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

Much clinical and experimental data is in support of a significant role played by viruses in the etiology of diabetes mellitus. This hypothesis is borne out by the association of diabetes mellitus with Coxsackie B, mumps, rubella and herpes simplex virus infections, the presence of high persistent titers of neutralizing antibodies in diabetic patients, the in vitro permissiveness of human beta cells to viruses, and the recovery of viruses from the pancreas of diabetic patients. Viral multiplication is facilitated in HLA B8, B15, B18, Dw3 and Dw4 carriers. Experimental inoculation of EMC and Coxsackie B viruses to mice shows that beta cell involvement is dependent upon viral strains, viral membrane receptors, interferon production, immunological response and less essential factors such as age and sex. The virus is responsible for a specific immunological response and produces autoimmunological phenomena. These result in a decrease in the number and activity of insulin-producing cells through cytotoxic mechanisms. Pathological findings corroborate these physiopathological hypotheses.

Thalamic hematomas occur chiefly in hypertensive patients aged 50 to 70; characteristic presentation is a triad associating a sensory syndrome, oculomotor disorders, and alterations in consciousness; computed tomography not only establishes diagnosis but provides additional information, particularly on the size and volume effect of the hematoma which may, according to some authors, indicate surgical removal.

Two patients with chronic granulocytic leukemia (C.G.L.) undergoing transformation were treated by high dose chemotherapy and total body irradiation followed by autografting of hematopoietic stem cells collected and cryo-preserved at the time of diagnosis. Recovery of hematopoiesis was characterized by disappearance of the Philadelphia chromosome in most metaphases. A new approach of the management of C.G.L. is discussed.

Although urticaria is usually held to be a type 1 hypersensitivity reaction, it may also be the cutaneous manifestation of vasculitis mediated by immune complexes. In this study of 35 patients with chronic urticaria, the authors attempted to specify the prevalence of vasculitis and its possible correlations with particular clinical and/or immunological findings. In 10 cases, lymphocyte subpopulations were also studied, using monoclonal antibodies. Patients included 21 women and 14 men, aged 19 to 80. In each patient: a) systemic signs were looked for by history taking and physical examination; b) a skin biopsy was examined by optic microscopy and direct immunofluorescence; c) the following biological investigations were done: blood count, sedimentation rate, protein electrophoresis and immunoelectrophoresis, IgE, B virus markers, circulating immune complexes, anti-nuclei and anti-ADN antibodies, latex and Waaler-Rose tests, total complement, C3, C4, and C1 esterase inhibitor. Visceral involvement and various immunological disorders are most common in those patients with leukoclastic (n = 7) or mononuclear (n = 9) vasculitis. These patients, as well as those recently studied in the literature, have idiopathic chronic urticaria, the least severe of urticarial vasculitis.

Different connective tissue diseases were observed in two HLA--and DR--identical sisters. The daughter of one of the index patients and their father exhibited closely related symptoms. With reference to this familial observation the authors discuss the significance of DR3 which is correlated with immunologic disturbances producing multiple clinical and biological manifestations.

Clinical and ultrasonographic findings in five patients with cardiac echinococcosis are presented. In each case chest film showed abnormal shape or enlargement of the heart shadow, with calcifications in three patients. In four cases, echocardiography was suggestive of a cystic lesion. Echocardiography associated with plain chest film seems to be a reliable technique for positive diagnosis and follow up after treatment. However, it is insufficient for preoperative work up in which selective coronary arteriography remains the cardinal procedure.

Biologic and radiologic investigations in the diagnosis of Cushing syndrome are evaluated. A two-step diagnostic procedure is propounded. The combination of absence of overnight suppression of plasma cortisol by dexamethasone and elevation of urinary free cortisol and midnight plasma cortisol levels establishes the diagnosis of Cushing syndrome in most patients. The next step is to determine the precise cause of Cushing syndrome by baseline plasma ACTH assays, the high-dose dexamethasone test and the visualization of the adrenals by iodocholesterol scintigraphy and/or computed tomography.

From a catamnestic study of sixty-three alcoholics hospitalized over three years in an adult psychiatry district (4th district; North Charente - D' Daniel Menard) and regularly visited at home, we have attempted to define the optimum conditions for maintaining absolute abstinence. This has led us to emphasize: the importance of detoxification and of the quality of the therapeutic agreement; rigorous follow up in mental health outpatient clinics, taking into account the psychopathologic dimension of alcoholism; membership in an association of veteran drinkers; the importance of chemotherapy prescribed at discharge, the best results having been recorded with tiapride alone or associated with antidepressants and/or vitamins B1, B6 and B12.