La Tunisie médicale
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La Tunisie médicale · May 2006
Case Reports[Large ostium secundum atrial septal defect discovered after severe mitral regurgitation. A case report].
Mitral regurgitation is associated with ostium secundum atrial septal defect in about 22% of cases. mitral valve prolapse induced by atrial shunt is the main cause of this regurgitation. Ususually, atrial septal defect discovery precedes that of mitral regurgitation. The aim of this paper is to focus on clinical, hemodynamic and evolutive details of atrial septal defect and mitral regurgitation association. We report the case of large atrial septal defect in 37 years old girl referred for hemodynamic investigation of mitral regurgitation. The divergence of clinical data, electrocardiogram and echocardiography findings has led to atrial septal defect discovery. Hemodynamic data showed severe pulmonary arterial hypertension (medium pulmonary arterial pressure: 45 mmhg). Hence, mitral valve substitution by mechanical prosthesis and closure of atrial septal defect have been carried out. Ten hours after surgery, death occurred because of severe pulmonary arterial hypertension and heart failure. ⋯ Association of severe mitral regurgitation and large ostium secundum atrial septal defect is an original anatomo-clinic entity caracterized by mitral valve lesions diversity and severe secondary pulmonary arterial hypertension. Danger of such a hypertension is due to progressive and infra clinical rise of pulmonary resistances and association of increased pulmonary blood flow and capillary pulmonary hypertension.
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La Tunisie médicale · Apr 2006
Review[Procalcitonin as a prognosis and diagnosis aid in post-operative cardiac surgery].
Procalcitonin (PCT), has been identified as a reliable marker of bacterial infection in critically ill patients. After cardiac surgery, infectious and non infectious inflammatory processes can cause a significant increase in PCT production. ⋯ PCT levels < 2ng/ml can be observed after extracorporeal circulation in case of systemic inflammatory response, in the absente of any post operative complication. However, bacterial infection with organ dysfunction should be suspected when PCT levels are higher 5 ng/ml.
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To evaluate locoregional recurrence rate of breast cancer, determine its anatomoclinical characteristies and discuss the available therapeutic alternatives. ⋯ Prognosis of breast cancer depends on distant metastasis. LRR constitutes the second major risk liable to influence the overall prognosis.
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Traffic accidents are a very important leading cause of death in young adults in our country and the most cause of non penetrating cardiac trauma. Cardiac contusions represent the most common form of non penetrating cardiac trauma but a wide spectrum of cardiac injury ranging from, cardiac valve is not usually foremost in the minds of physicians dealing with acutely injured patients because initial screening is usually focused on others classic and common injuries. ⋯ This paper describe the most important blunt cardiac injuries and emphasizes indirectly the need for early diagnosis that becomes an easy one, if the physician keeps in mind such a possibility in all traumatised patients. Another concern is to point out the importance of appropriate therapeutic approach that may significantly improve outcomes in patients with blunt cardiac trauma.