[Evaluation of the gastrotoxicity of anti-inflammatory drugs: contribution of general registries of digestive endoscopy]. / Evaluation de la gastrotoxicité des anti-inflammatoires: apport des registres généraux d'endoscopie digestive.

The evaluation of the rate of gastroduodenal toxicity of anti inflammatory drugs is a difficult problem. We tried to analyse that question by studying the general endoscopic registers of the Gastro-Enterologic department of the hospital. This retrospective study concerns 2,945 endoscopies performed during the year 1988 and 1992 randomly chosen among the last 5 years. 992 results show injuries suggestive of non steroidal anti inflammatory drugs (NSAID) toxicity, however only in 65 cases the potential role of an anti inflammatory drug is mentioned: 36 men and 29 women, mean age: 50.6 +/- 19.6 years. Concerning the drugs, only the pharmacological classes they belong to are mentioned except for Aspirin. Acetyl salicylate acid 7 cases, NSAIDS 36 and Steroids 22. In the drug group 63% of injuries are located to the stomach (ulcers 13%, gastritis 50%), 37% to the duodenum (19% ulcers, 18% duodenitis). Compared to the groups with the same kind of injuries, but without any mention of drugs, there are no statistical difference in the proportion of ulcers. Aging and sex are not influent in our results on the genesis of drug induced ulcers. These results must be discussed because a lot of datas are missing in the registers and so the number of patients taking drugs is probably underestimated. This means that unless a prospective study is held with someone enquiring for all the risk factors, the study of the general endoscopic registers is not a good way to estimate gastrointestinal damages due to drugs.

[Phlebitis of the upper limbs on pacemaker electrodes. 4 cases and review of the literature]. / Phlébite du membre supérieur sur sonde de pace-maker. Quatre observations et revue de la littérature.

We report four cases of deep venous thrombosis of the upper extremity, which occurred in two women and two men (mean age 79 years) in whom a pacemaker electrode had been inserted 4 years on averages previously. In three of these four cases phlebitis developed after immobilization of the limb containing the electrode. Deep venous thrombosis of the upper extremity is rare, but 28% of catheterizations are responsible for phlebitis. One to 3% of patients fitted with a pacemaker have symptomatic phlebitis, but these figures rise to 28-65% when phlebography is systematically performed in subjects wearing a pacemaker. The clinical signs are the same as those of the classical forms, and the diagnosis is made by doppler-ultrasonography and by phlebography which informs on the collateral circulation. Cure is obtained with efficient anticoagulant therapy. These cases prompt us to prescribe a preventive subcutaneous heparin therapy in those pacemaker-fitted subjects whose arm is immobilized. The heparin dosage remains to be determined precisely.

[Malaise and its cost: the cost effectiveness of complementary tests]. / Le malaise et son coût: rentabilité des examens complémentaires.

A study of 200 patients hospitalized in the Internal Medicine ward for malaise enabled us to specify several clinical features and to estimate the cost of this disorder. Clinical data from our investigation showed that the mean age of patients was 60 +/- 1.7 years, the women were older than the men, and age is an important parameter for orienting examinations which affects the length of hospitalization and increases with it. Among the etiological diagnoses of malaise, the systematic search for orthostatic hypotension is extremely important: it was responsible for 22 of the malaises of which only half were diagnosed in the emergency room. In addition, 12% of our series of malaises were medication-associated. The 200 patients represent 1,300 hospital-days at a total cost of 2,273,000 FF (congruent to US$454,600), and an average cost of 11,660 FF (congruent to US$2330) per malaise, of which 730 FF (congruent to US$145) was paid for complementary examinations. Thus it appears that the "hotel accommodations" part of the bill is the major element. All the complementary examinations ordered during the etiological search do not provide the same information and cost-benefit analysis showed that several simple tests, i.e., ECG, blood-sugar level, blood electropherogram and dosage of toxic substances, led to approximately 75% of the diagnoses; more sophisticated tests, e.g., cerebral computed-tomography scanning, Holter ECG or echocardiography, did not concern more than 25% of the malaises studied.(ABSTRACT TRUNCATED AT 250 WORDS)