[Diagnosis and localization of ventricular septal defects by two-dimensional echocardiography. 50 cases]

A series of 50 children aged between 1 month and 15 years old, with ventricular septal defects (VSD) were investigated by two-dimensional sector scanning and cineangiography. Fifty other children of the same age group with congenital heart disease without VSD were also investigated by two-dimensional echocardiography and angiography. No VSDs were diagnosed by echocardiography in children with angiographically intact inter ventricular septa. In the group with VSD, two-dimensional echo localised with precision: --36 membranous VSDs (36/36) --5 infundibular VSDs (5/6) --2 isolated muscular VSDs (2/2) --I atrioventricular canal type VAD (I/I) --3 multiple VSDs (3/5). The subcostal view was the most useful for visualising the VSD in 49 out of 50 cases. The parasternal views only showed the VSD in 23 cases, and the apical views only in II cases. The dimensions of the left heart chambers and the movement of the interatrial septum gave an indication of the volume of the left-to-right shunt. Dilatation of the left heart chambers and bowing of the interatrial septum into the right atrium in systole were observed in all cases where QP/QS greater than 2, except when there was an associated atrial septal defect. Two-dimensional echo also detected associated lesions: pulmonary stenosis (9/9), prolapse of an aortic valve cusp (4/5), atrial septal defect (2/2), stradling of the tricuspid valve (I/2). Two-dimensional echocardiographic short axis subcostal views are reliable in the detection and localisation of VSD. Nevertheless, trabecular and apical VSDs are particularly difficult to visualise and the use of pulsed Doppler coupled with two-dimensional echocardiography should enhance the sensitivity in diagnosing this type of VSD.

[Diagnosis of a complete atrioventricular canal with infundibular pulmonary stenosis and left superior vena cava by 2-dimensional contrast echocardiography. Apropos of a surgically treated case]

The case of an eight year old child with complete atrioventricular canal, pulmonary infundibular stenosis and persistent left superior vena cava draining into the coronary sinus is reported. Two-dimensional echocardiography with injection of contrast in a left arm vein gave a precise and complete diagnosis of the malformations before catheterisation and angiography. The complete atrioventricular canal was demonstrated by apical four-chamber views. The pulmonary infundibular stenosis was visualised by a short axis subcostal view. Contrast echocardiography in the apical four-chamber view showed a right-to-left shunt at atrial level at the site of the ostium primum and a right-to-left shunt at ventricular level just below the hemivalve. The left superior vena cava was detected by a short axis suprasternal view which visualised its vertical trajectory as far as the coronary sinus. The lesions were confirmed at surgery, and a complete repair was performed.

[Vitamin B12 deficiency in chronic atrophic gastritis. 3 cases (author's transl)]

The megaloblastic anaemia observed in patients with chronic atrophic gastritis is usually due to malabsorption of vitamin B12. In some cases, the absence of intrinsic factor supports the diagnosis of pernicious anaemia but other factors, the importance of which varies from case to case, are also involved. They include proliferation of bacteria in the lumen of the gut, intestinal cell abnormalities resulting from lack of vitamin B12 and low hydrochloric acid output with subsequent reduction in the release of vitamin B12 from foodstuffs. With regard to treatment, it would seem justified to combine oral broad-spectrum antibiotics with parenteral administration of vitamin B12.

Mass fragmentographic determination of xanthine and hypoxanthine in biological fluids

The method presented for the simultaneous determination of xanthine and hypoxanthine, uses mass-fragmentography in the electron impact (EI) mode, after the gas chromatographic separation of butylated derivatives. Butylation, rather than methylation, is used in order to avoid interference coming from exogenous caffeine, which is frequently encountered. [7,9-15N]Xanthine is used as the internal standard, and for each sample, a blank is obtained by xantine oxidase reaction. In the biological fluids studied the sensitivity was about 50 ng/ml.

[Tienilic acid-induced hepatitis associated with liver/kidney microsomal antibody (author's transl)]

Six patients developed acute, subacute or chronic hepatitis after taking tielinic acid, a new diuretic used in the treatment of hypertension. Two died of acute liver failure. The condition was characterized by marked increase in serum transaminases, parenchymal necrosis and portal and/or lobular inflammatory fibrosis. In addition, the serum of all patients contained high titers of a liver/kidney microsomal antibody, which disappeared either after tienilic acid was discontinued or after prednisolone was introduced. The study shows that tienilic acid may be responsible for acute or chronic hepatitis and suggests that a liver/kidney microsomal antibody could be a sero-immunological marker of drug-induced liver disease.

[Value of urgent ultrasonography after renal injuries. A report on 12 cases (author's transl)]

The results of ultrasonography recordings carried out urgently in 12 patients after renal trauma are used by the authors as a basis for outlining the ultrasonography features discovered in post-traumatic renal lesions, and for discussing the value and place of this examination in overall investigations of these lesions. Ultrasonography findings are compared with those of intravenous urography, and in certain cases with those of arteriography. Ultrasonography appears to be indispensable in many cases in order to confirm intravenous urography results, to complement them, and possibly to make up for their deficiencies. It is of particular value in 2 conditions: a) renal artery thrombosis, in which case it is the only examination capable of supplying information on the parenchyma, b) benign renal contusions which may not appear on intravenous urography.

[Rénal oxalic and gallbladder lithiasis after ileal resection for Crohn's disease: a report on one case (author's transl)]

The authors report the association, in a 64-year old man with previous large ileal resection (110 cm) for Crohn's disease, of gallstone and oxalate renal stones. The oxaluria was 60 mg per day (normal, less than 25 mg) and the fecal fat excretion was 50 g per day (normal, less than 6 g). A low--oxalate and--fat diet for 3 months reduced dramatically the steatorrhea, but was totally ineffective for the reduction of hyperoxaluria. The physiopathological mechanisms and the therapeutic consequences of these metabolic complications of ileal resections are discussed.

Glycogen-depletion method of intrafusal distribution of gamma-axons that increase sensitivity of spindle secondary endings

1. The glycogen-depletion method was used in cat tenuissimus muscles to investigate whether the action of static gamma-axons that increase the sensitivity of spindle secondary endings to muscle length is associated with a specific pattern of distribution of these axons to intrafusal muscle fibers. 2. In each experiment, a single gamma-axon acting on a secondary ending of a precisely located spindle was repetitively stimulated, and subsequently the intrafusal muscle fibers of that spindle were examined for glycogen depletion. 3. The gamma-axons whose repetitive stimulation increased the length sensitivity of secondary endings depleted all the chain fibers in one or both poles of the spindle, with the bag fibers being inconstantly involved. The gamma-axons whose stimulation did not exert this effect produced much more restricted patterns of glycogen depletion. 4. The length sensitivities of two secondary endings belonging to the same spindle were similarly affected by a single gamma-axon, whereas a gamma-axon could increase the sensitivity of a secondary ending without altering that of the primary ending of the same spindle. 5. The action exerted by single gamma-axons on secondary endings appears related to their intrafusal distribution since enhancement of the secondary endings sensitivity was observed only when all the chain fibers of at least one spindle pole were activated. 6. If several static gamma-axons supplying a given spindle are firing together, an increase in the length sensitivity of the secondary endings of that spindle can be expected since probably all chain fibers are activated.

[Supraventricular tachycardia in newborn infants and infants]

Four types of supraventricular tachycardia were identified in a retrospective study of 71 babies who presented under the age of 3 months. The arrhythmia originated in the atrium in the first two types (25% of cases, atrial tachycardia 10 cases, chaotic atrial tachycardia 7 cases). In the other types the arrhythmia originated at the atrioventricular node. Reciprocal rhythms were most common (62%) and those starting in the bundle of His the least common (5%). It is relatively easy to distinguish the different types which are important because treatment may vary. Overall 75% recover completely, 11% have sporadic recurrences and 10% have a chronic arrhythmia. The junctional varieties have the worst prognosis.

Histophysiological observations on fast skeleto-fusimotor axons

In three instances, repetitive stimulation of a single fast skeleto-fusimotor axon supplying cat tenuissimus muscle was observed to activate a secondary ending belonging to a precisely located spindle. Prolonged repetitive stimulation of these beta-axons elicited glycogen depletion in the intrafusal muscle fibres of the located spindles and in extrafusal fibres. The intrafusal depletion affected the longest of the chain fibres in two instances, and the bag1 and bag2 fibres in the third instance. In one experiment, the discharge from the primary ending of the located spindle was also recorded. The fast beta-axon (it supplied the longest chain fibre in the spindle) had a static action on the primary ending. The extrafusal muscle fibres of the 3 fast beta-motor units belonged to the fast oxidative-glycolytic type.

[Ureteral metastases from prostatic cancers. 2 cases. Review of the literature]

The authors report two new observations of ureteral metastases from prostatic cancers and review the 17 already published cases. The relative rarity might well be only apparent, in relation with the delay in the exploration of the first observations. The diagnostic criteria are less clinical and radiological than anatomo-pathological, the metastases contrasting themselves with ureteral invasion by direct propagation. The anatomical status shows no predominance between tumoral or infiltrating forms, nor of any particular site on the ureter, while noting a relative frequence of bilateral involvement. The therapeutic approach is dependant upon these factors. The prognostic is reserved, at the cost of a segmental ureteral resection or a nephro-ureterectomy.

"Fast" and "slow" skeleto-fusimotor innervation in cat tenuissimus spindles; a study with the glycogen-depletion method

The glycogen-depletion method was used to investigate the motor supply to tenuissimus with respect to the presence of fast beta axons and to assess the total proportion of both fast and slow beta-innervated spindles in this muscle. In a first series of 5 expts., groups of motor axons with conduction velocities higher than 85 m/s were repetitively stimulated so as to produce glycogen depletion in the muscle fibres they innervated. The whole muscle was then quick-frozen, serially cut, stained to demonstrate glycogen and examined for intrafusal glycogen depletion. Zones of glycogen depletion were found in 16 of the 46 examined spindles; they were most frequently located in the longest of the chain intrafusal muscle fibres. Since it is known that there are no purely fusimotor axons to tenuissimus with conduction velocities above 50 m/s, it was concluded that beta axons are present among the fastest axons to this muscle. In a second series of 5 expts. as many motor axons as possible with conduction velocities above 60 m/s were stimulated. Zones of glycogen depletion were found in 19 of the 47 examined spindles. They affected chain fibres in about half of the instances and bag1 fibers in the others. As this latter location is characteristic of slow dynamic beta axons, it was concluded that both slow and fast beta axons occur regularly in the motor supply to tenuissimus. beta-innervation is present in at least 40% of tenuissimus spindles with almost no convergence of fast and slow beta axons onto the same spindle.

On the subdivision of static and dynamic fusimotor actions on the primary ending of the cat muscle spindle

1. Using large ramp and triangular stretches a survey has been made of the effect of stimulating single gamma fusimotor fibres on primary endings of muscle spindles in the peroneus brevis to see whether 'intermediate' types of fusimotor action could be recognized, falling between the well known static and dynamic types. 2. Responses were classified into six groups, as detailed on pp. 844-846, ranging from apparently 'pure' dynamic action (category I) to apparently 'pure' static action (category IV). Models for a putative mixed action were produced by combining the stimulation of a static and of a dynamic fibre to the same spindle. The clearest sign of static action was firing on the releasing phase of the stretch. The essential sign of dynamic action, which survived combination with the more dominant static action, was the low adaptive decay of firing with a time constant of about 0-5 sec that occurs on the plateau of the ramp stretch. 3. Out of 153 responses, each elicited from a primary ending on stimulation of a single fusimotor fibre, 67% were apparently 'pure' examples of dynamic and static action. The remaining 33% of responses were to some degree suggestive of an admixture, in various proportions, of static and dynamic actions. For only 18% of them was there firm indication of such admixture. 4. When a given fibre was tested on more than one ending then, with one exception out of thirty-six instances, its action always proved to be either predominantly static or predominantly dynamic. There was no special tendency for an axon with a mixed action on one spindle to have a similarly mixed action on other endings so that individual fusimotor fibres were best classified as static or dynamic without intermediate grades. 5. Simultaneous stimulation of two fusimotor fibres eliciting apparently 'pure static and dynamic actions, could mimic all the intermediate types of action. 6. The results are discussed in relation to recent studies, especially those based on glycogen depletion. It was concluded that dynamic action arises from activation of the bag1 intrafusal muscle fibre, and that static action arises from the bag2 and chain fibres, whether acting individually or collaboratively. The intermediate actions are suggested to arise from an overlap of motor innervation to contrasting types of intrafusal muscle fibre. 7. On the basis of effects on the regularity of the afferent discharge the findings support the view that a given static action axon can innervate bag2 and chain fibres in various proportions in different spindles, so that they do not provide separable effector pathways. 8. Responses to large amplitude sinusoidal stretching were also studied in relation to our classification.

Fast-conducting skeletofusimotor axons supplying intrafusal chain fibers in the cat peroneus tertius muscle

1. In six experiments on cat peroneus tertius muscle, from 12 to 23 motor axons with conduction velocities above 85 m/s were repetitively stimulated so as to produce glycogen depletion in the muscle fibers they innervated. 2. The whole muscle was then quick-frozen, serially cut, stained to demonstrate glycogen, and examined for intrafusal glycogen depletion. 3. Zones of glycogen depletion were found in 27 of the 99 examined spindles: they were almost invariably located on chain fibers and specifically on the longest of the chain fibers in affected spindles. 4. Since it was shown that there are no purely fusimotor fast axons in the motor supply to peroneus tertius, it is concluded that skeletofusimotor axons are present among the fastest motor axons to this muscle.

Frequency of tendon organ discharges elicited by the contraction of motor units in cat leg muscles

1. The responses elicited in individual tendon organs by the contraction of single motor units were studied in peroneus longus, peroneus brevis, tibialis anterior and soleus muscles. 2. No simple relation was found between the discharge frequency of a tendon organ and the tension produced in the muscle tendon by the contraction of individual motor units. 3. The sensitivity of a given tendon organ to contractile tension was not the same for each of the motor units which elicited its discharge. There was no correlation between the sensitivity of the receptor and the strength of the motor units. 4. Upon repetitive stimulation of a tendon-organ-activating motor unit at increasing rates, the frequency of the receptor sustained discharge reached a maximal value for rates of stimulation eliciting submaximal tetanic tension. Higher rates only produced an increase in the dynamic component of the tendon organ response. 5. These observations show that the contractile tension sensed by a tendon organ is not a simple fraction of the tension which appears at the muscle tendon. They might be accounted for as consequences of the fine structure of tendon organs and of variations in the number of muscle fibres contributed by different motor units to the bundle inserted on each receptor. The location of most tendon organs at musculo-aponeurotic junctions rather than in the tendon proper, could also be responsible for some of the observed discrepancies.

[Phosphorus requirements of bacteria metabolizing hydrocarbons in the sea]

The artificial stimulation of biological purification of sea-pollutant hydrocarbons requires phosphorus supply. The concentrations, corresponding to the optimal bacterial growth, depend, in particular on ionic strength. They range between 2 and 8 X 10(-4) M for waters in which the salinity is close to the mean salinity of an oceanic environment and between 1.5 and 3 X 10(-3) M when these waters receive a significant supply of freshwater or when salinity is naturally weak. Inhibition of bacterial development has been observed either with a microflora, or with pure strains for concentrations higher than the upper limits of concentrations so defined.

[Quantitative separation of biological lipids by successive chromatographic runs on juxtaposed thin layers (author's transl)]

During a study on incorporation of 14C-labeled precursors in biological lipids, we had to elaborate a method of quantitative separation of lipid classes, based upon three successive chromatographic runs on juxtaposed thin layers. The first thin layer, on which the lipid extract is applied, consists of silica gel alkalised by means of sodium hydroxide solution. The second thin layer is constituted only by silica gel G. The three one-dimensional migrations are respectively carried out in the following solvent systems: diethyl ether-hexane-benzene (55:30:15), hexane-benzene (80:20) and diethyl ether-benzene-acetic acid (62:20:18). The lipid fractions are scraped out and counted by liquid scintillation. The reproducibility of the whole operation is discussed.

Heterogeneity of motor units activating single Golgi tendon organs in cat leg muscles

The aim of this study was to investigate whether an individual Golgi tendon organ can signal the contraction of motor units with different physiological properties. The axonal conduction velocity and tetanic tension of motor units were examined in four muscles of the cat leg (peroneus brevis, peroneus longus, tibialis anterior and soleus). The motor units which were found to activate a given tendon organ had contractile properties dispersed over the same range as those of the whole muscle population. The proportion of tendon organ-activating motor units found in the studied samples suggests that altogether, the Golgi tendon organs of a muscle monitor the contraction of every motor unit in this muscle.

Cytochemical and electron-microscopic study of the paraoesophageal bodies and related nerves in Schizophyllum sabulosum (L.), Diplopoda Julidae

The ultrastructural study of the paraoesophageal bodies of Schizophyllum sabulosum reveals the occurrence of two axonal types (ax 1 and ax 2) near secretory cells. Two possibilities exist for the functional role of the nerves related to these paraoesophageal bodies. The results of treatment with proteases (pronase, pepsin, trypsin) and the identification of glycogen in both the paraoesophageal bodies and the nerves that link them to the brain and Gabe organs, suggest transport of at least part of the secretions from the paraoesophageal bodies to the Gabe organs.

Unsutured Dacron prosthesis in groin hernias

We have repaired difficult groin hernias during the past six years by an original procedure consisting of fitting an unsutured Dacron patch between the peritoneum and the muscular layers using a median lower abdominal incision. Our standard technic is described along with its variations and applications.