Fluconazole penetration in cerebral parenchyma in humans at steady state.

We studied fluconazole penetration in the brain in five patients who had a deep cerebral tumor whose removal required the excision of healthy brain tissue. Plasma and brain samples were simultaneously obtained after oral ingestion of 400 mg of fluconazole daily for 4 days (90% of steady state). Fluconazole penetration in healthy cerebral parenchyma was determined.

[Management of a first antihypertensive treatment].

The first prescription for high blood pressure should be the fruit of clear thinking about the goals of the treatment and the best means to achieve these goals for each individual patient. The aim of treatment is not only to lower arterial blood pressure, but also to ensure the best possible prevention against cardiovascular risks in the hypertensive patient. Several factors are involved, notably metabolic factors.

[Laser CO2 arytenoidectomy by endoscopic approach in bilateral laryngeal paralysis. Apropos of 45 cases].

Between 1980 and 1993, 45 patients with bilateral cord abductor paralysis were treated by carbon dioxide endoscopic laser arytenoidectomy. Thyroid surgery was the main cause of bilateral laryngeal palsy (67%). Seven patients, who were tracheotomised before treatment, were decanulated.

[A new cause of prolonged fever of unknown origin: progesterone substitution therapy].

Objectives: Over the last 3 years, we examined 15 patients on progesterone substitution therapy who presented prolonged fever. Many explanations had been put forward before the diagnosis was suggested. We recall the thermogenic effect of progesterone.

[Antiphospholipid syndrome. 20 cases].

Objectives: We analyzed the clinical and biological characteristics as well as the clinical course and outcome observed in 20 patients with antiphospholipid antibodies and clinical signs including thrombosis or repeated spontaneous abortion to better identify the recently described antiphospholipid syndrome.

Methods: We retrospectively studied all patients observed in our unit from 1981 to 1992 who fulfilled the following inclusion criteria: a) at least one episode of arterial or venous thrombosis and/or repeated spontaneous abortions, b) positive for antiphospholipid antibodies.

Results: Twenty patients were included, 3 with systemic lupus erythematosus (according to the American Rheumatism Association criteria).

[Chemotherapy of bladder tumors].

Chemotherapy of bladder cancer is based on the methotrexate-vinblastine-cysplatinum (M-VAC) protocole. The neo-adjuvant therapy sterilizes 20% of the bladders, but the criteria of effectiveness are not precise enough to recognize the patients. Surgical indications have not been modified by this chemotherapy.

Transsphenoidal surgery for pituitary adenomas in children.

The authors have reviewed the results of transsphenoidal surgery for pituitary adenomas done on 66 children (younger than 16 yr of age) between 1966 and 1992. Ninety-four percent (62 of 66) showed clinical evidence of pituitary hormonal hypersecretion. The most common type was the adrenocorticotropic hormone-secreting adenoma (n = 36), followed by the prolactinoma (n = 18) and the growth hormone-secreting types (n = 8).

Bilateral pulmonary lobe transplantation: left lower and right middle and lower lobes.

It is difficult to find lungs of appropriate size for double-lung transplantation in teenagers and small adults. Nevertheless, many young patients suffering from cystic fibrosis are waiting for lung transplantation. We have performed two bilateral lobar transplantations (left lower lobe plus right middle and lower lobe) with good recovery.

[Anesthesia for tracheobronchial laser surgery].

Laser, performed using a rigid bronchoscope, permits the re-establishment of a sufficient tracheal airway diameter. This procedure requires a 15 to 60 minutes general anaesthesia including a neuromuscular blockade, a high frequency jet ventilation being delivered via the side channel of the bronchoscope. Concerning an adult patient of an average weight, presetting of the ventilator includes a supply pressure of 3 or 4 bar, a low I/E ratio and a frequency ranging between 60 and 120 cycles/min.

[Risk evaluation of oxygen desaturation after buprenorphine or morphine administration during the early postoperative period].

The purpose of this study, conducted in a PACU in the early recovery period of orthopaedic procedures under general anaesthesia, was to compare the time course of O2 arterial saturation (SpO2), measured by pulse oximetry, after the intramuscular administration of either buprenorphine (0.30 mg) or morphine (10 mg). The rate of patients who had an episode of O2 desaturation (defined as a SpO2 under 95%) was similar in both groups: 73% after buprenorphine vs 67% after morphine.

[Non-seminomatous germ cell tumors of the testis. Role of the pathologist in the assessment of prognostic factors based on the specimen of orchiectomy. Proposal of an anatomopathological examination report defined by the Study Group of the Committee of Cancerology of the French Association of Urology].

Non-seminomatous germ cell tumors of the testis. Role of the pathologist in the definition of the prognostic factors based on examination of the orchidectomy specimen. Proposal of a pathological examination report form defined by the study Group of the Oncology Committee of the French Urological Association.

[Pyelonephritis in pregnancy].

This article on pyelonephritis of pregnancy is based on data from the literature and on a retrospective study of 64 patients followed up from 1987 to 1991. Pregnancy is the cause of a more frequent progression from lower urinary tract infection to pyelonephritis. The clinical features and course of the disease are not specific of pregnancy.

Comparative effects of antihypertensive drugs on systolic blood pressure.

Importance of systolic over diastolic blood pressure measurements: Systolic pressure is known to be a more important independent cardiovascular risk factor than diastolic pressure in subjects over 50 years of age; after that age, a high incidence of two types of systolic hypertension is observed, sustained essential hypertension with a disproportionate increase in systolic pressure and isolated systolic hypertension. Effects of lacidipine on blood pressure in the elderly: The effects of vasodilators on blood pressure have been studied extensively. Recently, lacidipine, nitrendipine and enalapril were compared in a multicenter, randomly allocated, double-blind trial in elderly hypertensive patients with a disproportionate increase in systolic pressure treated for 8 weeks (n = 278).

Clonidine premedication for coronary artery bypass grafting under high-dose alfentanil anesthesia: intraoperative and postoperative hemodynamic study.

The purpose of this study was to assess the efficacy of clonidine in achieving perioperative hemodynamic stability in patients undergoing coronary artery bypass grafting performed under high-dose alfentanil anesthesia. Twenty-four patients with left ventricular ejection fraction greater than 0.5 were prospectively studied in a double-blind manner; those requiring emergency procedures were excluded.

Laparoscopic hepatic sonography.

Laparoscopic hepatic sonography is becoming a standard procedure with the arrival of specifically designed probes. The technique of liver exploration used in open surgery has to be adapted. The technique we propose is initiated by a sagittal sonography associated with rotation movements.

[Colorectal villous tumors. Treatment by electro-resection and laser photocoagulation. 134 cases].

Endoscopic snare resection prior to Nd:YAG laser photocoagulation was used to treat benign colorectal villous adenoma. One hundred and thirty four patients were included in the study: 72 with surgical contraindications, 61 for whom surgical resection appeared to be too drastic and 1 who refused surgery. Treatment sessions were repeated every fifteen days until total tumour destruction was achieved.

Tracheal sleeve resection for iatrogenic stenoses (subglottic laryngeal and tracheal).

Since 1975 200 tracheal sleeve resections for iatrogenic tracheal and subglottic laryngeal stenoses have been performed in our institution. Preoperative Nd:YAG laser is of paramount help in opening the stenoses. Tracheography is usually performed to specify the length of the stenosis and the distance from the vocal cords.

Urinary trypsin inhibitory activity for the diagnosis of bacterial infection: a prospective study in 690 patients.

Objectives: During the acute phase response, interleukin-1 induces production of inter-alpha-trypsin inhibitor. The measurement of urinary trypsin inhibitory activity which results from the effects of inter-alpha-trypsin inhibitor degradation products is easy, quick and inexpensive. We conducted a prospective study to investigate its value as a diagnostic tool in comparison with C-reactive protein.

[Disseminated peritoneal leiomyomatosis. Apropos of a case].

The authors report a case of disseminated peritoneal leiomyomatosis (DPL) occurring in a post-menopausal woman not using hormone replacement therapy. Her past history included a subtotal hysterectomy, with preservation of the adnexae, for metromenorrhagia due to a leiomyomatous uterus. This case confirms data in the literature concerning presentation, symptomatology, macroscopic appearance and histology.

[Female contraception by a normal dose progestogen after 40 years of age. Possible association of nomegestrol--17-beta-estradiol acetate by percutaneous route].

Although fertility declines with age, the use of an effective contraceptive remains necessary in women over 40. Endocrine disorders, which are common in this age group, may also often require control. Conventional estroprogestogens, even those of the latest generation, cannot be used in women with a high cardiovascular risk, since age cannot be totally excluded as a possible risk factor.

["Primary" pulmonary arterial hypertension associated with HIV infection. Two cases].

We report two cases of pulmonary arterial hypertension (PAHT) in HIV infected patients who never were, or had ceased to be, drug addicts. A study of these cases and a review of the literature show that this association is not fortuitous and persists after the classical causes of PAHT (pulmonary embolism, toxic factors, cirrhosis) have been excluded. The clinical features and the results of complementary cardiovascular examinations are identical with those of the so-called "primary" PAHT.