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The onset of spontaneous hemolytic jaundice in a young subject should lead to the search for Wilson's disease when clinical examination reveals cirrhosis. This hemolysis may evolve in the form of severe jaundice to a stage where the cirrhosis remains usually latent or well tolerated. The intervention of a toxic, allergic of infective factor liable to produce a hepatic lesion which frees a dose of copper sufficient to trigger off hemolysis, is discussed. The mechanism of the latter, that of the coagulation disorders observed, liver cell failure and widespread intravascular coagulation, are analysed in this paper and compared with data in the literature. The dramatic character of the case indicates that it is necessary to treat as a routine with penicillamine all homozygous forms of Wilson's disease.

In this paper are described two new examples of a peculiar semiological association of which the authors have already reported a case, and in which occured simultaneously a phreno-coeliac disease and merycism since childhood. Strong epigastric pains accompained the merycism. In these two cases, the compression of the coeliac trunk by the median arcuate ligament of the diaphragm was important; in one case existed besides a compressive stenosis of the superior mesenteric artery. After the surgical liberation of the coeliac artery and the peri-coeliac neurectomy in one case, all symptoms relieved. This good result persists after twelve months. Because of the rarity of the phreno-coeliac disease and of this type of merycism, the authors think that this association is not accidental, but the result of a new nosological association.

The authors report two personal cases of septal perforation during the acute phase of myocardial infarction which under medical treatment would have been rapidly fatal, and which were treated successfully by surgery on the second and fifth days respectively after the infarction, i.e. very early. After briefly recalling the main diagnostic and etiological factors of this serious complication, and the spontaneous prognosis which is usually catastrophic, they emphasise that in presence of poorly controlled heart failure and cardiogenic shock, uncontrollable by intensive medical treatment, only early surgical repair during the first few hours or days of the course of the coronary accident will permit one in certain cases to avoid a fatal issue as proved by their two cases and a review of recent publications. They emphasis the place of circulatory assistance by intraaortic balloon in the preparation of patients for operation and the methods of mycardial revascularisatin during the operation.

We describe a case of pancreatic cystadenoma (PC) concerning a 66 year-old woman. This PC was a highly vascular cystic tumor, with typical signs: pulsatile tumor, systolic epigastric souffle and demonstrative phonangiography; the selective angiography revealed a hypervascular mass. Microscopically, tiny cysts lined by small, cuboid and columnar cells containing no glycogen, and numerous capillaries. With this case and 210 cases from the literature, two problems have been studied in this paper: the problem of the vascularity of the PC and the problem of the associated diseases. The vascularity allows to distinguish two types of PC: PC with hypervascular pattern and hypo- or avascular PC. The study of the associated diseases shows the high incidence of the tumors (23%), benign and malignant (13%) and of the cysts in other organs (5%). Comparison with polycystic disease of the kidney and the Von Hippel-Lindau disease and hypothesis concerning angio-genesis and cystogenesis in the PC are discussed.

The authors report their experience of right ventricular endomyocardial biopsy by the technic of Caves and Schulz. The instrument which consists of a spiral metallic catheter covered with synthetic material, includes at one end a hand lever and at the other end a biopsy forceps 3 mm in diameter. It is introduced through the skin into the right internal jugular vein then pushed under direct vision with an image intensifier upto the tip of the right ventricle. The angle of the distal part of the bioptome may be freely modified before use. Passage across the tricuspid orifice from the right atrium is usually easy. 30 good quality samples were thus taken from 10 patients with various forms of heart disease. There were no complications. The simplicity, rapidity and benign nature of this technic are emphasised together with its use in the diagnosis of myocardiopathies.

We report on an unusual observation of a woman who lived with a gastrostomy for fifty-nine years. Gastrostomy was performed at age twenty-six after esophageal burn. The patient died at age eighty-five. Digestive functions were normal. Calorie intake was below normal requirements. Diet was monotonous and unbalanced with protein deficiency. However, body weight and plasma protein levels were normal. Psychological and gustative behaviours are discussed.

Thirteen patients with left ventricular failure complicating acute myocardial infarction were treated with intravenous nitroglycerin. The hemodynamic criterium for admission to this study was a pulmonary capillary wedge pressure greater than 15 mm Hg. All patients received intravenous nitroglycerin at infusion rates sufficient to lower pulmonary capillary wedge pressure by an average of 15 mm Hg, corresponding to the optimal left ventricular filling pressure in acute myocardial infarction. During this study, heart rate did not vary significantly; pulmonary capillary wedge pressure decreased from 24 +/- 0,7 to 15 +/- 0,8 mm Hg (p less than 0,001), mean arterial pressure from 95 +/- 5 to 80 +/- 4 mm Hg (p less than 0,005), mean right atrium pressure from 8,7 +/- 1 to 4,6 +/- 0,8 mm Hg (p less than 0,001), systemic vascular resistance index from 36,4 +/- 2 to 29,6 +/- 2 mm Hg/mm-1/l/m2 (p less than 0,005). Cardiac index increased from 2,5 +/- 0,2 to 2,7 +/- 0,1 l/mn/m2 (p less than 0,025) and stroke work index did not vary significantly. These data indicate that nitroglycerin provides a significant improvement of cardiac performance, more through reduction of preload than through reduction of afterload, the later being however significant. This study points out that intravenous nitroglycerin is a most efficient drug in patients with left ventricular failure complicating acute myocardial infarction.