[Program of Medical Information System and diseases of the respiratory tract (CMD, No.4). Study of 1,020 hospital stays out of the total of 18,253 hospitalizations at the Centre Hospitalier de Saint-Gaudens in the framework of the National Study of Costs]. / PMSI et affections de l'appareil respiratoire (C.M.D. n(o) 4). Etude de 1,020 séjours au sein des 18,253 hospitalisations colligées au Centre Hospitalier de Saint-Gaudens dans le cadre de l'Etude Nationale des Coûts.

OBJECTIVE: To analyse hospital activity, the characteristics and course of patients having been classified, by the programme of medical information system (French PMSI) in the major diagnostic category of respiratory disorders (CMD n(o) 4). STUDY: Using the files created by Saint-Gaudens Hospital (145 acute beds, 7000 annual admissions) for three years within the context of the national study of the cost of medical activity. A descriptive statistical analysis then an explanation of the variations of consumptions by stay and by patient. RESULTS: In CMD n(o) 4 there were 26 homogeneous groups of patients (GHM) representing 1020 hospital admissions (out of a total of 18,253) of whom 76 were admitted as an emergency, 63 were in the thoracic medicine group and 27 had a spell in intensive care, 73% were discharged home and 9.8% died. CMD n(o) 4 represented 9% of the hospitals synthetic activity index (ISA). Of these 822 patients had a mean age of 70, 60% of them had chronic disease and 20% were living alone. The variations of cost had been explained by GHM (P < 0.001), test of variants [ANOVA]) as well as by complementary indicators (performance status WHO) and a simplified index of severity. Men, elderly subjects and those with chronic disease consumed more. Hospital activity determined from CMD n(o) 4 has been compared to an extraction of stays based on pure diagnostic medicine (thoracic medicine) of the principal disorder: important differences were apparent, explained in large part by the method of admission, by the PMSI, respiratory tumours and ambulatory care. CONCLUSION: An analysis of activity in thoracic medicine has been able to give an over view of the hospital with the reserves linked to the system which were essentially economic and should be able to be compensated by later improvements seeking to give a more medical aspect to the description of hospital stays.

[A medical investigation of 160 chronic alcoholic patients hospitalized in a department of internal medicine. Nature and pathological consequences of the intoxication (author's transl)]. / Etude de cent soixante malades alcooliques hospitalisés en médecine interne. Nature et déterminisme de l'intoxication. Corrélations avec le retentissement pathologique.

160 hospitalized chronic alcoholics (124 men and 36 women) were evaluated by the same person. 21 biologic parameters were assessed. A histopathological examination of the liver was performed in 57.5% of the cases. The average daily alcohol consumption (ADAC) during the last five years exceeded 80 g in 140 patients. Results were as follows. Alcoholics usually have a poor socio-economic and professional background and a low educational level, most of them being farmers or workers. The ADAC is 170 g/day for an average duration of 32 +/- 3 years. The diet is unbalanced. The consumption of tobacco is related to age, sex and ADAC. There is no significant correlation between hepatic lesions (cirrhosis: 37 cases, alcoholic hepatitis without cirrhosis: 83 cases, normal liver: 36 cases) and age, sex, diet, ADAC, or the duration of intoxication. Pancreatic involvement was found in 13 patients (6.8%). Neuropsychiatric features were present in 92% of the patients. A significant correlation was found between stellar angiomas, clinical liver involvement, and ADAC, between palmar erythrosis, and clinical liver involvement and between hippocratism and ADAC. VMC and Gamma GT levels are significantly correlated to liver involvement and ADAC. There is a linear correlation between VMC and Gamma GT. The Gamma GT/BUN ratio is significantly correlated to ADAC. No correlation was found between serum vitamin B12, serum folic acid and VMC. No patient was HbS antigen-positive. Anti-HbS antibodies were found in 19.2% of the cases.

[Low 25-hydroxy-vitamin D (25-OH-D) plasma levels in pathology (author's transl)]. / Diminution des taux sériques de 25-hydroxy-vitamine D en pathologie.

Between october 1976 and march 1978, 160 patients with low 25-OH-D plasma levels were observed (25-OH-D less than 7 ng/ml). In this population, a high frequency of asthenia, anorexia, vertebral demineralization were noticed. Mean plasma level of calcium was significantly lower than controls. Mean plasma level of alkalin phosphatases was significantly higher than controls. These patients presented a varied pathology. These diseases were probably responsible for the low 25-OH-D plasma level. The mechanisms were varying, but anorexia and sun exposure defect were likely the main cause of the low 25-OH-D plasma level.

[Pulmonary mucormycoses (author's transl)]. / Mucormycose pulmonaire.

Mucormycoses are rare, acute infections, most often fatal, occurring usually in a host with decreased immunity. The agents are ubiquitous fungi belonging to the Mucoraceae family, an ordinary saprophyte becoming pathogenous in patients with a severe disease (malignant hemopathy, diabetes) or treated by immunosuppressive drugs. Pulmonary localizations remained exceptional (128 cases found in the literature). The observations reported draws its originality from: -- the etiological circumstances: an aged patient with no hemopathy or diabetes, without immunosuppressive treatment but undergoing a prolonged antibiotic therapy; -- the clinical signs: discovery on X-ray of excavated infiltrates in a background of a severe infection with a very poor physical condition; -- the diagnosis criteria with the demonstration of the responsible mucor in the sputum, the endobronchial aspiration and transparietal puncture; -- the great efficiency of Amphotericin B at rather small doses. A review of the literature underlines the exceptional character of the cure.