[The thorax of patients in diving accidents. Radiologic study]. / Le thorax de l'accidenté de plongée. Etude radiologique.

On the basis of a series including 185 files on diving accidents gathered between 1981 and 1988, the authors carry out a radiological study of the thoracic signs observed after drowning and lung overpressure. The typical radiological form and the various clinical forms of drowning and lung overpressure are described in this article. Emergency plain thoracic radiography in bed in the method of choice. However, the existence of many false-negative findings leads to proposing a study with computed tomography (CT) after initial treatment in order to better assess the lesions and to characterize the accident. The utility of radiology is also demonstrated for the follow-up of evolution. Lastly, the authors lay stress on the necessity to prevent such accidents, to which radiologists can contribute by detecting thoracic lesions (dystrophy and other evolutive lesions) for which diving is contraindicated.

[Chloroquine poisoning with respiratory distress and fatal outcome]. / Intoxication à la chloroquine avec détresse respiratoire d'évolution fatale.

Chloroquine poisoning can cause life threatening cardiovascular disturbances. We report three cases of suicide with chloroquine causing acute respiratory insufficiency from pulmonary oedema with lethal outcome, despite a treatment with diazepam, epinephrine and mechanical ventilation.

[Malarial hemolysis and renal insufficiency]. / Hemolyses palustres et insuffisances rénales.

The authors report on 5 cases of malarial haemolytic anemia associated with renal insufficiency over a 3 years period at Girard and Robic hospital resuscitation department. As the occurrence of these forms is somewhat frequent in Madagascar, the differential diagnosis has to be established from cerebral malaria. The primary diagnostic difficulties are reviewed, the various kinds of renal insufficiency are considered and the physico-pathologic troubles are anticipated. The prognosis is relatively satisfactory: a fatality out of 5 patients.

[Proteus septicemias. Apropos of 4 cases]. / Septicémies à "Proteus". A propos de 4 cas.

The authors record four cases of septicemia caused by Proteus, observed at the "Hôpital Girard et Robic" resuscitation department, in Tananarive, Madagascar. The patients were young and free from visceral disorders. The first case was a post-abortum etiology with a myocardial clinical picture. The second case also was a post-abortum etiology. The course led to the septic shock and to the death. The starting point of the third case was the urinary system, following upon the removal of an urinary obstruction due to post-operative anuresis. In the fourth case, the focus was urinary with a pulmonary clinical picture. The course led to the septic shock and to the death. In all instances, the germ showed sensitivity to amikacin and to the third-generation cephalosporins. The clinical course that led to the septic shock had deeply entailed the prognosis of these septicemias.

[Intracranial subdural hematoma during spinal anesthesia]. / Hematome sous-dural intracranien au decours d'une rachianesthesie.

Spinal anesthesia (SA) is frequently used in tropical zones. Intracranial subdural hematoma is an uncommon complication of SA. The purpose of this report was to describe a case of intracranial subdural hematoma observed during SA performed for cesarean section in a 22-year-old women in Senegal. After one month of persistent intense headache, diagnosis was confirmed by computerized tomography. The hematoma was successfully treated by drainage under general anesthesia. Intracranial subdural hematoma has been attributed to cerebrospinal fluid hypotension due to leakage through the dural puncture site. Diagnosis, which may be difficult in Africa, should be suspected in patients with persistent headaches after SA. Confirmation requires computerized tomography of the brain. Prevention of this complication depends on the use of fine beveled-tipped puncture needle which are rarely available in the African setting.

Paraplegia and decompression sickness.

Decompression sickness may include spinal cord damage, which sometimes persists. Casual divers are exposed, as well as professionals. In this study we have reviewed the clinical records of divers admitted with symptoms of spinal cord injuries in our area in the last 6 years. This study is divided into two groups: those who fully recovered (19 divers) and those with neurological sequelae (12 divers).