La Nouvelle presse medicale最新文献

In a patient with spondylodiscitis secondary to cardiac valve prosthesis infection with endocarditis the fungus Drechslera longirostrata, which had not yet been known to cause mycoses, was isolated from cultures of prosthetic material and an intervertebral disc. The cardiac prosthesis had to be replaced and the vertebral lesion, which extended along 3 lumbar segments and was destructive enough to produce neurological disorders, required surgical immobilization of the spine. The disc infection was cured after combined administration of amphotericin B and ketoconazole, both drugs having proved unsuccessful when given alone. Infections caused by rare opportunistic fungi are becoming increasingly common and are difficult to diagnose since immunological methods are inapplicable. In some resistant or extremely severe fungal infections antifungal agents can be used in combinations for their synergistic effects, with subsequent reduction of dosage and potential side-effects. Combinations must be based on in vitro sensitivity tests.

The statistical correlation between obesity and essential hypertension is well established. The beneficial effect of weight reduction and the detrimental effect of weight gain on blood pressure have also been repeatedly demonstrated. The pathophysiological mechanisms underlying this correlation are still obscure, but various hypotheses, which sometimes favour different types of diet, have been put forward. Some studies suggest that energy restriction and salt restriction might have independent beneficial effects. Furthermore, the metabolic abnormalities associated with obesity are often improved by diet, whereas antihypertensive drugs may have deleterious effects. It would be of interest to know whether blood pressure response to diet is dependent upon the type of obesity. Controlled clinical trials comparing the effects of drugs and diet are highly desirable.

Between november, 1974 and june, 1977, 64 adult patients with acute myeloid leukaemia in remission were divided at random into two treatment groups: chemotherapy alone (n = 32) or chemotherapy plus B.C.G. (n = 32). Fresh B.C.G. from the Pasteur Institute, Paris, was administered once a week, two or three times per month, in the intervals between chemotherapy cycles, using the Heaf-gun method. The duration of the first remission was significantly increased in the group receiving B.C.G. (median duration 685 days versus 390 days: p = 0.03 on log rank test) as was the overall survival (median duration of survival 1.471 days versus 554 days: p = 0.01). Second remissions were more frequent in the B.C.G. group (79% versus 42%; p = 0.014). In addition, prolonged survival was more frequent in the B.C.G. group, where 12/32 patients remained in first remission between 3 and 6 years, as against 5/32 in the chemotherapy group.

The influence of MOPP therapy on pregnancy and offspring was retrospectively studied by means of a questionnaire in 68 women who had been given 3 to 6 cycles of the drug combination for Hodgkin's disease between 1972 and 1976. All were aged from 16 to 45 years at the time of diagnosis; none had received abdominal irradiation. Before treatment, 72 pregnancies had occurred in 36 women; 31 children were born and 2 of these had minor congenital abnormalities. After treatment, 30 pregnancies were recorded in 22 of the 50 women who were still menstruating; 22 children were born, and only one had a minor congenital malformation; all children showed normal psychomotor development. It is concluded that MOPP does not seem to have any effect on fertility, pregnancy and offspring of those women (73,6%) who continue having menstruations after treatment.

The authors have performed 1 005 arthroscopies of the knee for diagnostic purposes. The exploratory method has made it possible to correct the initial diagnosis in 50% of the cases, to avoid arthrotomy in 10% and to suggest surgery in 9%. The most common cause of error was the radioclinical confusion between patellar and medial meniscus symptoms. The most frequent associated lesions were patellar chondropathy (73%), condylar chondropathy (33%) and middle patellar folds (34%).