[Renal-protective dose of dopamine: myth or reality?]. / Dopamine à dose rénale: mythe ou réalité?

Low dose dopamine is widely used to improve diuresis and renal function. This practice is defended by some and fought by others. Acute renal failure in the ICU is often due to tubular necrosis and is a predictor of worse prognosis. Dopamine at low doses is a delta agonist and stimulation of these receptors leads to diuresis and natriuresis. This natriuresis requires additional ATP consumption by the kidney. Low dose dopamine has also systemic hemodynamic effects and these effects can't be dissociated from direct renal effects. Clinical studies of systematic dopamine use in selected high risk patients fail to show a benefit, and side effects of catecholamine administration may lead to additional cardiovascular morbidity. We conclude that low dose dopamine has a demonstrated renal effect but its systematic use to prevent or treat a renal failure cannot be warranted.

Systemic mastocytosis following a malignant ovarian germ cell tumour.

Cases of mediastinal germ cell tumours associated with haematological disorders (two cases of systemic mastocytosis included) have been reported previously. This combination is more frequent than would be expected by chance alone. We report the case of a 30-year-old woman, who presented with a systemic mastocytosis following a malignant ovarian germ cell tumour which was treated by chemo- and radiotherapy. The patient predominantly complained of skeletal pains, which led to an erroneous radiological diagnosis of fibrous dysplasia for years. An aggressive variant of systemic mastocytosis was diagnosed on bone marrow examination. Systemic mastocytosis was confirmed by splenectomy, liver biopsy and finally autopsy. The present case is unique because of the ovarian location of the germ cell tumour. We suggest our observation could be related to the broad group of haematological malignancies associated with germ cell tumours.

[Invasive Streptococcus pyogenes infection (beta-hemolytic Streptococcus of group A)]. / Infections invasives à Streptococcus pyogenes (streptocoque beta-hémolytique du groupe A).

Group A streptococcal infections are frequent and most often benign. Severe invasive infections due to this microorganism have nevertheless been reported with increasing frequency in various countries for several years. Moreover, a toxic shock-like syndrome has recently been recognized and characterized in such infections. Two cases of invasive group A streptococcal infections (one primary peritonitis and one toxic shock syndrome) are reported to increase a better understanding of this disease in the light of a review of the pertinent literature. This is hoped to contribute to better management of what is a growing problem for many physicians who are nowadays no longer familiar with the broad spectrum of group A streptococcal infections.

[Microbiological findings of 97 cases of acute pyelonephritis]. / Données microbiologiques de 97 cas de pyélonéphrite aiguë.

To optimize the therapeutic approach to acute pyelonephritis (PNA), the medical records of 89 patients (73 women and 16 men) hospitalized with diagnosis of PNA between January 1984 and 1987 have been studied. According to routine bacteriological urinalysis, gram-negatives were found in more than 92% (E. coli in 79%, Proteus in 6%). Gram-positives were found in only 8%. The gram-negatives (n = 82) showed resistance to amoxicillin in 36%, to amoxicillin/clavulanic acid in 17%, to cotrimoxazole in 18%, and to ceftriaxone in 1%. No resistance to netilmicin or norfloxacin was found. These results justify treatment with norfloxacin or ceftriaxone instead of amoxicillin, amoxicillin/clavulanic acid or cotrimoxazole for gram-negatives. Among the 7 cases with gram-positives, resistance was found to amoxicillin/clavulanic acid, cotrimoxazole and also netilmicin, and to norfloxacin, ceftriaxone and amoxicillin. Therefore, an initial therapy using the association amoxicillin-netilmicin is recommended in PNA.

[Medicosocial characteristics of hospitalized alcoholic patients in 2 internal medicine departments of hospitals in French-speaking Switzerland]. / Caractéristiques médico-sociales des patients alcooliques hospitalisés dans deux services de médecine interne d'hôpitaux de Suisse romande.

Two prospective studies were performed in the medical services of two hospitals located in the French-speaking part of Switzerland to assess the prevalence of alcoholism and the comparative medico-social characteristics of alcoholic and nonalcoholic patients aged 18 to 75. Both investigations used the Michigan Alcoholism Screening Test, with a cut-off score of 5. The prevalence of alcoholism was similar in the two institutions (19.6 and 20.5%) and was much higher in males (30 to 32%) than in females (3 to 5%). Among alcoholics, the percentage of unmarried or divorced patients was higher than in nonalcoholics, as was the percentage of unemployed and subjects from lower socio-economic brackets. The most frequent type of alcohol-related disease was alcoholic liver disease, encountered in 25% of alcoholics in both services. Cigarette smoking was also much more frequent in alcoholics (60%) than in nonalcoholic patients (29%). The length of stay was 2 days longer for alcoholics in both hospitals, despite the lower mean age of these patients.