[Prognosis of ischemic mitral valve insufficiency]

Seventy-nine patients with ischemic mitral regurgitation were followed up for a period of 20 +/- 8 months. The risk of death increased with age and cardiac failure at the time of inclusion. The risk of cardiac events increased with these factors and also with raised serum creatinine and decreased echocardiographic fractional shortening. The global 2 year survival was 72.8% and survival without a further cardiac event was 48.7%. Surgery and angioplasty increased global survival and freedom from cardiac events of patients with severe regurgitation (74.9% and 68.8% versus 59.4% and 46.1% for medical therapy alone). The functional improvement was also greater in patients undergoing surgery or angioplasty (80% of patients in NYHA Stage I versus 53.8% in the medical group). Angioplasty was only performed in cases of paroxysmal mitral regurgitation by reversible papillary muscle ischemia. Surgery (coronary bypass usually associated with mitral valve replacement) was associated with better results than medical therapy alone in permanent mitral regurgitation by papillary muscle dysfunction or rupture. Despite a high immediate mortality, this option should be considered rapidly in cases of severe ischemic mitral regurgitation with pulmonary oedema.

[Is the prognosis of non-thrombolysed inferior infarction benign?]

Between 1978 and 1983, 2,970 coronary angiographies were performed at the Cardiology Clinic of Necker Hospital; 220 survivors of an initial Q-wave inferior infarction who had not received thrombolytic therapy were selected. The ejection fraction was 55 +/- 11 per cent, and the indexed end diastolic left ventricular volume was 108 +/- 29 ml/m2. The left anterior descending artery was diseased in 57 per cent of cases. The incidence of multivessel disease was 67 per cent. Two hundred and eleven patients (96%) were followed up for 79 +/- 22 months. The prevalence of cardiovascular events was: cardiac deaths: 22 (10%), recurrent infarction: 20 (9%), angina requiring coronary bypass surgery: 60 (28%), cardiac failure: 22 (10%). The 10 year actuarial survival was significantly lower in patients with an ejection fraction less than 45 per cent (46% vs 91%) and in patients with triple vessel disease (62% vs 92% and 88%). The survival was not lower in patients with stenosis of the left anterior descending artery.

[Listeria rhombencephalitis caused by Listeria monocytogenes with a cerebrospinal fluid initially normal]

A case of rhombencephalitis due to Listeria monocytogenes in a non immunocompromised patient, with initially normal cerebrospinal fluid, was marked by potentially fatal neurovegetative disorders and severe neurological sequelae partly due to delay in diagnosis and treatment. The possibility of Listeria infection should be considered in patients with fever and cranial nerves deficits, in order to initiate an appropriate antibiotic therapy and to keep the subject under close monitoring in an intensive care unit.

[Persistence of the perioptic ring of the ophthalmic artery. Anatomical and embryological observations]

At the foetal age, there is an arterial ring around the optic nerve inside the orbit. This ring, partially supplied by the ophthalmic artery, is transitory. A persistence at the adult age is absolutely exceptional. The case described in this paper is the second to be published. It has been found during a microdissection of the arteries of the orbit muscles. The authors discuss the variations of the origin and the course of the ophthalmic artery, according to the three embryologic origins of the orbital arterial vascularization: dorsal and ventral ophthalmic arteries, hyoïd artery. This multiple origin explains the formation of the ring and its persistence.