Adult Still's disease: study of a series of 11 cases

Adult Still's disease is a systemic disease of unknown etiology. We report a retrospective study of 11 cases (9 females and 2 males) of adult Still's disease collected during 25 years. The mean age was 36 years. Fever, arthritis and skin rash was constant. Adenopathies and splenomegaly were observed in 2 patients. The laboratory findings was characterized by a constant inflammatory syndrome and leucocytosis. Hypertransaminasemia and hyperferritinemia were observed respectively in 7 cases and 3 cases. Corticosteroids were prescribed in all patients. Methotrexate was administered in 3 patients. Outcome was favorable in 10 cases, death incurred in one patient, secondary to acute hepatitis.     

Smoking among school children in Sousse,Tunisia

In order to study smoking habits of children and adolescents from Sousse in Tunisia, we undertook an epidemiological survey on a representative sample of 1569 pupils aged between 13 and 19 years with a global answer rate of 95,4%. The objective of the study was both to describe Tunisian adolescent smoking behaviour and also to evaluate the influence of the home environment, friends and the different socio-demographic factors on acquiring or maintaining the habit. Students were surveyed in schools using a self-administered, anonymous questionnaire. Overall 7,6% of our sample smoked tobacco with prevalence amongst boys being much higher than in girls: 14,7% versus 1,1%; X(2)=103,4, p=0,00001. The smoking prevalence rose with age: in boys it increased from 3,4% at 13 years to 32,3% at 19 years; X(2)=40,9, p=0,0001. 60,6% of youngsters interrogated were exposed to passive smoking at home. Peer smoking behaviour has a clear effect on the tobacco habits of boys. These findings suggest school and medical authorities should design specific programs to limit the spread of the tobacco phenomenon in youngsters.     

Munchausen syndrome presenting as gross hematuria in two women

Munchausen syndrome is an uncommon disorder in which patients present with fictitious disorders and a self-destructive urge to undergo invasive procedures. We present 2 cases of nurses who presented with recurrent urinary tract infections, flank pain, and gross hematuria. One patient had such severe hematuria as to require transfusions of more than 1000 U of packed red cells during a 30-year period. Both patients underwent extensive investigations--all of which were normal. One patient even underwent nephrectomy, which showed normal pathologic findings. Both were found to be phlebotomizing themselves and infusing blood into their bladders.     

Prolapsed ureterocele after upper pole heminephrectomy

Prolapse of a ureterocele through the external meatus is uncommon, and a prolapsed ureterocele occurring after upper pole heminephrectomy is extremely rare. We describe such a case, occurring 2 months after surgery. The ureterocele was excised with the upper pole ureteral stump, and the lower pole ureter was reimplanted with a good outcome.     

Continuous epidural analgesia with bupivacaine 0.125% or bupivacaine 0.0625% plus sufentanil 0.25 microg.mL(-1): a study in singleton breech presentation

Epidural analgesia is the most efficient technique for labor pain relief. However, its resultant motor block might impair the mode of delivery, particularly in breech presentation where the risk of dystocia is high. In this trial, we compared bupivacaine 0.125% with a combination of a low concentration of bupivacaine (0.0625%) and sufentanil (0.25 microg.mL(-1)) both administered by continuous infusion. Analgesia, maternal and fetal/neonatal side effects and obstetric outcome were compared between group bupivacaine (n = 23) and group bupivacaine-sufentanil (n = 35). A greater number of patients in the bupivacaine 0.125% group required more than two top-ups (32 vs. 8% of patients, P = 0.03) while pain scores were similar. Motor block at delivery was more pronounced in the bupivacaine 0.125% group. Nausea and pruritus were more often encountered in the bupivacaine-sufentanil group. There was a trend toward a decreased rate of assisted or operative delivery in the bupivacaine-sufentanil group (92% vs. 74%, P = 0.09). Fetal/neonatal data did not differ between groups. Epidural analgesia with bupivacaine-sufentanil required fewer additional top-ups and produced less motor block than did bupivacaine 0.125%. However, there was no significant difference in mode of delivery between the two analgesic regimens.     

Positive modulation of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid-type glutamate receptors elicits neuroprotection after trimethyltin exposure in hippocampus

Experiments were designed to determine if gender influences the cardiac toxicity elicited by chronic high-level ethanol intake. Male and female ethanol-preferring P-rats were allowed free access to drinking water or water containing 25% ethanol for 6 months. Left atrial preparations were then isolated, bathed in Krebs-Henseleit solution (37 degrees C), and used to examine basal contractility at 3.0 Hz stimulation, the force-frequency relationship, and the positive inotropic response to the beta-adrenoceptor agonist isoproterenol. Basal contractile function was not affected significantly by ethanol in either gender; however, atria from ethanol-treated male rats displayed diminished contractility compared to control males when measured at slow stimulation frequencies (0.1 and 0.2 Hz), during post rest potentiation (at rest intervals of 20-60 s), and in response to higher concentrations of isoproterenol (> or =3 x 10(-7) M; EC50 values were not affected). In contrast, female atria showed no effect of chronic ethanol consumption. These data suggest that ethanol consumption diminishes the cardiac reserve in male, but not female rats.