[Responsibility of the vaccinating physician]. / La responsabilité du médecin vaccinateur.

Liability for vaccination concerns no fault liability for public financement. Personal liability of physicians may be engaged in cases of non-informed consent or in cases of malpractice.

[Hepatitis probably caused by exifone (Adlone)]. / Hépatites probablement dues à l'exifone (Adlone).

Exifone, a drug recently proposed for the treatment of cognitive deficiencies of old age, has been marketed in France beginning in April 1988. This report concerns 2 patients who developed jaundice after taking this drug for 2 and 5 months, respectively. Serum aminotransferase was markedly increased. There was no hepatic failure. In both cases, histologic examination of a liver sample showed centrilobular hepatocyte necrosis and cholestasis. Necrotic cells were infiltrated with numerous red blood cells and scarce inflammatory cells. These lesions were associated with alterations of the walls of centrilobular veins. Discontinuation of exifone was followed by the prompt disappearance of jaundice. Complete recovery occurred within 6 and 12 weeks, respectively.

[Oscillating algorithm in medical diagnosis : alternation of flow-charts and diary programs]. / L'algorithme oscillant du diagnostic médical : alternance d'arbres de décision et de programmes en calendriers.

26 programs of paraclinical tests for inpatients were written in diary form. Conditions of use were clearly defined with emphasis on optimal utilization of the first two or three days of the stay. Nine diaries are presented as examples. In order to reconcile various clinical, logical and economic requirements, the algorithm should oscillate between the flow-chart and the diary. For clinical evaluation, the flow-chart, completed by a health questionnaire, is satisfactory. But, for prescription of the first paraclinical tests, the diary appears more efficient under the specified conditions of use. The next step should then be a flow-chart, and so on. Flow-charts and diaries may be provided separately, each clinician having the possibility of alternating from one to the other, according to findings and local conditions.

[An unrecognised cause of hypercalcaemia: hypercalcaemia-hyocalcluria syndrome]. / Syndrome d'hypercalcèmie-hypocalciurie: une cause méconnue d'hypercalcémie.

A 32-year-old man with insulin-dependent diabetes secondary to chronic calcifying pancreatitis of alcoholic origin in whom hypocalciuria (22 to 88 mg/24 hours) was discovered by chance, renal function being normal. Plasma phosphate levels were between 25 and 35 mg/l and the level of parathyroid hormone was at the upper limit of normal. Cervicotomy led to the discovery of three parathyroid glands which were removed. Their weight was increased and their histological appearance normal. The fourth parathyroid was not seen. Hypercalcaemia and hypocalciuria were found during the operation and persis 3 years after, with none of the usual causes being found. This patient has a certain number of characteristics reminiscent of familial hypercalcaemia-hypocalciuria syndrome: high plasma calcium levels associated with low calciuria despite normal renal function and a plasma parathyroid level normal in most cases. The physiopathology of this syndrome remains unknown. Its course is benign, without renal complications. Partial parathyroidectomy is ineffective.

[Does the hepatitis of secondary syphilis exist? Two cases (author's transl)]. / L'hépatite de la syphilis secondaire existe-t-elle? 2 observations.

Two patients are presented as new cases of secondary syphilitic hepatitis. The closely resemble descriptions in the literature with the same clinical and laboratory "profile" and the same course spectaculary influenced by anti-syphilitic penicillin therapy. The presence of treponemes in the liver, which would definitely confirm the diagnosis, was not demonstrated. This is a particularly important diagnosis, which should not be missed since it leads to treatment of fundamental importance to the patient's future.