[Whipple disease associated with pulmonary arterial hypertension. Jarisch-Herxheimer reaction after antibiotic therapy]. / Maladie de Whipple associée à une hypertension artérielle pulmonaire. Réaction de Jarisch-Herxheimer après antibiothérapie.

BACKGROUND: Pulmonary hypertension is an uncommon feature of Whipple's disease and the underlying pathophysiological mechanism remains a subject of debate. CASE REPORT: A 57-year-old woman was hospitalized for exploration of migrating joint pain that had developed for 5 years. Histologically proven Whipple's disease was diagnosed on duodenal biopsies. The lung angiogram performed to explore signs of right heart failure demonstrated pulmonary hypertension and ruled out pulmonary embolism. Abundant pericardial effusion developed progressively. Antibiotic therapy using sulfamethoxazole-trimethoprime led to a systemic Jarisch Herxheilmer reaction. The pulmonary hypertension resolved rapidly, the pericardial effusion more slowly. DISCUSSION: The pulmonary hypertension in this patient appeared to be directly related to Whipple's disease, probably via vascular infiltration by Tropheryma whippeli.

[Primary malignant lymphoma of the liver and cirrhosis: an unusual association]. / Lymphome malin primitif du foie et cirrhose: une association inédite.

We report the seventeenth case of primary hepatic lymphoma. Its originality is an association with one cryptogenetic cirrhosis, which had never been described but does not seen fortuitous. We discussed the significance of such an association, one's being cellular immunity anomalies.

Bacterial adhesion in human upper gastrointestinal tract.

Small bowel biopsy specimens were taken from 21 patients undergoing gastrointestinal endoscopy to detect a possible adhesion of bacteria to the mucous layer of the upper gastrointestinal tract. In 30 control biopsy specimens taken from 10 patients free from gastrointestinal pathology, no associated bacteria were found, whereas in 23 biopsy specimens taken from eight gastrectomized patients an associated bacterial flora including E. coli or Pseudomonas was grown. Bacterial adhesion was confirmed by means of transmission electron microscopy of the eight patients yielding positive cultures. Bacterial adhesion induced local alterations of the brush border membrane. These results suggest that adherent bacteria may be present in hypochlorhydric patients. Pathophysiologic consequences require further studies.

[Primary lymphoma of the liver: an uncommon disease. Ultrasonic and x-ray computed tomographic aspects. Apropos of a case with review of the literature]. / Le lymphome primitif du foie: une affection exceptionnelle. Aspects échographiques et tomodensitométriques. A propos d'un cas avec revue de la littérature.

Although the very rare primary non-Hodgkin's lymphoma is resectable and responds to chemotherapy it has a very poor prognosis since the outcome was rapidly fatal in 7 of the 11 cases reported in the literature. Particular features in a patient with a primary non-Hodgkin's lymphoma of cirrhotic liver were the association of portal hypertension and portal thrombosis related to tumor invasion. Findings on ultrasound imaging and histologic diagnosis from guided needle puncture biopsy appear to be previously unreported aspects of this affection.

Comparison of transcutaneous and alveolar partial pressure of carbon dioxide during carbon dioxide breathing in healthy children.

In 18 healthy children three to 13 years of age, the transcutaneous partial pressure of carbon dioxide (PtcCO2) (Radiometer electrode) and the alveolar partial pressure of carbon dioxide (PACO2) (Beckman analyzer) were measured simultaneously during the breathing of room air and 5 percent carbon dioxide. The PtcCO2 electrode was placed on the anterior thorax and heated to 42 degrees C. The PACO2 was calculated on the 4/5 part of the carbon dioxide expired trace. Minute ventilation (VE) was measured in 11 cases. There was a significant correlation between PtcCO2 (in millimeters of mercury) and PACO2 (in millimeters of mercury) while breathing room air (PtcCO2 = 0.82 PACO2 + 19.7; r = 0.55; p less than 0.02) and while breathing 5 percent carbon dioxide (PtcCO2 = 0.77 PACO2 + 22.5; r = 0.61; p less than 0.01); however, the ratio of PtcCO2 over PACO2 was significantly lower while breathing 5 percent carbon dioxide (p less than 0.01) than while breathing room air. When considering the relationship between the increase in VE (delta VE while breathing 5 percent carbon dioxide and the changes in PACO2 (delta PACO2) or in PtcCO2 (delta PtcCO2), a significant correlation was found only between delta VE and delta PACO2, ie, delta VE = 0.41 delta PACO2 + 0.44 (r = 0.63; p less than 0.01). These results suggest that breathing carbon dioxide modified the factors acting on PtcCO2, possibly by changes in the vasomotor tone of cutaneous blood vessels. These modifications appeared to be variable from subject to subject. Therefore, we conclude that PtcCO2 does not appear to be an accurate quantitative index to assess ventilatory response to carbon dioxide.

[The problem of osteosynthesis in peripheral replantation]. / Zur Problematik der Osteosynthese bei der peripheren Replantation.

In this report, 16 cases of peripheral replantation are described, in which osteosynthesis was carried out by means of AO-mini or small-fragment plates with the obvious advantage of allowing early mobilisation. A disadvantage of this method is that it is necessary to dissect the soft tissue to a greater extent and to elevate the periosteum more than in using Kirschner wires, this dissection to permit sufficient fixation of the plate and screws. As a result, primary technical difficulties in the venous anastomosis may occur and there is a risk of adhesions developing between the extensor apparatus and the bone (two cases). Difficulties occur when using plates and screws for comminuted and juxtaarticular fractures. In these cases Kirschner wire osteosynthesis is preferred. For injuries in zones 1 and 2 in the majority of the cases an osteosynthesis with wire is indicated. Only in cases of replantation in zone 2, where the DIP joint is destroyed, can an arthrodesis be performed by means of a screw. When using the above mentioned osteosynthesis for peripheral replantations, we have achieved good to very good end results in the majority of the cases.

[Fractures of the femoral neck in children (author's transl)]. / Schenkelhalsfrakturen im Kindesalter.

Osteosynthesis is the preferred method of treatment in fractures of the neck of the femur in children. Operative technique requires attention to be paid to a few special features due to the problems caused by the neighbourhood of the joint of the femoral neck. Nine cases of fractures of the neck of the femur in children were treated by the authors during 1971 to 1978. Diagnosis of such lesions, which are no longer a rare occurrence, requires accurate x-ray films on two levels, because infractions are easily overlooked. The dreaded complications of necrosis of the femoral head can best be counteracted by immediate anatomical repositioning and exercise-stable osteosynthesis, as well as by temporary relief. The authors discuss the therapeutic procedure in detail, basing on the experience with their own patients, and the results are communicated.

[The technic of microvascular surgery and the use of it in orthopedics and traumatology (author's transl)]. / Technik der Mikrogefässchirurgie und deren Verwendungsmöglichkeiten in der Orthopädie und Traumatologie.

With two chosen examples we point out the applications of the microvascular surgery in orthopedics and traumatology. The technique of anastomosing the vessels from a diameter of 0.5-1.5 mm was explained, and the main principles for the success were pointed out.

[Progresses in the orthopedic-reconstructive surgery by microsurgery (author's transl)]. / Fortschritte in der orthopädischen Wiederherstellungschirurgie durch Mikrochirurgie.

After a short description of the microsurgical technique for operations of periphere nerves and small vessels, the possibilities for reconstructive operations in orthopedic surgery are demonstrated. The actual experiences allow a critical but also cautious prospective statement.