[Association of bacterial endocarditis and alcoholic cirrhosis in 9 patients]. / Association d'une endocardite bactérienne et d'une cirrhose alcoolique chez neuf malades.

Ten cases of bacterial endocarditis were observed in cirrhotic patients. In 7 cases, endocarditis was due to group D Streptococcus, 5 of which were Streptococcus D. bovis. Special features were the involvement of tricuspid valve and the involvement of two or more valves in 4 cases. Surgery was necessary in the acute phase in 5 patients: cure was definitely obtained in 8 cases after a particularly long interval. A colonic lesion could have been the portal of entry in some cases. Liver cirrhosis was considered as a predisposing factor for bacterial endocarditis, especially due to group D Streptococcus or to other bacteria of intestinal origin. This is probably related to the frequency of the colonic origin of group D Streptococcus endocarditis. Loss of filter function of the liver may partly explain the features of these forms of endocarditis.

Late prosthetic valve endocarditis. Bacteriological findings and prognosis in 29 cases.

Of 296 incidences of infectious endocarditis seen between 1971 and 1980, 29 cases of late prosthetic valve endocarditis (10%) occurred in 26 patients who had undergone valve replacement more than two months previously. The prosthesis was mitral in 8 cases, aortic in 9 cases, and multiple in 12 cases. The clinical picture consistently associated fever together with a regurgitation murmur in 12 cases (41%), a splenomegaly in 7 cases, a neurologic accident in 13 cases and other signs of endocarditis in 10 cases. Blood cultures were positive in 28 cases. The diagnosis was confirmed anatomically in 11 cases. Thirty-one causative agents were identified: 15 streptococci (48%), most of them were group D (11/15), 11 staphylococci (35%) 6 Staphylococcus aureus, 5 Staphylococcus coagulase negative and 5 other species. Two relapses and 3 recurrent infections were noted. The death rate was 58% with some factors being associated with a higher death rate: non-streptococcal micro-organism (87%) regurgitation murmur (83%) cardiac failure with dysfunction of the prosthesis (89%) neurologic complication (91%). Eight valve replacements were performed within a mean period of 32 days after the onset of the antibiotherapy with a death rate of 75%. It decreased to 50% for patients treated with antibiotic alone, and as low as 23% for Streptococcal endocarditis. These results suggest that earlier and more frequent indications for cardiac valve replacement could be an alternative to improve the prognosis.

[Infectious arteriopathies]. / Artériopathies infectieuses.

After reviewing the physiopathology, the authors report the principal features of infectious arterial disease observed in a department of infectious diseases. Excluding iatrogenic arteritis, particularly after vascular surgery, and some vasculitis in which an infectious agent may play a role, only the classical but now rare causes are described: rickettsial disease, syphilis and typhoid. The most commonly observed problem at present is infectious aneurysms: primary aneurysms secondary to atherosclerosis in which salmonella is by far the predominant organism, before the staphylococci and streptococci. The most serious complication is the major risk of rupture which may be the presenting event. Secondary aneurysms are essentially those of endocarditis. The mechanism is not fully understood and they occur at different stages of the course of the disease. The main problem associated with these aneurysms is their multiplicity and localisation; the intracranial forms are the most common and most serious in the experience of the authors, with their difficulties of diagnosis and treatment: extracranial aneurysms are usually located in the main limb arteries. Adjacent secondary aneurysms are exceptionally rare. Tuberculous and viral causes of aneurysm are among the rarest etiologies discussed.

[Extensive cellulitis during chicken-pox. Six causes (author's transl)]. / Les cellulites extensives au cours de la varicelle. A porpos de six observations.

The authors report 6 cases of extensive cellulitis, in 6 children with chicken-pox. This is a rare complication during this disease. If streptococcal etiology is not always proved, clinical aspect and the dramatic reponse to treatment by penicillin G, characterize this kind of complication.

[The rheumatism of acne conglobata (author's transl)]. / Manifestations rhumatismales de l'acné conglobata.

The authors report a case of painful joint, para-articular and muscular involvement accompanying acne conglobata. Fifteen other cases of rheumatism associated with this very special type of acne have been reported. The patients affected are young men suffering from acne conglobata (severe form of acne characterised by its ulcerating course and the possibility of its being accompanied by systemic manifestations), who suddenly develop fever, an altered general state and assymetrical arthralgia involving mainly the large joints, accompanied by signs of muscular involvement. The course is one of spontaneous recovery, relapses being possible. This falls within the context of the group of rheumatic disorders associated with the signs of an inflammatory skin disease.

[Acute purulent meningitis of traumatic origin. 16 cases]. / Méningites aiguës purulentes d'origine traumatique. 16 cas

The current frequency of road accidents leads to the necessity to seek a possible head injury in the past history of patients suffereing from acute purulent meningitis. This investigation must be all the more assiduous in the presence of a meningitis which is pneumococcal in origin and recurrent. Rhinorrhoea is a sign of primary importance. Tomography of the frontal and sagittal views of the skul remains of value. Radio-isotope studies of the CSF happile make up for the deficiencies of radiological examination, without providing an infallible means for the detection of osteomeningitis defects. The authors report their findings and therapeutic results in 16 patients collected in a series of 162 cases of acute purulent meningitis.

[Indications and choice of antibacterial treatment in patients receiving immunosuppressive agents and antimitotic drugs (author's transl)]. / Indications et choix des traitements antibactériens chez les malades soumis aux médications immunosuppressives et antimitotiques

Bacterial infections are the most common cause of death in patients with malignant blood diseases. After recalling the main bacteria responsible and the factors which predispose patients to infection, the authors consider various forms of treatment, including antibiotic therapy, transfusions of white blood cells, gammaglobulins, etc., and prophlyactic measures, such as antibiotics by mouth, isolation in a sterile ward, etc., which have been proposed for some years. During renal grafts, infective complications are also very frequenct. Their prevention is essential for on this, to a large extent, depends the success of the transplantation.