[From participating management to constructive management].
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Biomedical subjects
Publications and source records attributed to J Prieur.
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We have been able to record an atrio-ventricular block dependent upon bradycardia, but also no tachycardia, in a patient of 76 who presented with syncopal attacks. The basal electrocardiogram showed no significant delay in atrio-ventricular or intraventricular conduction. Intracavitary electrophysiological investigation allowed us to localise the site of this block in the main trunk of the bundle of His; we also established, under basal conduction conditions, a first degree block with an exactly similar relationship to the duration of the preceding diastole.
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Because of its clinical polymorphism and the difficulties to made a bacteriological and/or serological diagnosis, leptospirosis is an affection always non-detected. Nevertheless it is daily met affection in French Polynesia. Based on a homogenous series of 120 observations gathered from 1984 to 1990, all of them bacteriologically and/or serologically confirmed, we studied the different clinical and evolutive features of that disease. Fever is present in 91.6 p.c., cephalgia in 79.16 p.c. and myalgia in 70.83 p.c. Admission was necessary once out of four times. The four syndromes we observed in Tahiti are: infections syndrome, meningeal syndrome (30 p.c.) associated to an hyperproteinic grade in the C.S.F. (40 p.c.) and a lymphocytic reaction (60 p.c.). Liver syndrome, with hepatalgia (58.33 p.c.) and pain at the mass motion of liver (65 p.c.), that is an important sign in the local context; jaundice (28.33 p.c.) on the presence of which we must not based a diagnosis of leptospirosis: Biological renal syndrome displayed by transitory renal insufficiency with proteinuria, hematuria and leucocyturia. Neurological complications are mainly of encephalitic manifestations (5.8 p.c.). Hemorrhagic syndrome is expressed in digestive hemorrhage (8.33 p.c.) epistaxis (6.66 p.c.) and hemoptysis (6.66 p.c.). Cardiovascular manifestations are expressed in collapsus in 5.83 of the cases. Pulmonary abnormalities are frequent: cough (26.66 p.c.) and non specific X Ray image (19.16 p.c.). All patients are treated by Penicillin G (10 to 20 millions per day) by parenteral route with enteral alternative for an average of 10 days. Recovery was fast (7 to 10 days). In 65.8 p.c., slower in 15 p.c. (15 to 20 days); failure at first stage was observed in 10 p.c. of the cases, and relapse at medium or long term occurred under treatment in 8 cases (6.66 p.c.). Three dead were deplored (mortality 2.5 p.c.).
The examination of needle biopsy of the liver has permitted the identification of the aetiology of cholestatic jaundice in eighty five cases out of a series of one hundred-and-one patients, leaving eight without definite diagnosis and eight false diagnosis. The characteristic histopathologic lesions of lobular hepatitis and of obstructive jaundice are reviewed. The problems of identification of particular microscopic forms (obstructive jaundice with minimal portal tracts alterations, residual stage of hepatitis, cholangiolitic and hypercholestatic forms of hepatitis) are discussed.
The authors report on 37 new cases of eosinophilic meningitis collected in two years in an island with a population of 1,800. Recalling first the epidemiology of the disease, they describe the most frequent clinical signs met and the results of rachiocentesis which confirm the diagnosis. The disease strikes more than 1% of the population. It might not rapidly disappear as the only efficient prophylaxis would be to deprive the population, very attached to its traditions, of one traditional dish.
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