ABSTRACT
Advanced care decision in emergency medicine is difficult for the elderly. How to be fair, avoiding an unreasonable obstinacy? Based on the case of very old person, we show how an optimal management can be decided in accordance with the spirit of the law.
Subject(s)
Emergency Medical Services/legislation & jurisprudence , Legislation, Medical , Withholding Treatment/legislation & jurisprudence , Aged, 80 and over , Emergency Medical Services/ethics , France , Humans , Male , Palliative Care/ethics , Palliative Care/legislation & jurisprudence , Withholding Treatment/ethicsABSTRACT
This case-report focused on the occurrence of a crisis of malignant hyperthermia on a young biker (21 y.o.) victim of a severe traffic accident. This observation gives some key points: the delayed occurrence of the crisis after 4 hours of surgery, the multi-factorial events that triggered the crisis; the choice to perform a quick diagnosis through gene analysis in comparison to the standard tests of caffeine on a muscular biopsy. These different points are discussed with a proposal of algorithm in the situation.
Subject(s)
Genetic Predisposition to Disease/genetics , Malignant Hyperthermia/diagnosis , Malignant Hyperthermia/drug therapy , Accidents, Traffic , Algorithms , Bicycling/injuries , Biopsy , Caffeine , Central Nervous System Stimulants , Humans , Male , Malignant Hyperthermia/therapy , Multiple Trauma/therapy , Respiration, Artificial , Rhabdomyolysis/etiology , Rhabdomyolysis/therapy , Young AdultABSTRACT
Several studies of the association between HLA and type 1 diabetes have been carried out revealing differences between ethnic groups. Our study, as part of the studies that should be performed about this association in the rest of the word, aims at elucidating the HLA DRB1, DQB1 polymorphism in Tunisian type 1 diabetes. This study includes 43 unrelated type 1 diabetes patients, and their mean age at onset is less than 15 years. Analysis of the frequency of alleles and haplotypes in these subjects, compared to a reference group (n = 101) led to the following results. 1) The Tunisian insulin-dependent diabetics present similarities as well as differences with other ethnic groups (Caucasians, North Africans). 2) The haplotype DRB1*04 DQ*0302 and DRB1*03 DQB1*0201 is positively associated to type 1 diabetes. 3) The heterozygotic genotype DRB1*04 DQB1*0302 / DRB1*03 DQB1*0201 is strongly associated to type 1 diabetes. 4) The haplotypes DRB1*01501 DQB1*0602 and DRB1*11 DQB1*0301 proved to be protective. In addition, the study of the subtypes DRB1*04 showed that alleles DRB1*0405 predispose to type 1 diabetes, whereas the allele DRB1*0403, which is in linkage disequilibrium with the DQB1*0402 in the Tunisian population, has a protective effect.
Subject(s)
Diabetes Mellitus, Type 1/genetics , HLA-DQ Antigens/genetics , HLA-DR Antigens/genetics , Polymorphism, Genetic , Child , Female , Gene Frequency , Haplotypes , Humans , Male , TunisiaABSTRACT
Two new cases of Menetrier's disease with gastric adenocarcinoma in two men aged 62 and 81 years, respectively, are reported. In both cases, the diagnosis was established by histologic examination of the operative specimen. Emphasis is placed on diagnostic difficulties and on the risk of malignant transformation of Menetrier's disease, which should be viewed as a precancerous gastric lesion.
Subject(s)
Adenocarcinoma/complications , Gastritis, Hypertrophic/complications , Stomach Neoplasms/complications , Adenocarcinoma/pathology , Aged , Aged, 80 and over , Cell Transformation, Neoplastic/pathology , Diagnosis, Differential , Gastritis, Hypertrophic/pathology , Humans , Male , Middle Aged , Precancerous Conditions/pathology , Stomach Neoplasms/pathologySubject(s)
Gastritis, Hypertrophic/pathology , Gastritis/pathology , Granuloma/pathology , Adult , Female , Gastric Mucosa/pathology , Gastritis/complications , Gastritis/etiology , Gastritis, Hypertrophic/complications , Gastritis, Hypertrophic/etiology , Granuloma/complications , Granuloma/etiology , Humans , Stomach/pathologySubject(s)
Adrenergic Agents/therapeutic use , Anesthesia, Spinal/adverse effects , Ephedrine/therapeutic use , Hypotension/prevention & control , Vasoconstrictor Agents/therapeutic use , Aged , Data Interpretation, Statistical , Hemodynamics , Humans , Isotonic Solutions/administration & dosage , Middle Aged , Perfusion , Prospective Studies , Ringer's SolutionSubject(s)
Enterocolitis, Pseudomembranous , Acute Disease , Aged , Aged, 80 and over , Colectomy , Enterocolitis, Pseudomembranous/diagnosis , Enterocolitis, Pseudomembranous/pathology , Enterocolitis, Pseudomembranous/surgery , Follow-Up Studies , Humans , Ileostomy , Male , Prognosis , Time FactorsABSTRACT
The authors report one case of a intraperitoneal rupture of an hydatic cyst. The diagnosis of rupture was performed pre-operatively by tomodensitometry which has demonstrated the rupture and an intraperitoneal epanchement.
Subject(s)
Echinococcosis, Hepatic/diagnostic imaging , Peritoneal Cavity , Tomography, X-Ray Computed/methods , Aged , Echinococcosis, Hepatic/surgery , Humans , Male , Rupture, SpontaneousABSTRACT
The authors report a case of cystic lymphangiomatosis of the spleen. Study of this case and a review of the literature confirm the rarity of this site and problems of differential diagnosis with hydatid disease. Treatment remains surgical and the prognosis is good.
Subject(s)
Lymphangioma, Cystic , Splenic Neoplasms , Adult , Diagnosis, Differential , Female , Humans , Lymphangioma, Cystic/diagnosis , Lymphangioma, Cystic/surgery , Prognosis , Splenic Neoplasms/diagnosis , Splenic Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
The authors report a case of mesenteric venous infarction in a pregnant woman. After having studied the clinical characteristics of this accident, they discuss the role of pregnancy in its accuracy and also the therapy that has to be adopted.
Subject(s)
Colon/blood supply , Infarction/pathology , Intestine, Small/blood supply , Mesenteric Vascular Occlusion/pathology , Mesenteric Veins/pathology , Pregnancy Complications, Cardiovascular/pathology , Adult , Duodenum/blood supply , Female , Humans , PregnancyABSTRACT
Traumatic false aneurysm of superficial temporal artery is infrequent. About 21 cases were published during these last fifty-three years (1932-1985) in medical literature. The authors report a case of traumatic false aneurysm in a 50 y. o. woman, having had a frontal trauma one month before. They discuss the physiopathologic mechanism of this rare lesion. False aneurysm is always secondary to an arterial wall rupture. This rupture may be complete in arterial wound or partial with disruption of intima and media in simple contusion. It depends not only on the nature and the intensity of the trauma but also on the particular topography of the artery which is prone to such a complication.
