[Does chronic hepatitis due to phenindione really exist?].
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Biomedical subjects
Publications and source records attributed to R Roue.
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The authors evaluated the costs involved when alcoholic patients were admitted to a hospital medical department. Costs which were identical for all patients, such as basic services and hospitalization fees, were discounted, and only those for individual investigations and treatment were calculated. These costs were then compared with the average daily costs for non-alcoholic patients in the same department over the same period. The results are discussed in relation to other similar studies.
A patient aged 65 years was observed to have successive adenomegalic syndromes over a period of 4 years, with variable histological appearances. A right cervical adenopathy had the histological appearance of a simple antigenic-stimulation lesion. Three years later, a right inguinal adenomegaly presented all the histological criteria of angioimmunoblastic adenopathies, without, however, any humoral immunity disturbance. Two months later, a biopsy of a palatine tumour confirmed the diagnosis of an immunoblastic sarcoma. The condition then became generalized as a lymphoblastic type of diffuse lymphosarcoma, and autopsy one year later showed the presence of a pleomorphic lymphosarcoma in several lymphoid formations. This case serves as a basis for discussing the concept of angio-immunoblastic adenopathy; the result of various antigenic aggressions or the early stage of a haematosarcoma. It also clearly demonstrates the sometimes contingent characteristics and difficulties in classification of haematosarcomas.
Two cases of post-meningococcal inflammatory arthritis with a relapsing course in one case are reported. The authors then recall the characteristics of the joint manifestations during meningococcal infections in the light of other cases in the literature. These arthropathies are generally aseptic and their resistance to antibiotics is remarkable, whilst non- steroid anti-inflammatory drugs, even used alone as in one of the cases reported here, are remarkably effective. The pathogenesis of these cases of arthritis is not clear: it seems however according to Greenwood and Whittle that they are manifestations of immuno-allergic type. This "post-meningococcal rheumatism" may be compared to the gonococcal rheumatism of certain cases of Reiter's syndrome.
A report is given on 3 cases of arthritis after cerebrospinal meningitis caused by B meningococci, with a relapsing course in 1 case. The observations are compared with the literature and the characteristics of articular manifestations of meningococcal infections are outlined. Three types are distinguished. Type I is characterized by banal arthralgias masked by the symptoms of meningitis. Type II encompasses septic arthritides preceding or concurring with the meningitis and like the latter sensitive to antibiotics. Type III includes postmeningococcal arthritides with sterile articular fluid refractory to antibiotics and showing a spectacular reaction to non-steroid anti-inflammatory drugs. These arthritides constitute a true infective rheumatism, post-meningococcal rheumatism, and should be related to other post-meningococcal manifestations such as pericarditis, myocarditis, cutaneous and ocular changes. All these manifestations are attributed to the production of immune complexes. Postmeningococcal arthritides, whose characteristics are described, may occur after septic meningococcal arthritis or appear as such. The distinction of postmeningococcal rheumatism where only anti-inflammatory treatment is effective might lead to the question whether certain postgonococcal arthritides refractory to antibiotics and responding to anti-inflammatory drugs are not provoked by an immuno-allergic mechanism leading to postgonococcal rheumatism -a nosological entity that has been abandoned possibly too fully and definitively.
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The authors have analysed the development of various coagulation factors in 104 cases of common virus hepatitis in young adults. Total plasma coagulability, the prothrombin complex, factors VIII and IX, fibrination and fibrinolysis were followed up during this evolution and compared, using the usual statistical methods, with the results of the same investigations carried out on 100 healthy subjects belonging to the same age-group and on 31 patients suffering from cirrhosis of the liver. Statistical methods showed up the slightest disturbances of any significance which would have been overlooked if individual results only had been examined. As it was, there was total plasma hypercoagulability which was at its maximum at the onset of development but which persisted until the 7th week. It was mainly connected with an abnormality at the second stage of fibrination, that is : polymerisation of the fibrin monomers. The results obtained do not allow a conclusion to be drawn as to whether there exists an antipolymerase or dysfibrinogenaemia. Later research dealing specifically with the chemical structure of fibrinogen in hepatitis should provide further information. In practice, assessment of total plasma coagulability, using cephalinkaolin time, and analysis of fibrination by thrombin time are of definite value on account of their sensitivity.
The joint manifestations of parasitic diseases are rare. They may be due to the presence of a parasite within one or severed joints, to involvement of a neighbouring joint, or distant involvement due to an immuno-allergic mechanism. The latter category constitutes what one may call parasitic rheumatism. The latter is characterised by arthropathies of inflammatory type with raised sedimentation rate, marked but inconstant hypereosinophilia, and total inefficacy of antirheumatic treatments. The diagnosis of parasitic rheumatism depends on these criteria, on the diagnosis of the parasitic disease in question, above all filariasis but also other parasitic diseases, and above all the great efficacy of specific anti-parasitic treatments.
The authors report upon 152 cases of hepatic amebiasis (H.A.) observed in France between 1969 and 1983, among young european men (average age 29,2) who were hospitalised in the initial phase of their illness. H.A. was clinically revealed through a painful and febrile hepatomegaly in 3/4 cases and in 6 cases through complications. No chronic form was observed. The amebic serology (I.F.I. and/or H.A.P.) was always positive. The research of an intestinal portage of the parasite was generally negative. The hepatic functions were impaired in the third of the cases. Whichever technique was employed, the anatomic diagnosis has always been made in a phase of intra hepatic collection. The superiority of echotomography over other methods is confirmed (especially for diagnosis of multiple abscess: 47% of success). All patients recovered, most frequently through medical treatment (117 cases). The nitro-imidazoles (1,5 to 2 g per day during 7 to 14 days) remain the prefered treatment, but they are responsible for 5 failures which were overcome by emetine. On the other hand, 4 patients had, after being cured, showed middle and long term relapses without patient recontamination. The evolution of the treated H.A. is significantly correlated to the importance and/or the multiplicity of the liver collection: the voluminous abscess of the right lobe being the most potentially dangerous. The pathogenesis of the H.A. remains imperfectly known. The different clinical aspects which have been found, depend upon the preexistant immunity of the patient and could also be equally associated with a pathology of complex immunity systems.