La semaine des hopitaux : organe fonde par l'Association d'enseignement medical des hopitaux de Paris最新文献

This paper reports four cases of isolated compression of the deep branch of the ulnar nerve, and reviews the various etiologies (tumor, malformation and microtraumatism). The authors stress the importance of the electric examination, particularly conduction velocity in the palm in localizing the nerve lesion. Surgical exploration in these cases revealed a Giant cell tumor, two synovial cysts, and an abnormal fibrous band stretching between the flexor digiti quinti brevis and the opponens digiti quinti. Postoperative courses were uncomplicated and every patient recuperated quickly and completely. Early surgical exploration in such cases is mandatory.

The authors report a case of endobronchial non-Hodgkin lymphoma, in a 48-year-old woman. This is an exceptional localization. When it reveals the disease, as was the case in the index patient, clinical presentation is usually atelectasis with fever. Diagnosis was established upon bronchoscopy. Histologic examination of biopsy specimens showed an immunoblastic lymphosarcoma. Total pneumonectomy and chemotherapy failed to prevent rapid deterioration with a fatal outcome 7 months after onset. A selective total IgA deficiency and a familial history of malignant tumors were recorded. Immunoblastic sarcoma has a poor prognosis. It often follows a disease whose mechanism is ascribed to an immunological disorder. Lymphoma arising in a patients with prior immune disease should suggest the diagnosis of immunoblastic sarcoma.

The authors appreciate the possible responsibility of small intestine diverticulosis in three patients with iron deficiency anemia. In the first case, anemia was associated with colo-duodenal fistula. In the second and third cases, because of the negativity of gastric and large bowel investigations, a barium opacification was done, which showed diverticulosis. This was considered as probably responsible for the anemia. After a review of the literature, the authors conclude that small intestine diverticulosis may lead to iron deficiency anemia through chronic blood loss.

Severe head injury often produces complex intracranial displacements of the brain, resulting in widespread, often microscopic lesions. These are responsible for two types of edema: vasogenic edema, with outflow of molecules and fluid into the extracellular spaces by rupture of the blood-brain barrier and vasoplegia, and cytotoxic edema, with swelling of astrocytes due to membrane lesions. The connexions between these two types of edema are still obscure. Alterations in membrane phospholipids may impede function of Na-K pump enzymes, causing accumulation of water in the cell. Cerebral edema is responsible for intracranial hypertension and tentorial herniation, which in turn increase edema through venous compression, ischemia, and hypoxia. The least controversial anti-edema therapeutic measures include relative fluid and salt restriction, mannitol if called for, neuroplegia, in particular with diazepam and Gamma-OH, and assisted ventilation.

The authors report eleven new cases of nephrogenic metaplasia - a substantial addition to the sixty-three cases already reported in the literature. In their series, two cases involved the ureter, and nine, the bladder. They discuss the clinical and pathological aspects of the disease, and put forward suggestions concerning different aspects of the histogenesis. They consider the possibility of introducing new terminology.

In a general hospital (Hôtel-Dieu, in the center of Paris), run with a global budget, budgets determined for each unit were introduced as an experiment in 1980. Physicians were in charge of certain expenses, mainly: linen, drugs, transportation of patients to and from other hospitals within Paris, and blood fractions. The whole does not exceed 4% of the turnover (FF 20 millions in 1980) of a 67 bed internal medicine unit. Other accounts deal with the stays, admissions, prescriptions of technical acts, laboratory analyses, and X-rays. In 1980, expenses were 11% more than budgeted, but the increase in stays and particularly in admissions was significantly greater. The resulting savings were 8.8% and 18.7% for stays and admissions respectively. Psychic reactions were variable. The subsequent budgets followed the fluctuations of recorded expenses, which were fairly important in both directions. The unit budget may be an advance or a regression, in a restrictive and past-perpetuating context. The coherence between the unit budget and the global hospital budget is questionable. Physicians were willing to take part in accounting and saving. They have good reason for not enlarging their financial responsibilities. Conversely, they may give more attention to diseases of public opinion.

Cromoglycic acid (disodium cromoglycate) is a diacromone derived from khelline whose chief action in asthma is preventive, through inhibition of mastocyte degranulation. Since its digestive absorption is poor, it is given locally as a pulverulent aerosol. Cromoglycic acid is also used successfully in certain forms of ocular and nasal allergy. An oral preparation of cromoglycic acid is beginning to be used in food allergy and certain rectocolites. Trials are ongoing with several other substances, which have comparable properties and are active orally.

In a previous paper, meteorological circumstances of myocardial infarctions, cerebrovascular attacks, and suicidal attempts were studied by a univariate method. The present work used the same clinical reports, collected by the Medical Emergency Assistance System (SAMU) in the Paris area from 1975 to 1977, but with multivariate calculations. 150 potential predictive indicators were submitted to "progressive ascending selection". Selected indicators were then combined into a composite index by "linear canonic discrimination". This index was tested in terms of successful prediction. The 150 indicators were: 1) meteorological variables, recorded at ground level, such as wind and temperature (expressed respectively in 28 and 24 ways), airpressure, moisture; 2) variables computed from data recorded in altitude; 3) pollutants; 4) non-meteorological indicators, such as day of the week, season, solar activity; 5) the "past of the predictand", i.e. the frequency of infarctions during the previous days; 6) types of weather, defined after confronting meteorological maps with clinical data. The coding of qualitative data required a new procedure. The event to be predicted, which occurred only one day a week, was an incidence of infarctions of at least twice the average. The percentage of successful prediction was 78.7%. The type of weather was by far the best indicator. Detrimental circumstances were changing weathers, with in the order of decreasing correlations, atmosphere fluxes coming from S-SE, E, SW, and NW. These results complete those of univariate analysis. They validate a simple and efficient predictive method, similar in its principle to that used in Germany.

99 children, aged 6 to 14, received health education and were compared to 93 controls, living in another "children house" at the same resort. The two groups were similar, and completely separated. All children had respiratory and cutaneous infections or allergies, none of them being disabled. The health education consisted in five sessions held over three weeks. Topics were the excesses of what people put into their glasses, ash-trays, plates and medicine chests. The teaching method was mainly based on creative games. Evaluations were presented as games, with colored blocks. The answers given to ten questions, before the educational sessions, were similar in both groups. The final answers did not show any progress in the control group, whereas the rate of correct answers increased by 30% in the educated group. Differences were highly significant, in all age groups. Progresses concerned especially the excesses of sugar, tobacco and meat. The educational needs seemed different according to age, with the main excesses being sugar and other food in children under ten, and tobacco and alcoholic drinks in older children. Spa resorts, and La Bourboule in particular, are suitable for brief controlled health education actions.

Positive answers to health questionnaires, including 3 328 answers by 200 family physician patients and 3 439 answers by 115 hospital outpatients disclosed numerous symptoms, antecedents, and side effects of therapy. Several correlations between findings were detected. Data confirmed previous publications, and may be of use for teaching programs, care organization, and preventive medicine. However, these applications appear as accessory and the main utility of health questionnaires is to help diagnosis in individuals. Should the purpose be epidemiology, questionnaires would become longer as the result of the influence of psychosociologists and experts in data processing. They would only be suitable for polls. In everyday practice, questionnaires will be accepted only if they are kept short.