L''intoxication par antidépresseurs tricycliques chez l''enfant et l''adolescent.

During the last decade there has been a substantial increase in the number of poisonings due to tricyclic antidepressants in both children and adults. The main toxic manifestations are of anticholinergic origin, and the most frequent constitute the so-called central anticholinergic syndrome. Most of the deaths result from the cardiac complications. Three cases are presented that illustrate chiefly the toxic manifestations related to the central nervous system. The therapeutic management is reviewed in the light of the metabolism of the tricyclic antidepressants, their pharmacologic action and the mechanism of their toxic effects.     

Hypoglycémie spontanée et insuffisance rénale chronique.

Although glucose intolerance occurs as a consequence of chronic renal failure, improvement of a diabetic state by deterioration of renal function is a well known phenomenon. Recently occasional cases of spontaneous hypoglycemia in patients with chronic renal failure have been reported; two such cases and the results of metabolic studies are described in this paper. Pituitary, thyroid and adrenal function appeared to be normal. The results of an oral glucose tolerance test were normal; an appropriate insulin response was demonstrated in one patient, and a slightly elevated basal insulin value with a delayed insulin response to oral administration of glucose was demonstrated in the other. An insulin tolerance test did not support the hypothesis of increased insulin sensitivity as a factor, and the growth hormone response to hypoglycemia was normal. An intravenous glucagon test caused a subnormal increase in plasma glucose concentration, and the intravenous administration of tolbutamide produced hypoglycemia without an increase insulin sensitivity as a factor, and the growth hormone response to hypoglycemia was normal. An intravenous glucagon test caused a subnormal increase in plasma glucose concnetration, and the intravenous administration of tolbutamide produced hypoglycemia without an increase in insulin values. The plasma alanine concentration was low and the proinsulin/insulin ratio was increased. The origin of this hypoglycemia is not clear but is probably multifactorial. However, low hepatic glycogen stores and inadequate gluconeogenesis due to substrate deficiency seem to be involved.     

Les résidents et l'enseignement: revue de la littérature.

We reviewed the available data on residents' teaching role in the clinical setting to develop programs to improve their teaching skills. Articles published from 1966 to 1989 were identified through a computerized search of MEDLINE, and the bibliographies of identified papers were reviewed. Articles directly related to the topic were included and analysed. Taking into account their quality, we extracted data relevant to specific issues. Approximately 15% to 25% of an average work week was spent by residents in different teaching activities. Students acknowledged the importance of their contribution to clinical teaching. Residents benefitted from teaching by increasing their medical knowledge and promoting the development of important attitudes. Insufficient preparation for this task and the numerous practical problems faced by residents may explain their modest performance as teachers. Nevertheless, programs directed to residents might improve the quality of their teaching. We suggest some guidelines for the development of programs to improve their teaching skills and for future research.     

Etude comparée expérimentale de l'électrophorèse des protéines et des électrolytes chez des chiens

A higher survival rate and faster wound healing in dogs on a controlled and well-balanced diet have been demonstrated when compared with those not under dietetic control.

Electrophoretic comparison of serum proteins was carried out in two groups of dogs. The first was on a well-controlled and well-balanced diet; the second group received an uncontrolled diet. The dogs in Group 2 had a lower concentration of total proteins, and globulins, especially gamma-globulins, were diminished; however, the serum albumin was higher. The albumin/globulin ratio was 0.93 in Group 1 and 2.07 in Group 2.

Serum electrolyte levels also showed some slight differences. Sodium and potassium levels were higher in well-nourished dogs, while chloride and bicarbonates were slightly lower.