[Epidemiology of sinusitis seen in hospitalized patients. Apropos of 77 episodes of sinusitis among 72 patients between 1993 and 1996]. / Epidémiologie des sinusites observées chez les malades hospitalisés. A propos de 77 épisodes de sinusite constatés chez 72 patients entre 1993 et 1996.

The 77 cases of sinusitis seen in 72 patients admitted to the Briançon Hospital between January 1, 1993, and June 30, 1996, were studied. One or both maxillary sinuses were involved in 96.8% of cases. Sinus aspiration was done in 95 cases. All aspirates were subjected to microbiological studies. Of the 45 aspirates that yielded positive cultures, 36 grew one or more pathogenic organisms. The most commonly isolated bacteria were Pseudomonas aeruginosa (n = 7), Streptococcus pneumoniae (n = 5), and Haemophilus influenzae (n = 5). Nosocomial sinusitis defined on a set of criteria including hospital stay duration at onset and an acute tempo of evolution contributed 32.5% of cases overall, 55.2% in the intensive care unit and 18.7% in all other departments combined. Nosocomial cases in the intensive care unit were associated with well-known risk factors, namely tracheal intubation with ventilation and presence of a nasogastric tube. Other study criteria included the type of organism recovered by culture and whether patients ventilated via a tracheal tube had the same organism in their sinus and tracheal tube aspirates. Some nonintensive care patients had none of the known risk factors for sinusitis; prompt diagnosis and treatment of these cases of sinusitis is important to avoid infectious complications, which are, however, less common than in intensive care patients.

[Hypocaloric nutrition or strict protein intake in the postoperative period]. / Nutrition hypocalorique ou apport protéique strict en période postopératoire.

The purpose of this study was to verify the statements of Blackburn concerning the positive effects of strict nitrogen hypocaloric diets. Three groups of 10 postoperative patients received hypocaloric diets. A carbohydrate diet of 200 grams was given to the first series of patients, a nitrogen diet of 12.4 to the second and finally a carbohydrate-protein diet consisting of 200 grams Sorbitol and 12.4 grams nitrogen to the third. Patients were followed for five days. The existence of post-aggression reactions was determined through measurements of GH, Cortisol, glycemia, insulinemia, fatty acids and ketone bodies. Patients under the strict nitrogen diet presented a less elevated hyperglycemia than the other groups. Insulinemia was also lower with values returning to normal by the second day. This same group showed a significant rise of free fatty acids with ketonemia, an obvious sign of lipolysis. The respiratory quotient, near 0.7, was also indicative of lipolysis. The cumulative nitrogen balance over five days was much less negative than for patients under a strictly carbohydrate diet: the nitrogen balance closest to zero was however obtained for patients under the carbohydrate-protein diet. The combined analysis of the respiratory quotient and the nitrogen balance allowed an evaluation of the respective participation of lipid and carbohydrate nutriments to the energy supply in function of the three types of diet. Lipid participation was of 36% under the carbohydrate diet, 48% under the carbohydrate-protein diet and 84% under the strictly protein diet.