[Recurrent pleurisy as sole manifestation of familial Mediterranean fever]. / Recidiverende pleuritis als enige uiting van familiale mediterrane koorts.

Recurrent pleurisy as sole manifestation offamilial Mediterranean fever. An 18-year-old woman of Turkish descent visited our outpatient department with a 12-year history of recurrent self-limiting febrile attacks accompanied by chest pain. At first the symptoms were attributed to recurrent lower airway infections. However, the persistent nature of the attacks combined with her ethnic background and the spontaneous recovery from the short paroxysmal episodes, led to the consideration of familial Mediterranean fever (FMF). After undergoing treatment with colchicine the patient was free of symptoms. Later it became clear that her 28-year-old brother had the same clinical manifestations of FMF. He was also successfully treated with colchicine. The often long interval from disease onset to correct diagnosis reflects the unfamiliarity of physicians with this disease and the frequency with which it is confused with other syndromes. In patients with paroxysmal febrile attacks and chest pain, especially if they originate from the eastern Mediterranean area, FMF should be considered and colchicine be prescribed to relieve symptoms and prevent amyloidosis.

Anomalies of thoracic lymph duct drainage demonstrated by lymphoscintigraphy and review of the literature about these anomalies.

AIMS: To determine the frequency of supradiaphragmatic lymph nodes that receive lymph from the lower limbs and the intraabdominal organs. METHODS: Three hundred and thirty-four bipedal lymphoscintigraphy results of the lower limbs were reviewed. RESULTS: Lymph nodes were visualized in only the supraclavicular/retroclavicular (SRC) area in 113 cases (33.2%, 109 on the left and 4 on the right), in only the mediastinum in 5 cases (1.5%), in the mediastinum and the left SRC area in 18 cases (5.5%), in the mediastinum and right SRC area in 2 cases (0.6%), in the mediastinum and both SRC areas in 6 cases (1.8%), and in the mediastinum and as 1 chain draining in the left axilla in 2 cases (0.6%). CONCLUSIONS: Supradiaphragmatic lymph nodes associated with the thoracic duct and receiving lymph and/or chyle from the infradiaphragmatic body were demonstrated in 43.2% of our patients and in 11.1% of the cases these lymph nodes were not located in the left retroclavicular area. These data should be taken in mind by surgeons when confronting an intrathoracic and even extrathoracic supradiaphragmatic chylous effusion after surgeries which imply lymph nodes and/or lymphatic vessels.

[Lower limb edema and steatorrhea: value of scintigraphic technics]. / Oedème d'un membre inférieur et stéatorrhée: apports des techniques isotopiques.

The authors report the case of a young woman with right lower limb edema who also presented one steatorrhea. Her clinical history is typical for one primary lymphedema and the lymphoscintigraphic investigation of the lower limbs confirms the diagnosis. The scan showed the absence of the right iliac and lomboaortic lymph nodes but also that the thoracic duct was normally present. One C14-triolein breath test is pathological and proves the malabsorption of the fats. The authors discuss the interest of the scintigraphic techniques in such case and review the problem of the association between lower limb lymphedemas and fatty malabsorption.

[Limb edema and lymphoscintigraphy]. / Oedèmes des membres et lymphoscintigraphies.

Lymphoscintigraphic investigations represent techniques of nuclear medicine very contributive for the management and treatment of the limb edemas, either primary or secundary. Their principle is presented and methodologies proposed in the literature are reviewed. Their diagnostic contributions are detailed. The sensitivities and specificities of several protocols of investigation are reported. Some limitations of these examinations are analyzed and discussed. Clinical indications for their use are proposed and their interest with regard to the various treatments that can be applied to these limb edemas is discussed.

Popliteal artery pseudo-aneurysm and hereditary multiple exostoses.

We describe a rare case of a 21-year-old man presenting with hereditary multiple exostosis and a pseudoaneurysm of the popliteal artery caused by femoral osteochondroma. Principles of management and surgical technique are discussed.

Long-term treatment of chronic obstructive pulmonary disease with salmeterol and the additive effect of ipratropium.

The efficacy and safety of salmeterol alone was compared with the combination of salmeterol plus ipratropium and with placebo during long-term treatment in patients with stable chronic obstructive pulmonary disease. In addition, the single-dose effect in response to the first dose of treatment was studied over 12 h. The patients (n=144; age 64+/-7 yrs, forced expiratory volume in one second (FEV1) 44+/-11% pred) participated in a three-centre double-blind double-placebo parallel group study and were randomized after a run-in period of 2 weeks to receive either salmeterol 50 microg b.i.d., salmeterol 5 microg b.i.d. plus ipratropium 40 microg q.i.d. or placebo for a period of 12 weeks. The single-dose study demonstrated that salmeterol produced a significant increase in FEV1 (peak of 7% pred) and specific airway conductance (sGaw) (maximum of 60% baseline) for > or =12 h. The combination of salmeterol plus ipratropium elicited a greater bronchodilator response (11% and 94% increases respectively) than salmeterol alone during the first 6 h after inhalation. During treatment there were significant improvements in daytime symptom scores and morning peak expiratory flow in both the salmeterol and the salmeterol plus ipratropium groups (p<0.001), with an associated decrease in the use of rescue salbutamol. Improvements in FEV1 and sGaw were greater in the salmeterol plus ipratropium group than in the patients receiving only salmeterol. Thirty-five patients had an exacerbation; 11 (23%) in the salmeterol group (versus placebo NS), six (13%) in the salmeterol plus ipratropium group (versus placebo p<0.01) and 18 (36%) in the placebo group. In conclusion, in patients with severe stable chronic obstructive pulmonary disease, long-term treatment with either salmeterol alone or salmeterol plus ipratropium is safe and effective. There was added benefit from the combination therapy in terms of improvement in airways obstruction, but not for improvement in symptom control or need for rescue salbutamol.

[Pulmonary damage after radiotherapy for breast cancer]. / Longschade na radiotherapie voor mammacarcinoom.

Radiation therapy for breast cancer can cause pulmonary damage. This was diagnosed in two patients aged 75 and 57 years respectively. They had different types of radiation pneumonitis. The first patient presented with a so-called bronchiolitis obliterans organizing pneumonia (BOOP), four months after radiation therapy. Characteristic in BOOP are the bilateral and migrating lung infiltrates that are distributed predominantly in the middle and lower lung zones. The second patient developed a pneumonitis that classically was confined to the area of irradiation four months after radiation therapy. The two types of radiation pneumonitis can be treated successfully with corticosteroids. If symptomatic radiation pneumonitis is diagnosed early it can be treated well and than has a good prognosis.

Factors related to outcome after pneumonectomy: retrospective study of 62 patients.

OBJECTIVE: To find out which risk factors affect outcome after pneumonectomy. DESIGN: Retrospective study. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 62 patients who were treated for bronchial cancer by pneumonectomy between 1984 and 1995. MAIN OUTCOME MEASURE: Hospital mortality and postoperative complications. RESULTS: Hospital mortality increased with age, being 5/51 (10%) in the 40-69 age group and 4/11 (36%) in patients aged 70 or more. In the American Society of Anesthesiologists (ASA) class I group hospital mortality was 8% (2/26), in class II 12% (3/26) and in class III 40% (4/10). Hospital mortality was highest when the FEV1:FVC-ratio was below 55%. Cardiac arrhythmias developed in 8 (13%), early bronchopleural fistulas in 7 (11%), and postpneumonectomy syndrome in 5 (8%). These major complications had a high mortality. CONCLUSION: Respiratory function, ASA class, and age over 70 years are the main prognostic factors for hospital morbidity and mortality after pneumonectomy.

[Cutis marmorata telangiectatica congenita. Apropos of 4 new cases]. / Cutis marmorata telangiectatica congenita. A propos de quatre nouveaux cas.

Cutis Marmorata Phlebectasica is a rare congenital disorder characterized by persistent erythrocyanotic mottled areas associated with superficial phlebectases with cutaneous atrophy and ulcerations. The anomaly is present at birth. Spontaneous improvement is the rule. Four cases are described with vascular investigations, coloured echo-Doppler and phlebography. The deep venous tracts are shown to be dilated. Reflux is shown to the superficial veins.

[Effect of "anti-thrombosis" stockings on the venous hemodynamics of the lower extremities. Study using mercury gauge plethysmography]. / Influence des bas "anti-thromboses" sur l'hémodynamique veineuse des membres inférieurs. Etude par pléthysmographie à jauge de mercure.

Study by plethysmography with mercury gauge. The authors have analyzed the effects of "anti-thrombosis" stockings on venous hemodynamics of 18 lower extremities, by plethysmography with mercury gauge (Periflow J.S.I.). With this method, they delineate the limits of efficacy of the use of only elastic stockings as prophylactic treatment of the thrombo-embolic disease in immobilized patients.

[Management of mycotic aneurysms. Apropos of 3 cases]. / Attitudes thérapeutiques dans les anévrysmes mycotiques. A propos de trois cas.

The diagnosis of mycotic aneurysms remains rather difficult. When a mycotic aneurysm is found, two therapeutic measures should be taken without delay: on the one hand an antibiotherapy which is started preoperatively and continued at least six weeks postoperatively, and on the other hand a surgical intervention. In this review, the authors present three types of operations: ligation and excision of the aneurysmal mass, restoration of the arterial tree with a venous graft or extra-anatomical bypass with prosthetic material.

[Mercury strain gauge plethysmography. A noninvasive exploration method for monitoring the efficacy of treatment of deep venous thrombosis]. / La pléthysmographie a jauge de mercure. Méthode d'exploration non invasive monitorant l'efficacité du traitement de la thrombose veineuse profonde.

The plethysmographic tracings of a patient presenting a deep venous thrombosis, give information about the functional evolution of the affected limb. The plethysmographic parameters which are used to estimate the efficacy of the treatment of the deep venous thrombosis are: the venous capacitance, the venous outflow and the venous pressure. These values are always compared with the contralateral limb. The decision to stop an anticoagulant treatment is made after observing an increase of the venous capacitance and outflow and, simultaneously, a decrease of the venous pressure. During the last three years, we have followed up 200 patients with this method. It allows a rational therapeutic management which is based on the objective monitoring of the functional potentialities of the venous system.

[Microbial contamination of the bile and its effects on the course of the surgical wound after cholecystectomy]. / Etude de la contamination microbienne de la bile lithiasique et de son incidence sur l'évolution des plaies opératoires après cholecystectomie.

From a series of 58 cholecystectomies for chronic cholecystitis or for asymptomatic cholelithiasis, the authors have retrieved: 1) gall microbial contamination in 15,5% of the samples under study; 2) a complicated evolution--according to criteria defined for this research--of the operative wounds in 37,5% of the cases with positive gall cultures, and in 11% when the gall was sterile. It is the authors' opinion that cholecystectomy shows an actual septic risk, even in a non-acute clinical stage.

[Aneurysm ruptures of the abdominal aorta]. / Aneurysmarupturen der Bauchaorta.

Rupture of an abdominal aortic aneurysm remains a dramatic complication and its operative mortality is still about 50%. The authors reviewed 41 cases of ruptured abdominal aortic aneurysms which were operated from 1978 to 1983. On arrival at the hospital and after clinical diagnosis, the patients were rapidly brought to the theatre without specialized complementary examinations. Coated Dacron prostheses were used in all cases. The operated patients were brought to the intensive care unit where special attention was given to central venous pressure, arterial pressure and capillary wedge pressure (Swan-Ganz-catheter). The authors tried to determine the influence of shock, preoperative delay, blood loss, age and associated diseases on the mortality rate. In this series the perioperative mortality (30 days) could be reduced to 39%.