[Routine screening of splenic or portal vein thrombosis after splenectomy]. / Dépistage systématique d'une thrombose veineuse splénique ou portale après splénectomie.

BACKGROUND: Portal and/or splenic vein thrombosis (PSVT) is common after splenectomy. It can be a life-threatening complication, with a risk of bowel ischemia and portal hypertension. An early diagnosis allows an effective medical treatment and prevents life-threatening complications. There is no consensus regarding the benefit of systematic screening of patients after splenectomy for PSVT. We started in January 2012 a routine screening of PSVT after elective splenectomy. The aim of this study was to assess this policy. METHODS: Since January 2012, all patients undergoing an elective splenectomy had an abdominal CT-scan on postoperative-day 7. Demographic data, pathology, type of surgery, platelet counts before and after surgery, outcome, results of medical imaging, and management of PSVT and its results were recorded. RESULTS: Over 3 years, 52 patients underwent an elective splenectomy. All of them had a CT-scan at postoperative-day 7. A PSVT was found in 11 patients (21.2 %). They were all asymptomatic. Lymphoma and splenomegaly were the main factors associated with PSVT in the univariate analysis. All patients with PSVT were treated with anticoagulation and no complication of PSVT occurred. The follow-up CT confirmed the efficacy of anticoagulation therapy in all patients. CONCLUSIONS: Routine screening of PSVT after elective splenectomy is warranted because it allows to start anticoagulant therapy and avoid further life-threatening complications. The incidence of PSVT is particularly high among patients operated on for lymphoma or with splenomegaly.

[Multi-frequency tympanometry in experimentally-induced cochlear lesions in chinchillas and guinea pigs]. / Données de l'impédancemétrie multifréquentielle dans les pathologies cochléaires. Approche expérimentale chez le chinchilla et le cobaye.

OBJECTIVES: To establish that susceptance-conductance tympanograms at a probe-tone frequency of 2 kHz reflects the status of the annular ligament (AL) and through it of the cochlea. METHODS: Experimental study in 5 chinchillas and 22 guinea pigs. Six validating experiments were used: blockages of the stapes and of the round window membrane (RWM), fistula of the RWM, fluid removal from the cochlea, injection of saline in the scala tympani (ST) and acoustic trauma (AT). Quantitative data (mean values of Y226, FR, Y2000, G2000 and B2000) and shape of the curves were analyzed before and immediately after lesions were done. RESULTS: Guinea pig was the most convenient provided bulla was vented and the same tip was used along the experiments. Only the shape of the curves are discriminant: 1/a supplementary sharp peak, centered around negative pressures, is observed in Y/G tympanograms in every case of RWM fistulas and in some case of AT. 2/injection of saline into ST induces immediate and reproducible Y2000, G2000, et B2000 curves modifications. 3/RWM and stapes blockages provoke foreseeable stiffening and sharpening of the tympanograms at 2 kHz. 4/on the contrary, fluid removal from the cochlea induces multiple peaks curves. CONCLUSIONS: Experimentally-induced modifications at the AL either direct (stapes blockage) or indirect by AT or decrease/increase of pressure load at the cochlear interface at the footplate result in noticeable, constant, reproducible changes of curves registered at 2 kHz. The stapes behaves both as the plotter of the curves and the interpreter of the inner ear pressure.

[Multi-frequency impedance measurement and Meniere's disease. Analysis of the results of TEFLAG]. / Impédancemétrie multifréquentielle et maladie de Ménière. Analyse des résultats du TEFLAG.

We present today our preliminary results of the TEFLAG test performed on 58 patients suffering from Meniere's disease. This test completed in 1993 has already led to a 4-stage classification of noise induced hearing losses. On the one hand, it is based on the morphological study of susceptance B curves, and on the other hand, on the study of the resonant frequency (RF) of the annular ligament of the stapes, provided by a multifrequential impedancemeter. The endolymphatic hydrops coming with the Meniere's disease practically always cohabits in the intercritical period with the decrease of the perilymphatic pressure of the scala vestibuli, which is shown in the morphology of Stage IV curves especially, and the decrease of the annular ligament rigidity. Inversely, during the vertigo or around, we mainly have stage I curves, and an increase of the stapes annular ligament resonant frequency (RF), testifying the labyrinthic hydrops, which is the physiopathological essence of the Meniere's disease.

Risk of spontaneous abortion among nurses handling antineoplastic drugs.

The purpose of the study was to evaluate the frequency of spontaneous abortion in two groups of women. One group consisted of women regularly involved in the preparation of cancer chemotherapy perfusions and therefore considered to be exposed to cytostatic agents; the other consisted of women not occupationally exposed to such agents. The study was carried out in four French hospitals. Four hundred and sixty-six women were involved; 534 pregnancies were described in which 139 were exposed and 357 were unexposed. The results showed that the frequency of spontaneous abortion was 26% for the exposed pregnancies and 15% in the unexposed ones (odds ratio 2.0). These results do not seem to be due either to the classic risk factors of spontaneous abortion (age, cigarette consumption during pregnancy, pregnancy order) (adjusted odds ratio 1.7) or to possible errors concerning the retrospective evaluation of prior gynecologic and obstetric history.

Hodgkin's disease in children. Results of therapy in a mixed group of 178 clinical and pathologically staged patients over 13 years.

One hundred seventy-eight previously untreated children with biopsy-proven Hodgkin's disease of clinical Stages I and II were treated and followed between 1965 and 1978. Staging laparotomy was performed in 30 patients. Ninety-four percent of the patients obtained a complete remission; 24 patients have died. The actuarial survival rate for all patients was 90% at 5 years, and 81% at 10 years. The disease-free survival rate was 69% at 5 years, and 65% at 10 years. When nitrogen mustard, vincristine, procarbazine, and prednisone (MOPP) chemotherapy was added to either extended field or involved field irradiation, the relapse rate was significantly decreased as compared with the protocols without MOPP and prophylactic para-aortic irradiation. The authors believe that surgical staging may not be necessary as splenic involvement may be treated in some patients by MOPP chemotherapy alone or in association with splenic paraaortic radiotherapy. However, the side effects of MOPP need further study by other chemotherapy programs.

Sequential study of the bone marrow granulocytic progenitor cells (CFC *) in children treated by chemotherapy for non-hodgkin malignant lymphomas.

We have studied the time course changes in committed granulocytic progenitor cells (CFC) in 54 pediatric patients treated by chemotherapy for a malignant non-Hodgkin lymphoma. This study has revealed the following points: 1) In the absence of patent bone marrow invasion, the bone marrow CFC concentration is, before treatment, less than normal; 2) Bone marrow invasion coincides with a large decline in bone marrow CFC concentration; 3) The aplasia induced by the initial chemotherapy is mediated by a quasi-complete destruction of CFC; 4) After regeneration from the initial therapeutic aplastic state the CFC exhibited a quite variable behavior from one patient to another. This phenomenon is probably linked to the variable recuperation time for each patient; 5) Following the conclusion of treatment, the patients, although having a normal peripheral leukocyte count, appeared to maintain a major aftereffect characterized by a clear and prolonged reduction in the concentration and total number of CFC.

[Present-day aspects of leprosy in Martinique]. / Aspects actuels de la lèpre a la Martinique

Altogether my observations agree with the facts reported by others authors. Two data however should be pointed out: -- in spite of the progresses for its demonstration, lepra remains frequent in La Martinique; -- with 47% lepromatous forms and 25% tuberculoid forms, lepra in the West Indies constitutes an intermediary level between African lepra (60% tuberculoid forms) and South-American lepra (60% lepromatous forms).