[Diagnostic and therapeutic angiography in severe retro- and subperitoneal hematomas]. / Angiographie diagnostique et thérapeutique dans les hématomes rétro et sous-péritonéaux graves.

This study of the value of arterial angiography was carried out in 22 patients with serious retroperitoneal hemorrhage. In the first instance, this investigation determines the number of hemorrhages, their sites and flows. Later on it can be used to evaluate the volume of the hemorrhage and its effect on vascularisation of the abdominal viscera so that an initial prognosis can be made. At a later stage it also provider valuable date when setting up an appropriate selective embolisation based on the number of sites involved.

[Paradoxical systemic emboli. 5 case reports]. / Embolies paradoxales systémiques. 5 observations.

Paradoxical systemic embolism by venous emboli in the arterial circulation can be explained by a right-left shunt. In 5 patients, the diagnosis of paradoxical emboli was definite in three cases, and suspected in two others. Venous, arterial and cardiac angiography define the anatomical criteria which alone can confirm the diagnosis. The introduction of a caval filter can prevent recurrent emboli which has a serious prognosis.

[Endocavitary drainage (Monaldi's technic) in the treatment of pulmonary abscess]. / Le drainage endocavitaire (d'après Monaldi) dans le traitement des abcès du poumon.

The technique of intracavitary aspiration introduced by Monaldi in 1938 in the treatment of tuberculous cavities and then applied by him in the treatment of lung abscesses was forgotten for nearly 30 years. The advent of antibiotics and their success explain its abandonment. It may take an important place again in the treatment of difficult cases, as a last resort, after failure of properly conducted classical medical treatment. A study of 20 hospitalised patients in an intensive care unit presenting with severe pulmonary abscesses demonstrates this point. After recalling the causes, the therapeutic difficulties and the complications of these abscesses, the authors describe the medications, the method of endocavitary drainage and the technical problems posed by its use in patients often artificially ventilated. The absence of any major dangers inherent in using this technique is also discussed. Finally the short (one month) and long term (20 months) results were analysed. Three deaths occurred during the initial period, although largely explained by associated lesions in these patients. The other 17 patients, of whom 11 were followed up for more than six months, had a satisfactory outcome from the respiratory stand-point. The disappearance of all signs of infection was constantly obtained and in only four patients the bullous cavities persisted. The authors conclude by attesting the efficacy of the technique and its low risk often in the most critically ill patients.

[Purulent pleurisy caused by anaerobic bacteria. Apropos of 2 observations]. / Les pleurésies purulentes à germes anaérobies. A propos de deux observations.

Purulent pleural effusions due to anaerobic organisms secondary to infections of the pulmonary parenchyma are complications which often occur following the inhalation of organisms from the buccal cavity. The most commonly found organisms belong to the endogenous anaerobic flora of Veillon. Rapid encystment of the pleural collection is suggestive of this diagnosis. Treatment consists of drainage of the cavity associated with specific antibiotics.

[Autotransfusion in experimental hemoperitoneum. Hematologic study]. / Autotransfusion dans l'hémopéritoine expérimental. Etude hématologique

In order to study the hematologic repercussions of pre-operative autotransfusion, ruptures were made in experimental spleens followed by retransfusion after intraperitoneal barbotage of long duration in 8 dogs. This was performed without any heparinization. The following facts could be established:--although the blood shed was rich in red globules, it presented major alterations with a loss of clotting agents and evidence of fibrinogenic degradating elements.--A study of the blood during the transfusion and after the intervention did not reveal any intravascular coagulation but only a loss of fibrinogen and thrombocytes proportional to the amount of autotransfused blood. The limit of haemostatic tolerance with no supply of external blood was an autotransfusion ranging about 75 p. 100 of the initial blood volume.

[Metabolic acidosis and intravenous injections of fat emulsions (role of phospholipids. Experimental study)]. / Acidose métabolique et injection intra-veineuse d'émulsions lipidiques (role des phospholipides. Etude expérimentale)

In explanation of metabolic acidosis during parenteral nutrition, the authors considered the supply of H+ ions by fat emulsion, containing phospholipids of egg or soy. During intravenous infusions of 24 grams of lecithins to two healthy subjects, they observed an increased output H+ ions in urine, about 74,05 and 75,88 mEq, and a metabolic acidosis of the plasma. The theorically forcasted supply of production was 74,6 mEq. Indeed the metabolism of phospholipids supplies phosphoric ions (PO4H3), giving H+ ions at pH 7,40. The most used fat emulsions are able to give between 37 (intralipid 10%) and 61 (lipihysan 15%) mEq of H+ ions/liter.

[Severity factors and diagnosis of nonhemodynamic pulmonary edemas]. / Facteurs de gravité et diagnostic des oedèmes pulmonaires non hémodynamiques

This syndrome is characterised by changes in the pulmonary capillary bed allowing filtration of edema fluid rich in proteins. It provokes an alveolo-capillary block and a fall in compliance. Positive diagnosis is envisaged from the clinical circumstances implicating a change in the pulmonary capillaries (blast, shock, microemboli). The fall in pO2 is early and intense. The fall in compliance is later and leads to hypoventilation necessitating ventilatory assistance. Diffuse radiological opacification of both pulmonary fields is characteristics, in its appearance and also in its prolonged course. In the differential diagnosis one should try to eliminate acute pulmonary edema and refractory hypoxia of bronchogenic origin. Prognosis of the condition is fixed by the course (of the pO2, of possible hypoventilation, of the radiological pictures), under treatment. Although persistance of the syndrome for more than one or two weeks is of bad prognosis, cases have been known to progress for more than three weeks and to heal leaving no after-effects. The syndrome can be complicated by cardiac incompetence, organic renal failure, which again aggravate the prognosis.