Spectrum of neuropsychiatric complications in 791 cases of typhoid fever

Summary Over a 6-year period, we studied 791 patients with multidrug-resistant typhoid fever, of whom 665 individuals (84%) developed neuropsychiatric manifestations. These were: acute confusional state (73%); myelitis (6%); cerebellitis (1%); parkinsonism (1%); acute psychosis (0.6%); meningo-encephalitis (0.5%); encephalitis (0.25%); sensory motor polyneuropathy, polymyositis, acute schizophrenia and bizarre neurological syndromes (0.12% each). Severe parkinsonian rigidity and meningo-encephalitis are associated with significant morbidity but very low mortality (0.5%).     

Endometrial actinomycosis. Two case reports]

Actinomyces is an aerobic, Gram positive bacteria saprophyte of the genital tract. The endometrial involvement is extremely rare. The authors report two cases of pelvic actinomycosis in a 58 and 55 year old women, the second using intrauterine device for 11 years.     

L’analgésie péridurale thoracique et rachidienne ont des effets comparables sur la douleur et la fonction respiratoire après chirurgie thoracique

PURPOSE: To compare in a prospective randomized trial the effects of thoracic epidural infusions of fentanyl (F) and bupivacaine (B) to intrathecal morphine (M) and sufentanil (S) on analgesia and respiratory function following thoracotomy. PATIENTS AND METHODS: 55 patients undergoing an elective postero-lateral thoracotomy were randomly assigned to one of two groups: Group I (n = 27): received intrathecal S (5 microg) and M (0.5 mg) one hour before surgery. Group II (n = 28) received, after induction of anesthesia, an initial dose of 10 to 20 mL of a solution of B 0.25% and F 2 microg.mL(-1) via an epidural thoracic catheter previously inserted between T5 and T8. The same solution was infused during surgery. After surgery, patients received a continuous infusion of B 0.1% and F 2 microg.mL(-1) with a bolus every 15 min if needed. Heart rate (HR), mean arterial pressure (MAP), SpO(2), PaCO(2), respiratory rate (RR), forced expiratory volume in one second, peak expiratory flow rate and forced vital capacity were recorded at different times from the day before surgery till T48 = 48 hr after surgery. Subjective pain was assessed using a 10 cm visual analogue scale (VAS) scoring at rest and during cough. RESULTS: No significant difference was noted between both groups concerning VAS, HR, MAP, SpO(2), PaCO(2) and RR. Variations of the respiratory function tests were identical in both groups. CONCLUSION: This study shows that intrathecal M and S offer analgesia comparable to thoracic epidural infusion of B and F.     

Use of Rh positive blood in emergency situations

The emergency blood needs of 449 patients were met by supplying 1,717 uncrossmatched units of either red blood cells (RBC) type specific Whole Blood or group O RBC. The RBC were all Rh positive, and 601 units were transfused to 262 untyped patients. None of the patients presented with anti-Rh antibodies. Only 20 patients who were Rh negative received group O Rh positive RBC, and most of these patients were male. There were no acute hemolytic reactions or sensitizations of young females. Group O Rh positive RBC is our first choice to support patients with trauma who cannot wait for type specific or crossmatched blood. Those who do survive the emergency conditions can be reverted to blood of their own type without problem. Acceptance of Rh positive emergency transfusions by physicians giving emergency care can prevent unbalanced shortages in a regional blood supply system.     

Sensitization to pollen in the asthmatic child. A study of 86 cases

This retrospective study was designed to determine the place of pollen sensibilization in asthmatic child and to assess its epidemiological and clinical characteristics. 86 from 638 asthmatic child were allergic to pollen and included in the study. The mean age was 4 years (extremes : 1-12 years). The mean age of first respiratory manifestations was 1 and half years. The male/female ratio was 1.46. Asthmatic attacks was noted in 77% of cases, chronic cough was the only allergic manifestation in 16% of cases. Associated rhinitis or conjunctivitis were found in 55% of cases, atopic dermatitis was found in 4 patients (4.6% of cases). Atopic asthma was per annual in 78% of cases. Pollinic asthma was diagnosed in 51 child. Other sensibilization were found in 60% of cases. 26 child (32%) were allergic to pollen only and 18 child to sample pollen. The gramineae pollen sensibilization is the most common allergy, followed by olive tree and cypress tree and herbaceous pollens.