[Should the insulin resistance associated with hepatic iron overload be researched during diabetes mellitus type II?]. / L'Hépatosidérose dysmétabolique doit-elle être recherchée systématiquement au cours du diabète de type II?

The insulin resistance-associated hepatic iron overload is the first aetiology of iron overload disorders in France. If we do not know its mechanism, the prevalence among type II diabetic patients is around 40%. Hyperferritinaemia is present in all cases, but is not specific of the diagnosis. This pathology features liver fibrosis among 10% of the patients and some cases of primary liver cancer have been described. Moreover, a large body of evidence favors the direct involvement of iron in the development of extra hepatic neoplasia, while therapeutic phlebotomy to maintain low to normal body iron stores can prevent all known complications of insulin resistance-associated hepatic iron overload. In addition, treatment of type II diabetes mellitus and other features of insulin resistance syndrome is essential. In conclusion, it is important to detect this syndrome during type II diabetes mellitus.

[Prolonged survival in peritoneal mesotheliomas. Apropos of a case]. / Survie prolongée des mésothéliomes péritonéaux. A propos d'une observation.

A case of peritoneal mesothelioma discovered during laparotomy for ascites is reported. A long-term survival of 5 years was observed with combined treatment: surgery and chemotherapy. Peritoneal mesothelioma is a rare neoplasm often related to asbestos exposure and its prognosis is poor. No laboratory test other than histologic examination is specific for the diagnosis. Combined treatment with radiotherapy and chemotherapy seems to improve the survival rate.

[Surgical treatment of hemorrhagic gastritis]. / Traitement chirurgical des gastrities hémorragiques.

The authors report a review of the literature concerning an observation of rebleeding hemorrhagic gastritis which needed a total hemostasis gastrectomy. 479 interventions are analysed, with all surgical procedures combined. The surgical mortality is 28% and rebleeding reaches 30%. These figures express the evolutive gravity and the difficulty in choosing a treatment for hemorrhagic gastritis. Numerous techniques exist with varying results: the simple gastrotomy with ligations gives 58% rebleeding and 50% mortality. The subtotal Gastrectomy presents a non perfect control of hemorrhage (48% rebleeding, 30% mortality). Among the conservative procedures the choice can be either truncular-vagotomy-pyloroplasty (28% rebleeding, 24% mortality) or vagotomy-resection (18% rebleeding, 34% mortality). All these methods are not perfect and present a rebleeding risk. Only the total gastrectomy provides a definitive cure when the patient can resist the operation. Total gastrectomy was previously considered to be impossible during hemorrhage. However it represents the only way to save patients who continue to bleed following conservative surgery. Total gastrectomy represents a logical technique and should be reconsidered as a second procedure. As first procedure total gastrectomy is debatable. If systematic, it could lead to abusive intervention. If refused, there is a risk of mortal bleeding. Where elderly patients are involved the decision seems to be clear due to the risks of multiple transfusions or second interventions.

[Tiapride and alcoholism]. / Tiapride et alcoolisme.

The physician-patient relationship plays a major part in the management. The consultations should be extended and fruitful for the patient, but the physician should also provide pharmacodynamic help and to achieve this tiapride is of value. Tiapride is effective against disorders of sleep, of affect and of behaviour. Twenty patients were given 300 mg tiapride daily (1 tablet three times a day) for one month. Results were as follows: in disturbances of sleep: 83,3% good results; in disorders of affect: 79% good results; in behavioural disorders: 77% good results; in alcoholic tremor: 100% good results. In the series studied tolerance was excellent in 18 cases. Only two patients had orthostatic hypotension which did not require any modification in the treatment. Tiapride therefore proves a highly effective therapeutic agent in chronic alcoholism, providing rapid action, good results and excellent tolerance with small dosages.

[Pneumoperitoneum. A remarkable technique for its detection (author's transl)]. / Le pneumopéritoine. Une remarque technique pour sa recherche

A study made in 30 cases indicated that, in contrast to current habits, the emergency erect plain film of the abdomen used to detect a pneumoperitoneum should be taken in expiration. A film in inspiration may be considered to be a supplementary view.