[The family bath: a risk of contamination by the hepatitis A virus].
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Biomedical subjects
Publications and source records attributed to N D Manchon.
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In cirrhotic patients, spontaneous bacterial peritonitis is frequent and severe. This study was performed to determine if low protein concentration in ascitic fluid on admission could predict the occurrence of spontaneous bacterial peritonitis during hospitalization. Ninety-two cirrhotic patients with ascites, without spontaneous bacterial peritonitis were studied. Bacteriologic study and cultures of ascitic fluid were performed on admission and repeated every 5 days, and if any suspicion of infection occurred; 11 patients developed spontaneous bacterial peritonitis during hospitalization. Among the 92 patients in the study, protein concentration in ascitic fluid was initially less than 10 g/l in 45 and 10 of these 45 patients (22 p. 100) developed spontaneous bacterial peritonitis during hospitalization; protein concentration in ascitic fluid was initially greater than 10 g/l in 47 patients; only one of these 47 patients (2.1 p. 100) developed spontaneous bacterial peritonitis during hospitalization. This difference (22 p. 100 vs 2.1 p. 100) was significant (p less than 0.01). Ascitic fluid protein concentration (6.9 +/- 2.3 g/l) was significantly lower (p less than 0.01) in the spontaneous bacterial peritonitis group than in patients without peritonitis (13.8 +/- 10.5 g/l). These results suggest that: 1) ascitic fluid protein concentration on admission is lower in patients who will develop spontaneous bacterial peritonitis during hospitalization than in patients without infection and 2) patients with ascitic fluid protein concentration under 10 g/l on admission represent an high risk group for spontaneous bacterial peritonitis.
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Gaucher's disease is a sphingolipidosis which may be accompanied by severe pain in the bones. We report a case of Bacteroides fragilis osteomyelitis consecutive to surgical biopsy. The bone pain may be due to ischaemia of the bone or to a pyogenic osteomyelitis which is iatrogenic in most cases. The clinical and paraclinical features of these two entities are described after a review of the literature, and the main complementary examinations leading to their diagnosis are presented.
The medicinal treatments of 639 patients aged over 65 were recorded on admission to hospital. The mean number of drugs consumed was 4.4 +/- 2.8 per patient. Drug interaction was found in 37 p. 100 of the patients on the basis of data published in the Vidal dictionary. The prevalence of interactions increased with the number of drugs prescribed. The medicinal families most frequently involved were digitalis derivatives, antiarrythmic agents, diuretics, anticoagulants and psychotropic drugs. Thirty patients (4.7 p. 100) presented with a side-effect that was directly ascribable to an interaction. Among the iatrogenic adverse reactions 11 were life-threatening, including 8 cases of severe dysrhythmia and 3 cases of gastrointestinal haemorrhages. Altogether, one-third of all iatrogenic disorders were consecutive to a drug interaction. Simple precautions would have considerably reduced the frequency of such side-effects.
We report a case of neuroma of the main bile duct arising twenty years after cholecystectomy. The patient, a 82-year-old woman, was admitted for jaundice. Endoscopic retrograde cholangiography showed a regular stenosis of the main bile duct. Histologic examination demonstrated neuroma. Based on the analysis of this and 15 other previously published cases, the following features of bile duct neuroma were outlined: a) variable interval between cholecystectomy and the onset of jaundice (6 months to 35 years); b) the generally complicated postoperative course, c) the various localizations on the biliary tree (cystic, main bile duct, intrahepatic bile duct) and, d) the circumstances of onset.
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