L’endoscople d’urgence: les structures,les techniques,le personnel et les statuts

Acta Endoscopica - L’urgence en endoscopie est une situation toujours difficile, qu’elle soit au lit du malade s’il est intransportable, ou au bloc d’endoscopie. Elle...     

Cognitive consequences of early phase of literacy.

The effect of the degree of illiteracy (complete or incomplete) on phonological skills, verbal and visual memory and visuospatial skills is examined in 97 normal Brazilian adults who considered themselves illiterate, and 41 Brazilian school children aged 7 to 8 years, either nonreaders or beginning readers. Similar literacy effects were observed in children and in adults. Tasks involving phonological awareness and visual recognition memory of nonsense figures distinguish the best nonreaders and beginning readers. Children performed better than adults at oral repetition of short items and figure recall, and adults better than children at semantic verbal fluency, digit span, and word list recall. A principal component analysis of the correlations between tasks showed that phonological awareness/reading, phonological memory/oral repetition, and semantic verbal memory/fluency tasks, generated different components. The respective role of culturally based preschool activities and literacy on the cognitive functions that are explored in this study is discussed.     

Conservative management of the prolapsed mitral valve.

Prolapsed leaflet is the result of ruptured chordae, elongated chordae, or ruptured papillary muscle. Various techniques adapted to each of these lesions were developed, and repair of 213 prolapsed mitral valves was performed between 1969 and 1977. There were 109 patients with ruptured chordae treated by quadrangular resection of the prolapsed leaflet; 103 patients with elongated chordae were treated by either a "sliding plasty" of the papillary muscle or a "shortening plasty" of the chordae; and 1 patient with ruptured papillary muscle was treated by reimplantation. The great majority of patients had an associated annular dilatation or deformation requiring the use of a Carpentier ring to remodel the annulus and reinforce the repair. The operative mortality was 4% and the late mortality, 3%. There were 6 reoperations, 3 of which occurred within 1 year. Thromboembolic complications occurred in only 1 patient (0.5%), even though the majority of patients received no anticoagulation treatment. Actuarial curves demonstrated a 91% survival at 8 years.     

Traumatic mitral valve insufficiency after percutaneous mitral valve angioplasty. Mechanisms and surgical technique]

Eighteen patients underwent surgery for traumatic mitral regurgitation following percutaneous mitral valvuloplasty (PMV). Three patients required emergency surgery (delay less than 6 hours). In the remaining cases, the operation was performed one week after PMW (n = 11) or delayed for up to 3 months (n = 4). The operative findings were: ruptured papillary muscle (n = 1); torn anterior leaflets (n = 4), torn posterior leaflet (n = 1), anterior paracommissural tear (n = 3), posterior paracommissural tear (n = 9). Associated lesions included left atrial thrombosis (n = 2) and greater than 1 cm atrial septal defect (n = 4). Conservative mitral valve surgery was possible in over half the cases (n = 10), including two extensive tears of the anterior leaflet. The other patients required mitral valve replacement (n = 8). There were no postoperative complications in any of the patients.     

Book reviews

Abstract

Memory and Amnesia. By A. J. PARKIN, Oxford, Basil Blackwell Ltd. (1987). Pp. viii. + 227. Cased £22.50, Paper £7.95

Rehabilitation of Memory By B. A. WILSON, New York, The Guilford Press (1987). Pp. xi + 259. Cased £19.95.     

Skin responses to topical dehydroepiandrosterone: implications in antiageing treatment?

Background  Although low dehydroepiandrosterone (DHEA) is suspected to have a role in skin ageing, little information is available on the mechanisms potentially involved. Objectives  To obtain information on androgen receptor (AR) and procollagen expression in ageing skin during DHEA treatment. Methods  A placebo‐controlled, randomized, prospective study was performed with 75 postmenopausal women aged 60–65 years. The women were treated twice daily for 13 weeks with 3·0 mL of placebo or 0·1%, 0·3%, 1% or 2% DHEA cream applied on the face, arms, back of hands, upper chest and right thigh where 2‐mm biopsies were collected before and after treatment. Results  Although the overall structure of the epidermis was not significantly affected at the light microscopy level, AR expression examined by immunocytochemistry was markedly increased by DHEA treatment. In the dermis, the expression levels of procollagen 1 and 3 mRNA estimated by in situ hybridization were increased by DHEA treatment. In addition, the expression of heat shock protein (HSP) 47, a molecule believed to have chaperone‐like functions potentially affecting procollagen biosynthesis, was also found by immunocytochemistry evaluation to be increased, especially at the two highest DHEA doses. Conclusion  These data suggest the possibility that topical DHEA could be used as an efficient and physiological antiageing skin agent.     

Cardiac fibroelastoma. Six operated cases and review of the literature

The authors reviewed the cases of 6 patients operated between September 1994 and February 1999 for a rare benign tumour: papillary fibroelastoma of the heart. These patients, aged 51 +/- 14 years, all have single valvular involvement: mitral (N = 3), aortic (N = 2), tricuspid (N = 1). Five patients were symptomatic: transient ischaemic cerebral events (N = 3) associated with mesenteric infarction requiring ileal resection in 1 case; constituted cerebrovascular accident (N = 1); syncope (N = 1). In this last patient, the fibroelastoma was diagnosed fortuitously on the tricuspid valve. The features and location of the tumours were determined by transoesophageal echocardiography. Surgical treatment in all patients consisted in excising the tumour and preserving the valve. One aortic cusp was reconstructed after excising the tumour with a cryopreserved partial aortic homograft. Peroperative transoesophageal echocardiography confirmed the absence of regurgitation after the procedures in all patients. There were no postoperative complications in any of the cases. No cases of valvular regurgitation or of tumour recurrence were observed during follow-up. Despite the benign histology, cardiac fibroelastomas should be excised because of their embolic complications. Absence of recurrence justifies conservative reconstruction of the affected valve.     

Aortic cusp extension valvuloplasty for rheumatic aortic valve disease: midterm results

BACKGROUND: The introduction of composite graft repair of aortic root aneurysm by Hugh Bentall in 1968 promised Marfan patients the choice for a normal life expectancy. We performed our first Bentall composite graft procedure in 1976 and herein report our 24-year experience with 271 Marfan patients. METHODS: Between September 1976 and August 2000, 232 Marfan patients had a composite graft replacement of the aortic root, 15 patients received a homograft, and 24 had a valve-sparing procedure. RESULTS: Two hundred thirty-five Marfan patients underwent elective aortic root replacement with no 30-day mortality. Two early deaths occurred among 36 patients who underwent urgent or emergent operation. Eighty-three percent of patients in this series are currently alive. The actuarial freedom from thromboembolism, endocarditis, and reoperation on the residual aorta 20 years postoperatively was 93%, 90%, and 74%. Twenty-four patients have undergone valve-sparing procedures with encouraging results. CONCLUSIONS: Elective aortic root replacement for Marfan patients can be performed with low operative risk. Elective repair before the aortic root reaches 6 cm in diameter is recommended to minimize risk of dissection and rupture.