Giant Arteriovenous Malformation of the Neck.

Arteriovenous malformations (AVM) have a wide range of clinical presentations. Operative bleeding is one of the most hazardous complications in the surgical management of high-flow vascular malformations. In the cervical region, the presence of vital vascular structures, such as the carotid artery and jugular vein, may increase this risk. This is a case of massive arteriovenous malformation deforming the neck and the face aspect of this aged lady and growing for several years. A giant mass of the left neck occupied the carotid region and the subclavian region. The AVM was developed between the carotid arteries, jugular veins, and vertebral and subclavian vessels, with arterial and venous flux. The patient underwent surgery twice for the cure of that AVM. The first step was the ligation of the external carotid. Seven days later, the excision of the mass was done. In postoperative period the patient presented a peripheral facial paralysis which completely decreased within 10 days. The first ligation of the external carotid reduces significantly the blood flow into the AVM. It permitted secondarily the complete ablation of the AVM without major bleeding even though multiple ligations were done.

[Watery diarrhea with fever: consider the possibility of pneumococcal meningitis]. / Diarrhée fébrile "jus de melon": penser à la méningite à pneumocoques!

The purpose of this report is to describe two rare cases of pneumococcal meningitis observed in Africa. Both cases were revealed by gastrointestinal symptoms characterized by abdominal pain and watery diarrhea. Due to the potential severity of bacterial meningitis, early diagnosis is required. Since diarrhea with fever is a common occurrence in Africa, differential diagnosis is necessary. Isolated diarrhea can be caused by meningeal syndrome and calls for testing to detect invasive pneumococcal infection.

Intermittent androgen castration: a biological reality during intermittent treatment in metastatic prostate cancer?

INTRODUCTION: To assess the effects of intermittent maximal androgen blockade (IMAB) on testosterone (T) levels during on- and off-treatment periods. MATERIALS AND METHODS: A total of 51 patients with metastatic prostate cancer underwent a 6-months period of continuous maximal androgen blockade (MAB) consisting of leuprorelin (3.75 mg at monthly intervals) plus flutamide (250 mg t.i.d.) followed by IMAB. During each cycle, the cut-off prostate-specific antigen (PSA) levels to stop and resume treatment were 4 and 10 ng/ml, respectively. IMAB continued until progression under treatment occurred. Monthly PSA and T measurements were performed in central laboratories. RESULTS: From the 51 patients included (mean age 67.6 years), 27, 16, 12, 8 and 5 underwent a second, third, fourth, fifth and sixth cycle, respectively (mean follow up: 17 months). Before treatment, 4 patients had a T lower than normal laboratory value but these recovered all to a normal T value at the end of the first cycle. During the 6 cycles, only 8 patients did not recover a normal T at least once during the off-treatment periods (OTP). The mean T values at the end of each OTP did not change during these 6 cycles (Anova test, p=0.621) with a mean stable recovery delay of 32-43 days (Anova test, p=0.722). CONCLUSION: IMAB protocol with an initial 6-month treatment period can result in an intermittent castration with the recovery of normal T levels in most patients during six consecutive cycles of treatment.

[Evaluation of the health inpact of the floods in the Gard on respiratory health of disaster victims]. / Evaluation de l'impact sanitaire des inondations dans le Gard sur la santé respiratoire des sinistrés.

In 2002 the Gard was subjected to exceptional flooding, as much by their size as by the number of affected community victims, more than the Nimes floods in October 1988. No community was spared and more than 800 families had to be rapidly re-located. As the medical bibliography of the impact of the floods on respiratory heath was not conclusive we have proposed to the CHU of Nimes a hospital clinical research project undertaken by the members of RNSA, the Institute of Public Health of Brussels and the European Centre for Medical Bioclimate Research and Teaching, who have accepted to share their knowledge with the Gard. It seems to us to be indispensable, considering the certifications made by the professionals on the health on the department, to validate the study methods for the evaluation of the health impact of the floods, with regard to the development of moulds in the environment, so as to recognise the risk to health, in the very special circumstances, and so allow the mobilisabion of useful resources more rapidly than previously. The new floods to which the department was subjected in December 2003 made us regret that we had not developed this project more quickly.

[Explanatory factors of length of stay at the diagnosis-related group 129: common pneumonia and pleurisy, aged over 69 and/or associated co-morbidities]. / Facteurs explicatifs de la durée de séjour au sein du groupe homogène de malades 129: pneumonies et pleurésies banales, âge supérieur à 69 ans et/ou comorbidites associées.

BACKGROUND: Utilization of diagnosis related groups (DRGs) for hospital comparison, based on length of stay (LOS). OBJECTIVES: Inside a DRG (Pneumonia and pleurisy > 69 and/or associated comorbidities), to point out the explicative factors of LOS and the variables which could be recorded for a better description of these patients. SETTING: Pneumologic unit of Limoges' teaching hospital. METHODS: From 01-01-94 to 31-12-94, the DRG 129 was studied through the medical unit summary, the performance status at entrance, the social complexity, the characteristics of pneumonia (symptoms, temperature, arterial pressure...), the severity by American Thoracic Society (ATS) criteria, the procedures (chest X-ray, biology, fibroscopy...), the antibiotic treatments (intravenous and oral). Statistical tests associated univariate analysis, linear and logistic regressions. RESULTS: LOS was 15.53 d +/- 8.57 (m +/- SD). The mathematical model explains 69% of the variance of LOS logarithm. The logistic regression found 5 variables with a significant odds-ratio (OR) for an increased LOS: a high ATS score, repeated laboratory tests, a complex social situation, an increase length of antibiotic treatment (intravenous and oral). CONCLUSION: A better description of LOS, inside a DRG, needs supplementary variables. For pneumonia admitted in Limoges' hospital, the severity of the disease, the number of laboratory tests, the antibiotic treatment, the social complexity are the more significant indicators.

[Explanatory indicators of the length of stay in a pneumology department]. / Indicateurs explicatifs de la durée de séjour dans un service de pneumologie.

BACKGROUND: Utilization of Diagnosis Related Groups (DRGs') for hospital payments in France. OBJECTIVES: To search the variations and the explicative factors of length of stay in a pneumologic unit, to analyse the relevance of the indicators by using the DRG's and the supplementary variables in a medical and economical perspective. SETTING: Pneumologic unit of Limoges' teaching hospital. METHODS: From 1-4-93 to 31-5-94, a prospective study analysed 1081 stays (one-day-longer) by the medical unit summary and by some variables describing the stay (planned admission, appropriateness), the patient (physical mobility at entrance, severity of disease), the procedures (physiotherapy, social needs). Statistical tests associated univariate analysis, linear and logistic regressions, hierarchic segmentation. RESULTS: DRG's explain 23% of logarithm length of stay. The mathematical model has separated five variables, which are associated with an increase of length of stay (age, number of procedures, physical mobility at entrance, social complexity, intensity of physiotherapy), one associated with a decrease of length of stay (planned admission). CONCLUSION: DRG's, alone, do not describe the dispersion of the length of stay, which is usually used to assess the consumption of resources during an hospitalization. The record of supplementary variables needs further studies, to improve the patients' classification.