[Evaluation of care in the intensive care unit of a general hospital]. / Evaluation des soins dans le service de réanimation d'un hôpital général.

The current concern for good management and economy in matters of health makes it mandatory for intensive care units, which are particularly expensive, to make use of criteria by which the severity of the conditions treated, the different means of treatment and the results obtained can be expressed in figures. The method based on Knaus's severity indices, previously used only in university hospitals, has been applied in the general hospital of Gap with coherent results confirming the value of these indices. Similarly Cullen's TISS scores can be used in peripheral intensive care units. For most patients the prognosis is similar to that obtained in university hospitals, and if general hospitals are weak in supervision, the therapeutic equipment available to them is the same. However, there is still no way by which the real cost of treatment can be evaluated accurately and compared with the cost of cure in other hospital units.

[Prognostic value of the phytohemagglutinin intradermal reaction in patients in an intensive care unit]. / Intérêt pronostique de l'intra-dermo réaction à la phyto-hémagglutinine chez des malades d'un service de réanimation polyvalente.

It is fundamental importance to have available a simple method for testing the resistance of patients admitted to an intensive care unit in order to modify treatment and, where applicable, monitor its effects. This study evaluated the response to intradermal injections of Phytohaemagglutinin (PHA) (Difco: 7.5 micrograms in 0.1 ml) in 71 patients. The principal results were as follows: In forty patients, reactive on admission, mortality was 17.5 per cent, whilst it was 71 per cent in thirty one non reacting patients (p less than 0.0001). Taking into consideration only the last tests performed, the relationship between non-reaction/death became even more significant: 10 per cent of the 40 reacting patients, as against 81 per cent in the 31 non-reacting patients (p less than 0.00000001). Association with study of the tuberculin test did not notably improve the sensitivity of the test (75% mortality in the case of non-reaction to both tests). By contrast, there was a correlation with serum albumin levels measured at the time of admission (33.4 plus or minus 2.6 for 29 survivors; 28.4 plus or minus 3.9 for the 19 patients who died) (p less than 001). Continuation of the study emphasised the importance of the technical protocol in the value of the results and the major influence of nutrition intake on the positivisation of tests. In conclusion, intradermal injections of PHA offer a simple and reliable method for the assessment of immune defences.

[Myocardial infarction in diabetics (author's transl)]. / L'infarctus du myocarde chez le diabetique

In 160 patients admitted during the first 8 days following myocardial infarction during the period November 1st 1974 - March 15th 1975, the prevalence of diabetes was 17%. Among 655 patients treated for a month in a convalescence centre following the acute phase of myocardial infarction during the period January 1st 1974 - March 15th 1975, the prevalence of diabetes was 17.5%. Mortality rate during the first 8 post infarction days was 28% in diabetics and 13% in non-diabetic patients in the coronary care Unit; over the subsequent month, the mortality rate was 7.7% in diabetics and 3.7% in non-diabetics while at the convalescence Centre. The higher mortality rate from myocardial infarction in diabetics could not be contributed to a greater severity or more wide spread nature of the coronary artery disease as evidenced by the results of coronary cineangiography performed in diabetic and non-diabetic patients with severe ischaemic heart disease. In the cases in which an aorto-coronary by-pass was performed, there was no apparent difference in the response of diabetics compared to non-diabetic subjects. Despite progress in intensive treatment of myocardial infarction, mortality rate of this disease in diabetics remain very high. Reduction of the incidence of ischaemic heart disease in diabetics requires early identification and reversal of all of the many risk factors for arterial disease.

[Transport of newborn infants. Apropos of 114 cases]. / Transport des nouveau-nés (a propos de 114 cas)

The transport of 114 newborn less than 24 hours old carried out in 1972 and 1973 by the Paris SAMU (Professor M. CARA'S Unit) is studied. (he delay of arrival of the medical team is on the average one hour, the child arrives in the Resuscitation center approximately two and a quarter hours after the call. In 15 cases an umbilical catheter was put in place; in 27 cases the child was intubated, artificial ventilation was carried out during transport. On arrival, from the mean values, the temperature was 25.2 degrees, the pH 7.28, the pO2 112, the blood sugar 1.53 g.Three practical conclusions must be drawn: reserve high risk deliveries for specialized centers, when the degree of emergency compells delivery in a badly equipped center, contact the SAMU from the beginning of labour, render the actions carried out by the transporting doctor even more rigorous and controled, which implies an organized SMUR which is well equipped and trained.