Association of malignant insulinoma and type 2 diabetes mellitus: a case report.

We report a case of recurrent hypoglycemia due to malignant insulinoma in a type 2 diabetic patient correctly controlled for years with the same doses of oral antidiabetic agents. A 79-year-old woman was admitted for recurrent severe hypoglycemia. She had a history of type 2 diabetes since 2000.

[Hypertrophic obstructive cardiomyopathy in elderly patients. Retrospective study of 23 cases].

This retrospective study was based on data obtained from 23 patients over 65 years old (72 +/- 1.04 years) with hypertrophic obstructive cardiomyopathy followed up for 3 years (37.2 +/- 5.

[Obstructive myocardiopathy in the elderly. A retrospective study of 18 cases].

From a retrospective study of 18 cases of obstructive cardiomyopathy in elderly people collected over a 5-year period, it appears that the incidence of the disease is probably underestimated. It seems to vary in severity, but only one-third of the patients present suggestive clinical symptoms associated with an obvious obstructive syndrome. The best diagnostic method is phonomechanography, which is easy to perform, systematically completed by a pharmaco-dynamic test.

[Emboligenic abscess of the aortic ring disclosing gonococcal endocarditis. Value of echocardiography].

Echocardiography has become a valuable diagnostic modality in bacterial endocarditis and of even more importance in following the subsequent course of the infection while on medical therapy. It can play an extremely important role in certain clinical circumstances, even before blood culture results are available or hemodynamic or auscultatory abnormalities appear. Nevertheless, in spite of this usefulness, the limitations of echocardiography should be recognized.

[Left intraventricular thrombosis. From diagnosis to treatment].

Left ventricular thrombi are the source of much concern in numerous conditions affecting the ventricles. Refinement in echocardiographic and isotopic techniques is enabling earlier diagnosis and a more rational approach to therapy. These thrombi occur very frequently, and are most often asymptomatic (more than 2 to 3 times out of 4), and their natural course is not well known.

Mechanocardiography in evaluation of left ventricular function. Relevance of combined study of apex cardiogram and systolic time intervals in diagnosis of cardiomyopathies.

The study of left ventricular performance by means of systolic time intervals, especially represented by the PEP/LVET ratio and indices drawn from the first derivative of the apex cardiogram, makes possible a good approach to the functional anomalies of patients suffering from hypokinetic cardiomyopathies or hyperkinetic conditions of obstructive or unobstructive hypertrophic cardiomyopathies and of patients with hyperthyroid conditions. In hypokinetic states, the sensitivity and the specificity of the PEP/LVET ratio proved to be good, as was the case for indices taken from the first derivative of the apex cardiogram. However, the sensitivity and the specificity of the cardiogram were much better in the detection and evaluation of hyperkinetic conditions, hypertrophic cardiopathies or hyperthyroiditis.

[Phonomechanographic evaluation of left ventricular function in hyperthyroid states].

Hyperthyroidism is associated with a hyperkinetic syndrome, the mechanisms of which are not fully understood but which include an increase in heart rate, a reduction in systemic arterial resistance and a debatable increase in myocardial contractility. The limitations of radioimmunological assay of the hormonal mediators underline the diagnostic value of an atraumatic method of quantifying left ventricular systolic function. In view of the variable sensitivity of phonomechanographic and echocardiographic indices with respect to changes in heart rate, pre- and after load, we studied apex cardiographic indices during the phase of isovolumetric contraction.

[Semi-automatic acquisition and processing of mechanocardiograms].

Like echocardiography and radio-isotope techniques, mechanocardiography has a special place in the evaluation of left ventricular function in heart disease. This recognized technique can be easily performed by clinicians or pharmacologists or in aerospace medicine. A programme has been developed from micro-processor material (HP 9845 S - SP 9835 - HP 6940 B multi-programmer) already in use in the department.

[Evaluation of left ventricular function and regional kinetics following myocardial infarction. Comparative study of angiocardiography, echography and radionuclide angiography].

Left ventricular function and regional wall motion were studied three weeks after a myocardial infarction in 25 patients who had undergone L.V. monoplane cineangiography.

[Phonomechanography: a premature requiem].

The value of phonomechanographic recordings has been contested in recent years. This seems to be the result of the upsurge in other non-invasive methods of investigating cardiac diseases and left ventricular function such as those based on ultrasound, pulsed Doppler or radioisotopes. Far from opposing these techniques, phonocardiography has benefited from their comparison and association which have validated the systolic time and amplitude indices previously used empirically.

[Bacterial endocarditis and mitral valve prolapse].

The suspected diagnosis of bacterial endocarditis is based on a presumption. Over the last few years, ultrasound, which can identify valvular lesions and their repercussions, has established itself as a supplementary diagnostic tool in the early stages of this disease. The existence of false negatives should not be underestimated, but one must also be aware of the possibility of false positives.

[Valvular or muscular cause of heart sounds?].

During the last twenty years, the genesis of the high frequency heart sounds could be outlined in the opposition between "valvular" and "muscular" theories challengers. The latter argued with haemodynamic results and the former with echographic results. The improving investigation methods permitted recently the understanding of valvular closure and authorize conciliation.

[Cardiac sarcoidosis. Mechanisms of valvular dysfunctions].

The sudden onset of massive tricuspid insufficiency in a patient with ocular and pulmonary sarcoïdosis diagnosed fifteen years earlier exemplifies the possible occurrence of sarcoid heart disease, an entity often misdiagnosed or overlooked. After excluding pericardial effusion and rhythm disturbances we point out the specific characteristics of endomyocardial involvement and discuss the mechanisms of valvular dysfunction. In this particular localization, the possibly deleterious effect of steroid therapy is mentioned.

[Calcifications of the mitral annulus mimicking rheumatic mitral valve disease. A case].

Long neglected, the significance of mitral annulus calcification had now been re-evaluated with the help of echocardiography. An unusual case with clinical symptoms mimicking rheumatic mitral valve disease has enabled the authors to discuss the acoustic manifestations of this entity, its evolutive potential and its causative factors. It is concluded that mitral annulus calcification should no longer be considered as a benign feature of the ageing heart.

[Gastroparesis diabeticorum and bezoar (author's transl)].

Gastroparesis diabeticorum has been isolated by Kassander in 1958. Since that time, 65 well documented cases have been published. Very often the patients are asymptomatic and the disorder is discovered by an occasional X-ray examination of the G-I tract.