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La réforme de la décentralisation en 2019 a dynamisé l’institution régionale par l’accélération de sa mise en place et l’octroi d’un statut spécial aux régions du Nord-Ouest et du Sud-Ouest, alors en crise. Cependant, elle n’accentue pas l’autonomie fiscale de ces collectivités locales, pour lesquelles l’accomplissement des missions de développement reste un défi crucial. Forte de ce constat, la présente réflexion sur l’autonomie fiscale des régions au regard de l’évolution actuelle de la décentralisation met en évidence la limitation de ladite autonomie par l’État. Il est ainsi démontré, en premier lieu, que cette autonomie est retenue au profit de l’État qui, en plus, n’a pas arrimé de régime fiscal dérogatoire au statut spécial des deux régions susmentionnées. En second lieu, cette autonomie est rationnalisée en vue de préserver la stabilité et l’autorité de l’État ; mais l’aménagement de cette rationalisation peut être envisagé dans une perspective de concrétisation du développement local.

Une vaccination par MenBVac® était engagée en Seine-Maritime en réponse à l’hyperendémie d’infections à méningocoque B : 14 : P1.7,16. MenBVac® est un vaccin spécifique de clone B jadis développé en Norvège face à une épidémie à B : 15 : P1.7,16 ; une étude préliminaire a montré une activité bactéricide équivalente contre B : 15 : P1.7,16 et B : 14 : P1.7,16 de sérums de Norvégiens vaccinés par MenBVac®. La vaccination a débuté mi 2006 (J0-S6) chez les enfants de 1 à 5 ans de Dieppe. Cependant, la 3e dose (prévue à S12) a été différée (retard de livraison) et une inspection a relevé des écarts (processus modifié ; produit sub-potent ex vivo). La DGS a recommandé la poursuite de la vaccination, mais avec une étude évaluant la réponse immunitaire. L’étude a eu lieu juste avant et 6 semaines après la 3e dose (réalisée à M8). Sur les 2 835 enfants ayant reçus J0-S6, 400 ont été tirés au sort, 262 (66 %) ont accepté de participer, et 235 avaient 2 sérums analysables. Le critère principal de jugement était le pourcentage de sujets ayant un titre d’activité bactéricide du sérum analysé en sérum humain (hSBA) ≥ 4. Il était de 37 % (IC 95 % : 31 %-43 %) avant la 3e dose et augmentait (p < 0,01) à 88 % (IC 95 % : 83 %-92 %) après la 3e dose, une valeur supérieure au taux seuil attendu de 75 %. Pour 32 enfants le titre hSBA a été déterminé vis-à-vis d’une souche hétérologue B : 2a : P1.5 ; il était faible (2,1 en moyenne après la 3e dose contre 40,6 vs B : 14 : P1.7,16), confirmant l’activité spécifique de clone du MenBVac®. MenBVac® induit chez les enfants dieppois une réponse immunitaire vis-à-vis de B : 14 : P1.7,16 comparable à celle jadis observée en Norvège vis-à-vis de B : 15 : P1.7,16 ; cette protection croisée est attribuable à l’épitope commun P1.7,16. [Copyright &y& Elsevier]

The nursing cooperation protocol developed within the Paul-Brousse hospital's liver transplant department is fully in line with the health establishment's historical dynamic. It formalizes the transfer of skills established some thirty years ago within the internal organization, enabling healthcare professionals to engage in a cooperative approach to better meet patients' needs., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

The coordination team of the hepatobiliary unit of Paul Brousse hospital in Villejuif, is made up of four coordination nurses and an assistant. This team cares for patients awaiting a liver transplant or multi-organ (liver, heart, kidney, pancreas) transplant, the recipient patients, living donors and their family. Its role consists in educating, guiding, coordinating and listening., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

In the case of a liver transplant, the patient undergoes a particular space-time experience. From the announcement of the diagnosis and the prospect of death in the absence of a transplant, until the moment of the procedure, the nurse-coordinator supports the patient who will experience successive times of waiting, hope, fear and survival.

Introduction: The treatment of pseudomyxoma peritonei (PMPs) and appendiceal mucocele (AM) has changed radically. To assess the contribution of preoperative imaging to the treatment strategy and choice of approach, a surgeon and a radiologist different from the initial radiologist examined the files of all patients treated for PMP or AM in four facilities in one district from January 1, 1996, through December 31, 2008., Patients and Methods: The study included 27 patients (20 men and seven women, mean age: 63+/-13 years). Eleven patients had an intact AM, seven synchronous PMP (malignant appendiceal lesion in two of seven), six metachronous PMP (five with peritoneal mucinous carcinomatosis and one with diffuse peritoneal adenomucinosis) and three a ruptured AM but not PMP. The incidence of mucin-secreting tumors observed (27 cases in 12 years in a region of 500 000 inhabitants) corresponds to a prevalence of approximately five cases per year per million inhabitants. Acute clinical pictures (7/27) were significantly more frequent for the malignant forms (5/7) (p<0,02)., Results and Discussion: The overall sensitivity of computed tomography (CT) for all the criteria studied was 93%. The predictive value for AM rupture of visualization of thick calcifications was 100%. On the other hand, rupture never occurred when the CT showed an AM under pressure, with thin walls and septa. The predictive value for PMP of "scalloping" was 100%. The diagnostic accuracy of the initial reading was 25/27 for the imaging overall and 25/25 for the CT. Preoperative visualization of the exact size of the intact AM or of diagnostic information about ruptured AM and PMP helped to select an appropriate approach in 25 of 27 cases.

Giant diverticula of the small intestine and colon are rare. Four cases treated at our institution in the last year are reported and compared to published cases; specific features and those which differentiate them from abdominal pseudocysts are described. They most commonly present a clinical tableau similar to commonplace diverticular disease. Awareness of this unusual condition and a good CT study are the keys to diagnosis. Giant diverticula may be acquired or congenital. The acquired type is simply a more spectacular version of commonplace diverticulosis while the congenital type, having a muscular wall and myenteric plexus, is more akin to intestinal duplications. Treatment is surgical and, in the case of sigmoid giant diverticula, usually requires a colon resection similar to that required for sigmoid diverticulitis.

Retrospective study of 2,665 laparoscopic cholecystectomies (LC) performed between April 1988 and December 1994 in the French technique with selective intra operative cholangiography. Obesity was present in 13% of patients, respiratory insufficiency in 4%, inflammation in 13% and common bile duct (CBD) stones in 4%. Those cases are now good indications for L.C. A conversion to laparotomy occurred in 52 cases (2%). The rate of post operative complications was 1.6%, including 24 non biliary complications with 2 death and 17 biliary ones concerning the CBD in 6 cases. Those results compare favourably with the ones of open cholecystectomy and the cost is about the half.

The development of laparoscopic cholecystectomy is only justified if it can ensure the good results obtained by laparotomy. The purpose of this work is to study all complications which occurred in a homogeneous group of patients. From May 1988 to January 1993, we operated on 2006 patients by laparoscopy (724 men and 1282 women) with a mean age of 50.6 years. Signs of stones in the common bile duct were noted in 4.1% and acute cholecystitis was detected in 12.5%. A conversion to normal laparotomy was necessary in 2.1% of patients. All complications were systematically investigated restrospectively in any patient hospitalised for more than five days. Residual stones in the common bile duct were not taken into consideration when they were not complications obviously related to the operation. We observed five intraoperative complications (4 hemorrhages, 1 ileum puncture) and 40 postoperative complications (25 non biliary and 15 biliary). The 25 non biliary complications consisted of: 1 death by pulmonary embolism, 9 hemorrhages, 4 cases of acute pancreatitis, 4 subphrenic abscesses, 2 colon punctures, 2 parietal complications, 1 ulcer perforation, 1 myocardial infarction and 1 phlebitis. The 15 biliary complications consisted of: 3 lateral punctures of the common bile duct, 9 fistulas of the cystic duct (4 with a residual stone in the common bile duct and 5 without), 2 punctures of an abnormal right hepatic duct, one of which was treated by "Roux en Y loop" intestinal diversion, and a late stenosis of the common bile duct.(ABSTRACT TRUNCATED AT 250 WORDS)

Laparoscopic treatment of small intestinal obstruction is associated with immediate advantages and it may be expected that the recurrence rate will be decreased because of the reduction of wound scars. Between september 1989 and september 1991, 25 patients (16 men and 9 women), mean age 53.8 years, underwent initial laparoscopy for acute small intestinal obstruction. These patients had undergone a total of 43 (1.7 per patient) laparotomies an average of 13 years previously. One patient had never been operated on, 13 had one previous laparotomy, five had two, four had three, and two had four previous laparotomies. Laparoscopic treatment of intestinal obstruction was possible in nine cases including three cases of bands and six cases of adhesions. In sixteen cases, laparoscopy had to be completed by laparotomy, 13 immediately and 3 secondarily. The cause of immediate failure was the impossibility of finding and/or treating the cause in seven instances, four cases of intestinal wounds, on case of intestinal necrosis which required resection, and one case of missed right colonic carcinoma. The cause of secondary failure were incomplete release of adhesions, volvulus, and missed left colonic carcinoma in one case each. Mean hospital stay and postoperative ileus were significantly shorter in the "laparoscopy" group than in the laparoscopy + laparotomy group (p < 0.001). Two complications, with one death, were noted in the laparoscopy + laparotomy group. In conclusion, laparoscopic treatment of intestinal obstruction seems possible but in less than half of cases. Failures are related to the difficulty with which the abdomen may be explored. Laparoscopic treatment should not be pursued in case of problems.(ABSTRACT TRUNCATED AT 250 WORDS)

The recent development of laparoscopic surgery has included the treatment of acute appendicitis. We report our results after three years' experience of this type of surgery. We have operated on 78 patients (54 men, 44 women) mean age 28.9 years, suspected of varying degrees of acute appendicitis. The operation was completely carried out by laparoscopy on 71 occasions, including treatment of an abscess in 4 cases and peritonitis in 4 cases (3 of which were sub-mesocolic and one was generalised). The laparoscopy was transformed into laparotomy in 7 cases, 4 of which were due to difficulties of appendix dissection. Mortality was zero. Four complications occurred: 2 minute infections of the trocar hole, one more severe parietal infection which was a cause of readmission and antibiotic treatment, one "syndrome of the fifth day". In conclusion, laparoscopic appendicectomy appears to be quite feasible in the majority of cases, particularly when the appendix is ectopic, with marked abdominal thickening and peritoneal reaction. The postoperative course is uneventful. The laparoscopic technique is very comfortable for the patient during the postoperative period. This technique is becoming increasingly feasible with the operator's experience, and this appears to us to constitute good training for any form of laparoscopic surgery.

The surgical treatment of stones of the common bile duct by transcystic extraction of stones without biliary and peritoneal drainage greatly simplifies biliary surgery. Postoperative course and average hospital stay are similar to those encountered after conventional cholecystectomy. This surgical option was successfully achieved in almost 60% of the 153 patients with stones of the common bile duct of our series, operated between 1981 and 1987. Other patients were treated more conventionally because of failure or impossibility of complete transcystic extraction of stones. A choledochoduodenostomy was performed in 28 patients. In a limited number of patients (n = 12) endoscopic sphincterotomy was associated pre or postoperatively with the surgical treatment. Although 25% of the patients were older than 75 years, there was no operative mortality, which demonstrates that biliary surgery can be performed safely without any vital risk. Successful transcystic extraction of stones simplifies the course of stones of the common bile duct and should be attempt more often.

Cholecystectomy which is the best treatment for gallstones can be performed via laparoscopy in cases of uncomplicated stones. Thirty patients have been operated upon by this technique. The advantages are: small scars, easy recovery and short hospital stay. Nevertheless there are some risks, particularly hemorragic and traumatic complications in the biliary tract, so that operation must be done by a surgeon trained in biliary surgery.

Laparoscopic cholecystectomy is possible. Under general anesthesia, the optic and the instruments are introduced through 4 trocarsheaths. The cystic duct and artery are dissected and clipped. The gallbladder freed by the retrograde way is removed through the umbilicus. 330 laparoscopic cholecystectomies were done with few and only benign complications. The advantages are the simple post-operative course, the short hospital stay and the minimal parietal traumatism. Some limits remains in case of too much peritoneal adhesions.

The aim of this study was to evaluate the placental transfer of cefodizime (HR 221) in 28 women undergoing a cesarean section. After a single injection of 1 g cefodizime i.m., maternal blood, amniotic fluid and foetal cord blood samples were collected after 0.5 to 12 hours. The antibiotic assay was carried out by a microbiological procedure. The results showed a significant placental transfer of cefodizime with an early peak of 5.8 micrograms/ml at the 2nd hour in the cord blood and a progressive diffusion of the drug in the amniotic fluid until a maximal value of 9.9 micrograms/ml 11.5 hours after injection.

Penetration of ceftazidime into bronchial secretions was studied in 23 patients, of which 18 had cystic fibrosis. Ceftazidime was used as the single drug for treating exacerbations caused by Pseudomonas aeruginosa. Dosage was 6 g/1.73 m2/day divided into three intravenous injections for 14 to 21 days. Bronchial secretion samples were obtained by fiber-optic bronchoscopy or physical therapy. Serum and bronchial secretion ceftazidime concentrations were assayed using a microbiological method. Ceftazidime concentrations in both media were lower in children than in adults : elimination half-life is shorter (1.7 h against 2.45 h in adults), extravascular distribution is faster, with earlier (1 h against 2 h in adults) achievement of the peak bronchial secretion concentration (2 micrograms/ml). The ratio of bronchial secretion concentration to concomitant serum concentration did not exceed 5% at the time of peak bronchial concentration. These results suggest that in cystic fibrosis patients, the faster and lower bronchial penetration of ceftazidime may be due to faster elimination as compared to adults. Although transient elimination of Pseudomonas aeruginosa was achieved in 12 study patients, our findings support the use of higher dosages or alternative administration modalities designed to increase in situ ceftazidime concentrations.

The broad spectrum of activity of cefmenoxime, its beta-lactamase stability and its harmlessness for the fetus, confer upon this new cephalosporin, a possible efficacy in the treatment of obstetrical infections. This study was designed to evaluate the placental transfer of cefmenoxime. The study group consisted of 21 pregnant women undergoing a cesarian section. After a single IM injection of 1 g of cefmenoxime, samples of maternal blood and umbilical cord blood samples were both taken 1, 2, 3 or 4 hours after the injection, in order to evaluate the kinetics of the drug. Amniotic fluid samples were also taken at delivery. The results of the study showed : a peak level of 16 micrograms/ml in the maternal serum with a slow decrease and a residual value of 3.08 micrograms/ml at the 4th hour ; increasing levels of the drug in the cord blood, with a peak value of 4.8 micrograms/ml ; progressive diffusion of cefmenoxime in amniotic fluid, reaching the highest value of 4.7 micrograms/ml at the 3rd hour ; parallel kinetics of the drug in amniotic fluid and in cord blood. On the whole, this study showed a significant placental transfer of cefmenoxime, achieving therapeutic concentrations required against microorganisms responsible for obstetrical infections.

Diffusion of aztreonam into female genital tract tissues was investigated. After a single IV injection of 1 g, aztreonam was assayed in uterine tissue, uterine tube tissue and peritoneal fluid in 15 patients undergoing coelioscopy or hysterectomy. In addition, to evaluate placental transfer of aztreonam, maternal blood, amniotic fluid and cord blood samples were collected in five women undergoing cesarean section. Concentrations of aztreonam were determined using a microbiologic method. Mean concentrations 1 to 2 hours after administration of the drug were 11 to 25 micrograms/g in the endometrium and uterine tube tissue and 18 to 30 micrograms/g in the myometrium. Concentrations in peritoneal fluid samples were lower, ranging from 4.7 micrograms/ml (0.5 h) to 16 micrograms/ml (1 to 2 hours after the injection). The ratio of tissue concentrations to serum concentrations found at the same time, expressed as a percentage, ranged from 50 to greater than or equal 100%. Placental transfer of aztreonam proved comparable to that of other recently studied beta-lactams: the amniotic fluid/maternal blood and cord blood/maternal blood ratios ranged from 27 to 33% thirty minutes after administration of the antibiotic. No adverse effects were recorded in the offspring. These results indicate that diffusion of aztreonam into female genital tract tissues is good, producing concentrations capable of preventing or curing gynecologic and obstetrical infections caused by Gram negative bacilli.

Lesions of sigmoiditis do not extend beyond the recto-sigmoid junction and Douglas' pouch. However, in 9 out of 271 patients operated upon for sigmoiditis the lesions invaded the rectum either anteriorly by perforating Douglas' pouch, or around it and posteriorly through the meso-rectum. These cases of "lower" sigmoiditis have several features in common: a long history of infection, frequent haemorrhages and fistulae, pseudo-tumoral lesions, sometimes very large, detectable by rectal palpation. Surgery is indicated only in cases with serious complications, since many technical problems may be encountered. Wide resection of the rectum followed by low-sited anastomosis ensure stable results.

This was a comparative study of antibiotics in the pus of otitis and from the sinuses as well as in the adenoids. Three antibiotics were chosen: Trioleandomycin, Josamycin, Amoxicillin. The study protocol was strict. Results obtained were as follows: high concentrations of macrolids in discharge of otitis and the sinuses as well as in the adenoids. Concentrations were higher than serum concentrations. By contrast, in the case of amoxicillin tissue concentrations were lower than the serum concentration. This leads to the conclusion that there is good penetration of infectious ENT sites by macrolids.

We report the results of the study of the bronchial concentrations of several antibiotics. The experiment included 280 patients and the concentrations achieved in bronchial secretions were measured for 11 antibiotics. The samples of bronchial secretions were taken in situ by fibroscopy or through the tracheostomy cannula. The results of the study show that the rate of penetration is variable according to the different drugs; even in the same antibiotic family such as beta-lactam antibiotics the rate of penetration is variable. The bronchial levels of aminoglycosides, macrolides and tetracyclines are worthwhile, and are often superior to the MIC of the infecting organisms; the penetration is also dependant of the inflammatory conditions of the bronchi. Otherwise the sampling conditions were the best possible since samples taken by fibroscopy or by tracheostomy are not contaminated by saliva which is a factor of dilutional error. The methodology used in this study is an approach of pharmacokinetics of antibiotics in respiratory tract.

The authors sought to determine whether the combination of rifampicin and isoniazid altered the rate of acetylation of the latter drug by possible hepatic involvement. INH inactivation and transaminase levels were studied in 36 patients with tuberculosis, before and after 30 days of treatment with a combination of INH in a dose of 5 to 7 mg/kg/day and rifampicin in a dose of 600 mg/day. The results failed to confirm such a hypothesis since, whatever the phenotype of inactivation, no significant difference was seen between residual INH levels at 3 and 6 hours, before and after treatment, nor any significant increase in transaminases.

Piperacillin is a ureido-penicillin characterized by the presence of a piperazine group at the position 6 of the beta-lactam ring. This group confers a broader spectrum that includes Pseudomonas. In vitro studies have shown that piperacillin is active against clinical strains recovered from intensive care unit patients with severe lower respiratory tract infections. The purpose of our study was to investigate the usefulness of piperacillin in such patients by evaluating the drug's diffusion into bronchial secretions. A single 4 g dose of piperacillin was given intravenously over three minutes to each of 6 intensive care unit patients. Serum and bronchial secretion samples (obtained through a tracheal intubation or tracheostomy tube) were taken 1/2 hour, 2 h, 4 h and 6 h after the injection to evaluate piperacillin kinetics. Serum piperacillin concentrations were maximal 30 mn after the IV (mean value: 90.6 +/- 23.8 micrograms/ml) and thereafter fell gradually (mean value after 4 hours: 40.4 +/- 27.5 micrograms/ml). Peak concentrations in bronchial secretions were recorded at 2 hours (12.2 +/- 8.5 micrograms/ml); the mean residual value at 6 hours was 4.9 +/- 8.7 micrograms/ml. The diffusion ratio (ratio of bronchial secretion concentration to simultaneous serum concentration) was 15.5% to 24.5%. Our results show that the diffusion of piperacillin into bronchial secretions is outstanding and support the use of this drug in severe respiratory tract infections.

Two cases of choledochoduodenal fistula due to a duodenal ulcer located below the bulb are reported. Both patients were operated upon. Truncular vagotomy and antrectomy were performed, followed by gastro-duodenal anastomosis; the fistula itself was left untouched. Subject to some technical precautions, this operation, feared by most authors, is perfectly adequate, as it provides optimal conditions for healing of the ulcer, which is the main purpose of any surgical intervention in such cases.

Nitroxoline (8-hydroxy-5-nitroquinoline) has been used since 1962 in the treatment of urinary tract infections especially those due to gram negative bacilli (E. coli). The current renewal of the drug is in relation to the recently shown activity of nitroxoline against fungi (Candida, Torulopsis), Mycoplasma and U. urealyticum, as well as Trichomonas. In order to update the knowledge of the drug, the aim of this study was a pharmacokinetic study in serum and urines collected after administration of one single dose (2 X 100 mg) and after multiple doses (200 mg X 3). Eight healthy volunteers were included in the study. The assays were carried out by means of the microbiological procedure and HPLC comparatively in the same samples. From the results several comments should be made: 1) In all subjects, serum levels were measurable 15 to 30 min. after administration, suggesting a rapid absorption. 2) Despite individual variations due to oral administration, pharmacokinetic parameters could be calculated: Tmax: 1.75 +/- 1.04 h; Cmax: 5.59 +/- 3.15 mg/l; t 1/2 beta: 2.63 +/- 2.66 h. 3) The hepatic metabolization of the drug into conjugated derivatives occurs early as shown by early levels of conjugated nitroxoline as measured by means of HPLC; the metabolization seems to be variable according to the subjects quantitatively and as for its kinetics. 4) The urinary elimination of nitroxoline is extremely rapid, and high levels of free drug and conjugated derivatives were measured at the 1st hour after the administration. Persistent high levels were measured at the 10th and 24th hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Aminoglycosides are often used in the treatment of severe Gram-negative infections, particularly those involving the respiratory tract. The purpose of this study was to evaluate the penetration of netilmicin into bronchial secretions. In 8 tracheostomized patients samples of bronchial secretions were taken at intervals through the tracheostomy cannula after intramuscular injection of netilmicin 2 mg/kg bodyweight. Concentrations of the drug were measured in bronchial secretions and in blood samples taken simultaneously, using the agar diffusion method (Grove and Randall procedure). The results showed significant penetration of netilmicin, with a mean bronchial peak reaching 3.4 micrograms/ml 1 h after the injection. Elimination was slow, with a mean residual level of 2 micrograms/ml at 6 hours. The bronchial to serum levels ratio was high (greater than 30% at 1 hour). Individual variations in both serum and bronchial levels were noted; they were unrelated to the underlying pathology. However, changes in bronchial concentrations correlated with changes in serum concentrations, which suggests passive diffusion across the blood-bronchoalveolar barrier. The fluctuations in bronchial levels and the usually low bronchial concentrations of aminoglycosides previously reported are discussed in relation to the methods used.

These sixty five cases of abdomino-trans anal excision account for approximately one third of 210 operations performed for carcinoma of the rectum. In the context of curative surgery, indications for preservation of the sphincter must be strict in order to permit satisfactory excision inferior to the tumour and to avoid the risk of local recurrence. Post-operative care and early complications involve the segment of colon which must be brought down. Gangrene of the exteriorised colon did not, in general, compromise the definitive result, at the price of an early colostomy which could always be closed later. Long term results are encouraging: 22 patients out of 26 who underwent non-palliative surgery are alive, without recurrence, after 5 years. The functional result can be assessed only after 6 months adaptation. One patient in two considers himself to be normal. The other half are forced to used enemas, and one in four must wear a protective dressing.

The authors present the case of a 59 year-old patient with numerous stratified stercoliths within a large Meckel's diverticulum. An abdominal X-ray without contrast material, done while the patient was in acute abdominal pain showed a liquid-density mass. The diagnosis was considered because of the presence, within the mass, of a fluid level and several unusual calcifications. Ultrasound ruled out a gall-bladder or urinary origin. Surgical excision of the mass confirmed the diagnosis; the X-ray of the specimen allowed a comparison with the previous abdominal X-rays. The authors review the literature on the subject and suggest a gamut for the differential diagnosis of stratified calcifications of the abdomen.

The objective of this study was to evaluate the penetration of fosfomycin in bronchial secretions in 11 tracheostomized patients which allowed sampling at successive times, following intravenous injection of 4 gr of the drug during 4 hours. In simultaneous samples of serum and bronchial secretions, the measurement of fosfomycin was performed according to the agar diffusion microbiological method. The results of the study showed a worthwhile penetration of fosfomycin, with a mean bronchial concentration reaching 13,1 micrograms/ml, half an hour after the end of the injection, decreasing slowly with 7,04 micrograms/ml remaining two hours after the injection. The ratio between bronchial levels and corresponding serum levels reached 13% two hours after the injection. Fosfomycin diffusion from serum to bronchial secretions realizes significant amounts that are superior to the MICs of fosfomycin for most bacteria responsible for serious broncho-pulmonary infections in intensive care units.

Used in pelvic surgery in women, supra-pubic disinsertion of the rectus muscles, combining a satisfactory aesthetic result, comfort and the possibility of enlargement, was associated with a minimum of complications (4 haematomas, 4 hernias and 2 cases of breakdown) and would be suitable as a routine approach in surgery of this type.

Hiatus hernia was repaired in 108 adult patients by a technique combining posterior gastropexy, as described by Toupet, with anterior gastropexy on the lesser curvature. The purpose of the anterior gastropexy is to avoid intra-hiatal reascension of the anti-reflux montage, a complication which seldom results in recurrence of clinical symptoms but is reflected in radiological images of relapse with often troublesome psychosomatic effects.

Minimal inhibitory concentration (MIC) of miokamycin (M) were evaluated by agar dilution for 1,024 bacterial strains isolated in 6 hospitals and classed as a function of susceptibility and resistance to macrolides, lincosamides, streptogramins group (MLS). MIC of M ranged from 0.25 to 4 micrograms/ml (mode MIC 1-2) on Staphylococcus susceptible to MLS and on MLSB inducible strains; M was inactive on MLSB constitutive strains. MIC of M ranged from 0.016 to 4 micrograms/ml (mode MIC 0.12 to 0.5) for Streptococci and Pneumococci susceptible to erythromycin (E) and from 0.12 to greater than 128 for strains resistant to E. Enterococci susceptible to E were inhibited by 0.5 to 2 micrograms/ml (mode MIC 1) and strains resistant to E by 4 to greater than 128. Haemophilus were inhibited by 2 to 64 micrograms/ml (mode MIC 32), Neisseria by 0.12 to 4 (mode MIC 0.5-1) and B. catarrhalis by 0.12 to 8 (mode MIC 1). L. pneumophila was very susceptible to M: MIC 0.016 to 0.12 (mode MIC 0.06). MIC of M ranged generally from 0.5 to 2 micrograms/ml (mode MIC 1) for C. perfringens and from 0.03 to 2 (mode MIC 1) for B. fragilis. Thus, M was shown to be among macrolide antibiotics of resistance non-inducing type on MLSB inducible resistance strains. Its activity was similar to that of spiramycin slightly superior on Staphylococci, slightly inferior on Streptococci and Enterococci, similar on Pneumococci, very superior on Neisseria, Legionella and anaerobes. M had a good activity on Branhamella and, as others macrolides, was poorly active on Haemophilus.

The penetration of cefamandole into bronchial secretions was investigated in 5 tracheostomized patients with respiratory tract infections and purulent or mucopurulent expectorations. Bronchial secretions were collected by aspiration through the cannula at successive predetermined times after an intravenous injection of 1.5 g of the drug. Cefamandole concentrations in simultaneous samples of serum and bronchial secretions were measured by the agar diffusion microbiological method. Useful concentrations of cefamandole were obtained in bronchial secretions, with an early peak (mean: 1.97 microgram/ml; range: 0.5 -- 4.6 microgram/ml) one hour after the injection. The ratio of bronchial concentration to simultaneous serum concentration reached 24% six hours after the injection. These results show that cefamandole achieves bronchial concentrations which are superior, or at least equal, to the MICs of organisms responsible for respiratory infections. This and the resistance of cefamandole to beta -lactamases suggest that this second generation cephalosporin can be valuable in acute bronchopulmonary infections.

Operative coelioscopy, widely used in gynaecological surgery and appendicectomy, can be helpful in cholecystectomy. Sixty-three patients have been operated upon by this technique which has the advantages of small scars and rapid recovery with shortening of hospital stay. At the moment, its sole indication is cholecystolithiasis without acute complication. The risks associated with this new technique justify a careful selection of its indications and make it imperative for the operator to be a surgeon with wide experience of biliary tract surgery.