[Cooperative program for domestic accidents of children in the department of Doubs. Epidemiological aspects]. / Programme coopératif de prévention des accidents domestiques de l'enfant dans le département du Doubs. I. Aspects épidémiologiques.

This work presents the results of a survey carried out among 818 families in the department of the Doubs. Each family had a child between one and 6 years of age. Its aim was to come as close as possible to exploring morbidity in accidents by questioning parents about the accidents which took place a month before the investigation, and to study the influence of certain psychosocial factors on this pathology, for example the attitude of parents confronted with risks. The annual accident morbidity rate was 1,056 accidents per 1,000 children. In other words, each child has, on the average, one accident per year. Even though no significant difference between town and country has been noted, serious accidents occurred more frequently in rural areas. This may be explained by the way dangerous products are stored (medicines, household cleaning and agricultural products), looser parental surveillance (predominance at games outside home), as well as the fact that children are more often in the kitchen when they are indoors, which is potentially the most dangerous room. Classical notions of disturbing events occurring prior to the accident (divorce, moving, a.s.o.) and children who are "repeat offenders" have also been noticed. The examination of parental attitude in dealing with the possibility of accidents (instructive, lax or repressive) did not allow us to demonstrate in any significant way the influence of these attitudes on accidental morbidity. On the other hand the so-called "instructive" parents are the ones who best put away the poisonous products. There is therefore, an encouraging connection between attitude and behavior.

Effects of early high-dose streptokinase intravenously on left ventricular function in acute myocardial infarction.

One hundred seven patients who recently had acute myocardial infarction were randomly assigned either to standard heparin therapy or to intravenous streptokinase within 5 hours after the onset of symptoms in 7 hospitals without catheterization facilities. In the third week, the patients were referred to a university hospital, where the patency rate of the infarct-related artery was studied by selective coronary arteriography and left ventricular function by radionuclide angiography. Fifty-five patients received heparin and 52 streptokinase within a mean period of 190 minutes after the onset of symptoms. Seven patients in the heparin group and 4 in the streptokinase group died in hospital. The patency rate of the infarct-related artery was identical in both groups (69% in the heparin group vs 68% in the streptokinase group). Left ventricular ejection fraction was not statistically different (0.44 +/- 0.13 in the heparin group vs 0.45 +/- 0.12 in the streptokinase group). Left ventricular ejection fraction was significantly higher in patients with a patent infarct-related artery than in patients with an obstructed infarct-related artery (0.49 +/- 0.12 vs 0.41 +/- 0.15, p less than 0.01). In patients with inferior wall infarction, left ventricular ejection fraction was identical (0.50 +/- 0.10 in the heparin group vs 0.52 +/- 0.09, in the streptokinase group). In patients with anterior wall infarction, left ventricular ejection fraction was significantly higher in the streptokinase group than in heparin group (0.40 +/- 0.10 vs 0.33 +/- 0.09, p less than 0.05). Analysis of regional wall motion revealed that improvement occurred in the lateral wall of the left ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative study of heparin and a very low molecular-weight heparin in hemodialysis in chronic renal insufficiency]. / Etude comparative de l'héparine et d'une héparine de très faible masse moléculaire en hémodialyse dans l'insuffisance rénale chronique.

In the course of dialysis sessions, we have compared the antithrombotic effect of two heparinization regimens: low molecular weight heparin (CY 222, mean molecular weight: 2,500, Institute Choay, France): 90 anti-Xa units/kg bodyweight as a bolus injection followed by a continuous infusion of 1,000 anti-Xa units/hour (regimen 1); or 300 anti-Xa units/kg as a bolus injection (regimen 3), with a standard heparinization regimen (100 IU/kg regimen 2). Eight patients received the 3 regimens successively. Factor IIa and factor Xa inactivation was measured by a method that uses chromogenic substrates. The frequency of adverse effects, ultrafiltration rates, creatinine and BUN clearances of the 3 regimens were similar, whereas dialyser blood loss was higher in the first regimen. At the dose of 300 anti-Xa units of CY 222 (regimen 3), inactivation of factor Xa was similar to Xa inhibition reached through the conventional treatment (regimen 2) but IIa inhibition was less pronounced.

[Intravenous streptokinase versus heparin in recent acute myocardial infarction. Randomized multicenter study in the Franche-Comté]. / Streptokinase intraveineuse versus héparine dans l'infarctus du myocarde aigu récent. Etude randomisée multicentrique franc-comtoise.

A multicentre randomised therapeutic trial was undertaken in 8 hospitals in the Franche-Comté department of France (Belfort, Besançon, Dole, Lons-le-Saunier, Luxeuil, Montbéliard, Vesoul, Pontarlier) in which 101 patients with acute primary myocardial infarction were treated within 5 hours of onset of symptoms with either intravenous streptokinase (1,500,000 U in 30 mn) or conventional heparin therapy. The results were assessed on the clinical outcome, arterial patency in the necrosed territory and global and regional ejection fractions (EF) at the 3rd week. After randomisation, 51 patients were given heparin and 50 received streptokinase. Seven patients died in the heparin group and 4 in the streptokinase group (NS). At the third week, the artery in the necrosed zone was patent in 69% of the heparin group and in 68% of the streptokinase group (NS). The EF was significantly higher in the patients with patent arteries in the necrosed zone than in those with occluded arteries (0.49 +/- 0.12 vs 0.41 +/- 0.15, p less than 0.01). There was no significant difference in EF between the heparin and streptokinase groups. The EF was significantly higher in patients with anterior infarction who received streptokinase than in those who received heparin (0.40 +/- 0.10 vs 0.33 +/- 0.09 p less than 0.05). Segmental wall motion was significantly better at the apex and free wall. There was no significant difference between the two groups in posterior infarction. These results show that reestablishment or maintenance of arterial patency in the necrosed zone improves left ventricular function and that patients with anterior wall infarction are the ones most likely to benefit from streptokinase therapy.

Expression of plasma renin activity in terms of urinary sodium excretion and posture in normal subjects on free sodium intake.

Supine and upright plasma renin activities (PRA) were measured in 151 normal subjects on free sodium intake. Supine and upright plasma renin activities were then related to the 24-hour urinary sodium or the 2-hour urinary sodium excretion, measured in the morning after overnight fasting. Urinary sodium excretion was expressed as the urinary rate per hour or as the urinary Na/creatinine ratio. Correlations were found between both supine and upright PRA and 2 h urinary sodium excretion expressed as the Na/creatinine ratio. Supine and upright PRA values are expressed in terms of these correlations with confidence intervals.

[Urinary myelin bodies and the nephrotoxicity of aminoglycosides]. / Corps myéliniques urinaires et néphrotoxicité des aminoglycosides.

In a significant number of cases, the administration of aminoglycosides induces renal failure. Electron microscopy has now shown that the renal lesion is mainly characterised by the appearance of myelin figures (myeloid bodies) in lysosomes of proximal convoluted tubules. These figures are then eliminated by urinary excretion. The search for and quantification of the myelin figures in urinary sediment seems to us to link the renal failure to the administration of aminoglycosides. Our study is based on 75 patients: 54 received aminoglycosides and 21 were controls. In each case myelin figures in the urinary sediment were grouped into one of 6 classes (O to V) according to their quantity. Comparison of the results with clinical factors showed 3 different correlations: 1) between the presence of myelin figures in the urine and the administration of aminoglycosides; 2) between the quantity of myelin figures and the accumulated dose of aminoglycosides; 3) between the quantity of myelin figures and obvious renal failure. The absence of myelin figures in control patients attests to their diagnostic value. Urine analysis to detect myelin figure appears to be a reliable technique in confirming the aminoglycoside's origin of an acute renal failure. It would also aid in determining and evaluating aminoglycoside nephrotoxicity in animal experimentation and human pathology. Since this method is non invasive, repeated studies are possible in man as well as animals.

[Histoprognostic factors of non-infiltrating urothelial tumors of the bladder]. / Facteurs d'histopronostic des tumeurs urothéliales non infiltrantes de la vessie.

The authors reported a pathology and clinical study about 215 cases of non infiltrating transitional cell carcinoma of the bladder. During the successive treatments of these lesions 475 specimens were collected. 5 tumours characteristics were analyzed: size of the tumour, multiplicity, microscopic structure, grade, mitotic index. The average time of supervision was 39,6 months. 75% of the patients presented a tumour recurrence over the 5 years period and in 3% of the cases deaths were directly attributable to the tumour. Multiplicity and especially mitotic index are the only tumour characteristics which correlated well with the likelihood of new tumour occurrence. The grade and the mitotic index are the best criteria to assess the risk of recurrence as an infiltrating carcinoma. The distribution of tumour characteristics shows that this type of lesion roughly keeps the same pathological pattern during recurrences. Nevertheless there exists a cellular dedifferentiation trend as well as an increase of mitotic index.

[The treatment of stress incontinence of urine in the woman by urethro-cervicopexy. Long term results of 100 operations (author's transl)]. / Traitement de l'incontinence urinaire d'effort chez la femme par urétro-cervicopexie. Résultats à long terme de 100 interventions.

The authors present a homogeneous series of stress incontinence of urine in the woman treated by a method of indirect suspension of the cervico-urethral region. Results were assessed after a follow up of between three months and twelve years, with more than 5 years in 23 patients. After studying the underlying condition in which the disorder developed, they analyse the long term results which are presented using an actuarial technique. The deterioration in results seen during the first year (20% failures) was often related to associated instability of the detrusor. After one year the results remained stable with follow up periods of more than 10 years.

[Haemorrhage from an ileal loop bladder secondary to portal hypertension (author's transl)]. / Hémorragie d'un conduit iléal secondaire à une hypertension portale.

Whilst haemorrhage from the stoma is a classical complication of ileal canal, portal hypertension is rarely responsible since only six cases have been reported in the literature before that described here. The responsibility of portal hypertension having been confirmed by umbilico-portography, and a mesenterico-caval shunt was performed. This did not prevent a further bleed 15 months later which led to the discovery of obstruction of the shunt. Despite this there were no further problems up to the time of the patient's death 22 months later as a result of encephalopathy. On the basis of the present case and those already published, the authors discuss the mechanisms and therapeutic possibilities of this rare complication.

[Relations between the renin-angiotensin-aldosterone system and urinary elimination of sodium: study of healthy subjects in clinostatism and on a sodium-free diet]. / Relation entre système rénine-angiotensine-aldostérone et élimination urinaire du sodium: étude chez l'homme sain en clinostatisme, et en régime sodé libre.

In 94 normotensive subjects and free sodium diet, the relationship between SPRA and the 2-hour urinary sodium excretion was significantly better fitted by an hyperbolic function (p less than 0,001); r = 0,53) than a linear one (p less than 0,001; r = -0,31) between SPRA and the 24-hour urinary sodium excretion. (SPRA = Supine Plasma Renin Activity).

[Evaluation of the efficacy of cis-diamino-dichloro-platinum as monochemotherapy in the treatment of advanced malignant tumours of the bladder (author's transl)]. / Evaluation de l'efficacité du cis-diamino-dichloro-platinum en monochimiothérapie dans les tumeurs malignes évoluées de la vessie.

The authors report the results of a trial of the treatment of recurrences of advanced carcinomas of the bladder using Cis-Diamino-Dichloro-Platinum administered by continuous IV infusion over a period of 24 hours at a dose of 100 mg/m2, under cover of hyperhydration and anti-haematizing drugs. The trial involved 10 patients who has had the following initial treatment : - excision for 8 of them (2 total cystectomies for T4, one total cystectomy for T3B, 2 total cystectomies for T3A and 3 partial cystectomy for T1); - preoperative cobalt therapy for 7 of them (2 flashes of 7.5 gray) - postoperative chemotherapy (VM26 and 5FU) for 5 patients. The targets evaluated were : 7 remaining pelvic tumours or recurrences, 3 lung metastases, two cases of venous compression with oedema of the lower limbs, 3 node metastases, 3 bone and 1 sciatic metastases. Results : - 1 complete remission with disappearance for 10 months in the same patient of pulmonary metastases, venous compression and an inguinal node; - 3 partial remissions for 2 to 9 months; - 2 minor remissions of 3 to 5 months; - 3 stabilizations and 1 progression. It is interesting to note the greater efficacy on distant metastases (2/3 complete disappearances of lung metastases, 2/2 disappearances of oedema of the lower limbs) than on pelvic tumours (4/7 regressions). In total, 4 objective responses out of 10 occurring between the 2nd and 6th week after the first course. The authors announce a valuable synergism of DDP with cyclophosphamide and adriamycin.