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Tearing of the chordae is a common complication of prolapse of the mitral valve; which becomes increasingly common with age. In contrast, aneurysm of the Valsalva sinus is rare in patients over 65 years of age. The antero-left sinus is an unusual location, but may be complicated by compression of the left coronary artery, which is reported in 16 cases in the literature. The case reported is unusual due to the combination in a 66-year old subject of acute mitral incompetence, due to tearing of the chordae following prolapse of the mitral valve, and an aneurysm pressing on the coronary trunk whilst remaining asymptomatic. Complete correction of the lesions was successfully achieved by surgery.

The authors refer to the technique of the serum digoxin enzyme immunoassay, and they report the results of 297 dosages concerning 111 hospitalized patients. The normal plasmatic rates are of 1,4 +/- 0,6 microgram/l in patients who present no sign of digitalic overdosage. The rates are of 5,2 +/- 1,6 microgram/l in cases of intoxication. The difference between these rates is greatly significant (p less than 0.001). The limit between therapeutic and toxic rates is situated around 3 microgram/l with an overlapping from 2 to 3 microgram/l. Authors then examine the individual factors that intervene in digoxin metabolism and especially study the influence of age, myocardic factors and renal insufficiency. On the basis of these results and review of the literature, they emphasize the interest of serum digoxin determination in the diagnosis of digitalis toxicity, as well as in the management of high risk patients, and of cardiopathies difficult to stabilize.

Zinc, an important enzymatic cofactor, takes part in numerous metabolic pathways. In man, zinc deficiencies may be due either to deficient absorption or to excessive use. In this study in 285 patients hospitalized in a department of internal medicine for acute or chronic conditions, serum zinc assays have shown the following results: serum zinc concentrations are significantly decreased in acute critical conditions (cardiovascular ischemic disorders, heart failure, infections); in chronic conditions, serum zinc is decreased in some instances (renal failure, cancer, alcoholism, diarrhea), while it remains normal in others (compensated heart failure, non-insulin dependent diabetes, arterial hypertension, obesity). The fall in serum zinc concentrations is usually correlated with the severity of the clinical condition.

One hundred and fifty-four patients from 70 to 85 years old (mean 74.5 +/- 4.5 years), including 105 men and 49 women, underwent a bicycle exercise test, in the upright position, with 3 minutes triangular levels (levels of 20 watts or more often 30 watts). Blood pressure (BP) was measured at rest and at the end of each level, using the auscultatory method and a mercury manometer. These 154 patients were divided in 59 "healthy" old people, 21 patients suffering from coronary insufficiency but with normal BP, 12 hypertensive patients and 62 patients receiving antihypertensive therapy. The results showed, as in younger people, a linear relation between BP and heart rate (HR). The slope of BP reported to HR determined the exercise BP of each subject. The mean value of "healthy" old people defined the normal exercise BP of people over 70 years old. Slope of systolic blood pressure (SBP) was higher in men than in women, but declined in both sexes in people over 80 years old. Slope of SBP was lower in the case of coronary insufficiency. In hypertensive patients, slope of SBP was the same as in normotensive patients, but was shifted upward. Finally mean exercise BP was lower in patients receiving antihypertensive therapy, compared to non-treaded patients with equal rest BP. The knowledge of exercise BP is useful for the right interpretation of exercise testing in old people suffering from coronary insufficiency or hypertension, as well as in presumed healthy old people.

The association of a drug related hypersensitive vasculitis followed two years later by angio-immunoblastic lymphadenopathy is reported. The hypothesis of a similar pathogenesis of these two conditions is discussed.

Perforations of the colon and rectum during administration of barium enema. Six cases report. The authors have stated six cases of accidental perforation occurring during barium enema examination. They recall their principal modality of unexpected arrival, in particular: the type of nozzle used, the means of injecting the contrasting liquid, the role played by the pathological associated colon-rectum lesions. The diagnosis may be postponed especially when the perforation is under the peritoneal seat. The pain during or after the opacification as well as the rectorragies are the most frequent alarming symptoms observed. The prognosis is on the whole serious but is can be improved by a rapid and appropriate therapy.