[Endoscopic case: endotracheal hair!].
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Biomedical subjects
Publications and source records attributed to G Haguenauer.
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The authors report a new case of primary chylopericardium in an asymptomatic 26 year old male. In view of the negativity of the complementary etiological investigations a surgical subxiphoid window was performed and this confirmed the diagnosis. After failure of isolated evacuatory drainage, the patient was cured by pericardectomy. The anatomo-clinical, biochemical and diagnostic features of this condition are described based on a review of the other cases of primary chylopericardium reported in the literature. Surgical pericardectomy seems to be the only effective long term treatment.
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The dialysate of an extract of leucocytes having transfer factor (TF) activity was administered, at a daily dose of 1 mg/ml of orcinol-sulphuric positive material, by intramuscular injection to 12 patients with bronchopulmonary cancer for 6 days. An increase in the percentage of E-rosettes and the absolute number of T lymphocytes was observed in 7 cases out of 10. Rapid healing of a widespread intercurrent zona and a regin of B.C.G. scarification reaction was also noted. The TF was well tolerated in most cases.
Five observations of mediastinal brochogenic cysts are used to illustrate the diagnostic and/or therapeutic difficulties encountered in cases with an ectopic topography or complications. In two cases, one of which was clearly located in the posterior mediastinum and associated with a false erosive appearance of the nearby vertebral body, it was possible to establish the degree of ectopic displacement of the bronchogenic cysts, and to comprehend the pre-operative diagnostic difficulties and nosological problems associated with these sequestrations. As far as complications are concerned, one observation was able to confirm that a sudden volume increase doesn't always correspond to a septic process, and that rapid secondary reduction in volume is not always accompanied by fistulation. Intracystic suppurations differ in appearance according to their location. In the subcarinal region they can cause a fistula, as in the case reported. In other regions, in this case the left lateral tracheal area, suppuration is enclosed, but it can be associated with suppurative lesions of the adjacent lung. The operative difficulties, partial cystectomy in one case and associated lobectomy in the other, are further evidence for the need for systematic excision of all bronchogenic cysts as soon as they are diagnosed and before complications occur.
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Previously fatal in the majority of cases, traumatic interventricular communications are now curable by surgery. This is illustrated by the case described here of a 20 year old man. 62 other cases were found in the literature. A systolic murmur is the essential feature in diagnosis but it may be discovered some time after the accident. The demonstration of cardiomegaly has less diagnostic significance than ECG signs suggestive of an infarction. Haemodynamic studies are essential to confirm the diagnosis and to provide an accurate assessment of the lesion. The spontaneous course is serious since death results in two thirds of cases. Surgery is indicated, other than in well tolerated forms with a minimal shunt. The approach used has almost always been right cardiotomy. However, incision of the left ventricle offers better visibility of the lesions which may be masked by the papillary muscles when a right-sided approach is adopted. This was used in the present case with an excellent result since the patient was able to continue the military career for which he had opted.
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An echographic study, both before and under isoproterenol infusion, was performed on 50 normal subjects. The movements of the posterior wass of the left ventricle were found to be averagely increased of 62% as regards the amplitude, 114% for the mean speed and 124% for the maximum speed of contraction. The transcerse diameter of the left ventricular cavity decreased by 5.25%. The circumferential fibres shortening speed expressed in circumference by second increased by 128%. An uninvasive method, echography, as cineangiography, makes it possible to assess the myocardial contractility on the basis of measurement of the average speed of circumferential fibres and of the diameter of the left ventricle.
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