[Medical reconciliation for hospitalized patients in orthopedic surgery department: Return of experience over 2 years of practice]. / Conciliation médicamenteuse à l'entrée des patients dans une unité de chirurgie orthopédique : retour d'expérience sur plus de 2 ans de pratique.

OBJECTIVES: Some medication errors can be prevented by pharmacist action such as medication reconciliation. The main objective of this study was to evaluate the medication reconciliation activity after two years of practice. The secondary objective was to assess the medical staff's satisfaction following the setting up of the activity. METHODS: This retrospective study was realized over a period of two years in our hospital. Patients meeting the following criteria were included: 65 years and over, hospitalized in orthopedic surgery department, preferentially after a discharge of the emergency room. After the best possible medication history was established, it is compared to medicines ordered. The discrepancies were defined as intended or unintended. Study data were collected and analyzed using Excel and SPSS statistics®. RESULTS: A total of 899 patients met the inclusion criteria during the study period, mean age was 78 years (27; 104). A total of 84 % of our cohort was admitted after a discharge of the emergency room. Seventy five percent of the population had at least an unintended discrepancie, a mean of 2,3 unintended discrepancies per patient was identified. Seventy five percent of the unintended discrepancy were discussed and resolved. The medical staff was mostly satisfied of the activity. CONCLUSION: The medication reconciliation secured the drug management of hospitalized patients.

Transcutaneous pressure adjustable valve for the treatment of hydrocephalus and arachnoid cysts in adults. Experiences with 75 cases.

The authors report a series of 75 adults treated over the last four years for hydrocephalus (69 cases) or arachnoid cysts (6 cases) by using a transcutaneous pressure adjustable valve (Sophy SU 8), the mechanism of which is recalled. The shunt was ventriculo-atrial 46 times, ventriculo-peritoneal 23 times and cysto-peritoneal 6 times. The opening pressure of the valve was initially adjusted 56 times to the medium, 9 times to the high, and 10 times to the low position, according to each particular patient's needs. Following the evolution of the neurological status and/or the CT findings, the opening pressure was secondarily modified in 27 patients (i.e., in 36%), and in some of them several times. It was raised 16 times: 10 times because of subdural hygroma(s) (complicated by a subdural haematoma which required surgical removal, in one case), and 6 times because of clinical symptoms of intracranial hypotension associated with hyperdrainage signs on CT. It was diminished 20 times because of the absence of clinical improvement and persistence of dilated ventricles on CT. In these 27 patients the Sophy SU 8 valve allowed modification of its opening pressure according to the clinical and CT evolution, without need for re-operation. It is concluded that the patients who can benefit most from this valve system are patients with normal pressure hydrocephalus or with arachnoid cysts.

[Practical value of transcutaneous pressure adjustable valves (Sophy SU 8) in the treatment of hydrocephalus and arachnoid cysts in adults (75 cases)]. / Intérêt pratique des valves à pression d'ouverture adjustable en transcutané (valve Sophy SU 8) dans le traitement des hydrocéphalies et des kystes arachnoïdiens de l'adulte (75 cas).

The authors report a series of 75 adults treated over the four last years for hydrocephalus (69 cases) or arachnoid cysts (6 cases) by using a transcutaneous pressure adjustable valve (sophy SU 8) the mechanism of which is recalled. The shunt was ventriculo-atrial 46 times, ventriculo-peritoneal 23 times and cysto-peritoneal 6 times. The opening pressure of the valve was initially adjusted 56 times in a medium, 9 times in a high, and 10 times in a low position, according to each particular patient's features. Following the evolution of the neurological status and/or the CT findings, the opening pressure was secondarily modified in 27 patients (i.e. in 36%), and in some of them several times. It was raised 16 times: 10 times because of subdural hydroma(s) (complicated with a subdural hematoma which required a surgical removal, in one case), and 6 times because of clinical symptoms of intracranial hypotension associated with hyper-drainage signs on CT. It was diminished 20 times because of the absence of clinical improvement and persistence of dilated ventricles on CT. In these 27 patients the Sophy SU 8 valve allowed modification of its opening pressure according to the clinical and CT evolution, without need for reoperation. It is concluded that the patients who can benefit the more from this valve system are patients with normal pressure hydrocephalus or with arachnoid cysts.

[HLA typing in classical and African Kaposi's disease]. / Typage HLA dans la maladie de Kaposi classique et africaine.

HLA A, B, C, typing have been done in 39 patients with clinically and histologically documented classical Kaposi's sarcoma. Thirty three were also typed for HLA DR antigens. Twenty seven were males, 12 were females and three ethnic groups were represented: european caucasoids 41%, north african caucasoids 38.5% and negroids 20.5%. The only statistically significant abnormality is an increase of HLA DR5 frequency (60.6 vs 26. p less than 0.001 et RR = 4.2). Such an increase has been evidenced also in AIDS patients, with or without Kaposi's sarcoma and then is not discriminant between all this different types of the disease.

[Study of the HLA-DQ system by the complement fixation test on lymphocytes stimulated by phytohemagglutinin. Existence of HLA-DQX allele(s)]. / Etude du système HLA-DQ par réaction de fixation du complément sur lymphocytes stimulés par la phyto-hémagglutinine. Existence d'allèle(s) DQX.

The complement fixation microtechnique against PHA blasts has been used to study HLA-DQw1, 2, 3 specificities with sera from multiple transfused patients and/or from multiparous women. Several sera (6 or 7) have been used to define each DQ specificity. The sera have been chosen because of their reactivity with cells from HLA-DR 1, 2 or w6 donors (for DQw1), DR3 or 7 donors (for DQw2,) DR4 or 5 donors (for DQw3). Correlation coefficients between DQ and DR specificities were from 0.56 to 0.91. Correlation coefficients between sera were from 0.51 to 0.92 in each cluster of sera. The segregation of DQw1, 2, 3 specificities has been studied in 46 families with 234 children. This study showed haplotypes lacking DQw1, 2, 3 specificities. The segregation of such 11 DQX haplotypes has been observed in 38 children from 8 families; 5 children were DQX/DQX homozygotes. Up to now, no serological reagent defining the specificity (or specificities) corresponding to DQX has been found. No preferential association was observed between DQX and DR specificities. The gene frequencies observed in 170 haplotypes in these 46 families were as follows: DQw1: 0.400; DQw2: 0.252; DQw3: 0.282; DQX: 0.065. Detecting DQ specificities seems easier by CF on PHA blasts than by lymphocytotoxicity microtechnique against B lymphocytes and monocytes from pheripheral blood. This suggests that PHA blasts express larger quantities of DQ molecules than B lymphocytes and monocytes. The results confirm that complement fixation microtechnique against PHA blasts is efficient for HLA-DQw typing.

Ovarian ectopic pregnancy in association with a copper-7 intrauterine device in situ.

A case is reported of a primary ovarian pregnancy in a patient with a Cu-7 intrauterine device. A brief review of the literature on this subject is exposed. As the action of intrauterine devices on the ovulatory mechanism and tubal transport of the ovum is still unknown, further studies should be carried out to explain this association.

PIP: A case report of ovarian pregnancy in a young white nulligravida, with a Copper 7 IUD in situ, was presented. The patient had the IUD inserted 1 year prior to her January 1977 admittance to the hospital for abdominal pain. After the IUD was removed, laparoscopy revealed blood in the abdominal cavity. The uterus, tubes, and left ovary were normal. The right ovary had a hemorrhagic cystic mass. A corpus luteum was visible near the mass. Microscopic examination of a section of the hemorrhagic mass revealed immature chorionic villi and a corpus luteum separated from the villa by ovarian connective tissue. In the literature on ectopic pregnancy, the risk of ovarian pregnancy was defined as 1/40,000 deliveries. Several studies indicated that the risk was considerably higher for IUD users. The manner in which IUDs enhance the risk of ovarian pregnancy is unknown.