Crystal Structure, Bonding, and Phase Transition of the Superconducting Na2CsC60 Fulleride.

The crystal structure of superconducting Na(2)CsC(60) was studied by high-resolution powder neutron diffraction between 1.6 and 425 K. Contrary to the literature, the structure at low temperatures is primitive cubic [See equation in the PDF file], isostructural with pristine C(60). Anticlockwise rotation of the C(60) units by 98 degrees about [111] allows simultaneous optimization of C(60)-C(60) and alkali-fulleride interactions. Optimal Na(+)-C(60)(3-) coordination is achieved with each sodium ion located above one hexagon face and three hexagon-hexagon fusions of neighboring fulleride ions (coordination number 12). Reduction of the C(60) molecule lengthens the hexagon-hexagon fusions and shortens the pentagon-hexagon fusions (to approximately 1.43 angstroms). On heating, Na(2)CsC(60) undergoes a phase transition to a face-centered-cubic [See equation in the PDF file] phase, best modeled as containing quasi-spherical C(60)(3-) ions. The modified structure and intermolecular potential provide an additional dimension to the behavior of superconducting fullerides and should sensitively affect their electronic and conducting properties.

Epiglottis involvement in a visceral leishmaniasis.

The visceral form of leishmaniasis caused by Leishmania infantum is frequently observed in Mediterranean countries, however otorhinolaryngeal involvement has only rarely been reported in the literature. We report here the case of a 23-year-old Cameroon man, resident in France since 1991, and presenting with recurrent epistaxis and an epiglottis tumoral lesion. The visceral form of leishmaniasis with hepatosplenomegaly and pancytopenia was diagnosed. Culture of the epiglottal lesion revealed L. infantum. Serological test for human immunodeficiency virus was negative and the patient was not on immunosuppressive drugs. Dramatic improvement was observed with antimony.

Clinical screening for narcolepsy/cataplexy in patients with fibromyalgia.

We report two cases of fibromyalgia occurring during the course of a long-standing narcolepsy/cataplexy. This association is probably not fortuitous and we propose an easy clinical procedure to search for narcolepsy/cataplexy in these patients. Narcolepsy/cataplexy is a treatable condition requiring drugs that in turn may improve in the long-term symptoms of fibromyalgia.

Coronary artery damage during mitral valve replacement.

An anatomic study of 15 hearts has assessed the existing correlations between the mitral annulus and coronary arteries. The circumflex artery is sometimes located very close to the mitral annulus, as close as one millimetre, hence there is a risk of injury during mitral valvular replacement. This risk is especially when coronaries have a prevailing left anatomic position or a balanced coronary system.

Traumatic ventricular septal defect with tricuspid incompetence. Surgical treatment.

The authors report a case of traumatic ventricular septal defect associated with tricuspid incompetence after blunt injury of the chest. This case is the third one described in the literature. This case includes several unusual features: (1) the patient was a 52 year old man. Wounds of the heart usually happen to younger people; (2) clinical manifestations were immediately important; (3) there was a left bundle branch block on the electrocardiogram; (4) surgical treatment was performed as an emergency (less than a fortnight after the accident).

M-CSF serous rate evolution during post-transplantation days in a heterotopic heart graft model mice.

BACKGROUND: On heterotopic heart graft in mice, aged 7 weeks (C3H and B57), we investigate the variations of Macrophage Colony stimulating factor serous rate. The macrophage colony stimulating factor (M-CSF) is a cytokine involved in the immune response during transplantation. METHODS: Five groups were determined, group 1 with a heterotopic transplant without immunosuppressive treatment (N=24); group 2 with a heterotopic transplant and Corticoid treatment after the graft (N=29); group 3 with a heterotopic transplant and cyclosporine treatment after the graft (N=34); group 4 with an isogenic transplant (N=31) and group 5 undergoing a laparotomy (N=31). The mice are sacrificed at D4, D7, D10 or D14 and the M-CSF dosage are done by ELISA method. RESULTS: The serous rate of M-CSF is stable in the group with an isogenic transplant or with only a laparotomy. But in the group with a heterotopic transplant the M-CSF values increase (x1.5). If we use an immunosuppressive treatment the raising of M-CSF is less important. When we have a rejection graft, the serous rate of M-CSF increases but not significantly (Mann-Whitney test). CONCLUSIONS: We conclude M-CSF seems to be a reliable index of disorder during immune response, but is not a good marker of the rejection.

Successful surgical management of a ruptured abdominal aortic aneurysm in a renal transplant patient. A case report.

With extended indications for renal transplantation and increasing survival, it can be expected that atherosclerotic vascular disease in the post-transplant patient will become more frequent. The authors report a case of a ruptured abdominal aortic aneurysm in a renal transplant recipient. A temporary axillo-femoral shunt was used to maintain perfusion of the renal graft during aortic cross-clamping. They review the literature and discuss the available methods for preserving renal function.

Swan-Ganz catheter induced pulmonary artery perforation during cardiac surgery concerning two cases.

Two case reports describing patients having cardiac operations under extra corporeal circulation are presented. At the completion of the operation, a massive hemoptysis occurred in both patients after a Swan-Ganz catheter had perforated the pulmonary artery. A hemostasis lobectomy was then immediately required. The immediate and long term prognosis seems satisfactory. This is an unusual but serious complication. The incidence of this complication varies between 0.06 and 0.2%. The more frequently related risk factors include people over the age of 60, pulmonary artery hypertension, anticoagulant therapy, hypothermia and manipulation of the heart by the surgeon. When this accident occurs, many authors suspect the balloon. An early diagnosis is essential in the case of a major or even a minor hemoptysis, because this complication may be a lethal one as the mortality rate may reach 50%. According to us, the appropriate therapy which would reduce this mortality is a surgical one (hemostasis lobectomy).

[Vascularization of the sino-atrial and atrioventricular nodes]. / Vascularisation des noeuds sino-auriculaire et atrio-ventriculaire

A recent personal study of the coronary arteries has enabled us to give precise details of the blood supply of the nodal structures. The right coronary artery is the commonest source (supplying 67% of the sino-atrial nodes, 85% of the atrio-ventricular nodes, and both nodes simultaneously in 60%). During the course of this study we have also demonstrated that the sino-atrial node may have a double vascular supply. It seems likely that the blood supply to the atrio-ventricular node is complex; because of the limitations of our study method, we examined only the main source of supply.

[Results of singular valve replacement with a mechanical prosthesis or bioprosthesis in valve diseases with advanced myocardial failure]. / Résultats du remplacement monovalvulaire par prothèse mécanique ou bioprothèse dans les valvulopathies en défaillance myocardique avancée.

Surgery may prolong survival in some patients in advanced cardiac failure due to valvular heart disease refractory to digitalo-diuretic and vasodilator therapy. The operative risk is high and myocardial dysfunction after surgery is also a problem. However, in some cases, surprising improvement is observed. An analysis of the principal publications in the literature on the natural history of valvular heart disease and the results of surgery in the last ten years show that: In chronic aortic valve disease complicated by congestive heart failure, the natural prognosis does not exceed 2 to 3 years in either aortic stenosis or regurgitation. On the other hand, prosthetic valve replacement is associated with a 57% 4 years survival in aortic regurgitation, and a 70% 5 years survival in aortic stenosis, but with an operative mortality of 20 to 27%. Surgery is even more valuable in acute aortic regurgitation due to endocarditis, leading to a 60% 2 years survival compared to only 6% with medical therapy alone. In chronic mitral valve disease with advanced cardiac failure, the natural prognosis does not exceed 4.5 years in mitral regurgitation, 8 years in mitral stenosis and an intermediate period in mixed mitral valve disease. On the other hand, prosthetic valve replacement with an operative risk of 21 to 26% is associated with a life expectancy of 56 to 60% at 5 years, and 46% at 10 years, operative mortality included. The surgical results depend on good myocardial protection and intensive pre-, per- and post-operative care using positive inotropic agents, vasodilators and, when necessary, intra aortic balloon pumping.(ABSTRACT TRUNCATED AT 250 WORDS)

[Venous Doppler ultrasonography. Methods, indications and limits]. / Le doppler veineux. Méthodes, indications et limites.

The analysis of velocities by the Doppler effect has limited applications in venous pathology. There are, however, many potential advantages: the introduction of deep venous catheters, early diagnosis of venous thrombosis, studies of venous incompetence, right sided cardiopathies, follow-up of medical and surgical treatment (thrombolytics, venous thrombectomy, bypass surgery, vena cava clips). The results in a series of venous thrombosis are reported: the correlation between Doppler and phlebography was 86,5% in 110 investigations. Doppler sensitivity was 86% and specificity 91%. These results are compared to other reports. A 90% correlation was found with isotope venography in 32 cases in which the permeability of vena cava clips was studied. The sensitivity of doppler in the diagnosis of thrombosis of the clip was 75% and its specificity 100%. The main limitations were the lack of sensitivity in the diagnosis of distal thrombosis and incomplete occlusion (floating thrombi). As a complement to occlusive plethysmography and other non-invasive investigations, Doppler ultrasonography helps determine the indications for phlebography. It is useful in detecting high risk patients and is a sensitive, effective non-invasive method of surveillance in the postoperative period.

[Intermittent dysfunction of a Björk-Shiley tricuspid prosthesis caused by thrombosis suspected through pulmonary scintigraphy]. / Dysfonctionnement intermittent par thrombose d'une prothèse tricuspidienne de Björk-Shiley suspecté par la scintigraphie pulmonaire.

Thrombosis of a Björk-Shiley tricuspid valve prosthesis was observed 4 years after its implantation. The resulting dysfunction was intermittent blocking the disc in the closed position leading to recurrent near-syncopal malaises probably due to a temporary fall in cardiac output and cerebral blood flow and a right to left interatrial shunt which was detected at pulmonary scintigraphy performed to exclude pulmonary embolism. The Björk-Shiley prosthesis was replaced with a Carpentier-Edwards n. 29 prosthesis with a good result after a follow-up of one year.

[Aortocaval fistulas. Apropos of 5 cases]. / Les fistules aorto-caves. A propos de 5 observations.

UNLABELLED: 5 cases of aorto-iliac aneurysms which fistulised into the inferior vena cava are described. They illustrate the problems encountered in this condition. - DIAGNOSIS: although a classical diagnosis, it is only recognised in 27 p. 100 of cases because the clinical presentation can be very variable. A pulsating, expansive, abdominal mass very suggestive of an aneurysm of the abdominal aorta should alert to the possibility of a fistula within the inferior vena cava when the patient has unexplained cardiac failure, shock, lower limb deep vein thrombosis, urinary or psychological problems. In the absence of a continuous abdominal murmur, the diagnosis may be confirmed by complementary investigations; the investigations of choice are non-invasive. Abdominal ultrasonography showing an aneurysm of the abdominal aorta associated with dilatation of the inferior vena cava is very suggestive of the diagnosis. - The only treatment is surgery. The operative risk depends on the presence of absence of associated retroperitoneal rupture of the aneurysm, the respective mortalities being 83 p. 100 and 15 p. 100. - The principal causes of death are pulmonary embolism and renal failure which necessitate special prophylactic measures (surgical and anaesthetic).

[Calcified aortic valvular disease associated with adult progeria]. / Valvulopathie aortique calcifiée associée à une progeria de l'adulte.

Adult's progeria or Werner's syndrome is a rare condition of autosomal-recessive inheritance, characterized by an apparent acceleration of many of the processes associated with aging. We describe the cardiovascular findings in a 44 year-old man with this disorder. Slightly elevation of urinary hyaluronic acid level contributes to the diagnosis.

[Total replacement of the ascending aorta with reimplantation of the coronary arteries. Technic and indications]. / Remplacement total de l'aorte ascendante avec réimplantation des artères coronaires. Technique et indications.

Our experience with nine total replacement of the ascending aorta with reimplantation of the coronary arteries has led us to advocate this as the technique of choice for curative treatment of ascending aortic aneurysms when these involve the sinus of Valsalva, and of acute dissecting aneurysms of the aorta when the tear in the intima is situated in the ascending portion. An endo-aneurysmal approach simplifies the operation and considerably reduces the blood loss during surgery.

[The causes of intracranial hemorrhagic complications induced by antivitamins K]. / Conditions de survenue des accidents hémorragiques intracrâniens des antivitamines K.

Cerebral haemorrhage is the main life-threatening complication of oral anticoagulant therapy. In order to identify a means of prevention, the authors undertook a retrospective study of 68 consecutive cases of anticoagulant-related intracerebral haemorrhage. The mortality was 38.5%. The respective frequency of intracerebral haemorrhage, subarachnoid haemorrhage, acute and chronic subdural haematomas was 63.2, 16.2, 10.3 and 10.3%, respectively. On admission, nearly half the patients (53%) had prothrombin ratios inferior to 25%. A predisposing factor was found in 58% of cases: hypertension (30.6%), head injury (14.5%), alcoholism or drug interaction (11.2%), and one case of intracerebral aneurysm. A history of a transient ischaemic attack or of a cerebrovascular accident was found in 10.2% of cases and 11.7% had a previous anticoagulant related extracranial haemorrhage. The initial indications for oral anticoagulation were ischaemic heart disease (32%), atrial fibrillation (20.5%), secondary prevention of venous thromboembolic disease (17.6%) and primary prevention of venous thrombosis (11.7%). The duration of treatment for isolated ischaemic heart disease was over 6 months in all cases: the average duration of treatment was 12.4 months in phlebitis and pulmonary embolism. A critical review of the indications of treatment in the light of recent recommendations showed that if inappropriate indications were rare, the sometimes unnecessary prolongation of treatment was more common. Nearly half of these cases were receiving anticoagulants when the potential benefits were questionable at the time of the haemorrhagic complication. Clinical and biological follow-up is necessary for patients on anticoagulants; minor bleeding complications may be the prelude to major haemorrhage. Biological follow-up is based on control of the international normalised ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

[Tricuspid prosthetic replacements. Indications and results]. / Remplacements prothétiques tricuspidiens. Indications et résultats

Out of 350 cases of tricuspid regurgitation operated between 1968 and 1975, a serie of 53 prosthetic replacements (3 of them isolated) was analysed, with specification of operative indications, pre-operative condition, operative findings, procedure used and results. Operative death rate was high (28 per cent) and remote results (6 months to 7 years) were not all satisfactory. This is because functional "tricuspid regurgitation", secondary to advanced mitral lesions, expresses in fact considerable myocardial weakening with severe polyvisceral implications. This picture, where tricuspid patency is in fact contingent, is not always improved by mitral correction and reestablishment of a satisfactory tricuspid function, whatever the procedure used. Thus in very advanced mitral lesions, tricuspid repair should be done only if regurgitation is real and severe. Tricuspid prosthetic replacement should be reserved to valvular destruction; semi-circular annulo-plasty, which is efficient and not very traumatising, is applicable to all the other cases. The best treatment of this syndrome is preventive: as aortic lestions, mitral lesions should be operated early to permit a low risk operation and complete functional recuperation.

[Paraneoplastic arterial thrombosis. Apropos of 2 cases]. / Thromboses artérielles paranéoplasiques. A propos de deux cas.

The search for a cancer is part of the classical investigation of unexplained venous thrombosis. Arterial thrombosis associated with neoplasia is more rare. The authors report two cases in which arterial thrombosis was the final event of their malignant disease. The first case had abacterial thrombotic endocarditis and disseminated intravascular coagulation at the origin of multiple thrombotic complications. The initially unknown cancer was a pancreatic adenocarcinoma. The second case presented with acute occlusion of the iliac artery after ablation of a malignant melanoma. Despite embolectomy with a Fogarty catheter and effective anticoagulation, the thrombosis recurred several times at the same site. The clinical features and the mechanisms of these two cases suggestive of Trousseau's syndrome are discussed.

[Postoperative transparietal Doppler ultrasonographic study of the internal mammary artery graft flow with respect to quality of the underlying myocardium]. / Etude en écho-doppler transpariétal postopératoire du flux du greffon mammaire interne en fonction de la qualité du myocarde sous-jacent.

The authors studied flow in the internal mammary artery by Doppler ultrasonography after bypass surgery of the left anterior descending artery to determine the correlation between the flow pattern and the quality of the distal run off. A pulsed Doppler was used to record flow from the right and left internal mammary arteries in the first, second and third intercostal spaces and the supraclavicular fossa. Only the best quality recordings with the highest amplitudes were retained for analysis. Forty-nine patients (average age 61 +/- 10 years), 43 men and 6 women, were included and were examined between the 10th and 15th postoperative days. All had stenosis of the left anterior descending on coronary angiography: three subgroups were identified ad the time of evaluation: (I) revascularisation of an infarcted zone with important angiographic and echographic sequellae. (II) revascularised zones with slight wall motion abnormalities. (IIIa) revascularisation of myocardium with no abnormality (including a subgroup of 5 patients (IIIb) characterised by a postoperative low output state and echocardiographic changes not present before surgery). Significant changes were observed in the flow patterns of the different groups. (I) an exclusively systolic flow (diastolic velocity time integral = 2.85 cm), (II) systolodiastolic flow (diastolic velocity time interval = 9 cm) similar to that in group IIIb, and IIIa predominantly diastolic flow (diastolic velocity time integral = 15.2 cm). The amplitude of diastolic flow in the mammary artery graft was therefore related to previous ischaemia of the revascularised myocardium; detection of stenosis by Doppler ultrasonography should therefore take into account the previous history of the patient.

[Trapped popliteal arteries. Incidence, epidemiology, therapeutic considerations]. / Artères poplitées piégées. Incidence, épidémiologie, considérations thérapeutiques.

The trapped popliteal artery syndrome is an extrinsic dynamic compression of the vascular structures in the popliteal fossa by the surrounding fibromuscular structures. The condition mainly affects the popliteal artery resulting in atypical intermittent claudication because it often occurs in young and active patients. The arterial lesions are initially purely extrinsic and dynamic; sometimes they progress to thrombosis, embolism or aneurysm due to jet lesions. The diagnosis is obtained by radiology in the uncomplicated forms by showing compression or complete occlusion of the artery during contraction of the gastrocnemius and quadriceps muscles. Doppler studies of the posterior tibial artery may also demonstrate the condition during these manoeuvres. The epidemiological study was performed in 199 medical students and 80 athletes. A positional abolition of the posterior tibial artery was demonstrated in 39 students (19%) and 12 athletes (15%). The entrapment was commoner in females (24%) than males (13%). It was observed more frequently in dancers, cyclists and basket ball players: 12 control digitised intravenous angiographies were performed; the diagnosis was confirmed in 11 cases. Several anatomical anomalies of the popliteal fossa may give rise to this condition. The commonest is a deviation of the artery within the internal head of the gastronemius muscle; compression by the soleus or fibro muscular bands arising from the semi-tendinous or semi-membranous have been described. The treatment is surgical in very symptomatic or complicated cases; uncrossing the artery associated with venous grafting in cases of thrombosis are the procedures of choice.