Migraine diagnosis and management in general emergency departments in France.

BACKGROUND: We conducted a prospective study of patients admitted to 22 general emergency departments in France over 1 week. PATIENTS AND METHODS: Of 15,835 adult patients, 483 (3.1%) had headache and 98 (0.6%) had migraine. RESULTS: Compared with the migraine population in France, our migraine patients were similar in terms of proportion of female patients (75%) and mean age (37.6 ± 13.8 years) but presented earlier in their disease course. Patients sought emergency treatment because of a severe attack (49%) or because of ineffective treatment (20%). Non-opioid analgesics excluding non-steroidal anti-inflammatory drugs (NSAIDs), and NSAIDs, were most commonly prescribed as acute treatment, yet it took more than 48 h for symptom resolution in 36% of 92 follow-up patients. CONCLUSIONS: Results suggest there is room for improvement in choice of agents prescribed. We propose additional education and training of clinicians to improve adherence to clinical practice guidelines.

Results of resection for volvulus of the right colon.

The aim of the present study was to retrospectively evaluate the results of resection for volvulus of the right colon. Over a 17-year period, 45 patients (33 women) of mean age 64 years were admitted with acute right colon volvulus. Preoperative diagnosis was obtained in 53% of the cases. A right hemicolectomy was performed in all the cases, with primary anastomosis in 43 cases and double ileal and transverse stomy in 2 cases. Gangrene was observed in 23 patients (51%). Postoperative mortality was 6.6% (3 patients) due to septic shock and multi-organ failure in 2 cases, and respiratory failure in the other cases. Postoperative morbidity was 20% (9 patients), including 2 cases of anastomotic leaks. On the basis of this study and a review of the literature, it appears that right hemicolectomy is the treatment of choice for volvulus of the right colon, as it avoids all risk of recurrence and mortality is lower than that obtained with conservative treatment.

[Septic arthritis of a lumbar facet joint. A case report]. / Arthrite septique inter-apophysaire postérieure à l'étage lombaire.

Septic arthritis of the posterior lumbar joints is extremely rare in comparison with spondylodiscitis which is much more common. We report a case of an 86-year-old women with septic arthritis of the left L4-L5 lumbar facet joint associated with endocarditis. Arthritis diagnosis was made on CT scan and MRI, infection by Staphyloccocus aureus was proved by blood cultures. Heart growth was seen by echocardiography. Twenty-three cases were reported in the literature. Clinical and biological data failed to discriminate between facet joint septic arthritis and spondylodicitis. Diagnosis is established on imaging findings, computed tomography and magnetic resonance imaging, completed by blood cultures and, if they are negative, by aspiration-biopsy. Appropriate antimicrobial therapy is usually successful. Some back pain generally persists. In conclusion, lumbar pain with fever without spondylodiscitis is suggestive of septic arthritis of a lumbar facet joint. Epiduritis associated in 60% patients requires rapid treatment.

Laparoscopic cholecystectomy in the elderly: a prospective study.

BACKGROUND: The aim of this prospective study was to determine the feasibility and the complications or benefits of laparoscopic cholecystectomy (LC) in the patients older than 75 years. METHODS: From January 1992 to July 1998, a total of 863 patients underwent LC, of these patients, 102 patients older than 75 years (group 1) were compared with 761 younger patients (group 2). RESULTS: In the elderly, 35.3% were at high surgical risk (American Society of Anesthesiology [ASA] III and ASA IV). The conversion rate to open cholecystectomy (OC) was 21.6%. The mean length of hospital stay was 6.9 days for both laparoscopy and conversion. Morbidity and mortality rates were 13.7% and 1%, respectively. No patient suffered intraoperative cardiopulmonary complication, and there was no reoperation in the elderly. CONCLUSIONS: Elderly patients experience more complications and longer duration of hospital stay than younger patients. However, our results compare favorably with other OC studies in elderly patients.

[Internal hernia: a rare cause of intestinal obstruction. Apropos of 14 cases]. / Hernie interne: une cause rare d'occlusion intestinale. A propos de 14 cas.

AIM OF THE STUDY: Internal hernia is an uncommon cause of acute intestinal obstruction. The aim of this study was to retrospectively evaluate the diagnosis, the management, and the follow-up of the internal hernias operated over a 10-year period in our department of visceral surgery. METHODS: 14 spontaneous internal hernias were observed. The patients were evaluated with respect to symptoms, radiological findings, time elapsed between the onset of symptoms and surgery, type of operation performed, postoperative morbidity and mortality, postoperative stay, and follow-up. RESULTS: There were 8 men and 6 women. The preoperative diagnosis was evoked in only one case. The mean time elapsed between the onset of the symptoms and surgery was 31.1 hours (range 6 to 72 hours). Two intestinal resection were performed. Mean postoperative hospital stay was 11.3 days (range 6 to 22 days). The morbidity was 21.4% with no mortality. Mean follow-up was 7 months (range 3 to 15 months); one patient developed an incisional hernia. CONCLUSION: Since preoperative diagnosis of an internal hernia is difficult because of the lack of specific signs, morbidity and mortality can be decreased with early surgical intervention. Operative risks include vascular accidents, especially to hernia neck vessels.