[Disseminated tuberculosis and profound thrombopenia]. / Tuberculose disséminée et thrombopénie profonde.

Thrombocytopenia within the context of disseminated tuberculosis can lead to complications requiring rapid treatment. Although the origin is generally central, thrombocytopenia can arise from an immune disorder. We hereby report a case of disseminated tuberculosis associated with thrombocytopenia, which required, in addition to antituberculosis therapy initiated before bacteriological proof, corticosteroid treatment and multiple platelet transfusions. The discovery of anti-platelet antibodies along with the success of immunomodulator therapy confirmed the auto-immune origin of this thrombocytopenia.

[Benign serous cystadenoma of the pancreas. Duodenopancreatectomy and segmentary resection of the portal vein]. / Cystadénome séreux bénin du pancréas. D.P.C. et résection segmentaire de la veine porte.

Although the mandatory mesenterico-portal resection in patients with cancer of the pancreas is thought to have no anticancer effect, this wide exeresis does not increase operative mortality significantly. We performed this operation for a large benign tumour englobing the portal vein. The tumour was completely removed with no major per-operative problem with haemostasis. Venous circulation was reestablished by direct suture without prosthesis. The post-operative period was uneventful and the patient was asymptomatic three years later. We emphasize the technical procedure and draw attention to this operation in non-cancer cases.

[Neurologic complication of lymphography. Apropos of a case]. / Complication neurologique de la lymphographie. A propos d'un cas.

A lymphography was performed as a diagnostic procedure in a 69-year-old female patient hospitalized for protracted fever. Akinetic mutism with left hemiparesis occurred 10 minutes after the injection of ultrafluid lipiodol. The patient died 13 days later. Neurologic complications of lymphography are extremely rare but may be life-threatening. Speculations as to the mechanisms which may be responsible for these complications, through a modification of the usual distribution of the contrast media, include lymphovenous shunts, lymphatic vessel compression or obstruction, pulmonary arteriovenous shunts and right-to-left intracardiac shunts. These mechanisms may facilitate cerebral embolization of the contrast media. Indications of lymphography must be restricted in patients with patent lymphatic obstruction.

[Lactic acidosis and intensive care. 16 cases (author's transl)]. / L'ACIDOSE LACTIQUE EN REANIMATION. A PROPOS DE SEIZE OBSERVATIONS.

Sixteen cases of lactic acidosis are reported: 7 phenformin treated diabetes, 5 cardiovascular diseases (2 myocardial infractions, 2 pulmonary embolisms, 1 heart failure). In 2 patients no etiology was found. Concomittant renal failure or liver diseases were found in respectively 9 and 4 cases. Patients presented the usual criteria of lactic acidosis: clinical, polypnea, severe hypotension (9/16), peripheral symptoms of shock (12/16), hypothermia (9/16), abdominal pain (9/16): biologically, acidosis (pH = 6,99 +/- 0,01, HCO3- = 5,9 +/- 1,5 mmol), hyperlactatemia (14,1 +/- 3,6 mmol/l) with hig lactate/pyruvate ratio (105 +/- 73), and anion gap (24,3 +/- 4,2 mmol/l). Sodium bicarbonate infusion was performed in all cases (2,5 to 42 mmol/kg). Few cases required volhemic expansion or furosemid induced diuresis. One patient was treated with extrarenal dialysis. 13 patients were alkalinised with less than 185% of estimated deficit measured from alkalin reserve: 12 died. 3 patients received 185% more than this deficit, associated with furosemid (1,8 to 12,5 mg/kg): only one patient died ten days after by casual disease, with lactatemia of 3,2 mmol/l. In spite of the small number of patients, these findings suggest that an early and massive alkalinisation, with large doses of furosemid, can improve the severe lactic acidosis prognosis.

[Chronic constrictive pericarditis complicating an apparently stable rheumatoid arthritis. Report of a new case (author's transl)]. / Péricardite chronique constrictive compliquant une polyarthrite rhumatoïde apparemment stabilisée. A propos d'un nouveau cas.

The authors report a case of constrictive pericarditis complicating an apparently stable sero-negative rhumatoïd arthritis, a rarely described pathological association. The patient had a serious polyserositis due to an extremely marked and inflammatory pericardial constriction. The rhumatoïd origin was confirmed by pericardial effusion, histological and immunofluorescent studies. The inflammatory pericardial process rendered pericardiectomy virtually impossible and resulted in a fatal outcome.

[Septicemic complications of venous perfusion catheterization. 4 years' experience in an intensive care unit]. / Les complications septicémiques des cathétérismes veineux de perfusion. Expérience de 4 ans en milieu de réanimation

Septicemia is a complication of prolonged venous catheterisation; although rare, is at present important owing to the severity of the condition and the possibility of prevention. The severity should lead one to very careful precautions to avoid sepsis, which antibiotic therapy and emergencies often lead one to neglect. The development of research on the prophylaxis of septicemia suggests that in the future, prolonged intravenous fluid may be given less dangerously. They are usually essential during the initial stages of intensive care.