[Refractory hypoxia]. / Une hypoxie réfractaire.

We report a case of refractory hypoxia in an 85 years old smoker patient, who is known for cardiac and pulmonary comorbidities. The whole clinical picture at the time of his admission to hospital was pointing to a cardiac failure or a pneumonia that were causing the respiratory insufficiency. Despite an optimal treatment which stabilised these conditions, the patient remained severely hypoxic, but with relatively few symptoms. The non response to the oxygen and the worsening of the oxygen saturation when changing from the lying to the sitting (or supine) position finally evoke the syndrome of platypnea-orthodeoxia caused by a cardiac right to left shunt; that diagnosis was confirmed by a cardiac ultrasound with contrast which revealed an important inter-auricular shunt. The patient didn't wish to undertake the curative treatment (shunt closure).

[Geriatry]. / Gériatrie.

This review discuss several studies published in 2007 that will modify current therapeutic attitudes. New evidence confirm that antipsychotics increase mortality in demented elderly persons with behavioral symptoms. Unfortunately, donepezil was no more effective than placebo to treat agitation in these patients. Aspirine, nonsteroidal anti-inflammatories, as well as supplementation with folate, vitamines B6 and B12 did not prove beneficial to prevent cognitive decline. Hormonal substitution with DHEA, testosterone, and growth hormone is ineffective as anti-aging medicine, while calcium and vitamin d'effectiveness was confirmed in fracture prevention. Finally, several studies report prognostic information that will prove important to improve preparation plan for future heat wave.

Occupational hygiene: where from and to?

Occupational Hygiene was born in the forties in the USA, from the need to focus on the causes of the occupational diseases from a scientific and technical point of view. In other words this is to understand how to detect, how to evaluate and how to control the chronic risks at the workplace. The discipline developed very well from that time up to the nineties thank to a strong commitment of dedicated people and professional societies supported by international organizations such as the ILO and the WHO. Nowadays the situation of Occupational Hygiene differs considerably between countries which can arbitrarily be categorized according to the "culture and tradition" they have in this field. The development of this science has decreased in the countries where it has been very well established. This is probably due to the fact that the field of Occupational Health has been enlarged very much in the last decade so that Occupational Hygiene has to struggle more than before to defend its ecological niche (specificity) in this vast domain. In some countries the discipline is mixed with safety or environmental protection or even with the quality management and there is no curricula for Occupational Hygiene only. In many countries it simply does not exist. What will be the future of Occupational Hygiene? It is not possible to answer this question but there are clear opportunities to show the importance of Occupational Hygiene such as the REACH regulation in Europe which full comply with the core competencies of this profession. Other opportunities such as the elaboration of simple tools to assess and control the occupational hazards (toolkits) may also lead to a decrease in the need of well educated professionals since these tools will not require a long training to be used. In conclusion, the future will depend on the way the actual occupational hygienists will work to become more visible and to be considered as essential partners to reach the main goal of Occupational Health which is to build up healthy workplaces, for healthy companies in a healthy economy. The Occupational Hygiene Societies at the national level and the IOHA (International Occupational Hygiene Association) at the international level, will have a key role to play in this future evolution.

[Reactive arthritis induced by Clostridium difficile enteritis]. / Monoarthrite associée à une entérocolite à Clostridium difficile.

This article reports the case of an acute monoarthritis of the ankle occurring in a HLA-B27 positive female patient who presented with diarrhea and fever. We retained the hypothesis of a Clostridium difficile colitis, as she had previously received an antibiotic treatment. The culture of the synovial fluid remained sterile, which postulated that this arthritis was reactive. The diagnosis was confirmed by the presence of toxins A and B in the stool and positive culture. The outcome was satisfactory with metronidazole therapy.

[Complete urinary retention secondary to lumbosacral zona]. / Rétention vésicale complète secondaire à un zona lombo-sacré.

A case of complete urinary retention related to a HZV neurogenic bladder is reported. Different findings of the disease are discussed, e.g., urodynamics and physiopathology.

[Surgical treatment of Ménière's disease by sacculotomy, cochleo-sacculotomy and transtympanic aerators]. / Traitement chirurgical de la maladie de Ménière par sacculotomie, cochléo-sacculotomie et aérateurs transtympaniques.

Sixty-two patients suffering from severe Ménière's disease with invalidating vertigo attacks were treated between 1976 and 1987 by three minoir surgical procedures: sacculotomy (19), cochleo-sacculotomy (15) or a transtympanic ventilation tube (28). The results were assessed after the second post-operative year according to the criteria of the American Academy of Otolaryngology (1985). The overall success rate for vertigo control was 79% with sacculotomy, 80 with cochleo-sacculotomy and 82% with transtympanic ventilation tubes. Severe permanent hearing-losses occurred in 20% after sacculotomy and cochleo-sacculotomy. Drop-attacks were not improved. These three surgical procedures give similar results with respect to vertigo control without any vital risk. The precise mechanisme of action in these procedures is not yet well understood.

[The Devine urethroplasty. Our experiences apropos of 18 cases]. / L'urétroplastie selon Devine. Notre expérience à propos de dix-huit observations.

Our experience with a 1-stage procedure using free patch graft for correction or urethral stricture is reported. Eighteen cases of urethral stricture have been treated. Fourteen of the 18 cases (77%) had a good result. The follow up is more than 5 years. This procedure is recommended with considerable enthusiasm.

[The value of mobilization of the prostatic region via perineal approach in the treatment of ruptures and stenoses of the posterior urethra]. / Intérêt de la mobilisation du bloc prostatique par voie périnéale dans le traitement des ruptures et sténoses de l'urètre postérieur.

UNLABELLED: 11 cases of end to end anastomosis associated with the mobilization of the prostate is reported. The authors use only the perineal access. The operation is utilised in two circumstances: injuries or traumatic strictures to the membranous urethra. 4 ruptured prostato-membranous urethras with 4 good results. 7 stenosis with 5 good results. 2 recurrences which one of them had a good result with a simple urethrotomy. Complication: no incontinence. 2 cases of impotence are noted. One of them had recovered, the other is secondary of the pelvic fracture. Follow up: mean 3 years (6 months-5 years). CONCLUSION: our experience suggest that the mobilization of the prostate is an excellent aid to end to end anastomosis. This technique permits the only perineal access.

[An early case of hereditary spongious dystrophy (van Bogaert-Bertrand) (clinical aspects, radiology, anatomic pathology)]. / Cas précoce de dystrophie spongieuse héréditaire (van Bogaert-Bertrand) (clinique, radiologie, anatomo-pathologie).

A very early case of D.S.H. (Hereditary Spongy Degeneration of the central nervous system) is described: clinical examination, C.A.T.-Scan (computerized axial tomography), biopsy and autopsy. The case presented in a 3 weeks old girl as a "colic of early infancy". During the fourth week, sudden worsening took place with attacks of dyspnea, cyanosis and frothy sputum. Ultrasound showed an echogenic thalamus. Examination by C.A.T.-Scan showed pale areas in the mid-brain and the central nuclei on both sides suggesting cerebral lesions of circulatory origin. Despite a normal lumbar puncture, cerebral biopsy was performed to exclude a potentially treatable viral condition (herpetic encephalitis?). Death took place 24 hours later. No inflammatory or spongy degenerative changes compatible with D.S.H. were found at biopsy. At autopsy however, despite superimposed recent ischemic lesions, microscopy and electron microscopy were characteristic of Hereditary Spongy Degeneration of the C.N.S. Six previous cases of D.S.H. are reported in the literature (explored by C.A.T.-Scan and confirmed histologically), this being the first report of hypodensities in the brain stem and central nuclei. In conclusion, this case shows once more that C.A.T.-Scan can be a useful tool in this still little known condition.

[Cystic prostatic utricle in adults. Apropos of 3 cases]. / L'utricule prostatique kystique chez l'adulte. A propos de trois cas.

Three cases of cystic prostatic utricle, without any other urogenital abnormality, have been observed in patients of about thirty years old. Two of them were revealed by urinary and ejaculatory obstructive symptoms. The third, discovered by chance, contained calculi. In the three cases, treatment consisted of transurethral endoscopic resection of the anterior lining of the cyst which permitted ample drainage and ensured lasting healing.

[Synechia of the labia minora as a cause of dysuria]. / Synéchie des petites lèvres cause de dysurie.

Vulvar fusion is common in children but is rarely discovered in adult woman. The authors report two cases, observed in post menopausal women, and revealed by urinary symptoms.

[Internal urethrotomy with endoscopic resection of the callus. 32 cases with a follow-up exceeding 5 years]. / Urétrotomie interne avec résection endoscopique du callus. Trente-deux cas avec recul supérieur à cinq ans.

Thirty-two patients were operated for urethral stricture by internal urethrotomy with endoscopic resection of the callus. Complications consisted of one urethral perforation, one urethral haemorrhage and one case of acute epididymitis. With a follow-up of 5 to 15 years, the authors obtained 85% of good results for strictures less than 1.5 cm long. The success rate was 66% for strictures between 1.5 and 2 cm. The recurrence rate was high for strictures longer than 2 cm (75%). The indications for this technique therefore depend more on the length of the stricture than on its cause or its site. Lastly, endoscopic resection of the callus improves the results or urethrotomy alone by 15%.

Prevention of vertigo in Ménière's syndrome by means of transtympanic ventilation tubes.

The insertion of a transtympanic ventilation tube prevented the occurrence of vertiginous attacks in 82% of a series of 28 patients suffering typical Ménière's syndrome with incapacitating vertigo resistant to medical treatment. The follow-up time exceeds 2 years for all cases. It ranges from 2 to 4 years with an average of 2.5 years. This treatment had no effect on drop attacks. Also, hearing loss does not seem to be influenced. The presence of a transtympanic ventilation tube has not caused any major complications in these patients. Obstruction or loss of the tube was in some cases followed by the reappearance of vertigo. It is therefore important to check the patency of the tube before concluding that treatment has failed. The apparent benefit of ventilation tubes in reducing the occurrence of vertiginous attacks suggests that patients with endolymphatic hydrops are particularly sensitive to middle ear pressure.