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Therapeutic education was initially developed in the field of diabetology. In this chronic disease, it is the patient who is the major decision-maker. R. K. Bernstein is probably the first patient to have practised self glucose monitoring. He developed the basal-bolus technique for himself, which prompted the creation of functional insulin therapy courses by European physicians. This experiential approach has been adapted and simplified for patients in order to facilitate their management of uncertainty. The ASKAR method offers a frame of reference for the development of teaching-learning sequences. The acronym ASKAR refers to the five components of a person's experience: Action, Situation, Knowledge, Attitude and Resource. Working on these five components is a way for patients to improve their management of uncertainty.

An Antopol-Goldman lesion or subepithelial pelvic hematoma of the kidney is a rare cause of hematuria. We described a 26 year-old man hospitalized for macroscopic hematuria associated with a subepithelial hematoma whose development might have been favored by arterial hypertension secondary to a renal artery stenosis.

Purpose: To evaluate the efficacy of nerve roots block under CT and neurostimulator guidance for the management of pain., Material: and method. Nerve root blocks were performed in 27 patients (pudendal nerve, intercostal nerve, ilio-hypogastric nerve, thoracic and lumbar sympatholysis). These were performed with corticosteroids (Altim((R))) (20 patients) or phenol (7 patients)., Results: Seventeen patients (63%) had pain reduction during at least 15 days. The pain relief was longer with phenol. Complications appeared in the 3 lumbar sympatholysis (inguinal pain) and one of the thoracic sympatholysis (Claude Bernard Horner syndrome)., Conclusion: The nerve root blocks seem to have some efficacy and a further evaluation is necessary to assess their impact on the ability of patients to return to work and their need for pain medication. When performing these procedures, one must be careful to avoid potential complications and verify that the procedure is needed.

Unlabelled: The purpose of the study is to evaluate the efficacy of C1-C2 block from a posterior parasagittal approach to treat Arnold neuralgia., Materials and Methods: 24 patients have been interviewed after 33 blocks were performed. The mean delay was 22 months. The posterior approach had always been performed using fluoroscopy. 27 blocks were performed with Hydrocortancyl((R)), 6 with Altim((R))., Results: 71% of patients were symptomatically improved after one month, 62% after 3 months and more than 50% after one year. Using a visual analogue scale, pain was reduced of 5.8, i.e. 70% of patients were improved. An important reduction of pain killer requirements was noted for improved patients, patients with pain recurrence asked for a new infiltration. No significant side effect was noted., Conclusion: Our method seems to be an efficient alternative to blocks performed on the origin of the nerve and to surgical treatment.

About 1600 kidney transplants are performed each year in France. The quality of life of grafted patients has therefore improved, to the extent that such patients are now envisaging professional or other activity and stays in tropical or sub-tropical regions. However, this is not without some degree of risk or difficulty. Anti-malarial drugs may interfere with other medication, particularly ciclosporin in kidney grafted patients. Moreover, other vaccinations such as anti-amaril immunization are recommended or even required by certain countries. Yet the immunodepression induced by this in grafted patients is a contraindication for such vaccination. For the other types of immunization, the risk/benefit ratio is not always obvious.

A 52 year-old man was hospitalised for acute renal failure with thrombocytopenia and hemolytic anemia without oliguria. A haemolytic-uremic syndrome was diagnosed and prostacyclin infusion was started. Twenty-four hours later, the renal function improved as well as thrombocytopenia and anemia. Recovery occurred after 11 days of treatment. Haemolytic-uremic syndrome treatment is not well codified: plasmaphoresis, fresh frozen plasma, transfusions showed inconstant efficiency and data about prostacycline treatment are rare and often contradictory. Multicentric studies must be started in order to determine the precise benefit of this treatment.

The development of necrosis and macrophage infiltration increases the risk of renal graft rejection. But the macrophages secrete the alpha form of the tumour necrosing factor (TNF) which is also involved in several immunologic and inflammatory phenomena. We therefore studied the expression of the gene TNF alpha by in situ hybridization during advanced stage rejection after renal transplantation: the grafts were infiltrated with macrophage-like cells expressing the mRNA of the TNF alpha gene, particularly deep in the cortex and in the medulla. These cells then secrete the TNF alpha molecule since they are recognized by anti-TNF alpha antibodies. These antibodies also recognize certain other glomerular endothelial and tubular epithelial cells which do not express the TNF alpha gene: these cells are undoubtedly the TNF target cells. These findings confirm the synthesis of TNF alpha in advanced stage renal graft rejection.

Finding of specific anti-Fasciola antibodies in persons living in the central area of the delta of Niger shows that human fascioliasis is a reality in Mali. Fasciola gigantica, the single species affecting livestock is probably the parasite concerned. We think that this parasitic disease in humans is underestimated, obscured by schistosomiasis which is hyperendemic in the country. Complementary studies are much needed for better identification of the problem.

A serological investigation on adult female in Mali show a high degree of positivity of hepatitis B virus (HBV) markers, of which 42% HBs Ag +. Only 6% exhibit active replication. The low prevalence of anti-HBs (+) with a high degree of anti-HB (+) explain a high incidence of infection with a low immune response to HBs antigen. The existence of anti-Delta (+) asymptomatic carriers is an additional support to a vaccination programme.

In 25 non-premedicated patients, buprénorphine (5 micrograms/kg - 1) has been injected i.v. 30 mn before coelioscopic sterilization under general anaesthesia. Following the i.v. injection there no significant modification of the arterial systolic and diastolic blood pressure was observed but post-operative bradycardia. Tidal volume and minute/ventilation decreased whereas the respiratory rate remained stable. Arterial blood gaz analysis showed slightly hypoxaemia and a significant rise of PaCO2 with post-operative acidosis similar to that in the control group. Good postoperative analgesia was achieved but with profound sedation and a high incidence of nausea and vomiting.

A new automatic apparatus for the measurement of arterial pressure by a non-invasive technique was compared with direct intra-arterial measurement in 20 adult patients in a surgical intensive care unit. The apparatus works on the basis of the principle of oscillometry. Blood pressure is determined with a microprocessor by analysis of the amplitude of the oscillations produced by a cuff which is inflated then deflated automatically. Thus mean arterial pressure corresponds to the maximum amplitude. Systolic and diastolic pressures are deduced by extrapolation to zero of the amplitudes on either side of the maximum reading. Mean arterial pressure (AP) proved to be very reliable within the limits studied: 8.0 - 14.7 kPa (60 - 110 mmHg) with a difference in mean direct AP and indirect AP of 0,09 +/- 0.9 kPa SD (0.71 +/- 7 mmHg) and a coefficient of linear correlation between the two methods of r = 0.82. This non-invasive technique determined systolic arterial pressure (sAP) in a less reliable fashion than AP when compared with the invasive technique, with a tendency to flatten the extreme values. The correlation coefficient here was 0.68. Finally, diastolic arterial pressure (dAP) showed a better degree of agreement through with a difference in mean indirect AP and mean direct AP of 1.0 +/- 0.8 kPa (7.6 +/- 6.0 mmHg). These results indicate a good degree of agreement for measurements of mean arterial pressure, clinically the most important, between the two methods used. Measurements of diastolic pressure and above all of diastolic pressure seemed to be less in agreement. This difference could be due to an error in determination of the automatic apparatus tested or to the peripheral site (radial artery) of the intra-arterial catheter used, itself falsifying the humeral arterial pressure.

The action of sultopride was studied in patients with chronic psychosis during rehospitalization for a psychopathic episode. 22 patients (8 manic-depressive psychoses and 14 schizophrenias) were given sultopride as the sole therapy, in a daily dose of 4 vials. After symptomatic improvement therapy was continued by the oral route. Under these conditions, a satisfactory response was recorded in 81.8% of patients. These results are confronted with those previously obtained in a comparable group of patients given phenothazines. A statistically significant difference was found, with sultopride being more effective and acting more rapidly than phenothiazines.

The pathophysiology of posttraumatic pulmonary failure is today reasonably well known. Interaction of altered granulocytes with the pulmonary parenchyma in the form of an inflammatory reaction plays an important role. Gas exchange failure can be a major problem in these patients and influence the prognosis. No effective preventive treatment is known at present except for rapid and appropriate surgical management together with an adequate fluid resuscitation. In addition, the risk of infection and sepsis must be reduced as far as possible and dysfunction of other organ systems prevented if the prognosis is to be improved. Administration of anti-inflammatory agents and corticosteroids has been shown to be without beneficial effect and dangerous in this situation. Intubation and ventilatory assistance should be used depending on respiratory status and pulmonary gas exchange, although potentially lifethreatening side effects of this treatment must be considered. Continuous specific monitoring of respiratory function must be started in the patient after multiple trauma to follow the course of pulmonary dysfunction and adapt therapy.

Monitoring of respiratory function in the intensive care unit uses different techniques in spontaneously breathing patients and during mechanical ventilation. The simplest and most efficient means are clinical observation, non-invasive monitoring of respiratory movements and frequent blood gas analysis. The respiratory force and reserves can be assessed by measuring tidal volume, vital capacity and maximal inspiratory force (in cm H2O or mm Hg), and these values are helpful in deciding on ventilatory assistance or extubation. During mechanical ventilation the function of the respirator must be monitored by appropriate sensors and alarms. In addition, the measurement of functional residual capacity, compliance and distribution of ventilation, as well as changes therein with the application of positive end-expiratory pressure (PEEP), can contribute to evaluate of appropriate therapy and prognosis of pulmonary failure.

On the basis of 25 cases of laryngotracheal stenosis of mescellaneous etiology, the authors report their experience of Rethi's operation carried out in 14 cases, 8 patients having received medical and instrumental treatment, 1 undergoing surgery for resection and anastomosis according to Pearson's technique and 3 receiving symptomatic treatment by tracheotomy because of inoperable stenosis. The frequency of postop-operative complications of Rethi's operation was analysed (essentially infectious, but also as a result of obstruction of the calibration prosthesis which represents a definite vial risk). Functional results were also assessed, being relatively satisfactory from a respiratory functional standpoint, but less good from a phonetic standpoint. The authors then define their present therapeutic attidude which leans, in the case of pure sub-glottal and sub-glotto-tracheal stenosis, towards a direct approach with resection anatomosis according to Pearson's technique rather than calibration procedures which remain the treatment ofa choice for glotto-sub-glottal stenosis.