Value of early systematic transoesophageal ultrasonography after mitral valve replacement by Saint-Jude prosthesis

The aim of this study was to assess the value of the routine multiplane transoesophageal echocardiography (TEE) in the early postoperative period after mitral valve replacement with a Saint Jude Médical (SJM) mechanical prosthesis. This prospective work enrolled 56 patients who have been operated between September 1999 and September 2001, all these patients had a multiplan TEE after 14.7 days (8-29 days) of post-operative. The effect of peri-prosthetic leaks was 59%. They were always minimal and asymptomatic. 68% of them disappeared at the late exam. An asymptomatic intermittent blockage of an leaflet had been noted in one patient. It appears to us today indispensable to achieve a systematic TEE in the early post operative period after mitral valve replacement. This exam remains little aggressive and comfortably supportable by the patient in look of information brought.     

Side-to-side choledochoduodenostomy in the management of choledocholithiasis

Sixty patients with choledocholithiasis (either single or multiple stones of the biliary tree) were treated with lateral choledochoduodenostomy. Of these cases 83.3% were followed up for from 1 to 7 years. Only 1 patient developed cholangitis, which responded well to conservative treatment. The other cases have been asymptomatic following surgery. The diameter of the common bile duct is not an important problem in constructing a functional anastomosis.     

Do prothrombin time, transaminases, and platelet count predict the severity of fibrosis in viral liver diseases?

The goal of our study is to assess the performance of a score combining 3 serological parameters (PT, platelets and transminases) in predictive hepatic fibrosis. The study involved 54 patients, 29 of which resulted in distributing them according to the score of Metavir into 2 groupes: Group A with mild fibrosis (F1,F2) and group B with severe fibrosis (F3,F4). PT, platelets and transminase values in serum were assessed for all patients. The total score of the 3 biological parameters combined, was significantly more elabled in the severe fibrosis group than in the mild fibrosis group (P = 0.01) but it was not of much importance in 30% of cases as it did not allow to classify the patients with certainty in group A or in group B. This score does not seem to grant exemption from needle liver biopsy, but it can be improved by the association of other direct markers of fibrosis.     

Mature cystic teratoma of the fallopian tube. A case report

Primary teratomas of the fallopian tube are extremely uncommon. To date, only about 50 cases have been reported in the literature. They occur usually in the fourth decade. There association with nulliparity and reduced parity has been noted. Many have been discovered incidentally and none has been diagnosed preoperatively. The majority are cystic, show great variation in size and are commonly located in the ampulla or the isthmus. They can be intraluminal, attached to the serous surface by a pedicule and rarely intramural. Histologically they are similar to teratoma of the ovary and elsewhere. We describe a mature cystic teratoma of the fallopian tube found incidentally in a 35-year-old woman operated for suspicion of ectopic tubal pregnancy. The feature of benign teratoma of the fallopian tube is discussed.     

Endometrial stromal nodule: a case report

The endometrial stromal nodule is the rarest of the endometrial stromal tumours. It is a benign tumour composed of well-differentiated endometrial stromal cells arranged as a well-circumscribed nodule with smooth, non invasive margins. We describe a case of uterine stromal nodule occurring in a 45-year-old woman with history of menometrorrhagia in which case ultrasonography conclude to a leiomyoma. Epidemiology, pathologic aspects, differential diagnosis, treatment and prognosis are reviewed.     

Intracardiac thrombosis: unusual complication of Behcet's disease

Cardiac involvment is rare, and intracardiac thromboses are exceptional in Behcet's disease. We present a 29 years old male patient seen for right heart-failure, thrombophlebitis and pulmonary embolism. A right atrial thrombosis was showen at the echocardiography and confirmed by computed tomography and magnetic resonance imaging. The diagnosis of Behcet's disease was established on the finding of bipolar aphtous ulcers and skin hypersensitivity. We conclude that Behcet's disease shoud be considered as a possible cause of cardiac thrombosis in the youngs men of the Mediterranean basin.     

Current aspects and future perspectives of pharmacotherapy or type II diabetes

Type II diabetes mellitus is a group of metabolic disorders of fat, carbohydrate and protein metabolism that results from defects in insulin action. It is associated with microvascular and macrovascular disease complications. Goals of therapy in management of type II diabetes mellitus are directed at reducing symptoms of hyperglycemia, reducing the onset and progression of retinopathy, nephropathy and neuropathy complications, intensive therapy of associated cardiovascular risk factors and improving quality and quantity of life. Multidisciplinary teams of health care professions are needed to optimize outcomes in persons with diabetes mellitus. This article will focus on the pharmacotherapeutic agents used in type II diabetes mellitus with or without microvascular and macrovascular disease risk. We will describe also the agents used in prevention of this disense.     

Relationship between anorexia and loss of serotonin uptake sites in brain of mice and rats receiving d-norfenfluramine or d-fenfluramine

Previously, we have shown that repeated administration of d-fenfluramine (D-F) to rats is associated with development of tolerance to the initial anorexia, but that in mice no such tolerance seems to occur. In the first study, we show that chronic administration of neither d-norfenfluramine (D-NF; the principal metabolite of D-F) nor the serotonin (5-HT) 2C receptor agonist m-chlorophenyl-piperazine (mCPP) is associated with the development of anorectic tolerance tested using a dessert protocol. However, compared with mice receiving these drugs for the first time, both of these chronic treatments were associated with a significant attenuation of Fos immunoreactivity (Fos-ir) in several brain regions, including bed nucleus of the stria terminalis, paraventricular hypothalamus, and central nucleus of amygdala. This attenuation is similar to that described previously in rats. Because loss of efficacy of these agents could be related to loss of 5-HT transporter (5-HTT) sites, their presumptive primary mode of action, in the final study we determined the effect of various, low-dose regimens of D-F and D-NF on 5-HT uptake in frontal cortex of mice and rats. We show in mice that D-F causes a greater loss of 5-HT uptake than D-NF, and that at the lowest dose regimen used uptake was unaffected in rats but was reduced in mice. The data are discussed in terms of the species difference in behavioral tolerance and differences in neurochemical profile of D-F and D-NF.