[Hepatitis caused by suloctidil with antinuclear antibodies].
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Biomedical subjects
Publications and source records attributed to M Ferry.
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Principal signs and symptoms of renal parenchyma infections are discussed in relation to findings in 10 cases. Disorders studied were acute pyelonephritis and focal and bacterial acute nephritis, renal abscess and perinephritic phlegmon. Intravenous urography was only moderately sensitive (4/7) and of little specificity. Ultrasound imaging showed much greater sensitivity (8/10), undetected lesions being the earliest cases of severe acute pyelonephritis. The scanner was the most sensitive investigatory method since it associated anatomical and functional aspects in data obtained, justifying its initial use for certain authors.
CT analysis in 26 patients with well-identified muscle diseases, and 4 normal controls was performed to evaluate its diagnostic interest. Scans were obtained through pelvis, thigh and calves at comparable levels in all subjects. Results showed that elementary changes were devoid of specificity and density measurements did not significantly increase the diagnostic significance of images. A good correlation was found between the degrees of CT changes and clinical evaluation of the muscles. However, CT allowed a more precise study of abnormalities in muscles difficult to assess clinically and, in all pathological cases, led to a clear analysis of the topography and the selectivity of the pathological process. If safety criteria are fulfilled, CT would allow a precise follow-up study of muscle atrophies.
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About the case of the vertebral neurilemmoma diagnosed at the very beginning, purely inside the foramen, precursor of the classical "hourglass Tumor", the authors remain the clinical evolution and the anatomy of the intervertebral foramen's neurilemmoma. They insist on the insufficiency of the conventional radiology in early diagnosis. They also exposed the C.T. technic and his results; the neurilemmoma can be diagnosed before his extension over the limits of the intervertebral foramen, but only if a precis neurological level is known.
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Comparison of diagnostic accuracy using the two methods showed scanner imaging to provide superior results, with confirmation of herniated disc in 90 p. 100 cases based on purely discal semiological features. Limitations of the method result from the absence of epidural fat (narrow lumbar canals). A new hierarchy of radiological explorations in resistant lumbosciatica is proposed.
The authors report a case of histiocytosis X which presented with neurological manifestations in a 20 year old man: episodes of headache with vomiting, followed, three months later, by the development of paralysis of the right 6th and 7th cranial nerves associated with nystagmus. The CT scan revealed a tumour-like lesion on the floor of the IVth ventricle with a long axis of 18 mm. The chest x-ray revealed diffuse nodular opacities in the pleural and apical regions with features suggestive of histiocytosis X. The diagnosis was confirmed by surgical biopsy of the typical pulmonary nodules which were rich in histiocytes with X bodies on electron microscopy. The neurological signs disappeared after one month of treatment with Prednisone (1 mg/kg/day) and Vincaleukoblastine (10 mg/week). By the 3rd month, the pulmonary lesions were reduced and the intra-ventricular formation had regressed by 40%. In the authors' series of 29 cases of confirmed histiocytosis X in adults, the present case is the only one with a clinical neurological presentation, apart from 3 cases of diabetes insipidus. A review of the literature confirms the rarity of this type of presentation. The suggestion of the diagnosis by the chest x-ray appearance enabled a dangerous neuro-surgical operation to be avoided.
20 cases of pregnancy in women with complete atrioventricular block (AVB) (12 patients) or with permanent pacemakers (8 patients) were observed in a French cooperative series and compared with I30 previously reported cases. Most patients were asymptomatic but an increase in the number of syncopes during gestation might be observed : 4 out of 12 in our series. Although AVB remains functionally latent during pregnancy, regular cardio-obstetric follow-up is advised. Hospital admission a few days before the expected date of delivery is desirable, and it is essential that the patients are delivered in department specialised in high risk pregnancies. The need for prophylactic temporary pacing during delivery is not universally accepted. On the other hand, dizziness and syncope are clear cut indications for permanent cardiac pacing ; programmable pacers are excellent choices in young women of childbearing age ; nuclear pulse generators (Pu 238) do not seem to expose the mothers or foetus to serious complications. Rejection of pulse generators during pregnancy is rare. Nearly all mothers with AVB, whether paced or not, now have normal pregnancies resulting in normal viable children. This conduction defect is not therefore an indication for therapeutic abortion.
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A USEFUL TECHNIQUE IN GERIATRICS: Older people are at high risk of dehydration. In common practice, oral intakes are often inadequate. Intravenous infusion may be difficult and may generate complications. Hypodermoclysis or subcutaneous infusion is a useful technique for the prevention or cure of moderate dehydration in the older subjects. MANY ADVANTAGES AND FEW RISKS: When it is used correctly (i.e. volume and type of solutions, aseptic conditions) and when its contraindications are respected (i.e. emergency situations), hypodermoclysis is a simple technique that is safe, effective and comfortable. It does not need intensive surveillance and can be used both at home or in an institution, thus avoiding hospitalization of older subjects. A TECHNIQUE THAT SHOULD BE DEVELOPED: The numerous advantages of hypodermoclysis in older patients should encourage its wider use in geriatrics.
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