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Les auteurs, cliniciens et chercheurs en psychopathologie, développent un phénomène psychique transtructurel rencontré chez des patients obèses opérés d’une chirurgie bariatrique: des fantasmes et des délires de morcellement corporel. C’est à partir d’un cas clinique de névrose et un autre de psychose, que l’impact psychique de la chirurgie bariatrique sera étudié, avec la mise en lumière d’une altération de l’image du corps et de ses sensations qui serait à l’origine de ce phénomène de morcellement. The authors, clinicians, and researchers in psychopathology, developed a trans-structural psychic phenomenon found in obese patients who have undergone bariatric surgery: fantasies and delusions of body fragmentation. The psychic impact of bariatric surgery was studied based on a clinical case of neurosis and another one of psychosis, highlighting an alteration of body image and its sensations which would be at the origin of this phenomenon of fragmentation. Resumos Os autores, clínicos e pesquisadores em psicopatologia, desenvolvem um fenômeno psíquico transestrutural encontrado em pacientes obesos submetidos à cirurgia bariátrica: fantasias e delírios de fragmentação do corpo. Com base em um caso clínico de neurose e outro de psicose, será estudado o impacto psíquico da cirurgia bariátrica, destacando uma alteração na imagem do corpo e suas sensações, que estariam na origem desse fenômeno de fragmentação. Los autores, clínicos e investigadores en el campo de la psicopatología, desarrollan un fenómeno psíquico transestructural encontrado en pacientes obesos sometidos a la cirugía bariátrica: fantasías y delirios de fragmentación del cuerpo. Desde un caso clínico de neurosis y otro de psicosis, se estudiará el impacto psíquico de la cirugía bariátrica, destacando una alteración de la imagen corporal y de sus sensaciones, que serían el origen de este fenómeno de fragmentación.

Cibenzoline is a Vaughan-Williams class I anti-arrhythmic with properties intermediate between subclasses IA and IC which limit the incidence of proarrhythmic effects. These specific properties of the drug facilitate the prescription of cibenzoline in cardiology, particularly for the prevention of recurrent atrial arrhythmia: fibrillation, flutter, atrial tachycardia. This study demonstrates that cibenzoline is effective in these indications, since only 23% of the patients had relapsed after 6 months. This efficacy, combined with the good tolerance of the treatment, makes it possible to recommend the prescription of cibenzoline as a first-line treatment for the prevention of atrial arrhythmia. It represents an effective and safe option.

The efficacy and safety of oral cibenzoline were evaluated in 42 patients aged 67 +/- 7 (55-80) and with recurrent symptomatic atrial fibrillation for at least a year and for which at least one previous anti-arrhythmic agent had been stopped for inefficacy or intolerance. Cibenzoline was administered for 6 months at the dose of 260 to 390 mg per day in patients aged under 70, with the possibility of reducing this dose in those aged over 70. Clinical, electrocardiographic and 24-hour Holter evaluation took place at inclusion and after 3 and 6 months' treatment or at the time of trial termination for documented recurrence (atrial arrhythmia persisting for 60 seconds or more). The mean duration of atrial fibrillation was 5.6 +/- 5 years (1-26). It was related to ischemic (22%), valvular (17%), hypertensive (17%), hypertrophic (7%) or dilated (7%) heart disease. No etiology was found in 45% of cases. All patients had taken at least one anti-arrhythmic agent in the past (mean of 2 drugs, range 1 to 6). All patients were symptomatic, the commonest symptoms being palpitations (82%), chest pain (28%), feelings of vertigo (11%) or episodes of acute dyspnea (9%). Thirteen patients (31%) had a documented recurrence (60 seconds) during the six months of the trial. Recurrence occurred during the first months of treatment in the majority of patients (11 out of 13). The number of symptomatic patients decreased considerably during treatment with cibenzoline, with the disappearance of palpitations in 83% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

The tolerance and efficacy of propafenone were studied in cases of chronic ventricular extrasystoles of the elderly (age greater than 70 years). Only patients presenting more than 1,000 extrasystoles per day and requiring a treatment, were included in this study. Patients presenting non-compensated cardiac insufficiency, hypotensive patients, patients with conduction disorders without pacemakers as well as patients presenting a severe renal or hepatic insufficiency, were excluded. After making sure that the rhythm disorder was chronic, a control Holter was performed, then, 600 mg of propafenone per day, in 3 doses were prescribed for 5 days. On the 5th day, a Holter was performed as well as a blood propafenone level. Some patients received then 900 mg per day with a new Holter and plasma propafenone titration on the 10th day. 11 patients were studied in this fashion. The tolerance to 600 mg was good in 10 out of 11 cases. The efficacy, appreciated by the decrease of the number of isolated ventricular extrasystoles (-69%), doublets (-95%), triplets (-98%) and salvos of ventricular tachycardias (-100%), was excellent in 6 cases, average in 2 cases and mediocre in 3 cases. Increase of the dosage to 900 mg does not improve significantly the anti-arrhythmic efficacy while the side effects seem more frequent. It is not possible to establish a relationship between plasma concentrations and efficacy. At a dosage of 600 mg per day, propafenone is therefore effective in the treatment of ventricular extrasystoles in elderly patients and its tolerance is good. Higher doses are not advisable as they seem much less well tolerated without any additional advantage.

The villosities of the small intestine form a special structure (absorbing enterocytes, functional vascularisation of mucosa), manifestly adapted to the working of the absorption function. As a reciprocal, we propose the hypothesis that the maintenance of villous structures depends on the use of the absorption function and we have classified villous atrophies in three groups, according to their mechanism: by insufficiency of the absorbing enterocytary coating, alteration of the connective tissue and especially of functional vascularisation of mucosa, insufficient absorption (functional regression). Though based on a largely conjectural theoretical conception, this classification corresponds, in fact, to particular aspects of the mucosa as to organization of the connective tissue and especially to maturation of the enterocytary series: it should therefore help pathologists to add to the static appreciation of the hight of villosities and the abondancy of plasmocytes, an appreciation of anatomoclinical syndromes or, at least, of unquestionable lesional mechanism.