Brain swelling (BS) is a kind of response observed in 15%–20% of severe head injury. Its pathophysiology is not well known yet, and its diagnosis is exclusively scanographic in emergency.

L'etude NASCIS II (1) marque un tournant dans la conception therapeutique du traumatise medullaire: pour la premiere fois, une etude multicentrique randomisee, et controlee en double aveugle contre placebo, rapporte une amelioration en terme de pronostic fonctionnel chez un nombre important de malades atteints de traumatismes medullaires lorsqu'ils recoivent en phase aigue de fortes doses de corticoides (methyl-prednisolone). Cette etude interesse les medecins impliques dans le traitement du traumatisme medullaire: comment analyser la validitz des rzsultats rapportzs? Quelles sont les bases physio-pathologiques qui servent de support a ce traitement pharmacologique? Quelle est la faisabilitz de cette nouvelle therapeutique nzcessitant des conditions particulieres d'application

A total of 210 consecutive patients with aneurysmal subarachnoid hemorrhage (S.A.H.) of any clinical grade admitted from january 1985 through may 1990 were retrospectively studied to determine the effect of intravenous Nimodipine on survival and functional results and to analyse temperature curve as a prognosis factor. The 106 patients admitted from january 1985 through november 1987 constituted the reference series termed G1. The 104 patients admitted from december 1987 through may 1990 and treated with intravenous Nimodipine constituted the series termed G2. Of the 210 patients, 172 (82%) could be operated on with similar mean operative delay in both series (G1 = 9,5 days, G2 = 9,8 days). Of the 210 patients, 153 (73%) survived with an average follow-up of 111 weeks for G1 and of 64 weeks for G2.Nimodipine treatment was associated with a significant increase of survival (11,8%, P = 0,05) which was not the result of improved operative technique but of a lower incidence of deaths caused by postoperative vasospasm (G1 = 5 deaths, G2 = 0 deaths, P = 0,05) and by rebleeding (G1 = 15 deaths, G2 = 5 deaths, P = 0,03). No significant difference between the two series G1 and G2 was observed regarding functional results in the 153 survivors, frequency and seriousness of clinical signs of vasospasm during the waiting phase for surgery, radiologic signs of vasospasm on initial and second angiography, cerebral infarctus on second C.T.-Scan. Analysis of temperature curves of the 210 patients revealed that a delayed fever with a plateau pattern was associated with a higher incidence of vasospasm, rebleeding, and deaths. Nevertheless 73% of survivors with such a plateau type of temperature curve had finally a good functional result.Nimodipine reduced mortality caused by postoperative vasospasm in a series of patients with delayed surgery but did not change other parameters of vasospasm, i.e. preoperative clinical signs and radiologic sips on angiography and C.T.-Scan. The important decrease of rebleeding in the series with Nimodipine is amazing and unexplained but has certainly to be emphasized for several authors already noticed it. Lastly a delayed fever with a plateau pattern is really associated with a lower prognosis but temperature curve cannot be considered as the unique guide in operative timing.

A total of 210 consecutive patients with aneurysmal subarachnoid hemorrhage (S.A.H.) of any clinical grade admitted from January 1985 through May 1990 were retrospectively studied to determine the effect of intravenous Nimodipine on survival and functional results and to analyse temperature curve as a prognosis factor. The 106 patients admitted from January 1985 through November 1987 constituted the reference series termed G1. The 104 patients admitted from December 1987 through May 1990 and treated with intravenous Nimodipine constituted the series termed G2. Of the 210 patients, 172 (82%) could be operated on with a similar mean operative delay in both series (G1 = 9.5 days, G2 = 9.8 days). Of the 210 patients, 153 (73%) survived with an average follow-up of 111 weeks for G1 and of 64 weeks for G2. Nimodipine treatment was associated with a significant increase of survival (11.8%, P = 0.05) which was not the result of improved operative technique but of a lower incidence of deaths caused by postoperative vasospasm (G1 = 5 deaths, G2 = 0 deaths, P = 0.05) and by rebleeding (G1 = 15 deaths, G2 = 5 deaths, P = 0.03). No significant difference between the two series G1 and G2 was observed regarding functional results in the 153 survivors, frequency and seriousness of clinical signs of vasospasm during the waiting phase for surgery, radiologic signs of vasospasm on initial and second angiography, cerebral infarctus on second C.T.-Scan. Analysis of temperature curves of the 210 patients revealed that a delayed fever with a plateau pattern was associated with a higher incidence of vasospasm, rebleeding, and deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors relate a case of atrioventricular block supplied by junctional rhythm and without blood pressure alteration during a clomipramine poisoning. This electrocardiographic change is unusual and systematic electrocardiography during hospitalization is an absolute necessity.

The authors relate a case of atrioventricular block supplied by junctional rhythm and without blood pressure alteration during a clomipramine poisoning. This electrocardiographic change is unusual and systematic electrocardiography during hospitalization is an absolute necessity.

S.A.M.U. 51 practises thrombolysis in patient's house associated with cardiologists of the University Hospital and of a Private Hospital, in indication and following for treatment. This way of working gives a large security for using this therapeutic to the whole population whatever the chosen hospital.

A case of Flumequine poisoning is described; a 13-year-old girl was admitted for a psychiatric syndrome. 3 hours after, seizures, coma, and metabolic disorders were observed. Infectious, encephalitic or diabetic diseases were suspected, but not confirmed. After 12 hours of a symptomatic treatment, the clinical status improved and the patient was discharged. At that time a tablet was found in her bedroom and a mas spectrographic analysis was positive for Flumequine. This case report is in agreement with previous observations and confirms the small therapeutic index of quinolone, and the absolute necessity to assess carefully a psychiatric diagnosis.

A case of severe poisoning with ethylene glycol butyl ether (EGBE) after massive ingestion is described. Deep coma, metabolic acidosis, hypokalaemia, haemoglobinuria, oxaluria and a transitory rise in the serum creatinine level were observed. The elimination of the various metabolites butoxyacetic acid and oxalate was assessed in urine and a metabolic pattern for EGBE is suggested.