[Acute immuno-allergic interstitial nephritis after treatment with fluindione. Seven cases]. / Néphropathie interstitielle aiguë immuno-allergique après traitement par fluindione. A propos de sept cas.

We report seven cases of patients treated with fluindione, who presented with acute renal failure, associated with clinical features of allergy: poor status, fever, dyspnea, lymphadenopathy and erythroderma. All patients had elevated eosinophil counts. Renal biopsy disclosed in all cases a tubulo-interstitial nephritis with or without granuloma. The responsibility of fluindione, an oral anticoagulant widely used in France could be demonstrated. To our knowledge, there are only three reports of single cases of acute renal failure related to fluindione published so far to date. This serious side effect of fluindione should be recognized.

Radiocephalic fistula complicated by distal ischemia: treatment by ulnar artery dilatation.

Hand ischemic steal syndrome due to a forearm arteriovenous fistula is a rare occurrence. However, its frequency is increasing with the rise in numbers of elderly and diabetic patients. This complication, which is more common for proximal than for distal accesses, can be very severe and may cause loss of hand function, damage to fingers, and even amputation of fingers or the hand. Its treatment is difficult and often leads to access loss. We report here a case of severe hand ischemia related to a radiocephalic fistula successfully treated by ulnar artery dilatation.

[Quality management in the hospital environment: ISO 9002 certification: our experience]. / Démarche qualité dans le milieu hospitalier: la certification ISO 9002: notre expérience.

The nephrology-dialysis department of the Havre's hospital has launched a project of certification ISO 9002 in 1996, based on reflections from the centers of dialysis Upper Normandy. The problems encountered were mainly the lack of ways, a bad documentary structure, false ideas on the quality and a bad perception from the client. With the help of a quality manager, il has enable the project to advance and finalized, obtaining the certification of activity. In june 2000 "Procedure of taking in charge all the patient's medical and para-medical cost in the center of the Nephrology-Dialysis service" of the GHH (Hospital Group of the Havre) has brought not only the certificate but notable improvements on the level of documentary management, the errors, relationship clients-suppliers and projects of collaboration with the other services of nephrology dialysis of France.