[Vital prognosis in acute pancreatitis. Study of 5 clinicobiological indices]. / Pronostic vital dans la pancréatite aiguë. Etude de 5 indices clinico-biologiques.

The values of the Acute Physiology and Chronic Health Enquiry (Apache II) and the Simplified Acute Physiology Scores (SAPS) were compared with Ranson and Imrie scores to predict death after acute pancreatitis. Fifty-five (ten deaths) patients were evaluated. Patients who died had a mean score greater than those who survived. The accuracy of all scores was similar after 48 hours. The ICU (Intensive Care Unit) available at the time of admission may facilitate the early selection of patients for appropriate management.

[Diaphragmatic paralysis after puncture of the internal jugular vein]. / Paralysies diaphragmatiques après ponction jugulaire interne.

Two cases of paralysis of the diaphragm occurring after puncture of the internal jugular vein are reported. Both were old cancer patients, requiring an internal jugular venous catheter for intravenous feeding. Although the catheter was easily placed in both cases, the diagnosis of diaphragmatic paralysis was made postoperatively. The first patient remained asymptomatic, despite paradoxical breathing when lying supine; there was no change in her condition up to her death 4 months later. The second patient became increasingly breathless, with hypoxia and hypercapnia, during recovery from a gastrostomy under general anaesthesia. She required artificial ventilation, from which she could not be weaned and died 25 days later. A lesion of the phrenic nerve is possible when placing an internal jugular venous catheter, because they are closely related behind the sternocleidomastoid muscle. In the opposite to compression by a haematoma, or transient blockade following local anaesthetic infiltration, such a direct injury may be irreversible.

[Pheochromocytomas: diagnosis, anesthesia and treatment. Apropos of 17 recent cases]. / Phéochromocytomes: diagnostic, anesthésie et traitement. A propos de dix-sept observations récentes.

This article summarizes 5 years of systematic observation of 17 patients presenting with benign pheochromocytoma. The diagnosis was based on clinical and biological findings which were consistently positive. The topographical diagnosis was based on CT scans, and a combination of intravenous urograms and nephrotomography. The preoperative preparations were made with labetalol, and the anesthetic used was narconeuroleptanalgesic. The hemodynamic study was carried out with a Swann-Ganz catheter, which proved indispensable in the surveillance of the patient at operation. The surgical procedure is best performed with transperitoneal subcostal incisions, which the authors prefer. Morbidity was negligible, and mortality, zero.

[Malignant adrenal cortex tumors responsible for primary hyperaldosteronism and biological hypercorticism. Remarks apropos of 2 surgically-treated cases]. / Corticosurrénalomes malins responsables d'un hyperaldostéronisme primaire et d'un hypercorticisme biologique. Réflexions à propos de 2 cas opérés.

Two cases of malignant adrenal cortex tumors revealed by primary hyperaldosteronism with hypertension, and associated with a biological hypercortisonism, are reported. Diagnosis of this very rare affection depends on the finding of marked biological hyperaldosteronism associated with a large adrenal tumor. The outcome appears to be rapidly fatal for tumors exceeding 5 cm in diameter and associated with lymph node invasion. This raises the problem of the utility of surgery in these cases, operative intervention apparently accelerating progression of the lesion. In practice, however, a laparotomy is always justifiable, the most rational biopsy being excision of the tumor.

[Is there any justification to the scintigraphy and echotomography B association for the tracking down of hepatic metastases? (author's transl)]. / L'association scintigraphie et échotomographie B dans le dépistage des métastases hépatiques est-elle justifiée?

Regarding the tracking down of hepatic metastases, a study was made on 58 patients presenting either digestive or genital adenocarcinoma. The determining criterion of selection was the carrying out of the three following tests within the same month (Technetium 99 Scintigraphy, Echotomography B and surgery). The global breakdown of exact answers is in favour of echography (72% against 53%), echography being more reliable than scintigraphy. Therefore echotomography B seems to be the first morphological method that should be proposed; and for improving the tracking down, scintigraphy makes the interpretation of the results more difficult, and reduces the number of correct answers.

[Effect of long-term therapy of essential hypertension on serum creatinine, electrocardiogram and eyeground status: a study of 71 patients over 7 years (author's transl)]. / Evolution du retentissement viscéral dans l'hypertension artérielle essentielle traitée.

71 patients with essential hypertension have been followed for 7 years under effective anti-hypertensive therapy. Significant decrease in mean blood pressure was noted at the end of the first year and progressed linearly thereafter. Serum creatinine rose slightly, probably due to diuretics. Eyegrounds improved sharply during the first year, but deteriorated slightly thereafter: this may be due to increasing arteriosclerosis and validity of classification is questioned. Electrocardiogram improved during the first year, singularly in men: correlation with reduction in blood pressure was not clear. This discrepancy is discussed. It is concluded that improvement is sufficient to justify a continued treatment in this type of hypertension.