Comparative study of azithromycin and amoxicillin/clavulanic acid in the treatment of lower respiratory tract infections.

Forty-eight patients with acute bronchitis and four with pneumonia were randomly assigned to receive five doses (500 mg on day 1, plus 250 mg/day on days 2-5) of azithromycin; 54 patients with acute bronchitis and four with pneumonia were assigned 30 doses (625 mg every eight hours for ten days) of amoxicillin/clavulanic acid (CA). The two regimens were equally effective, with clinical improvement or cure in 92% and 87% of patients respectively, bacteriological cure in 89% and 86%, with 91% and 89% of pathogens eliminated. Minor side effects occurred in 6% and 12% of patients in the two groups, respectively. No major abnormalities in laboratory safety parameters were seen in either group.

[Etiological diagnosis of syncope and brief loss of consciousness in patients over 65. Results of a multicenter prospective study of 188 cases]. / Diagnostic étiologique des lipothymies et pertes de connaissance brèves après 65 ans. Résultats d'une étude prospective multicentrique de 188 cas.

In a prospective multicentre study a series of 188 patients over 65 years of age admitted for syncope (90) or transient loss of consciousness (98) was collected. There were 120 women and 68 men; mean age was 78.7 +/- 6.6 years; 140 patients had a significant history mainly of arterial hypertension and coronary disease; 81 patients were taking drugs (4.1 on average) and notably diuretics, antihypertensive agents, antiarrhythmic agents, nitrites and psychotropic drugs. The most frequent diagnoses were arrhythmia (20.2 p. 100), postural hypotension (15.4 p. 100), reflex and vasodepressive syncope (12.2 p. 100) and coronary disease (5.3 p. 100). Taken together, these diagnoses could be divided into cardiac diseases (26.5 p. 100), extracardiac diseases (54.2 p. 100), diagnosis unknown (19 p. 100). The condition was iatrogenic in 45 patients (24 p. 100). The means by which the diagnosis was reached were studied: in two-thirds of the cases, careful physical examination and electrocardiography alone provided a diagnosis. Seven patients died during their stay in hospital. Among the 181 survivors 148 (81.7 p. 100) were discharged and returned home.

[Malaise and brief losses of consciousness after 65 years of age. Clinical diagnosis and value of complementary studies in 512 patients]. / Malaises et pertes de connaissance brèves après 65 ans. Diagnostic clinique et valeur des explorations complémentaires chez 512 malades.

A retrospective study of the diagnosis and causes of malaise and loss of consciousness has been conducted under the aegis of the French National Society of Internal Medicine. This multicentric and retrospective enquiry, which involved 512 patients, revealed that up to 44% of the malaise had no diagnostic label and that those of known aetiology were frequently due to cardiovascular disorders, such as postural hypotension (11.7%) or arrhythmia (9.5%). The study also demonstrated that the clinical enquiry was more important than complementary examinations which yielded few useful data.

[Factitious diseases and Münchausen's syndrome]. / Les maladies factices et le syndrome de Münchausen.

Factitious diseases in which the symptoms are simulated or created intentionally are very varied: functional manifestations, haemorrhages, anaemia, pyrexia, metabolic disturbances (hypoglycaemia, hypokalaemia, hyperthyroidism, etc.), skin lesions and others. Different symptomatic associations are possible. The Munchausen syndrome which is mainly seen in anglo-saxon countries, is characterised by a long history of factitious symptoms in subjects with psychological profiles which are difficult to define because of the very behaviour of the patients themselves. Besides this syndrome, many psychological disorders have been described in patients presenting with factitious symptoms. One particular form is the creation of factitious diseases in children by their parents. The diagnosis of factitious disease is always difficult and confirmatory proof cannot always be obtained apart from certain cases in which laboratory tests show the presence of drugs in the plasma or urine. Psychotherapy which appears to be essential for these patients is generally very difficult to achieve.

[Reversible renal insufficiency due to clometacin treatment]. / Insuffisance rénale réversible au cours d'un traitement par la clométacine.

In a 74-year-old man with chronic renal failure, Clomethacine therapy was followed, on two different occasions, by transient exacerbation of renal failure. Once therapy was discontinued, serum creatinine levels returned to normal. The chronologic evidence and data from the literature confirm the responsibility of Clomethacine.

[Value of myoglobin radio-immuno-assay in myocardial infarction (author's transl)]. / Intérêt du dosage radio-immunologique de la myoglobine plasmatique dans l'infarctus du myocarde.

Serum myoglobin radio-immuno-assay was performed in 137 patients with myocardial infarction. Two groups, of 102 and 35 patients respectively, were seen in two different hospitals. Serum myoglobin was increased in 72 patients from the first group, and in 30 patients from the second group. In 10 patients from the first group, during the first 24 hours, the increase in serum myoglobin was isolated, without increase in CPK, LDH or SGOT. In the second group, a high serum myoglobin level with normal CPK was found in five patients. Increased serum myoglobin is not a specific indicator of myocardial infarction.

[Study of an homogeneous population of obeses people and of its regression of weight under hypocaloric diet in hospital. II. - Weight loss (author's transl)]. / Etude d'une population homogène d'obèses et de sa régression pondérale sous régime hypocalorique en milieu hospitalier. II. - La régression pondérale.

A study of 79 obese patients who were hospitalized and treated with a low calorie diet demonstrated that the weight loss occurred in a univocal manner, according to a semilogarithmic law. It was not influenced, as far as initial results were concerned, by the age, sex, or morphotype of the patient, or whether weight gain was recent or of long-standing. Factors affecting results, however, are the existence of functional signs, the amount of natriuresis during the first few days, and the quantity of alcohol ingested regularly. Short term results, one month after leaving hospital, appear to be moderate only. A diet supplying 800 calories causes weight loss at the expense of body fat. Individual variations in minimal calorie requirements during the treatment can be used as a basis for prescribing a personalized supplementary diet.

[Study of an homogeneous population of obese people and of its regression of weight under hypocaloric diet in hospital. I.--Characteristics of the population (author's transl)]. / Etude d'une population homogène d'obèses et de sa régression pondérale sous régime hypocalorique en milieu hospitalier. I. -- Caractéristiques de la population.

The study of a population of 79 obese people (62 women and 17 men) allowed to find out, and to specify a certain number of data shown through questionning, clinical examination and biological observations: the predominance of female application for weight regression treatments; the much more important number of major overweight with men; the idea of a "certain" age after which the micrease in weight is less important; the relation between the weigth after birth and overweight; the relation between how long you been futting on weight and the importance of your overweight; the frequency of overweight among your relatives. As for as spontaneous nutrition is concerned the frequency of normal food intake or even of hypocaloric intake, the immoderate proportion of fat intake and the frequency of the few, daily meals. As far as the biological aspect is concerned, the frequency of chemical diabetes and the possibility to distinguish from the oral glucose tolerance test together with the proportion of insulinemy, four groups of subjects ranging from the state of normal sugar regulation to proved diabetes, the frequency of hyperlipemy and hypercholesterolemy; the little difference between the free fat acids in the plasma, or an empty stomach as well as during the oral glucose tolerance test, with regard to normal subjects, with nevertheless, an important relation between the importance of the overweight and the average of fat acids.

[Psychological problems in a coronary intensive care unit]. / Les problèmes psychologiques dans une unité de soins intensifs de cardiologie

A psychological investigation carried out by a psychologist was performed on 58 patients with myocardial infarction, initially hospitalized in an intensive care unit. The results were compared with those obtained in 37 patients hospitalized in the same conditions, but for different diseases. The manifestations previously described have been for a large part recognized: anxiety, indifference, regression, displacement of anxiety or its projection, depression, sleep disturbances, hostility, "surviver" or "Minotaurus" syndrome. A few practical conclusions are put forward concerning the attitude of the nursing team on arrival at hospital, on the style of physician-patient relationship, the duration of the stay in intensive care unit, the interest of interviews performed by a psychologist.