Chronic pulmonary heart. Apropos of 41 cases at the Cardiology Department of the Ignace-Deen University Hospital in Conakry

In 5 years, 41 cases of chronic pulmonary heart were observed at the University Hospital Ignace-Deen in Conakry, representing 7.14 p. cent of hospitalized patients, thus ranking 4th after Hypertension, various myocardiopathies, and valvulopathies. These patients are from a rural background in 65.21 p. cent of the cases. Chronic bronchitis, 4 p. cent of the cases, and bronchial asthma, 27 p. cent of the cases, represent the main causes. An important factor is that all patients were hospitalized with heart failure, at different stages of NYAH.     

Failure of chemonucleolysis and its surgical treatment. Apropos of 268 cases

The authors have reviewed 268 cases of herniated lumbar discs treated by chemonucleolysis between 1980 and 1984. 52 patients had a laminectomy (19,40 p. 100) and 18 of theses failures were due to a large disc herniation (34,61 p. 100). The result of the surgical treatment after chemonucleolysis failure was good in 67,30 p. 100 of cases. A chymopapain injection is not indicated in patients with a large disc herniation.     

Severe renal forms of leptospirosis. Apropos of 6 cases seen in 15 years at one center

We report on six cases of leptospirosis observed in fifteen years in our department of nephrology. The contamination is two times from professional origin and four times linked to water leisures, during hot season, from june to september for the majority. Two serotypes are found: L. icterohaemorragiae characterized by marked jaundice, and L. patoc with anicteric form. Acute renal failure, five times oliguro-anuric, necessitates in the six cases hemodialysis (two to six sessions). Meningitis is found in four patients, associated in one case to an encephalitis and a polyradiculoneuritis. In one case, there were interstitial pulmonary lesions, in one another, a myocarditis with conduction disorders, responsible of the only death of this series, and finally, in three cases, a gastrointestinal hemorrhage. Bacteriological diagnosis seems little profitable and microagglutination remains the reference technique, helped by the IgM detecting through ELISA, looking forward to the evaluation of PCR (Polymerase Chain Reaction).     

Role of blood pressure in cardiovascular morbidity and mortality

Among the identified precursors of cardiovascular disease, hypertension plays a dominant role. Also, once an attack occurs, it is more likely to be fatal in the hypertensive. Although generally high, the excess cardiovascular risk in the hypertensive is not uniform. The factors influencing its impact on cardiovascular disease include the height of the blood pressure, ECG-LVH, serum cholesterol value, carbohydrate tolerance, the cigarette habit, and heart size on x-ray, among others. Blood pressure is best conceptualized as one ingredient of a cardiovascular risk profile, since its effect is markedly influenced by concomitant risk factors. Incorporating all these factors in a multiple logistic formulation, it is possible to isolate from the general population reservoir of potential disease a segment (10%) from which 25% of the coronary disease, 40% of the occlusive peripheral arterial disease, and 50% of the strokes will emerge. By selecting presymptomatic hypertensives with an unfavorable cardiovascular profile for early sustained and vigorous management, their risk of cardiovascular sequelae can be substantially reduced. This can be done using handbooks that give estimates of the probability of a cardiovascular event for any combination of an efficient set of contributors including blood pressure. Of all the risk factors considered, hypertension emerges as the most common, most potent, and most universal contributor to cardiovascular mortality. Elevated pressure, casual or basal, labile or fixed, systolic or diastolic, at any age in either sex, is a potent contributor to all forms of cardiovascular disease, the risk varying widely in relation to the number and level of concomitant risk factors.     

Transposition of the great vessels in western Africa. Apropos of 17 cases observed at the Institute of Cardiology in Abidjan

During the last 10 years, 17 children with transposition of the great arteries (TGA) were admitted to the Cardiology Institute of Abidjan: 1 case between March 1978 and December 1985, 16 cases between January 1986 and December 1989. The average age was 58 days (range 5 to 270 days) at the first consultation, and 90 days (5 to 270 days) at the time of admission. The diagnosis was confirmed by echocardiography and hemodynamic investigation in 12 cases. There were 9 simple forms of TGA, 7 with ventricular septal defects (VSD) and 1 with VSD and pulmonary stenosis. Two children were taken back by their parents before any treatment was given. A Rashkind atrial septostomy was carried out in 11 children which increased aortic oxygen saturation from 35 +/- 18 percent to 57 +/- 19 percent; there were 3 unsuccessful procedures in children aged 2, 3 and 5 months with 2 deaths. Five patients later underwent surgical correction by a Senning procedure in 4 cases and anatomical correction in 1 case with VSD. All are well after an average 15 months follow-up (1 to 48 months). One of the 8 children awaiting surgery died. Therefore, TGA is not a rare abnormality in Black Africa; it represents 2 percent of the 887 cases of congenital heart disease observed during the same period. The inadequacy of means of diagnosis is certainly the cause of the relatively low incidence of this malformation, of the considerable delay in under specialist care and, as a consequence, of the greater difficulties in treatment, especially with regards to atrial septostomy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Significance of left ventricular hypertrophy in cardiovascular morbidity and mortality

Being a classical sequel of hemodynamic burdens (pressure and/or volume), the untoward results of left ventricular hypertrophy (LVH) were traditionally related to its underlying causes. The Framingham study was the first to demonstrate the increased independent risk associated with LVH detected by ECG and/or by echocardiography. The presence of LVH in nonhypertensive individuals (e.g., obese), the association of LVH with age and gender, and the possibility of genetic control of left ventricular size via nonhemodynamic mechanisms had underscored the importance of LVH per se as a prognostic indicator. The presence of LVH in patients with hypertensive or coronary artery disease results in a severalfold increase in risk compared to similar patients without LVH. Early studies have indicated that the presence of LVH is associated with a significantly worse prognosis in patients recovering from myocardial infarction. We have studied the effect of LVH on long-term (mean 5.5 years) mortality in patients surviving myocardial infarction registered in the SPRINT database. The LVH patients were older and had more complications during hospitalization. The 1- and 5-year mortality rates were doubled in patients with ECG-LVH. Review of the mechanisms operating in LVH reveals important changes in the anatomy and physiology of hypertrophied heart, leading to increased fibrosis, inadequate vascular growth, impaired myocardial function (systolic and diastolic), reduced coronary reserve, and abnormal electrophysiological properties. Regression of LVH by proper treatment (achieved mainly by calcium antagonists and ACE inhibitors) may correct many of the above-mentioned adverse phenomena. Whether the regression of LVH per se will lead to improved prognosis remains to be answered in the future.     

Cancer incidence rate and mortality rate in sickle cell disease patients at Howard University Hospital: 1986–1995

The incidence of cancer in patients with sickle cell disease (SCD) is not known. The 10-year follow-up data on 696 patients with SCD was analyzed at our institution in order to determine the cancer incidence and cancer mortality rates. The age range was 18 to 79 years, with a mean age of 28.8 years. There were 377 females and 319 males. The median follow-up was 3 years. Five patients developed cancer during this period. The cancer incidence rate was 5/2,864 or 1.74 per 1,000 patient years. The 95% CI was 0.64 to 4.32 per 1,000 patient years. There were 68 deaths with 3 being due to cancer. The cancer mortality rate was 3/2,873 or 1.04 cases per 1,000 patient years. Our data represent the first published paper that the authors are aware of, where the cancer incidence and mortality rates have been calculated for any group of patients with SCD. Am. J. Hematol. 55:188–192, 1997. © 1997 Wiley-Liss, Inc.     

Five years of teleconsultation: experience of the Cardiology Department of Coimbra Pediatric Hospital.

BACKGROUND: Telemedicine is an excellent tool to expand specialized medical care, providing better access for patients and lowering costs for their families. The objective of this work was to evaluate the reliability of teleconsultation in pediatric cardiology, with similar results to traditional consultation. It can be a useful tool to upgrade technical skills among the staff involved and to improve the quality of life of patients and families. METHODS: The authors present their 5 years' experience of pediatric cardiology teleconsultation involving Coimbra Central Pediatric Hospital and district hospitals in the central region of Portugal. During this period 1761 consultations, involving 1056 patients, were given with a pre-established weekly schedule for each hospital and joint online reports were produced, with data confidentiality assured. RESULTS: Cardiac murmur was the most common reason for consultation (73%). No heart disease was diagnosed in 49% of the patients. Among septal defects, accounting for 43%, ventricular septal defect was the most frequent (20%). Only 10% of all patients had to be seen in the Pediatric Hospital Cardiology Department. Six emergency consultations were requested. CONCLUSIONS: Pediatric cardiology teleconsultation is a reliable procedure using the Medigraf platform, with a similar error rate to consultations by traditional methods. The costs are lower, especially for the families, who do not have to travel far from home or take time off work. The waiting time for a consultation is shorter and therapeutic decisions are faster. A pediatric cardiologist can cover a larger geographic area and the cooperative work during sessions is useful for exchanging knowledge and experiences.     

Chronic psychosocial stress predicts long-term cardiovascular morbidity and mortality in middle-aged men.

AIMS: To prospectively investigate the association between self-reported psychosocial stress and long-term cardiovascular (CV) morbidity and mortality in a population-based cohort. METHODS AND RESULTS: The Malm? Preventive Project is a population-based screening and intervention programme for cardiovascular disease (CVD) risk factors. Between 1974 and 1980, a total of 13,609 (2741 women) individuals, mean age 45 years, had self-reported chronic stress determined by questionnaire. CV morbidity and mortality were followed up in national registries. Median follow-up time was 21 years. The risk ratio (RR) for a fatal or nonfatal CV incident in the men and women of the group reporting chronic stress was 1.27 (95% CI 1.15-1.39). After stepwise adjustments for known CV risk factors, the RR was reduced to 1.14 (1.02-1.28). The highest RR was found for fatal stroke in men reporting chronic stress, 2.04 (1.07-3.88). For women alone, there was no significant increase in risk after adjustments. CONCLUSION: Self-reported chronic stress is an independent risk factor for CVD, particularly fatal stroke, in middle-aged men; it continues to be a risk factor after adjustment for several other known risk factors. The adjustment itself might reflect mechanisms whereby psychosocial stress directly or indirectly exerts its effects on the body, indicating a possible over-adjustment.     

Kawasaki's disease. Epidemiological aspects and cardiovascular manifestations. Apropos of 106 cases

One hundred and six patients fulfilling accepted diagnostic criteria for Kawasaki disease (90 p. 100 of French-Canadian origin) were evaluated with serial electrocardiograms and echocardiograms (M mode and two-dimensional). Half of the patients (53) had cardiovascular manifestations at one time during their illness. Thirty-one had abnormal electrocardiograms: non specific ST and T wave changes inferiorly (27), prolonged QT intervals (6), first degree AV block (3). M mode echo was abnormal in 31 cases showing: slight pericardial effusion (17), flat septal movement (11), left ventricular dilatation (4), decrease of shortening fraction (2). Seven patients (6.4 p. 100) presented fusiform coronary aneurysm detected in 6 by two-dimensional echography (with angiographic confirmation) and at autopsy in another. M mode echo and electrocardiogram abnormalities were transient in the great majority of patients disappearing during an average follow-up period of 10 months. Coronary aneurysm had disappeared at the end of follow-up in two patients, regressed in three and remained identical in another. There were no relations between severity of clinical symptoms, electrocardiographic or echocardiographic (M mode) abnormalities and the development of coronary aneurysm. Serial studies with two-dimensional echo should be done in every patient with this disease for early detection and follow-up of coronary aneurysm.     

Drop in cardiovascular and coronary mortality in Lombardia, 1969-1987. Evaluation of reliability of the estimates and possible explaining hypothesis]

The results of the present analysis indicate, from 1969 to 1987, a sharp and stable decline in cardiovascular (CVD) mortality in Italians aged 35-74 years (37.6% in males 53.6% in females). These trends were responsible for consistent reductions of total mortality (27.5% and 38% in the two gender groups, respectively), and for the increase of life expectancy. The decrease involved the two major components of CVD mortality, i.e. coronary heart disease (CHD) (23% in males and 44% in females) and cerebrovascular diseases (Stroke) (42.6% in the former and 51% in latter gender group). All these mortality decrements have been higher in the Lombardia Region. Comparing age-adjusted mortality rates in 1968 and 1987, it was possible to estimate that 23,040 deaths were saved in one year among the residents of this northern part of Italy, and the decrease of CHD mortality was responsible for about 30% of the total national decrement of CHD deaths, within comparable age strata. This is attributable both to the higher rates registered at the beginning of the studied period, and to the sharper decline observed. The social impact, in terms of reduction of deaths, was prominent for males. Among the northern male population, the amount of prevented deaths due to CHD and Stroke was equivalent (2072 vs 2172). Data from a MONICA Collaborating Center, located in the region--Area Brianza--, allow us to estimate, for coronary diagnoses reported on death certificates in the 1980s, acceptable levels of accuracy (Cohen's Kappa of .35, with 99% CI .27-.43) and sensitivity (87%). In comparison with earlier estimates carried out in the late 1970s, it is possible to hypothesize an increase of sensitivity over time for certified myocardial infarction diagnoses, which could have contributed to the underestimation of the observed decrements. In dealing with estimates of the reasons for these declines, only suggestions could be addressed because results of specific and comprehensive studies are not presently available. By comparing MONICA data with the results obtained in earlier surveys, it is possible to estimate that about 20 to 30% of the CHD decline, which occurred in the Region, might be attributed to the decrease of in-hospital coronary case-fatality. Moreover, major coronary risk factors (total cholesterol, blood pressure and cigarette smoking) show parallel positive changes, but their contribution in predicting the CHD downfall is difficult to evaluate on the basis of existing data.(ABSTRACT TRUNCATED AT 400 WORDS)     

Causes of gas gangrene seen at the University of Nigeria Teaching Hospital, Enugu, Nigeria

Gas gangrene (clostridial myonecrosis) is rarely seen and this rarity, coupled with its dramatic presentation and often devastating outcome, makes each case of gas gangrene a spectacular and memorable experience. This study analyses the cases managed, the causes and outcome. Gunshot wounds, compounded by late presentation with its accompanying florid infections, were seen as the causes in 14 cases of gas gangrene seen at the University of Nigeria Teaching Hospital, Enugu during the four-year study period from July 2000 to June 2004.     

Electrocardiographic strain pattern and prediction of cardiovascular morbidity and mortality in hypertensive patients

The ECG strain pattern of lateral ST depression and T-wave inversion is a marker for left ventricular hypertrophy (LVH) and adverse prognosis in population studies. However, whether ECG strain is an independent predictor of cardiovascular (CV) morbidity and mortality in the setting of aggressive antihypertensive therapy is unclear. ECGs were examined at study baseline in 8854 hypertensive patients with ECG LVH who were treated in a blinded manner with atenolol- or losartan-based regimens. Strain was defined by the presence of a downsloping convex ST segment with an inverted asymmetrical T wave opposite to the QRS axis in leads V5 and/or V6 and was present in 971 patients (11.0%). The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study composite end point of CV death or nonfatal myocardial infarction or stroke occurred in 1035 patients (11.7%). In Cox analyses adjusting only for treatment effect, ECG strain was a significant predictor of CV death (hazard ratio [HR] 2.26, 95% confidence interval [CI] 1.78 to 2.86), fatal/nonfatal myocardial infarction (HR 2.16, 95% CI 1.67 to 2.80), fatal/nonfatal stroke (HR 1.76, 95% CI 1.39 to 2.21), and the composite CV end point (HR 1.99, 95% CI 1.70 to 2.33). After further adjusting for standard CV risk factors, baseline blood pressure, and severity of ECG LVH, ECG strain remained a significant predictor of CV mortality (HR 1.53, 95% CI 1.18 to 2.00), myocardial infarction (HR 1.55, 95% CI 1.16 to 2.06), and the composite CV end point (HR 1.33, 95% CI 1.11 to 1.59). Thus, ECG strain is a marker of increased CV risk in hypertensive patients in the setting of aggressive blood pressure lowering, independent of baseline severity of ECG LVH.