[Hypercalcemic sarcoidosis and primary hyperparathyroidism disclosed by renal insufficiency]. / Sarcoïdose hypercalcémique et hyperparathyroïdie primaire révélées par une insuffisance rénale.

Primary hyperparathyroidism and sarcoidosis were found in one patient with hypercalcemia and renal failure. Cervicotomy disclosed a parathyroid adenoma and renal biopsy demonstrated interstitial nephropathy. Association of sarcoidosis with hyperparathyroidism, if not fortuitous, has not yet been clearly established.

[Endocrine hypertension in pregnancy]. / Hypertensions artérielles endocriniennes au cours de la grossesse.

Hypertension is a frequent complication of pregnancy and may compromise fetal and maternal outcome. Hypertension may be pregnancy-induced, essential or secondary to endocrine disorders. Most cases of endocrine hypertension are the consequence of adrenal diseases. Pheochromocytoma, hypercorticism, primary aldosteronism or glucocorticoid-remediable aldosteronism can be present or diagnosed at any term and may cause severe hypertension. The most hazardous form of endocrine hypertension during pregnancy is pheochromocytoma because it may involve paroxysmal arrhythmia and/or hypertension during labor. Clinical clues and biological tests are similar to those used in non-pregnant subjects. Tests for tumor location are limited to ultrasound and magnetic resonance scans in order to avoid maternal and fetal irradiation. Medication to prepare for pheochromocytoma surgery uses alpha- and beta-blockers. The timing of surgery depends on the term of pregnancy at the diagnosis of the tumor.

[Critical study of methods for the diagnosis of allergic asthma]. / Etude critique des moyens de diagnostic de l'asthme allergique.

A search for an allergic cause in asthma is fundamental to the diagnosis. Typically it is based on: A clinical history. Specific cutaneous and inhaled provocation tests which can produce a possible reaction (early and delayed) which are of great pathophysiological and therapeutic interest. In vitro tests (which enable the different phases of the allergic reaction to be distinguished) to know the serum IgE antibody levels (total IgE, specific IgE and their fixation to cell receptors) cell tests on the degranulation of basophils and the dosage of chemical mediators: histamine, leukotrienes, prostaglandins, P.A.F. in the serum or in the bronchial alveolar lavage liquid, from the study of cells or tissue samples. In this regard the authors stress two recent techniques enabling direct access to bronchial tissue and the pulmonary parenchyma, which are bronchoalveolar lavage and bronchial biopsy, both are possible today by using a fibroscope. The broncho-alveolar lavage still remains in the research area, and is not always well tolerated in asthmatics. It already allows a better definition of the major allergic cytological and biochemical components in asthma (IgE, IgA, albumin, phospholipids, mast cells and eosinophils). Bronchial biopsies with ultra-structural studies, and above all immunopathology (by immunofluorescent techniques and peroxidase stains) enable groups of asthmatics to be uncovered who were considered as non-allergic by the unsuspected intervention of hypersensitivity mechanisms to IgE (the presence of cells carrying IgE); these biopsies enable the importance of inflammatory factors to be confirmed and equally to establish the prognosis in certain asthmatics by the degree of irreversibility of the lesions (fibronectin).(ABSTRACT TRUNCATED AT 250 WORDS)

[Revascularization of atherosclerotic stenosis of the renal artery. Indications and results]. / Revascularisation des sténoses athéroscléreuses de l'artère rénale. Indications et résultats.

RISKS: Atherosclerotic renal artery stenosis typically occurs in high risk patients with coexistent vascular disease elsewhere. Patients with atherosclerotic renal artery stenosis may develop progressive renal failure but have a much higher risk of dying with a stroke or a myocardial infarction than of progressing to end-stage renal disease. REVASCULARIZATION RESULTS: Recent controlled trials comparing medication to revascularization have shown that only a minority of such patients can expect hypertension cure, whereas trials designed to document the ability of revascularization to prevent progressive renal failure are not yet available. Percutaneous renal artery angioplasty is the first choice because it is simpler than and as effective as surgical reconstruction. INDICATIONS: Revascularization should be undertaken in patients with atherosclerotic renal artery stenosis and resistant hypertension or heart failure, and probably in those with rapidly deteriorating renal function or with an increase in plasma creatinine levels during angiotensin-converting enzyme inhibition. Older age, long history of hypertension and a kidney size less than 8 cm are associated with little chance of blood pressure improvement or kidney function recovery. PRACTICAL ATTITUDE: With or without revascularization, medical therapy using antihypertensive agents, statins and aspirin is necessary in almost all cases. Blood pressure and plasma creatinine concentration should be measured every three months. Kidney size and renal artery patency should be assessed yearly.

[Arterial hypertension secondary to curable causes in adults]. / Hypertensions artérielles secondaires à des causes curables chez l'adulte.

EXTENSIVE AND COSTLY INVESTIGATIONS: Are not warranted in the vast majority of hypertensive patients. Characteristics identifying the patients at risk for secondary hypertension can be used to define the small percentage of patients with hypertension who require more extensive diagnostic testing and management of their condition. Exposure to certain medicines, foods or drugs may cause reversible rises in blood pressure. Renovascular and adrenal diseases cause curable forms of hypertension. IN MANY CASES, THE PATIENT'S HISTORY: Examination and simple tests can detect such exposures and disorders. Checking for secondary hypertension is therefore an early step required for the management of all patients with hypertension, provided it is based on clinical signs and inexpensive tests. This primary screening cannot exclude the possibility of renovascular or adrenal disease in a small number of asymptomatic patients. The risk of missing a diagnosis is acceptable provided that blood pressure is normalized by non-specific antihypertensive treatment. However, more extensive etiologic investigation is required in patients who subsequently develop resistant hypertension. This secondary screening requires imaging and biochemical tests that are not required for primary screening. CORRECTION OF THE CAUSES: Of secondary forms of hypertension may restore blood pressure to normal. The patient's age affects the reversibility of renovascular and adrenal hypertension after etiologic treatment: the younger the patient, the higher the probability of blood pressure normalization.

[Surgical treatment of calcanear fractures (103 cases). Reconstruction-arthrodesis, or reconstruction (author's transl)]. / Traitement chirurgical des fractures articulaires du calcanéum: reconstruction ou opération de Stulz? A propos de 103 cas opérés.

In a twelve-year period, 103 calcanear fractures (thalamus) were operated on, either by the Stulz procedure (calcanear Reconstruction-subtalar Arthrodesis [83 cases]), or by Reconstruction (20 cases). During the first seven years, the Stulz procedure had been performed systematically. During the following five years, indications were shaded between 28 reconstruction-arthrodesis and 20 reconstructions. A complete preoperative radiological study, including especially horizontal calcanear tomography enables to precise what type of injuries affects the four different parts of the calcaneus, and to choose between either procedure.

[Results of primary reconstructive arthrodesis of the calcaneus (study of a homogenous series of 55 fractures of the medical surface of the calceneus)]. / Résultats de la reconstruction-arthrodèse primitive du calcaneum. (ètude d'une série homogène de 55 fractures thalamiques)

55 cases of calcanear fractures (thalamus) have been treated with the Stulz procedure (early subtalar arthrodesis and calcanear reconstruction), associated with a repair of the great apophyse. All the cases are comparable and the results are considered as good or excellent in 93,8 p. 100 of them. The results are interpreted accordingly to subjective and objective tests. The result is depending of the type of the lesion, the patient's profession and the nature of the trauma. The result obtained at the time of fracture uniting will stay stable, will never deteriorate and sometimes improve. The early arthrodesis and reconstruction remains a good procedure for the comminutive fractures of the thalamus, which are considered as the most difficult to correct perfectly. For this reason, the simple reconstruction is often responsible of secondary subtalar arthrosis.

[Surgery of retrospinal disinsertion of the posterior cruciate ligament of the knee (author's transl)]. / Le traitement chirugical de la désinsertion rétrospinale du ligament croisé postérieur du genou.

Thus in all cases of an isolated tear of the posterior cruciate ligament, with an interglenoid fragment, whe fixation by a screw or clip was carried out, we obtained good results by simple surgical treatment. In spite of the small size of this series, the results were in perfect harmony with those of other authors, which justifies surgery. In three other cases of a tear of the posterior cruciate ligament, orthopedic treatment was adopted for various reasons; comparison of the results was definitely in favour of surgery owing to the duration of plaster immobilisation and physiotherapy in the first group and the functional sequelae with chronic invaliding laxity in the cases treated conservatively.

[Treatment of fractures of the humerus by intramedullary fixation]. / Traitement des fractures de l'humérus par "l'embrochage en bouquet"

The Hackethal's technique of intramedullaring wiring for humeral fracture represents the immobilisation procedure particularly convenient for this bone. This procedure can be realised without special instrumentation with Kirschner's wires and image intensifior. To allow the approach of the fracture, the patient's position is choosed upon the topography of the lesion. The intramedullaring wiring is always done from down to up. Indications for this procedure are: humeral shaft fracture, humeral neck fracture, and fractures of the shaft and of the neck. During the reduction of the fracture, the immoderate use of a image intensifior seams to be the major risk. Hackethal's technique for medullary wiring was used in 21 patients, only one pseudarthrosis was noted. The fonctionnal recovery of the arm is usually realised in three months.

[Protected distal aspiration in the identification of pathogenic microorganisms in pneumologic intensive care]. / Apport de l'aspiration protégée distale à l'identification de micro-organismes pathogènes en réanimation pneumologique.

To identify the micro-organisms responsible for bronchopulmonary infections in intensive care patients is an absolute prerequisite to successful treatment. Numerous techniques of specimen collection have been used to facilitate this bacteriological diagnosis. In this study, which involved 27 intensive care patients selected according to various criteria of infection, endotracheal aspiration (a commonly used but not very specific technique) was compared with protected distal brushing under fibroscopy and with protected distal aspiration. The latter method, still seldom used, proved as specific as protected distal brushing (hitherto regarded as the reference method), but it also presents the enormous advantages of being rapid, non-traumatic, devoid of side-effects and easily performed in hospital routine by paramedical staff.

[Tissue immunopathology methods for the diagnosis of bronchopulmonary diseases]. / Apport des méthodes d'immunopathologie tissulaire au diagnostic des maladies broncho-pulmonaires.

The authors draw attention to the diagnostic value of tissue immunopathology methods in numerous bronchopulmonary diseases. Having emphasized the strict technical requirements and difficulties of these methods--all obstacles that are necessary for an accurate evaluation of the lesion--they use concrete examples to demonstrate the usefulness of extra-thoracic, skin or muscle biopsies to diagnose some systemic diseases, such as lupus erythematosus or Churg and Strauss syndrome. They also refer to bronchial biopsies which provide information on the aetiology and pathogeny of adult asthma, and to the prognostic and therapeutic value of collagen studies in idiopathic pulmonary fibrosis.

[Intravascular bronchioloalveolar tumor or I.V.B.A.T. Apropos of a case and review of the literature]. / "Intravascular bronchioloalveolar tumor" ou I.V.B.A.T. A propos d'un cas et revue de la littérature.

Intravascular bronchioloalveolar tumor is a rare tumour of the lung. Having observed a case detected during systematic examination in a 44-year old woman, the authors compare the radiological, clinical, histological and evolutive signs of the disease with those reported in the 40 cases published since the first description by Dail and Liebow, in 1975.

[Prognostic value, at the onset of an asthma attack, of respiratory, hemodynamic, and acid-base equilibrium parameters]. / Valeur pronostique, au début d'une crise d'asthme, des paramètres respiratoires, hémodynamiques, et de l'équilibre acido-basique.

Sudden death is still a common complication of acute asthma. The authors analysed statistically the prognostic value of the respiratory rate (RR), the heart rate (HR), blood gases, systolic blood pressure (BP syst), and diastolic pressure (BP diast) and the amplitude of the P wave in lead II on the ECG, recorded at the beginning of the asthma attack. This retrospective study concerns two groups of patients distinguished on the basis of the severity of the attack (group I: simple retrospective study concerns two groups of patients distinguished on the basis of the severity of the attack (group I: simple attack; group II; status asthmaticus). A HR greater than 24 per minute, a P wave greater than or equal to 2.5 mm or a PaCO2 greater than or equal to 6.3 kPa (47.25 mmHg) are three highly sensitive and specific criteria of the evolution of the asthma attack towards a more severe form (status asthmaticus). Patients who present one or more of these parameters should be monitored in a respiratory intensive care unit in order to prevent avoidable sudden death.