[Contact tracing in a case of tuberculosis in a health care worker]. / Investigations autour d'un cas de tuberculose d'un soignant.

INTRODUCTION: Tuberculosis is a public health problem, of which the nosocomial transmission from a health care worker to patients has not been well documented. OBSERVATIONS: A Senegalese surgeon aged 32 was admitted to hospital on account of deterioration in his general health. He was found to have sputum positive tuberculosis and received standard treatment. We report the strategy employed for tracing the contacts of this health care worker. Of a total of 185 members of staff (permanent and temporary) and 91 patients who had been in contact with the index case, 180 (97.3%) and 71 (78%) respectively were screened. Of the 251 subjects screened, 5 staff (2.8%) and 11 patients (15.4%) showed evidence of latent tuberculous infection and 6 were treated. In total 97.3% of staff exposed were screened at the beginning of the study and 63% were reviewed at 3 months as opposed to 78% and 53% for the patients. CONCLUSION: This study shows poor compliance with the visit 3 months after exposure and the need to standardise the procedures in order to improve the screening and follow up of contacts.

[Long-term administration of calcium-heparin in thromboembolism (author's transl)]. / Traitement au long cours de la maladie thrombo-embolique par l'héparinate de calcium.

The profound importance of thrombosis in natural history of venous and arterial thromboembolism justifies long-term use of heparin, the best antithrombotic agent. Through the study of 88 cases concerning patients treated by subcutaneous calcium-heparin for a time from 3 months to 6 years, in several indications of venous and arterial thromboembolism, we can bring the following results: - The treatment is easily accepted when patients are inquired and trained. The doses must be adapted according to clotting assays, which do no more restrain patients than during oral anticoagulant treatment. - The frequency of hemorrhagic complications is the same than during antivitamine K treatments. - Thrombosis occur rarely during heparin therapy, but with high frequency during oral anticoagulant treatments. - Osteoporosis is a real but acceptable risk (10 p. cent) of long-term heparin prescription. - The true limit of treatment is the frequency (34 p. cent) of cutaneous hypersensibility reactions with high blood eosinophilia rate. Always mild, this reaction is related to the subcutaneous administration, and heparin is likely not the single impeached substance. These undesirable effects bind us to their thorough study, in order to obtain better tolerated drugs.

[The cost of alcoholism in a hospital medical department (author's transl)]. / Le coût de l'alcoolisme dans un service de pathologie interne.

The authors evaluated the costs involved when alcoholic patients were admitted to a hospital medical department. Costs which were identical for all patients, such as basic services and hospitalization fees, were discounted, and only those for individual investigations and treatment were calculated. These costs were then compared with the average daily costs for non-alcoholic patients in the same department over the same period. The results are discussed in relation to other similar studies.