[Ascites with high protein concentration 2 months after C-section delivery: diagnosis using adenosine deaminase analysis combined with iconography]. / Ascite riche en protides survenant deux mois après un accouchement par césarienne: diagnostic par association du dosage de l'adénosine-désaminase et de l'imagerie.

We report the case of a 38-year-old woman, born and raised in Congo, in France for 7 years, who developed ascites 2 months after delivery by C-section. Thrombopenia at 95,000 elements per millimeter cube was diagnosed during her pregnancy and her obstetrician initiated a treatment with corticosteroids. Analysis of the ascitic fluid showed a high concentration of proteins (55.7 g/l), with 2000 elements, 80% of which were lymphocytes, and very high levels of adenosine deaminase. Thoracoabdominal tomodensitometry revealed ascites, a multinodular spleen, and hyperemia of the peritoneum; but the liver and the lungs were normal and no adenoma was identified. Laparoscopy was not performed and the suspected diagnosis of peritoneal tuberculosis was confirmed by only one culture of ascitic fluid.

[Predictive factors in maintaining nocturnal continuous positive pressure in patients with sleep apnea syndrome]. / Facteurs prédictifs de l'observance de la pression positive continue nocturne chez les patients porteurs d'un syndrome d'apnées du sommeil.

A retrospective study was carried out on 347 case notes involving 303 men and 44 women who were suffering from a sleep apnea syndrome (SAS). The mean age was 57 plus or minus 10 years, and the diagnosis was made between 1982 and 1992. We have carried out the research to examine if there were clinical factors or factors related to respiratory function which would predict the acceptance in the short or long term and the correct observation in a daily time-table of nocturnal continuous positive pressure (PPC). The diagnosis of SAS was made using conventional polygraphy (35%), computerised cardiorespiratory recording 38%, or limited to transcutaneous saturation 27%. The mean number of respiratory nocturnal events in the three groups were respectively 48 plus or minus 25 per hour during sleep, and 45 plus or minus 23 and 51 plus or minus 20 per hour by the recording techniques. We have suggested a treatment by PPC in 235 patients: 86 patients refused at the outset (37%), 26 stopped secondarily (11%), and 108 (46%) continued until the end point 1992 with a mean duration of treatment of 24 (plus or minus 17), months and a mean duration of nocturnal usage of 6.2 (plus or minus 2.5) hours a mean level of positive pressure of 11 (plus or minus) 2) centimetres. The primary acceptance of PPC is significantly linked to the understanding of the patient of the functional signs (p less than 0.001) and of the severity of diurnal hypersomnolence (p less than 0.001). The acceptance in the long-term is linked in a weakly significant manner to the recognition by the patient of functional signs (p less than 0.04). None of the other 68 criteria used for assessing the severity of the patient and the SAS had any influence on the acceptance of PPC in short or long term. The compliance with a daily time-table is a weakly significant factor to the severity of the SAS judged by the number of nocturnal respiratory events (p less than 0.03).

[Reliability of transcutaneous PO2 measurements and ear oximetry at different levels of exercise]. / Fiabilité de la PO2 transcutanée et de l'oxymétrie par pince d'oreille à différents niveaux d'exercice.

Measurement of transcutaneous PO2 (PtcO2) and of the saturation of hemoglobin by ear oximetry (StcO2) are two non-invasive methods which can be used when performing exercise tests in patients with respiratory failure. To evaluate their reliability, we have compared 18 patients recording the PtcO2 (Radiometer electrode TCM1) and of StcO2 (Biox II A) with arterial samples using a radial artery catheter at rest and at a level corresponding to 50% of the maximal predicted effort and at maximal power (Wmax) obtained at the time of a triangular exercise (increasing the charge at 15 watts/min). The PtcO2 was significantly lower than the PaO2 at rest and on exercise: the variation between PaO2 and PtcO2 was 1.85 kPa at rest (confidence interval -0.25 to 3.96 kPa) but decreased with exercise reaching 1.22 kPa at the last level of exercise (confidence interval -1.2 to 3.65 kPa). The relative raising of PtcO2 in relation to the PaO2 masks a fall in the observed PaO2 on average for the entire group (the PaO2 falls from 9.49 kPa to 8.62 kPa whereas the PtcO2 only falls from 7.64 kPa to 7.39 kPa). The mean StcO2 does not differ from th SaO2 at rest as on exercise. However, the confidence interval of the scatters between SaO2 and StcO2 increase considerably at maximal power: whereas it ranges between -5.5 and 3.5% at rest and in the middle range effort, and is between -13.4 and 11.1% at the last stage.(ABSTRACT TRUNCATED AT 250 WORDS)