Search

From October 1983 to January 1985, 46 patients (38 men and 8 women; mean age 60 years, range 37-83) underwent peripheral vascular surgery either of the internal carotid artery or of arteries of the lower limbs. All patients had thorough clinical examination, ECG and thallium dipyridamole myocardial scanning before operation, as a result of which they were divided into 20 with, and 26 without chronic ischemic heart disease. Three major cardiac events were noted during or following a period of one month after surgery: two deaths due to a cardiac ischemic event and one post-operative unstable angina pectoris. The three patients with these complications were classified in the coronary group (NS). When the patients were reclassified according to the presence or absence of thallium redistribution on serial images after dipyridamole, 14 had redistribution and 32 had no redistribution. The three major cardiac events were found to have occurred in the group with redistribution (P less than 0.04). Our study suggests that patients with redistribution have a high incidence of postoperative ischemic events. They should be considered for a particular pre-operative coronary management to avoid post-operative major cardiac events and to improve survival.

The authors analyse the relations between tardive dyskinesias and affective disorders on the basis of epidemiological, clinical and biological arguments. They review the principal data in the literature and develop some hypotheses concerning the explanation of these relations.

Thirty-two women with breast cancer considered in active phase underwent, successively: internal mammary lymphoscintigraphy with 99m rhenium sulfide, chemotherapy and Pathey-type mastectomy with dissection of the axillary and internal mammary lymph nodes. Lymphoscintigraphy was successful in 97% of the cases, without complications. Its specificity was 0.88 (range: 0.76--0.99) and the sensitivity 0.6 (range: 0.19--0.92). Internal mammary lymph node dissection was technically successful in 87.5% of the cases; one patient developed chondritis. Thus, lymphoscintigraphy is usually successful, without morbidity and specific. However, it cannot pretend to provide a complete answer, as does internal mammary producing invaded lymph nodes.

After thoracoscopy and mediastinoscopy, pericardioscopy now completes the endoscopic techniques available for exploration of the pericardial cavity. During one year, we systematically associated pericardioscopy with pericardial drainage, using a mediastinoscope. Pericardioscopy visualizes the pericardium and guides biopsies. We report here this one-year experience of 12 pericardioscopies, describing the technique and listing its indications.

A method for determining plasma 3,4-dihydroxyphenylethyleneglycol (DHPG), a central noradrenaline (NA) metabolite, is described. The method used HPLC with dual coulometric detection set in screen mode of operation. The isolation of DHPG and related catecholamines (noradrenaline, dopamine and dihydroxybenzylamine) was performed on acid washed alumina extracted with 0.2 M HCIO4 containing EDTA (0.2%), and reduced glutathione as stabilizer. A reversed phase column with an eluting system containing 0.025 M citric acid-sodium hydrogen phosphate buffer in the ratio 3:2 (v:v) and 5% methanol was used. The experimental results of plasma DHPG levels compared favourably with the results from the literature, and a positively significant correlation with plasma MHPG was found. This method could be used as an alternative in central NA assessment.

The question of the previously reported changes in the density of high-affinity binding sites for [3H]-imipramine (IMI) in platelets from depressed patients was reexamined among the different diagnostic subtypes of depression according to the DSM-III classification and taking into account the possible influence of the low-affinity binding site. Using a least-square computer-assisted analysis, a precise determination of the [3H]-IMI binding parameters exclusively in relationship to the high-affinity site was performed in 46 untreated depressed patients and compared to 35 healthy controls. The results revealed a clear and highly significant 22% decrease in the maximal density (Bmax) of [3H]-IMI binding in all of the depressed patients compared to controls with no change in affinity values. Considering the diagnostic subgroups, we found that all the bipolar patients, the depressed as well as the euthymic or manic ones, had very low Bmax values and that some of them also exhibited an unusual low-affinity binding. Mean Bmax of the unipolar and dysthymic patients significantly decreased when compared to controls, although the Bmax values showed a large variability. Only dysthymic patients presented Bmax values which were significantly associated to symptom severity as assessed by the Hamilton Depression Rating Scale scores. Our results confirm the lower density of platelet [3H]-IMI binding in affective disorders, particularly in bipolar patients, and also suggest that this biological parameter is a trait marker in bipolar depression and a state marker in dysthmic disorder.

Since the initial description by Ganser and Wernicke at the beginning of the century, two types of problems have appeared in the history of the concept of pseudo-dementia. The clinical ones have been at the root of careful descriptions of the pseudodemential syndrome by the Anglo-Saxon authors of the sixties, and have emphasized the psychiatric etiology and the reversible aspect of the disorders. The others are concerned with the pathogenic problems coming from pseudodementia and take in consideration -- on the basis of bringing together the clinical and neuropsychological sides with subcortical dementia -- the mechanisms that could be common to the physiopathology of the degenerating, demential and psychoneurotic disorders. This article analyses the concept of pseudementia in this double view, dwelling on the clinical and diagnostic problems.

A new case of carcinoid tumour of the thymus is reported. Such tumours are extremely rare and of somber prognosis when accompanied by local or regional metastases or metastases in other organs.

The authors report the results of an open trial which aims at specifying the clinical profile of responders to carbamazepine among a population of twenty patients aged from fifteen to seventy, suffering from endogenous, schizophrenic, affective psychoses and paranoid states according to the criteria of the ICD 9. The trial points out a proof of Kishimoto's criteria and a preferential acting of the molecule on schizo-affective psychoses and mixed affective states. The results are interpreted according to psychopathological concepts from the Vienna school that highlight the clinical profile of the responders.

We have led over a four year period, from 1981 to 1985, a prospective study on all cases of penetrating chest wounds (77 cases) in the intensive Care unit and the Department of Thoracic Surgery at the Avicenne Hospital. These wounds, involving young males, are fortunately mostly benign. Their seriousness is based on the abdominal or mediastinal hemorrhage as well as lesions to the vital organs which need an emergency intervention. The latter, nevertheless, with the help of the mobile reanimation service for transfering the patient, has diminished the mortality rate to 2.6 per cent. Following their experiment and after a review of the literature, the authors expose their method of management of the penetrating chest wounds.

Animal studies have suggested interspecies differences in brain norepinephrine (NE) metabolism, especially with regard to the relative proportions of 3,4-dihydroxyphenylethyleneglycol (DOPEG) compared to 3-methoxy-4-hydroxyphenylethyleneglycol (MOPEG). In order to question the value of both glycol metabolites as peripheral indices of central noradrenergic activity, a comparative study of plasma DOPEG and MOPEG (measured by HPLC) related to depression, sex, age and diagnostic categories (DSM-III) was carried out on depressed and control subjects. In addition, two groups of 8 patients were randomly submitted to a desipramine 150 mg/day, or a metapramine 450 mg/day antidepressant treatment influencing the formation of DOPEG and MOPEG in a different way. The study did not demonstrate any difference between DOPEG and MOPEG for most of the experimental factors. We found also a significant positive correlation between plasma levels of DOPEG and MOPEG. Our results support the idea that each of these two biological indices can be used in the assessment of central noradrenergic activity.

The present study was attempted to determine whether a reduction in regional venous maximal coronary flow can indicate the presence of significant coronary stenosis. The great cardiac vein flow and the coronary sinus outflow were measured simultaneously in 8 open-chest dogs by a continuous thermodilution technique using a triple thermister catheter or two separate thermister catheters. The left anterior descending and circumflex coronary inflows were recorded using electromagnetic flow probes. Successive 70% coronary arterial stenosis maximal coronary flow and coronary reserve decreased significantly in the great cardiac vein and the coronary sinus. Significant correlations were found between the flows in the left anterior descending artery and in the great cardiac vein (r = 0.81) and between those in the circumflex artery and in the coronary sinus minus the great cardiac vein (r = 0.79) throughout the periods of preocclusion, occlusion and reactive hyperemic response. There were no significant changes in heart rate and hemodynamics. Using continuous thermodilution techniques, the inflows of the left anterior descending and the circumflex coronary arteries at a stenosis greater than 70% could be estimated from the changes in regional venous outflows.

In the group of adenomas of the trachea and bronchi, cystic adenocarcinomas or cylindromas are malignant tumours, whose outcome is much slower than those of the usual type of cancer. An unusual case is reported in which treated was firstly carried out with laser therapy and then surgery.

Gentamicin diffusion in pulmonary parenchyma was studied in 10 adult patients with normal renal functions before undergoing thoracic surgery. This aminoside was given in a one time dose of 120 mg directly and by way of IV route in 10 min time; blood samples from peripheral and pulmonary sources were drawn at regular intervals between the 10 min period and the 8th hr; parenchymal samples were collected 1 and 2 hrs after drug administration. After separation of residual blood by centrifugation at high speed, the tissues are grinded and homogenized. The assay was performed with an immunological method using a fluorescent polarized detection system. Tissue levels were low in all the patients (0.5 to 2.75 micrograms/g of fresh tissue) and this in spite of the high level of blood collected throughout the administration protocol. As a rule, the relation between tissue/blood is lower than those discussed in literature concerning bronchial secretion. Beside this, the concentrations are similar in peripheral and pulmonary blood collected. Practical conclusions are drawn for therapeutic purpose.

This study reports the experience of the medical centre of Villiers Saint-Denis, where about 40 cases of pyothorax with or without broncho-pleural fistula were seen between 1975 and 1981. The authors describe their method to drain and wash the pleural cavity. They use a single chest tube with an irrigation system in simple empyema and two chest tubes with an irrigation system when they must close a broncho-pleural fistula. With this method, the infection was eradicated in 90% of the cases, and the broncho-pleural fistula closed within about 4 months in 80% of the cases. This method is compared with other methods used to treat pyothorax.

Studies conducted by Italian and Anglo-saxon authors underline the thymoanaleptic properties of a transmethylant biological substance, the S-adenosyl methionine (SAMe). The authors discuss a review of literature concerning the use of SAMe in neuro-psychiatry, particularly in the treatment of affective disorders. The many physiopathological implications are subtended by the biological inter-relations of SAMe with other biological substances. Some hypotheses are proposed on the role played by phospholipid methylation, the folate metabolism and the purinergic transmission in mental diseases.

In a medical and biological perspective, the authors analyse the relations existing between diabetes mellitus and affective disorders on the basis of clinical, therapeutic, metabolic, neuro-endocrinal and epidemiological arguments. Besides the presentation of an original clinical case, the principal data of literature are detailed and criticized; some orientations of the future research concerning the explaining of these relations are given as well.

This work is based on the retrospective study of the case history of 26 patients who were treated between September 1979 and January 1987 in the department of thoracic and vascular surgery at the Avicenne Hospital--and who were all suffering from both lung cancer and atheromatous arterial disease. It is now well established by all the epidemiologic research that the link between lung cancer and atheromatous arterial disease is smoking tobacco. The risks involved in the misunderstanding of such an association are not without danger for the patient, particularly the risk of severe complication of possible coronary or carotid lesions, threatening survival; from this derives the necessity to decide automatically for a minimum of pre-surgery vascular investigations in the case of patients suffering from lung cancer. The therapeutic strategy in this association must be thorough, considering that there are three priorities in the vascular field which must absolutely be treated before the lung itself: --the coronary and carotid lesions which are likely to be complicated cancer after surgery and any state of emergency in the other vascular territories. The fight against tobacco smoking must also be considered as a priority aim.

We recently proposed the first scale for evaluating anxiety in psychotics: the "Psychotic Anxiety Scale" (PAS). The first version of this scale was tested in 45 psychotic patients. The multiple correspondence factorial analysis revealed that 4 factors account for respectively 50%, 18%, 17% and 10% of the variance. This scale thus evaluates anxiety along 4 axes: severity of the symptomatology, evolution in time, hetero-aggressiveness and self-aggressiveness. This analysis supports the hypothesis of the lack of specificity for the anxiety in psychotics, but distinguishes the nevrotic anxiety from the psychotic anxiety. The inter-rater reliability was assessed by a method which compared a rater with the others along 2 axes: the severity, and the profile of the assessment. The interrater reliability was unsatisfactory for only three items. They have been modified and a new version of the PAS is proposed.

From October 1983 to January 1985, 46 patients (38 men and 8 women; average age, 60 years; range, 37 to 83 years) underwent peripheral vascular surgery of either the internal carotid artery or the arteries of the lower limbs. Each patient had a thorough clinical examination, an ECG, and a dipyridamole-thallium-201 myocardial scan before operation. On the basis of results, they were divided into two groups: 20 patients with and 26 patients without chronic ischemic heart disease. Three major cardiac events were noted during or after a period of 1 month after surgery: There were two deaths due to cardiac ischemic events and one patient had postoperative unstable angina pectoris. These three patients were classified in the coronary group (NS). When the patients were classified on the basis of whether or not there was thallium redistribution on serial images after infusion of dipyridamole, 14 with redistribution and 32 without redistribution were noted. The three patients who had major cardiac events were in the former group (p less than 0.04). Our data suggest that patients in whom redistribution occurs have a high incidence of postoperative ischemic events. These patients should be considered for particular preoperative coronary care to avoid major postoperative cardiac events and to increase chances of survival.

Closed injury of the internal carotid artery is rare, as it represents only 4% of all the lesions affecting the carotid system. Diagnosis of this injury is difficult, the first signs often being missed as they usually occur in severely injured patients, with the neurological signs appearing later. The death rate remains high, and the sequelae very heavy. After a road traffic accident, three patients, all drivers wearing their seat-belts, presented with bone and/or abdominal lesions, a head injury and a left anterolateral flail chest. All three cases showed an unilateral mydriasis; the variations in their conscious levels led to further neurological investigations. The diagnosis was suggested in one patient by computerized axial tomography, and confirmed in all three by carotid arteriography. The results were excellent when early surgery could be performed (2 cases). However, in the absence of surgery, carotid dissection could only be a major contributing factor for the cerebral oedema associated with the previous hemispheric contusion. The mechanism of these carotid injuries would appear to involve rotation and extension or flexion movements of the neck, crushing the internal carotid artery against the transverse processes of the cervical vertebrae or the mandible: a possible part played by the seat-belt would explain the frequent association of the injury with chest trauma.

Paranoid schizophrenics are unable to balance affirmation and negation. Using the terms of Jean Piaget, they therefore only partially achieve the "équilibrations majorantes" of level II and never those of level III. In their thinking, they have access to the "généralisations inductives" (often excessive ones), but rarely to the "généralisations constructives complétives". They do not have access to the "généralisations synthétisantes" or to the feeling that logic is necessary. They oscillate between the positivist need to measure or verify and absolute beliefs issued from magical thinking.

Thoracic splenosis is the autotransplantation of splenic tissue in the thorax after an injury of the spleen with a tear of the hemi-diaphragm. Usually, there is no symptom and it is unfrequent. A scintigraphy with 99 m. Tc. sulfur colloid and a scan with 99 m. Tc. tagged-heated red cells give the diagnosis. For now, it is no necessary to operate these patients to remove these thoracic nodules.