[Blast lung injuries]

In armed conflicts and during terrorist attacks, explosive devices are a major cause of mortality. The lung is one of the organs most sensitive to blasts. Thus, today it is important that every GP at least knows the basics and practices regarding treatment of blast victims. We suggest, following a review of the explosions and an assessment of the current threats, detailing the lung injuries brought about by the explosions and the main treatments currently recommended.

[Cardiac arrest at induction of a patient with thyrotoxicosis. Have you thought of anaphylaxis?]

We report the occurrence of cardiac arrest shortly after the anaesthetic induction for thyroidectomy in a patient with decompensated thyrotoxicosis associated with taking amiodarone. After investigation, it was revealed that the cardiac arrest was linked to an anaphylactic reaction to suxamethonium. This accident, unrelated to hyperthyroidism, reminds us of the relative frequency and severity of anaphylactic reactions related to curare. This event, in the context of severe cardiac insufficiency, due to an amiodarone-associated thyrotoxicosis, is described here for the first time. Its diagnosis requires to remain consistent. Its support must be in compliance with the recommendations of learned societies of anaesthesia.

[Use of rFVIIa (Novoseven) in the case of a patient with mitral valvular prothesis and anticoagulant accident]

We report the case of an haemorrhagic shock observed in a woman who received heparin for a cardiac valve in mitral position, efficiently treated with rFVIIa. The haemorrhagic complications under anticoagulation treatment remain rare, but can lead to real therapeutic dilemma. The use of rFVIIa has been evaluated in different clinical situations, including traumatic or post-operative haemorrhagic shock. The use of rFVIIa in the treatment of haemorrhagic complication under anticoagulation treatment is discussed.

Percutaneous epiphysiodesis using transphyseal screws (PETS)

We describe a new technique of percutaneous epiphysiodesis using transphyseal screws (PETS) and our experience with it in 32 cases of limb-length inequality and nine angular knee deformities. A subgroup of 18 patients with postfracture limb overgrowth formed a clinical model for study of the real efficacy of PETS. It proved a reliable method with few complications and many advantages such as simplicity of technique, short operating time, rapid postoperative rehabilitation, and reversibility. Bone-length inequality decreased from a preepiphysiodesis average of 2.47 cm (range, 1.5-4.6) to 0.51 cm at skeletal maturity. The tibiofemoral angle reduced from a preoperative average of 7.66 degrees to 0.86 degrees at maturity. The screws began to exert significant growth inhibition within 6 months of insertion, slowing down the distal femoral and upper tibial physes by 68 and 56%, respectively. They achieved maximum growth retardation over the ensuing 12 months, slowing down the distal femoral physis by 89% and the proximal tibial physis by 95%. At skeletal maturity, total femoral growth was 45% and total tibial growth was 52% that of the normal side. Key

[Osteomalacia of renal origin disclosing Gougerot-Sjögren syndrome]

Latent renal tubular diseases are common in Sjögren's syndrome but rarely complicated by osteomalacia. The authors report a 28 years old woman's case where osteomalacia reveal the disease. In the other hand, pseudo-lymphoma is suspected from radiographic features. According to several studies, the authors review different types of renal diseases and describe different physiopathological hypotheses about bone involvement and pseudo-lymphomas.

[Disclosure of systemic lupus erythematosus in a case of hepatitis caused by ibuprofen]

We report the case of an hepatitis induced by ibuprofen in a young 32 years old woman, which allowed to discover an until then unknown systemic lupus erythematosus. After an analysis of the data of the literature, we are able to estimate at more than a 50% the specificity of the above mentioned induced effect of this drug for the diagnosis of lupus. Thus, non only a meningitis, but also an hepatitis induced by the ibuprofen need a systematic research of a connective tissue disease.

[Surgical treatment of pulmonary metastases. Apropos of 26 cases]

Twenty-six patients with known primary tumors were treated surgically for pulmonary metastases between 1951 and 1979. The metastases were diagnosed more often (58% of cases) by routine radiological examinations than because of thoracic symptoms. While diagnosis of the primary tumor and the metastases was simultaneous in three cases, the average lapse of time between the two diagnoses was 5 years and 1 month in the other cases. In four cases, it was 10 years or more. Lung X-rays showed single tumors more often than multiple tumors (12%). Broncho-fibroscopy was usually normal, but a preoperative biopsy showed the metastatic nature of the tumor in 5 cases. Ablation was by lobectomy (42%), pneumonectomy (23%) or atypical resection (27%). The hospital mortality rate was 7.6%. The survival rate at 1, 3 and 5 years (71%, 39%, and 17%) is identical to that of primitive bronchial tumors, and seems to be influenced by certain factors, such as the locus of the primitive tumor (with a particularly bad prognosis for ENT tumors), the lapse of time between the diagnoses of the primary and secondary tumors, the fact that there is one, rather than several, metastases, or that the metastases are monolateral rather than bilateral, and, finally, the limited nature of the exeresis. These factors prompt regular, systematic and prolonged radiological monitoring in search of further pulmonary metastases.

[Dirofilariasis, an unknown parasitosis. One case observed in Paris (author's transl)]

In France, dirofilariasis D. tenuis are rare (less than ten cases were recorded). They manifest themselves by subcutaneous nodules. The fact that sometimes important inflammatory signs exist, could being one to diagnose an infectious etiology. Diagnosis may be made when the nodule is in the periorbital region if the patient comes back from endemic area and specially if he noted a migration of the parasite. It is hardly possible to count on the laboratory exams and it is the biopsy that will prove the existence of the parasite and will assure the cure.

Antihypertensive effect of diacetolol in essential hypertension

1 Diacetolol is the N-acetylated metabolite of acebutolol and possesses beta-adrenergic receptor blocking properties. 2 Its antihypertensive action was assessed in accordance with a double-blind randomised cross-over scheme in 17 patients with moderate essential hypertension previously well controlled with acebutolol. 3 Significant reductions in lying mean arterial blood pressure were observed with daily doses of 200 mg (- 9%), 400 mg (- 10%) and 800 mg (- 14%), and were associated with significant decreases in heart rate and plasma renin activity. 4 The diacetolol mean plasma level measured 8 to 10 h after drug ingestion was proportional to the dose (207 +/- 27, 394 +/- 63 and 823 +/- 135 ng/ml for respectively 200, 400 and 800 mg/day).

[Study of serum concentrations and urinary excretion of secnidazole after oral administration in man. Comparison with tinidazole]

Secnidazole, a derivative of 5-nitro imidazole exhibits trichomonacid, amoebicid and antimicrobial properties; it has been studied in view of its biological fate in healthy volunteers (man and woman) comparatively with tinidazole. Both products were administered orally to the same volunteers at the single dose level of 2 g. The seric concentrations and the pharmacokinetic profile were determined up to the 72nd hour after drug administration. The whole urinary excretion (unchanged product + metabolites) during the same period was determined in percent of the administered dose level. Secnidazole is particularly different from tinidazole owing to its slower blood clearance. The apparent average half-life in the ten volunteers (5 men and 5 women) is about 17 hours for secnidazole and 13 hours for tinidazole. However, for both drugs, a difference between men and women was demonstrated: in female volunteers, the decrease in blood concentrations occurs a little quicker than in male volunteers. Regarding urinary excretion, it is also a little greater in female volunteers than in male volunteers.

Determination of nofedone in human serum by electron-capture GLC

An electron-capture GLC method to measure nofedone in human serum was developed. A homolog of nofedone was added to the serum as an internal standard before the sample was alkalinized with pH 9.5 phosphate buffer and extracted with ethylene dichloride containing 0.5% isopentyl alcohol. This organic phase was extracted with 0.2N HCl, the acidic aqueous phase was neutralized immediately, and the extraction with ethylene dichloride was repeated. The ethylene dichloride phase was evaporated to dryness, and the residue was reacted with heptafluorobutyric anhydride. The derivatives were chromatographed at 290 degrees on a 1% Dexsil 300 column. Data on apparent recovery, accuracy, and specificity are given. The detection limit was 5 ng/ml of serum. Serum levels over time in one patient after intravenous administration of 1 mg/kg and after oral administration of 50, 100, and 150 mg of nofedone are presented.

[Diagnostic and therapeutic problems occasioned by a voluminous cervical schwannoma (author's transl)]

A tumour of the nervous sheath, the schwannoma often entails difficult diagnostic problems linked to its anatomopathological polymorphism. A medical case of a benign schwannoma of the neck has been reported. In this case, it concerns a tumour moreworthy for its size, its adherence, elements which are unusual in a regular tumour which is well inserted in a capsule, and which has entailed difficult therapeutic problems. Its atypical histological shape brought up a debate between its diagnostic on the one of a fibro-myxoma.