[Teaching the patients with rheumatoid polyarthritis more about their disease]

A meeting in a hospital environment gathers, during 4 full days, five patients with rheumatoid polyarthritis, of similar evolutive stage, strictly selected after a complete work-up and determination of a medical and surgical treatment. The meeting around the rheumatologist and the nurse, of the physical therapist, ergotherapist, orthesist, chiropodist, psychologist, and the social worker, permits to explain to the patients, already informed about his/her disease, rules of hygiene, savings, training and rehabilitation which will be useful. The experience of 30 patients is presented and proposed as a desirable model, which is the only way to improve the patient's formation, since the physician does not have enough time to devote to this formation.

[Hepatic diffusion of ceftriaxone]

We studied the intrahepatic diffusion of ceftriaxone, a new third generation, very potent cephalosporin with a long serum half-life. Sixteen patients had percutaneous liver biopsy for suspected liver disease or protracted fever of unknown origin. Serum samples and liver biopsy specimens were taken simultaneously. Serial determinations of ceftriaxone concentrations showed that the hepatic half-life was significantly shorter than the serum half-life. We suggest that ceftriaxone be used in higher or more closely spaced doses for the treatment of liver infections.

Clinical and neuropsychological rating scales for differential diagnosis of dementias

Clinical and neuropsychological rating scales were used in two studies of patients. The first one included 20 patients with progressive dementia and was divided into two groups according to their ischemic score evaluation and ancillary examinations (EEG, cerebral evoked potentials, CT scan, Doppler, xenon-133 clearance). The first group consisted of 10 patients with primary degenerative dementia of the Alzheimer type (SDAT) (n = 10). The second group included 10 patients with dementia caused by multi-infarction (MID). The second study included 18 patients with a confusional state, examined repeatedly for 1-6 months afterwards. The clinical and neuropsychological procedure consisted of a multi-dimensional assessment including 8 rating scales. A significant difference was found in the overall clinical and neuropsychological profile of patients with SDAT and MID. Cognitive functions were homogeneously impaired in the group of SDAT patients and heterogeneously in the group of MID patients. In chronic confusional states the overall profile was similar to that of the group of MID patients. Further reassessment showed a normalization in 9 patients, a vascular MID profile in 6 cases, an SDAT profile in 3 cases, and an undifferentiated one in 2 cases. Reversibility of the confusional state might be predicted at the onset of the cognitive disorder by history-taking and evaluation of the ischemic score.

[Immediate hypersensitivity in brucellosis. New data (author's transl)]

The presence of clinical manifestations of the "immediate hypersensitivity" process has been frequently described in veterinarians, bacteriological laboratory technicians and some patients with chronic brucellosis. We have looked for the presence of specific IgE in these conditions. Twenty-four patients, three months at least after the acute phase of their brucellosis, were given exploration of their humoral, cellular and specific immunity against brucellosis. For this purpose, beside usual classical tests: serodiagnosis, total and specific IgE assays, intradermoreaction and lymphoblastic transformation test with specific antigen (PI fraction) and an adaptation of human basophil degranulation test (HBDT) with PI fraction were performed on all 24 patients. Exploration of immediate hypersensitivity allows us to show neither an abnormal increase of hyper-IgE frequency nor an increase of anti-brucella specific IgE. HBDT is positive in 41 p. cent of the patients. It confirms that immediate hypersensitivity exists. HBDT gives justification for trying desensitization which has been proposed in the past. HBDT will possibly allow us to evaluate desensitization effectiveness.

Evidence of a pure "contraction alkalosis= in awaken rat

A pure contraction alkalosis with no urinary loss of bicarbonate was evidenced in awaken rat, after a Furosemide IV injection. We observed: 1) an early and important respiratory compensation possibly owing to a simultaneous contraction of CSF volume, thus increasing bicarbonate concentration. 2) a net shift of HCO3- towards intracellular compartment, in proportion to the magnitude of the contraction rather than to bicarbonate gradient across the membrane.