[Acute abdomen film: is there hope of changing referring patterns?].

An abdomen radiograph (KUB) is frequently requested by ER physicians as part of the inital work-up of patients. However, other imaging studies are now routinely available in the acute setting that may make the KUB an obsolete and unnecessary examination. The first part of this study was to assess the current referral patterns for urgent KUB in our center; the improper referral pattern for KUB in terms of requests for unnecessary exams 48,5% as well as number of technical errors in terms of inadequate radiographic projection for the suspected pathology 47% were recorded.

Psychiatric disorders among patients admitted to a French medical emergency service.

Objective: The authors assessed the prevalence of psychiatric disorders among a population of patients examined in the emergency service of a French general hospital. They compared patients with and without psychiatric disorders. They also compared patients where the primary motive of emergency was psychiatric to those whose psychiatric disorders were secondarily diagnosed by a systematic assessment.

Screening for domestic violence among patients admitted to a French emergency service.

Objective: The authors assessed the prevalence of domestic violence among patients examined in the emergency service of a general hospital. They compared the socio-demographic status and psychiatric comorbidity of victims of domestic violence and other patients.

Method: An assessment was made on 126 consecutive patients received by the emergency service of Bichat-Claude Bernard hospital (Paris, France).

Predictive factors of malaria in travelers to areas where malaria is endemic.

Background: The differentiation of malaria from other causes of fever is difficult. The development of tools for rapid and specific clinical diagnosis is of paramount importance for the identification of individuals infected with malaria.

Method: A 4-year prospective study to identify the clinical and biological variables associated with malaria included all patients suspected of having malaria who presented in the emergency department (ED) of a French hospital.

[Evaluation of three testing strategies for detection of hepatitis C in a hospital medical consultation and in an HIV testing center].

Aims: Testing for hepatitis C virus (HCV) is recommended. The purpose of this study was to evaluate the efficacy of HCV testing in a medical consultation without an appointment and in an HIV testing center based on three testing strategies: 1997 French Consensus Conference, "Lettre de la Direction Générale de la Santé" (January 1996), and extension to other risk factors.

Patients And Methods: For 6 months a free blood test was offered to any patient with a risk factor according to the literature.

Alcohol dependence among patients admitted to psychiatric emergency services.

We assessed the prevalence of alcohol dependence among patients examined in the psychiatric emergency service of a general hospital. We compared socio-demographic data and psychiatric status of patients with and without alcohol dependence. One-hundred and four consecutive patients received by the psychiatric emergency service of Bichat-Claude Bernard Hospital (Paris, France) were assessed.

Control of a prolonged outbreak of extended-spectrum beta-lactamase-producing enterobacteriaceae in a university hospital.

Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLPE) were isolated from clinical specimens from 130 to 140 patients/year in 1989-1991 in our hospital. In February 1992, a control program was initiated: screening tests in 3 intensive care units (ICUs) and contact-isolation precautions in all units. The septic surgical unit served as an isolation ward for surgical patients from whom ESBLPE was isolated.

Emergence of antibiotic-resistant bacteria in cases of peritonitis after intraabdominal surgery affects the efficacy of empirical antimicrobial therapy.

In cases of community-acquired peritonitis, the adequacy of emprical antibiotic treatment has been shown to attenuate mortality and morbidity. The impact of empirical antibiotics on the outcome of postoperative peritonitis has never been evaluated. This study included 100 consecutively studied patients with postoperative peritonitis.

Penetrating abdominal trauma: the challenge.

High-velocity missiles fired from weapons of war cause severe injuries because of the intense energy that they transfer on impact with the living targets. The most important factors in the reduction of morbidity and mortality are first aid, rapid evacuation of victims and early primary surgery. Infection of wounds can arise from skin organisms and from enteric aerobes and anaerobes.

[Bacteriological safety in enteral nutrition in intensive care units. Comparison of 4 types of pumps].

Enteral nutrition may appear as a risk factor for infection in intensive care patients if bacterial growth is not prevented. The authors have tested in the microbiology laboratory, 4 types of pumps (3 cooling machines: SEC Nutridose/Climadose, Peters NPR 3000, Vial "Alaska" and 1 flow regulator Sherwood Kangaroo 330) using food contaminated with a low inoculum of Klebsiella pneumoniae. Bacterial growth was investigated periodically in the food container and in the feeding tube during the testing of the pumps.

[Pancreatic trauma: diagnostic and therapeutic emergency. Apropos of 35 cases].

35 consecutive pancreatic trauma were operated (21 blunt trauma and 14 penetrating injuries). 30 patients were operated in emergency and diagnosis was suspected before laparotomy in only one case. 12 patients had a superficial lesion, 21 had a wirsung disruption (14 in the left pancreas, 7 in the right pancreas), 2 had a diffuse pancreatitis.

[Necrotizing fasciitis of the upper limb. 12 cases].

Twelve cases of necrotizing fasciitis or streptococcal cellulitis of the upper limb are reported. Four cases presented with a low grade aggressive for and one case was chronic. Seven fulminating cases resulted in two deaths.

Bronchoalveolar lavage for rapid diagnosis of the fat embolism syndrome in trauma patients.

Objective: To evaluate the usefulness of bronchoalveolar lavage in establishing the diagnosis of the fat embolism syndrome in trauma patients with long-bone fractures.

Design: Case series.

Setting: Referral hospital.

[Infections of soft tissues by bacterial synergism].

The treatment of synergistic bacterial soft tissue infections includes usually surgical debridements and radical excisions of necrotic tissues, antibiotic therapy and volumic resuscitation. Hyperbaric oxygen therapy did not prove efficient in these plurimicrobial infections. Their severity is due to virulence synergy of aerobic and anaerobic micro organisms in the involved areas.

[Nosocomial infections caused by Acinetobacter. Epidemiology and therapeutic difficulties].

Nosocomial infections due to Acinetobacter calcoaceticus are not easy to treat particularly in intensive-care and surgical units. Our study included 33 cases of nosocomial infections which developed during 1987 in the surgical intensive care unit and in the urology department. Acinetobacter was isolated from various types of nosocomial infections: urinary tract infections (43 per cent); septicaemia (15 per cent); surgical infections (27 per cent) and respiratory tract infections (15 per cent).

Midazolam infusion for basal sedation in intensive care: absence of accumulation.

This study was designed to: (1) determine plasma midazolam concentrations producing adequate sedation in ICU patients; (2) establish an intravenous regimen to provide continuous sedation and rapid recovery after discontinuation of infusion. Initially, 13 ICU patients were given midazolam as a bolus injection, 0.20 mg.

[Massive digestive hemorrhage caused by aorto-esophageal fistula].

A very rare diagnosis before a terminal hemorrhagic accident, aorto-esophageal fistula (FAO) is almost always fatal. Three cases of this exceptional lesion are reported. The first patient died within a few minutes of admission from a cataclysmic hematemesis.

Variations in plasma thyroxine-binding prealbumin (TBPA) in relation to other circulating proteins in post-operative patients during rapid oral refeeding.

Variations in plasma thyroxine-binding prealbumin (TBPA) were investigated in 15 well-nourished patients who underwent minor orthopaedic surgery and resumed normal oral feeding on the first post-operative day. TBPA fluctuations were analysed together with those of other nutritional and inflammatory markers including albumin (ALB), some acute-phase reactant proteins, C-reactive protein (CRP), orosomucoid also named alpha 1-acid-glycoprotein (alpha 1GP), alpha 1-antitrypsin (alpha 1AT) as well as cortisol and haematocrit. Measurements were conducted the day before operation, after the administration of anaesthesia, 2 h after the patient regained consciousness and then daily for a period of one week (days 1 to 7).