Laparoscopic colorectal surgery still requires evaluation. Technical problems remain, particularly in obese patients. Also, there is a learning curve during which patients are exposed to serious morbidity. In nonmalignant conditions, the indications for laparoscopic colorectal surgery need to be determined based on studies of short- and long-term outcomes, benefits, and cost. In malignancies, the potential for disease-control problems such as involvement by the tumor of trocar orifices indicate that prospective studies should be limited to patients with small, well differentiated tumors that do not involve the serous membrane.
Gastric carcinoma is relatively sensitive to anticancer drugs. However, in metastatic stomach cancer chemotherapy offers only modest improvements in survival, which remains under nine months, and in quality of life as compared to palliative therapy. Experience with single drug chemotherapy has allowed to identify active drugs, including 5FU, mitomycin, adriamycin, and cisplatin. More recent agents have shown promise. Several combination chemotherapy regimens have been studied (FAM, FAMTX, and more recently ECF or FP). No standard protocol has been established as yet, and neither is there any validated approach to adjuvant therapy. Neoadjuvant chemotherapy can in some cases allow resection of tumors considered inoperable at first. Participation in therapeutic trials remains indispensable.
Two arboviruses were isolated in 1981-1982 in the Mayenne area of France during routine field studies. The Eyach virus is a coltivirus found in Ixodes ricinus ticks, and the Erve virus is a nairovirus found in the shrew Crocidura russula. Several years elapsed before evidence was found that both viruses circulate actively among small and large wild mammals in Europe and can cause severe neurologic disorders in humans. To date, these viruses have been found in France, Germany, The Netherlands, and the Czech republic.
1) Foreword2) Eating more fruit and vegetables3) Eating less fat, particularly those rich in saturated fatty acids4) Avoiding obesity5) Avoiding microbiological contaminationFragile links in the cold chainTemperature fluctuationsShelf-life: microbial quantum; "dangerous" organisms: "conventional" mesophilic organisms; "modern" psychrotrophic organisms; classification of foodstuffs by storage temperature required by regulationThe consumer link: the household refrigeratorThe design of refrigerators (25 million refrigerators in France and 130 million in Europe) deserves reappraisal: inadequate use6) Possible role of chemicals from the human body7) Related problem: organic farming8) Intake limits for salted and smoked foods9) Recommendations.
Survival has increased steadily in heart transplant recipients since the introduction of cyclosporin. As a result, these patients are being increasingly exposed to the complications of corticosteroid therapy including osteoporosis, which is a major source of morbidity. Objective: to retrospectively evaluate the potential effects of heart transplantation and concomitant treatments on lumbar spine and femoral bone mineral density. Patients and methods: lumbar spine and femoral bone mineral density (BMD) was measured using dual-energy absorptiometry (Sophos XRA) in patients who were on a heart transplant waiting list or had received a heart transplant between 1991 and 1995. Results. a) 51 patients evaluated prior to heart transplantation had osteopenia at the lumbar but not the femoral site: b) 17 patients had a BMD decrease at the femoral but not the lumbar site after as compared to before heart transplantation, uncorrelated to the cumulative corticosteroid dose; c) 10 patients had a significant increase in BMD at the lumbar but not the femoral site between the twelfth and twenty-sixth month after transplantation; d) 10 patients showed no significant BMD changes between the twenty-fourth and forty-sixth months after heart transplantation. Conclusion: heart transplantation is associated with changes in ED, and patients at highrisk for osteoporosis should be evaluated prior to transplantation to allow initiation of prophylactic or therapeutic measures as appropriate. New therapeutic strategies need to be developed and evaluated.
Posttraumatic epilepsy usually occurs within eight days to five years after the head injury; the interval is shorter than two years in 80% of cases but can be as long as 30 years after a severe head injury. The risk of post-traumatic epilepsy is greatest after a severe head injury with an Intracerebral hematoma, a subdural hematoma, a hemorrhagic contusion, or clinical neurological sequelae, Minor head injuries are not associated with a significantly increased risk of epilepsy. Patients who develop a seizure shortly after a severe or even a moderate head injury have a significantly increased risk of post-traumatic epilepsy. Prophylactic treatment is not warranted in the absence of an early seizure and does not remove the risk of posttraumatic epilepsy. Symptomatic treatment is the same as in primary epilepsy, although 25% of cases may prove difficult to treat.
Anaphylactic shock, the most severe manifestation of anaphylaxis, is characterized by three clinical features, namely a precipitous onset, a potentially fatal course in the absence of treatment, and a dramatic response to epinephrine therapy. Clinical manifestations are cutaneous, pulmonary, cardiovascular, gastrointestinal, and neurologic. Epinephrine should be given immediately. Admission to an intensive care unit for 24-48 h is mandatory because of the risk of recurrent shock. Investigations to detect the offending antigen followed by preventive measures are imperative.
The population is aging gradually in France, and pneumonia is the most common infectious condition in the elderly. Predisposing factors include age-related factors (immunological alterations, comorbid conditions and their treatments) and local factors of which the most common is repeated aspiration of food. Symptoms are often considered atypical in elderly subjects, with neurologic or abdominal signs sometimes being more prominent than respiratory signs. S. Pneumoniae is the agent most often responsible for community-acquired pneumonia in free-living elderly patients, whereas anaerobes and gram-negative rods predominate in institutionalized patients; a third category is nosocomial pneumonia. The prognosis is poor, with half the unfavorable outcomes being ascribable to the pneumonia itself and half to the comorbid conditions. Drug dosages and galenic forms should be appropriate for elderly subjects and selected according to the identified or suspected causative organism. Treatments used by consensus are almost the same from one country to the next. Amoxicillin alone or with clavulanic acid is the first-line drug in free-living patients. In institutionalized patients, the high frequency of aspiration pneumonia makes the amoxicillin-clavulanic acid combination the treatment of choice. Most cases of nosocomial pneumonia in patients admitted for acute symptoms are due to gram-negative rods or staphylococci.
A host of web sites have recently been developed on the Internet by institutions, corporations, individuals, and government organizations. The amount of information available via the Internet to health care providers is growing at an extraordinary pace. As a result, new tools are needed to evaluate and select the sites that best meet the needs of users. The authors have developed a grid to help librarians and information retrieval specialists. In the field of health care, search engines and the Rouen Teaching Hospital web site were used to draw up a 1998 inventory of sites constructed by French health care facilities. These sites were evaluated using a grid developed jointly with the ADBS (an organization of information retrieval specialists). This grid was designed to allow evaluation of all types of sites based on the relevance of the organization and services offered. The intrinsic scientific quality of the information provided was not evaluated. The criteria used in the grid fall into two categories based on whether they evaluate formal site characteristics (access, structure, and design) and site content (authors, validation, links, information typology, audience, documentary products, access to primary documents, availability In several languages). Based on an analysis and discussion of the results, trends regarding web sites in the health care field are described and the criteria needed to improve selection of Internet information resources for hospitals are defined.
Sjogren's syndrome is a multisystem disorder in which tubulointerstitial nephropathy is a feature in 20% of cases and osteomalacia secondary to tubular acidosis an occasional complication. Three cases are reported in patients who met European diagnostic criteria for Sjogren's syndrome. The diagnosis of osteomalacia was based on clinical, laboratory lest, and imaging study findings. Whether the pathophysiology of such cases involves a direct effect of H+ ions on hydroxyapatite crystals or disturbances in vitamin D metabolism is discussed based on these three cases and a literature review. Although rare, osteomalacia due to tubular acidosis should be considered routinely in Sjogren's syndrome patients with bone pain.
TABLE OF CONTENTS A) Undesirable combination of two antiinfectious agents with a potential for antagonistic effects or cross-resistance a) antibacterial antagonism b) antiviral antagonism and/or cross-resistance between two antiviral agents c) antiparasite antagonism d) antifungal antagonism B) Undesirable combination of drugs with similar toxicities : gastrointestinal, hepatic, neurological, renal, hematological, cardiac, and allergic effects. C) Undesirable combination of drugs with pharmacokinetic interactions involving: 1) digestive absorption, 2) plasma protein binding, 3) metabolic induction or inhibition or cytochrome P450 enzymes, 4) renal excretion.
Sacroiliitis during the course of sarcoidosis is an uncommon event usually due to tuberculosis. Sacroiliitis due to sarcoidosis itself is exceedingly rare. A case is reported in a 73-year-old woman who developed acute destructive bilateral sacroiliitis as the first manifestation of diffuse sarcoidosis involving the lungs, liver, spleen, and bone. Serum calcium was elevated. Computed tomography of the sacroiliac joints showed subchondral erosions and joint space loss most marked on the right. A sacroiliac joint biopsy confirmed that the cause was sarcoidosis.
Three cases of hydatid cysts of the thyroid gland were managed surgically at the ENT department of the August 20 Hospital in Casablanca, Morocco. The diagnostic and therapeutic challenges raised by hydatid disease of the thyroid gland are emphasized.
