[Management of typhoid perforation of the small bowel: a case series in Western French Guiana]. / Conduite à tenir face aux perforations du grêle d'origine typhique: à propos d'une série observée dans l'Ouest Guyanais.

The purpose of this retrospective study of a five-year period in western French Guiana is to report our experience in the management of small bowel perforation due to Salmonella typhi and to underline the main diagnostic and therapeutic pitfalls. Even if clinical and laboratory findings were compatible, final diagnosis was reserved until confirmation by postoperative bacteriological findings. In patients without advanced peritonitis, excellent results can be achieved by excision of the edges of the lesion followed by direct suture in cases involving single perforations and by segmental resection followed by end-to-end anastomosis in cases involving multiple perforations. However these techniques cannot be extended to patients presenting severe peritonitis who must be treated by bowel diversion.

[Renal actinomycosis with fistulized lumbar abscess]. / Actinomycose rénale avec abcès lombaires fistulisés.

The authors report a case of renal actinomycosis in an adolescent presenting with two fistulized lumbar abscesses. This rare disease, which generally has a good prognosis, is difficult to diagnose, both clinically and radiologically. The positive diagnosis is based on histological examination, more frequently of the nephrectomy operative specimen, than ultrasound-guided fine needle aspiration biopsy of an atypical renal tumour. Conservative treatment with high-dose penicillin gives excellent results.

Evaluation of women with hirsutism.

Hirsutism is a common disorder of androgen activity that manifests in women as excessive growth of terminal hairs in androgen-dependent regions of the body. In most women with hirsutism, the condition is idiopathic or caused by polycystic ovary syndrome. However, a thorough evaluation is necessary to exclude more serious causes of hirsutism, such as adrenal or ovarian neoplasm. In most patients, an appropriate history and physical examination and minimal laboratory evaluation suffice. However, signs of virilization demand more extensive diagnostic evaluation.

Adverse psychiatric effects of systemic glucocorticoid therapy.

Glucocorticoid therapy causes psychiatric side effects in many patients. Although psychiatric side effects occur most commonly in women and middle-aged patients, no clinical features have been identified to predict which patients are at risk. The most frequent side effects are mood changes ranging from mild euphoria to hypomania, but other reactions, including depression, dementia and psychosis, are possible. The incidence of psychiatric side effects is directly related to dosage. The mechanism by which glucocorticoids produce psychiatric symptoms is probably multifactorial, including both direct and indirect effects on the brain. Psychiatric symptoms usually resolve with dosage reduction or controlled withdrawal of glucocorticoids, but antipsychotic medication may be indicated if symptoms are severe or prolonged.

Use of percutaneous silastic central venous catheters in neonates and the management of infectious complications.

A prospective study of 35 patients in the neonatal intensive care unit was conducted to examine the safety and feasibility of percutaneous Silastic central venous catheters for the provision of prolonged parenteral alimentation. Particular attention was directed to the possibility of maintaining these lines through intercurrent episodes of infection. Catheters were placed in 34 infants (97%). At the time of insertion, 21 patients (62%) weighed less than 1000 gm and 13 patients (38%) weighed less than 750 gm. The average duration of catheterization was 32.0 +/- 18.2 (SD) days; 19 patients (56%) had lines in place for more than 30 days. Mechanical difficulties complicated the course of five patients (15%). Four cases of bacteremia were identified; this represents 3.7 infections/1000 days of catheter use. All infections were caused by methicillin-resistant staphylococci. Two patients required catheter removal to clear their infection, but in two of the four bacteremic patients, the infection was cleared and the line was sterilized by the administration of antibiotic therapy through the central catheter. We conclude that Silastic central venous catheters can be used safely to deliver intravenous nutrition to extremely small preterm infants over a prolonged period of time, and in carefully selected patients, successful treatment of complicating infections may be achieved without catheter removal.

The development of a testicular self-examination instructional booklet for adolescents.

Testicular cancer (TC) is the most common cancer in 15-34-year-old males, but many young men are unaware of their risks, symptoms, and possibility of detection by testicular self-examination (TSE). After a pretest to determine baseline knowledge and TSE activity, 66 young men, 15-20 years old (means = 18.5 +/- 1.5), were given a programmed-learning self-instructional booklet to read. A posttest after completion of reading the booklet assessed attitudes and new knowledge. A 2-year follow-up tested knowledge and current TSE activity. Pretest analysis revealed that only 15% of the subjects were aware of their risks of TC, and only 6% had been taught TSE by a health professional. Subjects were unable to correctly identify the symptoms of TC, and only 1.5% reported regularly performing TSE. At 2-year follow-up, 95% (p less than .001) knew that a small lump was the most common symptom of TC, and 67% reported performance of TSE (p less than .001). These results suggest that adolescent males are not being taught about TC and TSE, and that our booklet is effective in teaching young men about TC risks and symptoms and how to perform TSE. This self-instruction method may be useful in health education classes for high school and college age youth.

Clitoral size in full-term infants.

We have provided standards for clitoral length and width. These measurements are simple, reliable, and reproducible and should be included as part of the newborn physical examination.