Traitement des menaces d'avortement et des avortements habituels par la médroxyprogestérone

A clinical study was made of an oral form of medroxyprogesterone in a group of pregnant patients with signs of a threatened abortion or with a history of habitual abortions, under conditions very similar to those obtaining in general practice. The aim was to assess the agent's effectiveness, its harmlessness, and its effect on the pregnancy in respect of both the mother and the infant.

During a 31-month period, 43 pregnant women were administered this drug. The overall result in terms of live and healthy babies was 70%. This result was somewhat lower than that expected on the basis of previous studies; both public and private patients were included and no selection of patients was attempted. There were no apparent harmful side effects to mother or infant or evidence of virilization of female infants; postmaturity was not a problem.

     

Evaluation d''un nouveau cholécystocinétique

Boyden's test meal (egg yolk beaten with cream), used during cholecystography, remains in the stomach for a long time and could interfere with the radiological findings on barium meal examination performed after cholecystography.

A new preparation based on corn oil emulsion (G.P. Prep) was evaluated in 33 patients with and without symptoms of gallbladder disease. The criteria used in the evaluation of results were three: reduction in the gallbladder dimensions, variations in the cholecystovertebral angle, and visualization of the extrahepatic bile ducts.

The gallbladder dimensions were determined before and after contraction with the aid of a metallic perforated ruler (Colcher's) placed at the estimated level of the gallbladder at the time of exposure.

     

Aérosolthérapie à la kanamycine dans 200 cas de suppurations bronchopulmonaires

This paper describes the results obtained in 200 patients with bronchopulmonary suppurative diseases who received kanamycin aerosol therapy under intermittent positive pressure and in whom bacterial sensitivity study (antibiogram) was favourable.

This method of treatment was well tolerated and was practically free of side effects. In most cases the improvement was rapid, was maintained and was often life-saving.

The first series contained nine patients with pulmonary tuberculosis and a constant finding of sputum positive for Koch bacillus; four of these became negative after eight weeks of treatment. This suggested that kanamycin aerosol therapy had some effect on the Koch bacillus and that the study should be continued with a much larger group of patients with tuberculous suppurative pulmonary diseases to determine the efficacy of this antibiotic.

     

La cholécystite et la cholélithiase chez l'enfant

Cholecystitis and cholelithiasis in children would appear to be a rare surgical finding; however, the authors have encountered 15 cases. Although in approximately half the children with this condition the symptomatology is sufficient to draw attention to the biliary tract, in the other half the presence of periumbilical or right lower quadrant abdominal tenderness can easily be misleading. Only by considering the use of cholecystography will one be in a position to make a diagnosis of cholelithiasis in these latter cases.

Among the possible causally associated factors in the adult, sex (female) and obesity alone may be applicable in children. Cholecystectomy with peroperative cholangiography is the treatment of choice, even though the occurrence of migratory calculi in the common bile duct is exceptional.

     

Hypercalcémie idiopathique de l'enfant: Deux nouvelles observations et revue de la littérature

Several reports of idiopathic hypercalcemia of childhood have been published since Lightwood in 1932 described dwarfism associated with mental retardation, strabismus, hypercalcemia, nephrocalcinosis and osteosclerosis. The present paper adds two new cases. The first patient was 15 months old when first seen with stunted physical and mental growth, a systolic murmur, and a serum calcium value of 13 mg. %. This child suffered several severe infections and in spite of a low calcium intake and the administration of chelating agents her blood calcium rose until death six months later. The other patient, three years old, also had delayed physical and mental development, typical facies, a systolic murmur, skeletal lesions, and nephrocalcinosis. Varied therapeutic attempts failed.

Idiopathic hypercalcemia of childhood is reviewed in the light of the 94 reports already published.

     

Importance de la médiastinographie gazeuse (pneumomédiastin) dans le diagnostic radiologique des tumeurs du thymus

Diagnostic pneumomediastinography in a series of 675 cases revealed that thymic tumours accounted for 13% of all mediastinal neoplasms. In more than 50% of instances, thymic enlargement associated with myasthenia gravis was not apparent on ordinary frontal or lateral tomograms prior to the injection of air. In this procedure 500 to 600 c.c. of air is injected into the anterior mediastinal space by the supra- and retro-sternal (or suband retro-xiphoid) route. One hour later, tomography is performed at appropriate angles and levels. Diagnostic pneumomediastinography is well tolerated, even by myasthenic patients. It is valuable in the positive and differential diagnosis of mediastinal disease and is especially useful in the detection of abnormal thymic shadows.

Typically, benign enlargements of the thymus appear as comma- or banana-shaped retrosternal shadows of moderate density, separated from the breastbone and from the cardiovascular opacity. The significance of the presence of a notch visualized between the heart and the tumour is emphasized. An irregular shadow, a poor gaseous contrast, suggesting a locally invasive lesion, and adhesions usually are indicative of malignancy.

     

Le dosage des séromucoïdes dans la cardite rhumatismale: (Etude de 120 cas)

Seromucoid values were determined in 120 patients with rheumatic carditis, aged 5 to 20 years, who were in the acute, subacute or chronic phase of the disease. The following results were obtained: (1) Seromucoid values were elevated in all 32 of the acute cases and remained above normal as long as rheumatic activity was present. (2) Seromucoid values were unaffected by cortisone therapy, unlike the sedimentation rate and the level of C-reactive protein. (3) Greater values for seromucoid were found in severe cases.

This study suggests that seromucoid determination is a useful method for following rheumatic activity and may be of value in assessing the severity of the disease.

     

PUVA therapy for psoriasis: choosing a suitable régime

Three age- and sex-matched groups of 30 patients with chronic plaque psoriasis were treated by photochemotherapy (PUVA). Groups I and II received routine maintenance PUVA therapy at different intervals and Group III had no maintenance treatment. The remission time after the clearance treatment with PUVA is compared with the total cumulative dose of long wave ultraviolet light (UVA). A lower mean dose of UVA (51.0 ± 1.7 joules/cm²) in Group III (no maintenance PUVA) achieved a comparable remission period to that after larger cumulative doses following routine maintenance therapy (87.8 ± 4.9 and 77.0 ± 4.1 joules/cm² in Groups I and II).     

Fécondation extracorporelle d'oocytes humains et transfert d'embryons: quelques considérations techniques et éthiques.

In vitro fertilization of human oocytes is successful only when several techniques are perfectly mastered. Accurate prediction of imminent ovulation by rapid radioimmunoassay of luteinizing hormone in the plasma, suitable hormonal treatment or ultrasonography, or a combination of these, leads to the recovery of mature oocytes. Factors such as suction strength and bore size of the aspiration needle may interfere with the recovery of follicular oocytes during endoscopy. Capacitation of the spermatozoa, the most critical part of the whole process, requires the presence of serum or serum albumin. Fertilization and embryonic development in vitro occur in well defined experimental conditions. However, in spite of all the precautions currently taken, the rate of success, in terms of pregnancies continued to term, is still much lower than that observed under natural conditions. Much better results will likely be obtained in the near future. The literature suggests that in vitro fertilization and embryo transfer do not have any harmful physical effects on the offspring. Moreover, the laws of biology suggest that in vitro fertilization of human oocytes does not raise any ethical problem with regard to the potential offspring. However, it is extremely difficult to identify ethical problems related to the influence of the technique of in vitro fertilization on the evolution of man and human society.     

Arthrite rhumatoide traitée par noréthynodrel associée à mestranol: Aspects cliniques et tests de laboratoire

A cause de l'effet favorable de la grossesse sur l'activité de l'arthrite rhumatoïde, on s'est demandé si une pseudo-grossesse, produite par un progestatif de synthèse n'entraînerait pas une rémission du moins partielle de cette maladie.

Noréthynodrel associée à mestranol (Enovid), 30 mg./jour, a été administrée à 44 femmes pendant quatre à 24 mois. A cause d'effets secondaires indésirables, 11 patientes furent soustraites de l'investigation. Les résultats s'appuient sur 33 cas. Une rémission apparente complète s'est manifestée chez sept patientes aux stades précoces de la maladie; chez 15, une amélioration objective des signes inflammatoires a été observée; chez quatre, une amélioration subjective seule a été notée; chez sept, il n'y a eu aucune amélioration. Dix-sept femmes sur 36 ont présenté une altération d'un ou plusieurs tests hépatiques. Trois présentèrent un ictère cholestatique. Les 17-OH plasmatiques se sont élevés à trois ou quatre fois la normale.

De cette étude il ressort que noréthynodrel associée à mestranol peut produire une atténuation des signes inflammatoires de l'arthrite rhumatoïde. L'effet est palliatif, mitigé et non curatif et ne résulte pas nécessairement de l'état de pseudo-grossesse en soi.

     

Une évaluation des besoins en transplantation d'organes au Québec.

OBJECTIVES: To evaluate the demand for organs for transplantation and to recommend a reorganization of transplantation services in Quebec. DESIGN: Retrospective study. SETTING: Province of Quebec, 1988 to 1992. PATIENTS: All patients on waiting lists for organ transplantation and patients who received transplants registered in national data banks. MAIN OUTCOME MEASURES: The actual annual demand for organ transplantation and the rate of transplantations performed. RESULTS: The rates of heart transplantation were lower than the actual annual demand, which resulted in many patients dying while awaiting transplantation. The actual annual demand for heart transplantation decreased during the last 5 years from 10.9 per million people in 1987 to 6.7 in 1992. The rates of heart transplantation in Quebec were higher than the Canadian average. The actual demand for lung transplantation was only 2.9 per million people on average in 1992. Demand for liver transplantation increased annually, reaching 8.6 per million in 1992. The rate of transplantation increased likewise but remained insufficient. The demand for kidney transplantation reached 27.2 per million people in 1992, and the transplantation rate was 17.8. CONCLUSIONS: Taking into account the actual demand for and supply of organ transplantation, to insure high-quality service and to control costs associated with organ transplantation, we recommend that the present system in Quebec be reorganized so that transplantations are performed in 12 centres: 7 for kidney transplantation, 2 for hearts, 2 for livers and 1 for lungs.     

Salmonellose chez les enfants: Etude de 95 cas à l''Hôpital Ste-Justine, Montréal, en 1963-1964

A retrospective study was done in children in whom salmonellosis was confirmed by laboratory findings with the aim of reviewing etiology, epidemiology, clinical manifestations and therapy. The 15 serotypes most frequently isolated from stool, and in exceptional cases from urine, are discussed. If patients with typhoid fever are excluded, only one patient (who subsequently died) had a blood culture positive for Salmonella, specifically S. enteritidis.

No seasonal or other peaks of incidence were noted. Age appeared to be important; of 81 patients with gastroenteritis, 30 were less than 6 months old.

Two children in the older age group developed complications; one with appendicitis required surgery.

Ten strains of Salmonella out of 23 tested by the disc method showed in vitro resistance to ampicillin on primary isolation.

Acquired in vitro resistance to one or more antibiotics appeared to develop with six Salmonella strains reisolated from patients after or during antibiotic treatment.

In several children the stool cultures remained positive after clinical signs had disappeared. These findings strongly suggest that, even though antibiotic therapy may improve the symptoms of Salmonella infection, it does not decrease the number of carriers during the convalescent period.

     

Comparaison de la réponse métabolique du petit prématuré alimenté parentéralement, puis au lait maternel de prématurité.

The nitrogen retention and plasma amino acid concentration were determined in eight preterm infants (mean birth weight 970 +/- 130 g; mean gestational age 28 +/- 1 weeks) receiving successively total parenteral nutrition and their own mother's milk. The nitrogen retention during both regimens was comparable to the fetal accretion rate. Plasma amino acid concentrations were lower during the enteral phase of the study than during parenteral nutrition. The metabolic response of small preterm infants is related to the quality of amino acids as well as to the route of intake.     

La déficience en alpha-1 antitrypsine: corrélation entre épreuves biochimiques et phénotypes dans une famille

Phenotypes (Pi) for serum alpha-1 antitrypsin (AAT) were determined in a family of 19 members spanning three generations and presenting a deficiency in this protein. The standard Fagerhol crossed immunoelectrophoresis procedure was used for this purpose. The individual phenotypes consisted of seven MM, three ZZ, five MZ, one SZ and three MS. AAT levels were obtained by radial immunodiffusion, trypsininhibitory capacity measurements and from cellulose acetate electrophoresis. Good correlation was found between the phenotype and the three biochemical methods for demonstrating the normal phenotype MM and the severe deficiency state ZZ. Some discrepancies were observed for the heterozygotes. It is concluded that these various assays are inaccurate for the interpretation of intermediate AAT concentrations. Since Pi typing is not suitable for use on a routine basis, it is suggested that this analysis should be performed by a specialized laboratory if intermediate deficiency is suspected.     

Correction de l'hypertension intracrânienne créée par compression mécanique directe du cerveau

An attempt has been made to correct cerebral hypertension induced by direct compression of the brain in a group of six dogs. The animals, which had been previously fitted with an inflatable subdural rubber balloon, were either kept eupneic (isolated mechanical hypertension) or deliberately hypoventilated (mixed mechanical and acidotic hypertension). In the first instance, administration of urea brought the intracranial pressure back to control values while, in the second case, injection of an amine buffer controlled only the acidotic component of intracranial hypertension.     

Evaluation comparée des effets subjectifs de la dextroamphétamine, du méthylphénidate et du placebo

The subjective effects of dextroamphetamine, methylphenidate and placebo were evaluated in 16 medical students during the period just prior to their final oral examinations. The subjects served as their own controls. The order of administration of the three medications for each student was randomized, and a double-blind technique was used throughout. A questionnaire method was employed for the collection of results, which proved to be a useful and effective means. It demonstrated that dextroamphetamine, methylphenidate and placebo were statistically different from one another with regard to their effect on efficiency of studying, fatigue, duration of sleep and appetite. There were also significant differences in the number of side effects caused by the three medications. The stimulants, however, did not increase the number of study hours, nor was their use recommended by the students when preparing for important examinations.     

Effets de la chirurgie á coeur ouvert sur les mécanismes de défense contre lea infections bactériennes

Extracorporeal circulation during open-heart surgery may damage cellular and humoral factors in the blood. Phagocytic functions of circulating polymorphonuclear leukocytes were investigated in 10 patients 1 day before, then 1 hour, 2, 4 and 10 days after open-heart surgery. Transient diminutions in the phagocytic capacity of polymorphs was found for Staphylococcus aureus and Escherichia coli in one patient, and E. coli only in two patients up to the 4th postsurgical day. A positive correlation was found between the duration of extracorporeal circulation and the transient diminutions in phagocytic capacity for these three patients. However, the bactericidal capacity of polymorphs and their capacity to reduce nitroblue tetrazolium were normal in all patients. The serum concentrations of total hemolytic complement, C3, IgG and IgM were generally diminished up to the 4th day after surgery, but the opsonic power of the serum was almost normal in all the patients.     

L'utilisation de services de santé et de médicaments par des personnes âgées de Montréal qui reçoivent des soins maintien à domicile.

A survey was conducted among 160 persons aged 64 year or more in Montreal who were receiving home care. They answered at home a questionnaire on their use of health care services and drugs, and showed the interviewer all the drugs they were taking. In comparison with similar data from elsewhere, the use of health care services (an average of 8.0 encounters with a physician per person per year) and of drugs (an average of 5.3 per person) by this group seems high. Perhaps this group of people was obviously sicker than others of the same age, but this remains to be shown. Moreover, despite the reported frequency of health problems, it is uncertain whether such use of services and drugs was necessary. The question is raised whether the home care system is doing for the patient what it was intended to do.     

Les sténoses pulmonaires périphériques congénitales: Présentation de 16 observations et revue de la littérature

Sixteen cases of peripheral pulmonary stenosis have been studied clinically and by cardiac catheterization. Diagnosis has been proved in all cases by manometric measurements and/or cineangiocardiography. All patients except two were below 2 years of age. Ten cases were of type I, i.e. the stenosis was localized to the pulmonary trunk or its main branches. Six patients were of type III, i.e. they had diffuse stenosis of the pulmonary arterial tree. The physical findings, which in many cases are typical and include the presence of a systolic murmur over both lung fields, should alert the physician to the diagnosis at the bedside. At cardiac catheterization the configuration of the pressure tracing in the main pulmonary artery is typical, showing an abrupt rise and fall of the systolic wave followed by a low situated dicrotic notch. There is no doubt that in the past many cases of peripheral pulmonary stenosis have been wrongly diagnosed as “essential pulmonary hypertension”.     

Utilisation des céphalosporines comme antibioprophylaxie lors de césariennes.

Cefoxitin, a second-generation cephalosporin, was compared with cefazolin, a first-generation cephalosporin, and a placebo in a prospective, double-blind study of antibiotic prophylaxis in women undergoing nonelective cesarean section. In the groups that received cefazolin or the placebo there eas no statistically significant change in colonization of the cervix by aerobic bacteria by the fourth day after the operation, but there was a statistically significant increase in colonization by anaerobes. Cefoxitin had the opposite effect. Of the 14 postoperative infections in 11 patients, significantly more were in patients who had received the placebo; the numbers were too small to show a difference in effectiveness between the two antibiotics. Of the microorganisms implicated as the infectious agents, group B Streptococcus was the most frequent aerobe, and Peptostreptococcus and Bacteroides bivius were the most frequent anaerobes. Among the 15 patients for whom at least one perioperative specimen yielded positive culture results, a postoperative infection developed in 5 of the 6 who received the placebo, 2 of the 4 who received cefazolin and 1 of the 5 who received cefoxitin.