Acute renal failure following collective intoxication by Cortinarius orellanus.

Twenty-six young men with no previous medical history all ingested mushroom soup, exclusively made with Cortinarius orellanus. They were hospitalized 10-12 days after the incident. On admission, 12 patients presented with acute tubulointerstitial nephritis with acute renal failure; 8 required haemodialysis. In addition to symptomatic treatment, 9 patients were given corticosteroids. In this group of 12 patients, 8 recovered rapidly, and the other 4 suffered from chronic renal failure for several months. In the other group of 14 patients, initial leukocyturia was observed in 12 cases, although renal function remained normal during a one-year follow-up. Hepatic acetylation and hydroxylation tests performed after 6 months in 22 patients did not provide any explanation for the strong individual sensitivity to the renal toxicity of this fungus.

[Water intoxication in psychiatric patients. 13 cases of severe hyponatremia]. / Intoxication par l'eau chez des malades psychiatriques. Treize épisodes d'hyponatrémie sévère.

Water intoxication mostly occurs in psychiatric patients. We observed 13 episodes of severe hyponatremia (less than 120 mmol/l) following a period of increased water consumption in 10 psychiatric patients (5 men, 5 women, mean age 48.8 years) treated with neuroleptics and/or benzodiazepines. Other causes of hyponatremia were excluded. The initial clinical signs were associated with severe gastrointestinal and neurological disorders requiring intensive care. In every case a gradual return to normal of natremia was obtained by creating a negative water balance while compensating for the sodium loss. From a study of urine and plasma osmolality ratio (U/P osm) on admission, several physiopathological mechanisms could be envisaged. A U/P osm ratio lower than 1 (6 cases) suggested a water intake exceeding the maximum dilution capacity of the kidneys (20-25 1), or a lesser water intake with little or no osmolal intake, or again an intrarenal disorder of urine dilution. When the U/P osm ratio was higher than 1 (7 cases), reflecting inappropriate secretion of the antidiuretic hormone, the hyponatremia could be explained by the psychosis itself, the treatment taken by the patients, a disorder of thirst regulation and/or a non-osmotic stimulation of vasopressin. This population, therefore, was heterogeneous: the mechanisms which contribute to this pathology are not fully elucidated, and they probably involve several factors.

[Adult respiratory distress syndrome, a manifestation of severe pneumococcal infection]. / Le syndrome de détresse respiratoire de l'adulte, manifestation de l'infection pneumococcique grave.

A retrospective study analyzing the case notes of 49 hospitalized adults, either in intensive care (n = 26) or in thoracic medicine units (n = 23), for acute bacteriologically proven pneumococcal pneumonia based on samples obtained other than by sputum examination. The mortality was 54% in intensive care and 17% in the thoracic medicine unit. This significant difference may be explained in part by a respiratory distress syndrome in whom there were adequate criteria on admission for 7 patients in the intensive care group. Among these latter only one patient had had a splenectomy. The others did not have underlying disorders (three were chronic alcoholics); 7 patients were shocked on admission, four with a leukopenia less than 5,000/mm3 and six had a thrombocytopenia less than 100,000/mm3; finally 6 had a temperature of less than 38 degrees C. 7 patients died in less than four days (mean 2 days) in a clinical context of refractory hypoxemia. The significance of the respiratory distress syndrome is probably very different from the usual pneumonia; it seems rather to be an integration of the toxins induced by the pneumococcus. Its presentation can be particularly misleading as regards the diagnosis; the prescription of antibiotics once a diagnosis is obtained would seem insufficient by itself in this context to obtain a cure.

[Treatment with a cefotaxime-fosfomycin combination of staphylococcal or enterobacterial meningitis in adults]. / Traitement par l'association céfotaxime-fosfomycine des méningites de l'adulte à staphylocoques ou à entérobactéries.

Thirty-two patients were included in this trial: 22 with staphylococcal meningitis (including 5 methicillin-resistant) and 10 with enterobacterial meningitis. Mean duration of treatment was 14.5 and 15.9 days respectively. The combination was synergistic in vitro against 10 of the 12 strains of Staphylococcus and 5 of the 6 strains of Enterobacteriaceae studied. Bacteriological sterilization occurred in all cases which could be evaluated, and clinical recovery was obtained in 95.2% of patients with staphylococcal meningitis (4 unrelated deaths) and 100% of patients with enterobacterial meningitis (2 deaths). Bactericidal power of the cerebro-spinal fluid, often less than 1/8, was not correlated with effectiveness against Staphylococci. Mean CSF concentrations of cefotaxime, desacetylcefotaxime and fosfomycin on the 2nd and 15th days of treatment were 4, 3.5 and 39.8 mg/l and 2.2, 2.1 and 28.0 mg/l, respectively. Clinical and biological acceptability was satisfactory. There were three cases of superinfection or colonization, by Pseudomonas and Enterobacter.

[Neoplastic pulmonary embolism. An uncommon cause of acute respiratory distress with normal pulmonary radiography]. / L'embolie pulmonaire néoplasique. Une cause inhabituelle de détresse respiratoire aiguë avec radiographie pulmonaire normale.

The incidence of neoplastic pulmonary embolism is certainly underestimated Necroscopy series report figures varying from 2.9 to 26. The clinical manifestations are similar to those observed in cruoric pulmonary embolism. We report two cases of acute respiratory failure with normal chest X-ray in which the diagnosis was neoplastic pulmonary embolism. The difficulties encountered for diagnosis resulted from the diffuse microvascular nature of the lesions. Perfusion scintigraphy and Swan-Ganz catheterism can be contributive, but certain diagnosis requires pathology examination. Prognosis is very poor. Clinicians should be aware of this pathology and entertain the diagnosis in all cor pulmonale patients with acute respiratory failure and a normal chest X-ray.

[Biermer's anemia with chronic lymphoid leukemia and hemolysis with autoantibodies]. / Anémie di Biermer avec leucémie lymphoïde chronique et heémolyse a auto-anticorps

The authors report a case of chronic lymphatic leukemia occurring four years after the onset of pernicious anemia. Multiple immunological abnormalities were detected. Hemolytic anemia with auto-antibodies and anti-thyroglobulin antibodies. Anti-intrinsic factor antibodies of type 1 were found but disappeared later. This case, the 9 th in the world literature, emphasizes the links between pernicious anemia, an auto-immune disease, and malignant disorders of the lymphatic and immune systems.

[Migraine or transient ischemic attacks in a patient with essential thrombocythaemia. Treatment with ticlopidine (author's transl)]. / Migraine ou accidents ischémiques transitoires au cours d'une thrombocytémie essentielle. Action de la ticlopidine.

Ischemic cerebrovascular symptoms occuring in patients with essential thrombocythaemia are usually attributed to platelet or platelet-fibrin emboli. A patient is described in whom transient ischemic attacks (TIA) had some features - namely the presence of headache and the progressive onset of symptoms - unusual for an embolic phenomenon but suggestive of a migrainous event. No further attack occured when the patient was treated by an antiplatelet drug ticlopidine, though platelet count was unchanged. The relationship between platelets, TIA and migraine are discussed.

[Macrocytic animia due to the combination trimethoprim-sulfamethoxazole]. / Anémie macrocytaire due a l'association triméthoprime-sulfaméthoxazole

The authors report a case of macrocytic anemia due to folate deficiency occurring suddenly after the administration of trimethoprime-sulfamethoxazole and completely cured by folic acid. This type of complication occurs particularly often in patients who already have a relative folate deficiency. In our case only moderate alcoholism was found. Thus individual predisposition due to enzyme abnormality must be considered. Prophylactic administration of folic acid in patients receiving this drug association is thus advisable.

[Thrombotic thrombopenic purpura associated with Hodgkin's disease]. / Purpura thrombotique thrombocytopénique (PTT) associé à une maladie de Hodgkin (MdH).

We report the second case of Hodgkin's disease associated with thrombotic thrombocytopenic purpura (TTP). Although the two diseases coexisted originally, TTP was diagnosed alone at first. Because of the very rare occurrence of this association the diagnosis of TTP is discussed according to the accepted criteria and taking into account the haematological complications which can reveal or be observed in Hodgkin's disease. No evident relationship between the two diseases can be suggested. But immunologic disorders observed in the two cases suggests that their coexistence is not necessarily accidental. The evolution of these two diseases is particularly good.

[Polycythemia resulting from abnormal hemoglobin with increased affinity for oxygen. Two cases (author's transl)]. / Polyglobulies consécutives à des hémoglobines anormales hyperaffines pour l'oxygène. Deux observations.

An abnormal hemoglobin with increased oxygen affinity has to be suspected in all the cases of polycythemia where no direct signs of "polycythemia vera", or any of the classical reasons for erythropoietic stimulation can be demonstrated. This fact is documented by two new observations, one concerning a 44 year-old man with Hb Kempsey, another concerning a 58 year-old woman with Hb Malmö. The diagnosis is based on a scrupulous electrophoretic study involving an isoelectric focusing on polyacrylamide gel, and, on the study of the oxygen binding properties of the red blood cells. This polycythemia being a compensatory mechanism allowing a normal oxygen delivery to the tissues has to be respected and a compromise must be found with the cardiovascular risk.

Cell volume measurements in acute leukaemia: method and value for diagnosis and prognosis.

Cell volume was measured using a Coulter counter in 42 cases of adult acute leukaemia, before any therapy. In every patient, the distribution was log-normal. A breakdown of the results with regard to the cell-type gives the following informations: The mean modal volume (M.M.V.) differs significantly from one type of leukaemia to another: the cell size in the myeloblastic type is larger than in the lymphoblastic, and smaller than in the monoblastic and myelomonocytic types. The dispersion of cell volumes, for a single patient, is low in acute lymphoblastic leukaemia, wider in myeloblastic cases and is even larger in myelo-monocytic patients. In 9 of the 10 acute myelo-monocytic leukaemias studied, the existence of two populations was shown by a double peak. Once relapse occurs, the cell volumes seem greater than during the first phase of the disease, at least in acute lymphoblastic leukaemia. No correlation has been found between the mean modal volumes and the labeling index, after incorporation of 3H-TdR.