[Diagnostic and therapeutic approach in thromboembolism disease. Reflexions apropos of 105 cases]. / Attitude diagnostique et thérapeutique au cours de la maladie thrombo-embolique. Réflexions à propos de 105 malades.

105 patients suffering from thrombo-embolic disease (MTE) were explored by venography of the lower limbs, ilio-vena cavography and pulmonary angiography at the time of the initial diagnostic work up. These examinations served as a control for the different therapies, anticoagulants, thrombolytics, curative and preventive surgery, separately (77 controls) or in association (92 controls). From the base-line vascular investigations it appears that the gravity of the pulmonary emboli was not correlated with either a proximal or distal site of venous thrombosis. From the results of controlled therapy there were significant differences between the efficacy of medical treatment at the level of the pulmonary artery and at venous level where the progression of phlebo-thrombosis was often seen. Recurrence of emboli and overall prognosis of the disease usually depended on the persistence of thrombi at venous level. Such a phlebo-thrombosis is rarely aggravated by techniques of partial interruption of the inferior vena cava (IPVCI) which ensure effective protection of the pulmonary circulation. The IPVCI often appears to be the only effective method of preventing recurrent pulmonary emboli, which has led us to reconsider its indications.

[Primary pulmonary arterial hypertension. Effects of vasodilators apropos of a case with a pulmonary biopsy]. / Hypertension artérielle pulmonaire primitive. Effets des vasodilatateurs à propos d'une observation avec biopsie pulmonaire.

A patient with primary pulmonary artery hypertension diagnosed by pulmonary arterial catheterisation, angiography and lung biopsy was the subject of several therapeutic trials of vasodilators. The short term and long term results over the next four years were on the whole disappointing. The type of study protocole used is discussed, as are the risks and cost.

[Disproportionate pulmonary arterial hypertension and lung respiratory diseases: distinctive clinical, hemodynamic and prognosis of patients versus primary pulmonary arterial hypertension]. / Hypertension artérielle pulmonaire disproportionnée : caractéristiques et pronostic d'une cohorte de patients niçois référés au laboratoire d'échocardiographie.

OBJECTIVES: To characterize and compare patients with disproportionate PH versus patients with primary pulmonary arterial hypertension (PAH). METHODS: All patients referred to our cardiology unit for echocardiography from November 2006 to May 2008 and who have been followed by our pneumologist were screened for severe PH (i.e mean arterial pulmonary pressure>35-40 mmHg at rest). Patients were excluded if a factor that could influence pulmonary hemodynamics was present. We investigated these patients by pulmonary function tests, echocardiography and right heart catheterisation. RESULTS: We reported 16 cases of severe PH in stable patients (n=8, chronic obstructive pulmonary disease-emphysema) and 13 patients with PAH. Our findings suggest that the patients with disproportionate PH had right heart dysfunction similar to that observed in PAH. But their outcomes were more severe. It seemed that specific vasodilatator therapy was not efficient.

[Tuberculosis and pneumocystis: an unusual co-infection]. / Tuberculose--pneumocystose: une association à ne pas méconnaître.

INTRODUCTION: Modern immunosuppressive therapy may be responsible for toxic, immunologic and infectious pulmonary diseases. CASE REPORT: We report the case of a 58-year old woman treated for rheumatoid arthritis who received leflunomide, corticosteroids, methotrexate and adalimumab. She developed disseminated tuberculosis, which presented with neurological symptoms (brainstem) and also pneumocystis pneumonia. CONCLUSION: Modern immunosuppressive therapy used to treat inflammatory disorders in connective tissue diseases and in transplantation may induce new respiratory diseases, new patterns of known respiratory diseases or co-infections that are very seldom seen outside the context of HIV. Pulmonologists, rheumatologists, internists and intensivists should be aware of this new spectrum of diseases whose presentation may be atypical.

[Determination of antibiotype by a computer program. Epidemiological significance and antibiogram-identification correlates]. / Détermination d'un antibiotype à l'aide d'un programme informatique. Intérêt épidémiologique et cohérence antibiogramme-identification.

By means of a computer program disk diffusion diameter were analysed and an antibiotic susceptibility code (antibiotype) was determined for enterobacteriaceae. This code was a 6 figure-number. Each figure summarised susceptibility (susceptible or resistant) to 3 antibiotics. Thus a 18 serial antibiotics was necessary to calculate the 6 figure-code. At least following antibiotics were chosen for their characteristic behavior: amoxycillin, ticarcillin, amoxycillin + clavulanic acid, cephalothin, ticarcillin + clavulanic acid, cefotaxime, gentamycin, tobramycin, amikacin, nalidixic acid, pefloxacin, ciprofloxacin, fosfomycin and colistin. This code allowed three kind of utilisation: epidemiology by comparing biochemical and susceptibility patterns of same isolated species; laboratory control: a data base with main antibiotic susceptibility patterns for each species allowed a rapid compatibility control of biochemical identification with antibiogram. An inconsistent result lead to a checking of biochemical and susceptibility tests or to record a new code in a file to a further enrichment of the data base. Impression of a message depending of the code for a therapeutic purpose.

[Comparative in vitro and in vivo study of several long-acting theophyllines]. / Etude comparative in vitro et in vivo de plusieurs théophyllines à action prolongée.

This study describes the comparative in vitro and in vivo release of six slow-release formulations. In vitro, with half-change method, differences appear in the profiles, some formulations showing a linear release (Dilatrane, Euphylline LA, Théostat), the others an irregular release with 'plateau' related to the pH gradient (Armophylline, Cétraphylline, Théolair). In vivo, at steady state, the fluctuations are less important and the comparative kinetic study in ten normal healthy volunteers after chronic oral dosing of six different formulations show a slight variability in the theophylline release during 12 h. Great interindividual variations appear with all formulations. In fact, none of the formulations present an ideal release over a 12 h period.

[Blood pressure in 6- to 45-month-old children. Apropos of a study of 264 children from nurseries]. / Pression artérielle chez l'enfant entre 6 et 45 mois. A propos de l'étude de 264 enfants des crèches.

The systolic, diastolic and mean blood pressure and pulse rate were measured among 264 children aged 6 to 45 months, during routine check-up in 4 day-nurseries. We took the mean value of 3 successive measurements taken at one minute intervals on the upper arm of calm, asymptomatic children, with an automatic oscillometric monitor (Dinamap). When the mean systolic blood pressure was greater than 110 mmHg, the measurement was repeated. The results were related to weight, height and age and to personal and/or family history. The systolic pressure was steady with a 97th percentile at 110 mmHg. The diastolic pressure presented two levels: 97th percentile at 81 mmHg before 24 months and 73 mmHg afterwards. Nine children born to toxemic mothers, and 14 having required neonatal hospital care, had lower diastolic pressure. The other family or personal data were not linked to particular pressure groups.