[A new Military Medical Service for the 21st century: a necessity]. / Un nouveau service de santé pour le XXIe siècle: une nécessité.

The Military Medical Service is at the cross-road of two deep restructurings, that of Defense and that of the public health system. It will have to be capable of supporting a professional army prepared to conduct foreign operations. The new Military Medical Service relies on seven basic principles which have been submitted to the National Academy of Medicine for examination. It will obviously have to face many challenges.

[The hospital policy of the Military Health Service]. / La politique hospitalière du Service de Santé des Armées.

After having pointed out what nowadays the military hospital area represents and what its missions consist in, the authors shed the light on the trends they want the Medical Corps organization to develop and follow in order to meet its needs within the field of its allowed means. As a conclusion, they bring out the fact that, in the future, doctors will have to assume responsibilities if they want to remain "deciders", as far as hospital management is concerned.

[Algodystrophy and venous thrombosis of the lower extremities. Diagnostic discussion. Apropos of 3 cases]. / Algodystrophie et thromboses veineuses des membres inférieurs. Discussion diagnostique. A propos de 3 observations.

The authors report 2 cases of probable algodystrophy of the lower extremities, associated to a definite deep venous thrombosis. They discuss the relationships between the two diseases and the difficulties of the differential diagnosis in light of a third case where the algodystrophy is definite and manifests itself as a deep venous thrombosis confirmed by phlebography. They insist on the absolute need to rule out a deep venous thrombosis before considering the exceptional diagnosis of algodystrophy with pseudo-phlebitic manifestations.

[Value of adrenaline in opaque arthrography of the knee. Comparative study of 100 cases]. / Intérêt de l'adrénaline dans l'arthrographie opaque du genou. Etude comparative portant sur 100 cas.

A prospective study evaluated efficacy of adrenaline in image improvement of opaque arthrography of knee. Of the 100 cases assessed, adrenaline was combined with contrast medium in 50%. Quality of images was compared by double reading of couples of images taken at end of examination. Marked improvement was observed in 2 of 3 cases and it is proposed to use adrenaline routinely to prolong quality of initial arthrogram.

[Severe algodystrophy of the foot simulating ischemic arteriopathy. Spectacular cure by regional sympathetic block with guanethidine]. / Algodystrophie sévère du pied simulant une artériopathie ischémique. Guérison spectaculaire par bloc sympathique régional à la Guanéthidine.

The authors report a case of severe algodystrophy of the foot complicating a typical episode of algodystrophy of the knee, and which resulted in appearances of acute ischaemia of the foot. Paraclinical investigations seemed to support this aetiology but arteriography excluded this diagnosis, showing only regular distal arterial narrowing. This case illustrates the extremely variable clinical and paraclinical features of algodystrophy and the possibility of significant hypofixation from the onset and during the course of algodystrophy in young patients. It shows that there are no specific, constant clinical signs or paraclinical changes. From the therapeutic point of view, it confirms the often spectacular effects of prolonged regional sympathetic nerve block with Guanethidine which may give an immediate and definitive cure of severe algodystrophy when all else has failed.

[Perirenal hematoma diagnostic of periarteritis nodosa. Apropos of a case]. / Hématome périrénal révélateur d'une périartérite noueuse. A propos d'un cas.

Hematoma of the renal space may be of various causes. Polyarteritis nodosa can be revealed by a perirenal hematoma as in the case reported but this is a rare complication of the disease. A case of a young man with a previous history of hepatitis Hbs+ is reported.

[Aneurysm of the celiac trunk. A review of the literature. Apropos of a new case]. / Anévrysme du tronc coeliaque. Revue de la littérature. A propos d'un nouveau cas.

Aneurysms of celiac trunk are rare (82 cases reported worldwide), and the clinical picture is usually little suggestive of the lesion, which may be totally asymptomatic. Positive diagnosis and determination of possible extension of the disease, as well as postoperative follow up is ensured by modern imaging techniques (ultrasound, CT scan, digital subtraction angiography). Etiology of the aneurysm varies but is generally atheromatous disease or intimal fibrodysplasia.

[To visualize the posterolateral segment of the external meniscus. Value of the position of internal flexion rotation]. / Visualiser le segment postéro-latéral du ménisque externe. Intérêt de la position en flexion rotation interne.

Interpretation of images of the posterolateral segment of external meniscus, during arthrography with contrasts of knee, is known to be difficult and this explains the possibility of false positives and the frequency of false negatives observed during exploration on this meniscus. A flexion-internal rotation projection of knee was used to improve the image of the posterior horn of the external meniscus, and analysis of results of about 100 examinations showed significant benefits. Use of the method is illustrated in a normal knee, and one with a rupture of posterior horn of external meniscus masked in extension and detected only in the flexion-internal rotation projection.

[Cowden's disease. Syndrome of multiple hamartomas]. / La maladie de Cowden. Syndrome des hamartomes multiples.

Cowden's disease is a phacomatosis (multiple hamartomas), which is a familial, hereditary, dominant autosomal affection presenting as typical buccolabial mucocutaneous lesions associated with digestive tract polyps. Differential diagnosis of the predominantly digestive form of the disease is polyposis. A new case of this rare disorder is reported, only 62 cases being documented in literature.

[Hemorrhage caused by rectal varices and portal hypertension]. / Les hémorragies par varices rectales et hypertension portale.

Hemorrhage from rectal varices due to portal hypertension is an exceptional finding (23 cases published), and arises as a result of derivation of hepatic blood flow into the inferior mesenteric vein (superior hemorrhoidal vein) associated with rectal vein dysplasia. A case is reported in a known cirrhotic.

[Knee pain of rare etiology]. / Une gonalgie d'étiologie rare.

A case of chronic knee pain of rare etiology is reported. Conventional radiographs excluded any articular pathology but ultrasound images showed features typical of a transsonic type tumor. Pathologic examination was necessary to establish the diagnosis, the tumor being an Antoni type A schwannoma.

[Dissecting osteochondritis of the patella. Apropos of 12 cases]. / L'ostéochondrite disséquante de la rotule. A propos de 12 observations.

The authors report 12 cases of osteochondritis dissecans of the patella. The relative rarity of this condition (one hundred published cases) is perhaps only apparent, as the diagnosis is sometimes difficult early in the disease. Drawing from their personal cases and from data in the literature, the authors recall the clinical and radiological signs, describe the place of complementary investigations and therapeutic indications and discuss the various pathogenic theories, none of which are fully satisfactory.

[Neurinoma of the abdominal pneumogastric nerve. Apropos of a case]. / Neurinome du pneumogastrique abdominal. A propos d'un cas.

Neurinomas of the vagus nerve are rare occurrences, and their localization to the abdominal portion of the nerve are even more exceptional events (two cases published). A case is reported where presenting symptoms were post-prandial abdominal pains of the pancreatic type. The lesion was of the necrotic hemorrhagic type. Radiological examinations confirmed the site and mixed nature of the mass but not its departure point. These patients must be kept under medical observation because of possible development of a non-systematized neurocristopathy.

[Involvement of the thoracic was in algodystrophy. Apropos of a case report]. / L'atteinte de la paroi thoracique au cours de l'algodystrophie. A propos d'une observation.

With reference to an unusually severe and extensive case of algodystrophia, the sternal and costal localizations of this disorder are described. These fit the definition of the painful anterior thoracic wall syndrome, described i 1955 by Printzmetal and Massumi, which may complicate chronic coronary insufficiency or myocardial infarction or occur as a primary disease.