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

With reference to eleven cases of renal cancer with involvement of the inferior vena cava, CT semeiology of this venous complication is detailed. Furthermore, the authors suggest that the images are capable of a pathological interpretation which may indicate whether the obstruction is caused by the tumor or a thrombus. Lastly, the value and limitations of CT scan for detecting caval obstructions associated with renal cancer are analyzed.

After pointing out the epidemiological significance of sexually transmitted diseases, the authors report results in 100 male patients given doxycycline polyphosphate during 2 weeks for urethritis. Ten patients had post-gonococcal urethritis and twenty others had persistent urethritis afer a first treatment had failed. The association Chlamydia trachomatis-Staphylococcus albus was the most common bacteriologic finding. Staphylococcus aureus and Neisseria gonorrhea were demonstrated in 24 and 12 cases respectively. Ureaplasma urealyticum was found in only four instances. Clinical and bacteriological results show that doxycycline polyphosphate was effective in 92 out of 100 cases. Circumstances of the eight failures are analyzed specifically. Clinical tolerance was excellent in every case. Following confrontation with recent data from the literature, these results lead the authors to conclude that gonococcal and non-gonococcal urethritis is an indication of choice for doxycycline polyphosphate.

We carried out a randomized double-blind trial to evaluate the analgesic effect, rapidity of action and tolerance of calcium carbasalate relative to a placebo, given in a single dose of 1 gr. aspirin equivalent immediately after an orthopedic surgical procedure. Autoevaluation by the patient using a visual scale and overall evaluation of analgesic effectiveness by the patient and relatives showed that pain was significantly less with the active therapy whose tolerance was excellent.

Sinusal histiocytosis with massive lymphadenopathy is a rare pathological entity since, as of 1983, only 200 cases have been published. Following the seminal description in 1965 by Destombes in Blacks, histological features of this disease were specified by Rosai and Dorfman in 1969 and 1972. We report three cases in young Ivorian subjects. The presenting finding is always chronically enlarged lymph nodes, but extranodal lesions are possible, most commonly involving the eye, salivary glands, upper respiratory tract, skin, bone, testis, and nervous system. Diagnosis can be ascertained only upon histologic examination of lymph node biopsy specimens which shows the three cardinal criteria, i.e. massive sinusal histiocytosis, lymphophagocytosis, and mature plasmocytosis. Although a few fatal cases have been reported, the disease usually runs a benign course, with exacerbations of variable duration. Great caution should therefore be taken in deciding upon management, particularly as regards corticosteroid therapy, radiotherapy or anticancer chemotherapy. Etiopathogeny of the disease is unsettled; there is general agreement as to the existence of a cellular immune dysfunction resulting in the lympho-histiocytic proliferation.

Analysis of fifty-five anaphylactoid accidents during general anesthesia (GA) in fifty patients shows significant female predominance (70%), relatively frequent allergic predisposition (34% as compared to 14.3% in a normal population) and fairly frequent responsibility of suxamethonium and succinylcholine. One or more, even recent, previous GAs do not seem to enhance the risk. 50% of intradermal skin tests to different anesthetics were negative, 40% were positive and consistent with clinical history, and 10% were positive but inconsistent clinically. Biological tests (basophil degranulation, lymphoblast rosettes, in vitro consumption of complement) were negative. Physiopathological mechanisms remain uncertain, whether they involve IgE allergy or complement activation. The frequency and severity of these unpredictable accidents must stimulate clinical and biological research in this field.

The authors report a case of Corynebacterium (group JK) endocarditis. The main characteristics of the causative pathogen are specified: diagnostic bacteriological criteria, pathogenic capability after cardiac surgery, therapeutic problems related to resistance to antibiotics.

The authors report a series of 67 patients presenting with 103 decubitus ulcers, treated between 1969 and 1977, and with a follow-up of one year or more. The majority of the patients were paraplegics, other etiologies being present in smaller numbers and raising different problems. They first studied the importance of the pre-and post-operative treatment. This was followed by study of the importance of different surgical techniques for each of the three localizations (sacral, ischial and trochanteric). They demonstrated the absolute need for surgical management, especially with paraplegic patients. Surgery alone allows rapid healing with a high success rate. While it does not, however, preclude any possibility of recurrence (whatever the technique used), it does at least allow the patient to live a normal life. The authors further emphasize the importance of the preoperative treatment, using the nutripump, and the postoperative treatment, using the pulsating air bed (in preference to the water bed). They consider the nutripump to be the most important breakthrough in this field, in recent years. As regards the different localizations, they consider muscle or musculocutaneous flaps to be the treatment of choice for ischial ulcers, but stress the need for wide ischiectomy and the excision of the bursa. In their experience, insufficient excision is a source of failure, even if the flap is good. Similarly, musculocutaneous flaps offer the best solution for trochanteric ulcers, but again, only accompanied by excision of the bursa. Recognition of coxofemoral arthritis is also essential, and no flap will take until this has been remedied. In the case of sacral ulcers, however, they prefer large rotation skin flaps, which allow further advancement in the event of recurrence. The association of two or three ulcers makes surgical management imperative because of the frequently severe undermining of the patient's general state of health. The treatment of two locations in a single stage is always preferable whenever it is feasible.

We have performed digital subtraction angiography (DSA) on 127 patients treated by vascular surgery. This technique was easily and safely performed in outpatients, without any complication. Our experience indicates that DSA is accurate for post operative evaluation in 96% of cases. In digestive arterial surgery, some examinations (3.3%) are insufficient. Distal run off is usually well seen, everywhere, except in kidneys. There is a good correlation between angiographic results and clinical status. However, significant abnormalities were discovered in 5% of cases without any clinical signs. Digital intravenous angiography is a safe and mildly invasive procedure for postoperative evaluation of vascular surgery.

On the grounds of studies carried out in the last ten years, the authors criticize the usual classification of comas and question the Glasgow scale (opening of eyes, verbal answer, motor response). Their description of brain stem injury by axial herniation and explanation of the role of diffuse encephalic lesions causing intracranial hypertension is based upon anatomo-clinical findings and results of investigations in comatose patients with head injury. For prognostic purposes, a simple and fairly reliable classification of post-traumatic comas is proposed. Comas are divided into five stages of rostro-caudal destructuration (cortico-sub-cortical, diencephalic, meso-diencephalic, mesencephalic and pontic) by studying the response to pain (unadapted, adapted, absent) and four brain stem reflexes (fronto-orbicular, vertical and horizontal oculocephalic, light reflexes).