Revista de medicina interna, neurologe, psihiatrie, neurochirurgie, dermato-venerologie. Medicina interna最新文献

A group of 12 patients with recent acute hepatitis (8/86 with HVB and 4/22 with alcoholic hepatitis) had a rapid evolution (under 2 years) towards hepatic cirrhosis (early H.C.). The clinical-biological, immunological and morphological study made evident several characteristics, which became predictive markers of the early cirrhotic evolution of acute hepatitis. Clinically, a persistence of dyspeptic disorders and appearance of several systemic manifestations is noticed. Biologically, the maintenance of some increased transmainases, variable bilirubinemia and decrease of serinemia. Immunologically, the transfer of IgM towards increased IgM, the decrease of the total T lymphocyte and of T1 substrate, the increase of the active B and T lymphocyte. The morphologic exploration is decisive for specification of the diagnosis in the early hepatic cirrhosis.

The object of the present investigation was the discovery of the arrhythmias in the patients with prolapse of the mitral valve (PMV), the types of arrhythmias, the factors favouring them, the therapy used. In a group of 126 patients suffering from PMV, 25 had mitral insufficiency, and 48% of the cases had arrhythmias too. The ventricular arrhythmias existed in 18 patients, in the most of them as ventricular extrasystoles. Only in 2 cases, ventricular paroxysmal tachycardia was noticed, and only one case of ventricular fibrillation was recorded. The following conclusions were drawn from the study: the increase of arrhythmias is low, their appearance is correlated with mitral insufficiency, ventricular arrhythmias are predominant, the majority are benign, they are more frequent than in the patients with neurovegetative dystonia (if considering the prolapse associated with systolic murmur), necessity of periodic control for discovering the cases with high risk of ventricular arrhythmias with malignant potential.

The Doppler method (pulsatile and continuous) was used for finding out and semiquantitatively evaluating the mitral insufficiency of various etiologies: inflammatory (rheumatic); prolapse of mitral valve; obstructive hypertrophic cardiomyopathy; dilatative cardiomyopathy; calcification of valvular ring. The Doppler parameters obtained after automatic processing of the image (speed transvalvular pressure gradient, flow period and acceleration) offer data on the diastolic performance of the left ventricle. Registration of the aortic flow makes possible the calculation of the cardiac flow (the diameter of the aorta is measured in echo-B), and of the aortic flow permits the noninvasive evaluation of the lung arterial pressure. The method offers a large vista in the noninvasive evaluation of the patients suffering from mitral insufficiency.

The 78 patients with mitral insufficiency studied in the present paper were chosen taking into consideration the following: regurgitant apex holosystolic or mesotelesystolic murmur, noise 3 and the dilation of the left atrium and/or left ventricle at Echo-20. The patients were investigated clinically, ECG, phonocardiographically and echographically (2D). The etiology was established in 75 patients; non rheumatic causes were present in 70% of the cases. The echographic study, besides the other methods, is very important in diagnosing the mitral insufficiency, in etiology, severity and the degree of deterioration of the pump function of the left ventricle. The Eco-2D examination, a noninvasive method, allows reaching therapeutic medical and surgical decisions at the best moment and helps in assessing the results.

The present paper analyzed the indications and surgical treatment in 505 patients with lesions of the mitral valve. 350 lesions were of rheumatic nature and 148 with nonrheumatic etiology. 31 patients with infectious endocarditis with mitral localization were operated; 3 deaths and 56 cases wits aggravation of the lesions after endocarditis with a mortality of 6%, were recorded. The severity factors, the complications and characteristics of the intervention in these patients were analyzed. 48 patients had dysfunctions of the mechanical prosthesis with disk and 11 with Edwards Carpentier's prosthesis. The dysfunction types, the diagnosis methods and the evolution were investigated. 16 emergency cases with dysfunctions of the prostheses were operated wits good results. The cooperation among cardiologist, surgeon, explorer and anesthesiologist is an essential condition for the best solution of the new and complex pathology.

The incidence, etiology and data on the severity and therapeutic implications of the mitral insufficiency were investigated in the patients admitted in the clinic during 10 years. The diagnosis was based mainly on clinical and echocardiography mode M data. 595 patients suffering from mitral insufficiency (below 2% of the total of the patients admitted) were recorded. In 65% of the cases mitral insufficiency had a rheumatic etiology (the majority associated polyvalvulopathies), in 14.8% an ischaemic origin, and in 10.9% an organic-functional one (the left ventricle was dilated). The primary prolapse of the mitral valve appeared in 6.9% of the cases (the low incidence was explained by the severe criteria applied in positive diagnosis). 4 cases of rupture of the subvalvular apparatus are described in the patients suffering from prolapse. All of them had a sudden onset, by severe cardiac insufficiency without a clear cause, appeared under conditions of seemingly complete health. Intense therapy followed by valvular prosthesis, resulted in a spectacular recovery of the heart function.

The prolapse of the mitral valve is an affection arousing much interest from the clinical and echocardiographical viewpoints. The present paper reports on the analysis of 456 cases (322 women--70% and 134 men--29.39%), suffering from prolapse of the mitral valve, selected out of 15,714 echocardiographic examinations (2.93%). All the patients were examined echocardiographically--Echo) in the M mode and bidimensionally; 256 cases underwent an Echo-Doppler examination, too and in 90 cases the phonocardiogram was also used. 983 cases were diagnosed as clinically suffering from prolapse, confirmed by Echo in 291 cases (29.62%), and in 165 cases the diagnosis was established only clinically. Phonocardiographically, the most frequent were recorded the mesotelesystolic click (40%), followed by click + holosystolic murmur (31.11%), telesystolic murmur (19.70%), holosystolic murmur (6.66%). The prolapse of the mitral valve was evidenced in 394 cases, both by M-Echo and by 2D-Echo; in 28 (6.1%) cases it was evidenced only by M-Echo, and in 34 cases (7.4%) only by 2D-Echo. In 62 cases (13.4%) the prolapse was better evidenced when the patients stood. The most affected was the anterior mitral valve, 203 cases (44.5%). The conclusion was drawn that the prevalence of the prolapse of the mitral valve is of 2.93% according to the Echo examination. A correct diagnosis requires the use of a rigorous examination technique and the observance of the clinical and Echo diagnosis criteria.

The paper reports on 13 cases of infectious endocarditis in the patients with prolapse of the mitral valve admitted for a period of 10 years (1979-1989) into the Clinic of Cardiology of the Fundeni Hospital. These cases stand for 3.6% of the cases with prolapse of the mitral valve admitted during that period, and 5% of the patients with infectious endocarditis. Our study dealt only with the cases of the prolapse of the mitral valve, clinically and echographically documented before the appearance of the septic graft. The hemocultures were positive in all the patients (viridans streptococci in 84.61% cases). The symptomatology, the clinical objective data and the paraclinical results (phonocardiographic, echocardiographic, electrocardiographic, radiologic, investigations with isotopes), the response to the treatment (medical, surgical) and the evolution in time were analyzed. An increase was found during endocarditis in the number of patients with holosystolic murmurs (30.7% cases) versus those with click-telesystolic murmur, the appearance in 41.15% of the cases of valvular vegetations at the Echo examination, and in 15.38% cases of ruptures of cordages. Mitral insufficiency secondary to endocarditis became worse, in 30.76% cases. The treatment with antibiotics resulted in the healing of the infection in all the cases. The surgery was not necessary in any patient during the evolution of endocarditis. The surgery (valvular prosthesis) was made in 23.07% cases, which presented, after curing the septic graft, important mitral regurgitation with cardiac insufficiency refractory to the medical treatment. Prophylaxis of the infectious endocarditis in the prolapse of mitral valve with mitral regurgitation is necessary.