Hepatitis C virus infection risk factors in patients admitted in hospital emergency departments in Picardy. Value of oriented screening based on recommendations of the 'Direction Générale de la Santé'.

OBJECTIVE AND DESIGN: Oriented hepatitis C virus (HCV) screening on the basis of transfusion, previous or current parenteral drug addiction, invasive procedures, and in family members of patients with hepatitis C, was recommended in France by the 'Direction Générale de la Santé' (DGS). The aim of this study was to estimate the frequency of these risk factors in patients admitted in hospital emergency departments in Picardy. METHODS: Between 1 June and 31 July 1996, physicians of the emergency units of seven hospitals in Picardy were asked to question admitted patients about risk factors mentioned in the DGS recommendations, and to suggest a screening test when at least one of these risk factors was present. RESULTS: Among 1648 patients, 68.7% had at least one of these risk factors. Screening was accepted by 723 patients, 58.7% of those with at least one risk factor, and more than 70% of those with history of transfusion and/or drug addiction. It was immediately performed in 451, and 2.4% had anti-HCV antibodies. The prevalence of anti-HCV antibodies was 1.5% in patients without history of transfusion or drug addiction and 7.9% in those with at least one of these two risk factors. CONCLUSION: Oriented screening based on transfusion or drug addiction history seems to have better efficiency than the screening policy recommended by the DGS. Poor reliability of answers about medical history was observed probably because of stress related to emergency circumstances. A screening test proposed to patients with these major risk factors by their usual physician would be probably more efficient.

[Cardiac involvement in Lyme disease. 2 cases]. / Atteintes cardiaques au cours de la maladie de Lyme. Deux observations.

Lyme disease is a systemic bacterial infection involving several organs. Cardiac involvement predominantly consists of disorders of conduction which may be associated with pericarditis, although this rarely occurs. Cardiac lesions in Lyme disease (disorders of conduction, myocarditis, pericarditis) are usually observed during the second stage of the disease. In the two cases reported here, the myocardial and pericardial signs suggested Lyme disease and in view of the context, pointed to the diagnosis.

[Mixed endocrine tumor of the pancreas (vipoma, glucagonoma). Treatment by somatostatin followed by one of its long-acting analogs]. / Tumeur mixte du pancréas endocrine (vipome, glucagonome). Traitement par la somatostatine puis par un de ses analogues d'action prolongée.

We describe the 4-year follow-up of an endocrine tumour of the pancreas (vipoma-glucagonoma) treated with chemotherapy. To control the endocrine syndrome we used somatostatin 14 by continuous subcutaneous infusion for 1 year, followed by the somatostatin analogue SMS 201-995 administered alone without antitumoral chemotherapy. Under SMS 201-995 (100 micrograms 12-hourly) the endocrine syndrome dramatically improved. This effect persisted for 12 months after which a relative resistance to the drug developed. It was necessary to increase the dosage (300-400 micrograms/24 hours) and to alter the mode of administration (continuous subcutaneous infusion) to obtain a clinical benefit inferior to that obtained during the first year of treatment with SMS 201-995. At present this drug is given combined with recombinant interferon alpha 2A. In spite of computerized tomography, ultrasonography and monitoring of hormone levels we were unable to determine whether or not SMS 201-995 exerted a partial antitumoral effect.

[Rhabdomyolysis with acute renal failure and malignant neuroleptic syndrome]. / Rhabdomyolyses avec insuffisance rénale aiguë et syndrome malin des neuroleptiques.

Seven episodes of rhabdomyolysis with acute renal failure (ARF) have been observed in 6 patients treated with various short-acting tranquilizers and antidepressants. Clinical features usually included severe hyperthermia, diffuse hypertonicity with or without coma, circulatory failure or unstable blood pressure, and often acute respiratory failure. Serum CPK were always elevated. The type of ARF was prerenal failure without oliguria in 5/7 episodes, and acute tubular necrosis in 2/7 episodes, requiring hemodialyses in one patient. Three patients died. In any case, the tranquilizers and antidepressants responsible for this syndrome were stopped, and electrolyte disorders and acidosis were corrected. Associated acute circulatory failure, septicemia and/or acute hepatic failure required prompt therapy, and artificial ventilation was required in 4 instances. The further use of phenothiazines, butyrophenones, sulpiride and their derivatives should be avoided in any patient having developed such an accident, whose pathophysiology is similar to that described in malignant hyperthermia of various origin.

Inferior mesenteric arteriovenous fistula associated with portal hypertension and acute ischemic colitis. Successful occlusion by intraarterial embolization with steel coils.

The authors report a case of postoperative arteriovenous fistula between the inferior mesenteric vessels. This fistula was revealed by portal hypertension, with bleeding esophageal varices, ascites, and encephalopathy, and by acute ischemic colitis. Histologic examination of the liver was normal. All of the symptoms disappeared after transcatheter embolization of the fistula with stainless steel coils. This case report favors the reality of the so-called "forward" portal hypertension and suggests that inferior mesenteric arteriovenous fistula might be a factor predisposing to nonocclusive ischemic colitis.

Microbiological evaluation of infected wounds of the extremities in 214 adults.

OBJECTIVE: The aim of this multicentre prospective study was to analyse microbial pathogens cultured from an infected wound. METHODS: The study was performed in the emergency rooms of 10 public hospitals. All adult patients with a clinical diagnosis of cellulitis after a wound in the upper or lower extremities were included. Cultures were obtained with swabs from infected lesions. Micro-organisms cultured were identified by the usual methods and susceptibility testing was performed. RESULTS: The study population consisted of 214 patients, 153 men and 61 women, with a mean (SD) age of 40 (10) years. Wound cultures remained sterile in 28 cases and infected with micro-organisms in 186 cases. Of the 186 positive cultures, three were not identified. Of the 183 remaining cultures, one micro-organism was present in 132 patients (62%) and several micro-organisms in 51 patients (24%). A total of 248 micro-organisms were isolated in 183 patients. Staphylococcus and streptococcus were the most frequently isolated micro-organisms (56% and 21% respectively) followed by Gram negative bacilli (18%). Determination of the susceptibility to the antibiotics commonly used to treat wound infections showed resistance in some cases. CONCLUSION: These results support the need always to take culture specimens from infected wounds for microbiological evaluation and antibiotic susceptibility determination, so that adapted chemotherapy can be prescribed.

[Bacteriologic, clinical and kinetic evaluation of cefmenoxime (SCE 1365) in the treatment of 68 cases of septicemia. A multicenter trial]. / Evaluation bactériologique, clinique et cinétique de la cefménoxime (SCE 1365) dans le traitement de soixante-huit septicemies. Essai multicentrique.

Cefmenoxime (SCE 1365), a new broad-spectrum, third generation cephalosporin was used in the treatment of 68 patients with bacteremia. Cefmenoxime was given as monotherapy to 63 patients in a mean daily dosage of 3 g (range: 1 to 6 g). 63 successes were recorded. Results were inconclusive in the remaining five cases. General and biological tolerance of cefmenoxime was excellent.