaker]. / Fréquence de l'hyperuricémie dans le bloc auriculo-ventriculaire. Etude systématique de 158 indications de pose d'un stimulateur cardiaque isotopique.

This is a study of 158 patients in whom the placement of an isotopic cardiac pacemaker was indicated; this procedure was carried out Broussais Hospital between 1970 and 1975. These patients, whose mean age was 39 (84 males, 47 females, 12 young men and 15 young women) were examined for uricaemia, and the levels compared with the mean for control population. The results were as follows: 91% had uricaemia at a level higher than the controls. Of these, 61% had uricaemia above 70 mg/l in the men and youths of over 15 years of age, and above 60 mg/l in the women and 50 mg/l in the adolescents. The highest uric acid levels were found in adults with post-operative atrio-ventricular block following surgical correction of a congenital cardiac abnormality, and also in children and adolescence with block which appeared to be congenital.

[Isotop cardiac pacemaker during pregnancy. 3 cases]. / Stimulateur cardiaque isotopique au cours de la grossesse. Trois observations

The authors report three cases of full term pregnancies, without complications, in women with isotopic pacemakers. The newborn infants were normal. In one case, pregnancy occurred in a patient who already had a pacemaker. In two cases, the pacemaker was inserted during pregnancy (at 1 and 1/2 and 5 months respectively), in the treatment of syncopal attacks due to paroxysmal atrioventricular block. This type of pacemaker using a radioactive source (Plutonium 238) is, by virtue of the low degree of radiation, harmless and may be used in women of childbearing age. Under the least favourable conditions (pacemaker box in abdominal situation), the dose delivered during pregnancy (57 mrem) is approximately 20 times less than the authorised dose (1125 mrem).

[Occurrence of hyperuricemia in atrioventricular block. (Results of a study of 158 patients with isotopic pacemaker implantations)]. / Fréquence de l'hyperuricémie dans le bloc auriculo-ventriculaire. (Résultats de l'étude de 158 indications de pose d'un stimulateur cadiaque isotopique)

The frequency of hyperuricemia is high in these patients with heart block, whose mean age is 39. 91% have serum uric acid levels above the normal range and 61% present "hyperuricemia," according to "gouty risk" criteria. The mean uric acid level, before surgery, of the patients whose total heart block follows "open-heart" is the highest in our statistics.

[Course of telesystolic mitral insufficiency. Apropos of a case followed for 7 years and operated on]. / L'évolution de l'insuffisance mitrale télésystolique. A propos d'un cas suivi pendant 7 ans et opéré

One case followedup for 7 years with progressive intensification of regurgitation, requiring a surgical operation at the age of 48 years, brings its contribution to knowledge of the natural history of late systolic mitral incompetence and of the anatomical lesions causing it. The presence of prolapsed posterior leaflet, of stretched chordae tendinae, of both septal and parietal muscle hypertrophy with biloculation of the ventricular cavity were suggested by angiocardiography and confirmed by operation. A review of the literature reporting the cases with operative or post-mortem verification poses the unresolved question of the diagnostic criteria of late systolic mitral incompetence at the stage of cardiac failure.