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Les douleurs pelviennes aiguës féminines constituent un motif fréquent de consultation en urgence. Une large gamme de diagnostics étiologiques est impliquée. Les causes gynécologiques et digestives sont les plus fréquemment rencontrées. Les causes gynécologiques sont représentées par les infections génitales hautes, ainsi que par trois « urgences chirurgicales » que sont la grossesse extra-utérine, la torsion d’annexe et la rupture hémorragique de kyste ovarien. Les causes digestives sont essentiellement représentées par l’appendicite aiguë qui constitue le principal diagnostic différentiel des douleurs pelviennes aiguës de cause gynécologique. La démarche diagnostique sera guidée par les données clinicobiologiques, les données échographiques, l’échographie pelvienne (sus-pubienne et endovaginale) étant l’examen de première intention dans cette population jeune, éventuellement par les données de l’imagerie en coupes (scanner et IRM) en cas de doute diagnostique persistant.

Abstract:  In a randomised double-blind trial conducted between 1990 and 1994, 616 patients from 43 centres, pefloxacin (group P, 316 patients) and a cefazolin-oxacillin combination (group C, 300 patients) were compared in the prophylaxis of bone infection after grade 1 and 2 open leg fractures. Samples were obtained at emergency, before and during surgery, and from drain aspirates. Antimicrobial susceptibility, slime production and adherence properties of the bacteria were tested. Cultures at emergency and before surgery showed similar distributions of gram-positive and gram-negative bacteria in both groups, while wound closure and infecting isolates showed prevailing gram-positive bacteria in group P and gram-negative bacteria in group C. Positive cultures at each stage were correlated with the occurrence of infection but were not predictive of the infecting species, which were nosocomial bacteria in most cases. Positive cultures at wound closure warn of a higher infection risk. Twenty-one of 316 (6.6%) patients in group P and 24 of 300 (8%) in group C were considered infected within 3 months. The difference is not significant (chi-square test =0.42;P=0.51). Infecting strains were isolated from 38 patients (group P, 18; group C, 20). Infecting species,although not predictable, appear to be those escaping the spectrum of the prescribed antimicrobial prophylaxis.

The aim of this trial was to compare a 5-day course of cephazolin with a regimen of 2 days of cefamandole in 965 total hip replacements (488 in the cefamandole group and 477 in the cephazolin group). The effect of the prophylactic antibiotic on the bacterial colonization of drains (mean duration of drainage: 3.2±0.3 days) and on the susceptibility of colonizing organisms was assessed. No significant difference was observed in the percentage of infected drains between the two groups. The cefamandole group had a lower rate of Gram-negative organisms (23% versus 44%, p<0.01). The rate of deep infections within one year after operation was 0.7% in the cefamandole group versus 0.5% in the cephazolin group, and the difference is not significant. Cefamandole given for two days appears to be an effective prophylaxis against sepsis in total hip replacements.

Trends in mortality for main cancer sites in France between 1950 and 1985 are presented by sex. In the population aged 35-65, where long term trends can most reliably be assessed, an overall 1.1% mean annual increase is observed for males and a 0.6% mean annual decrease is observed for females. For males, this increase in total cancer mortality is mostly due to the sites associated with tobacco and alcohol. The important increase for lung cancer, and lesser increases for bladder, pancreas and kidney cancers are related to the increase in tobacco consumption from 4.7 g per adult per day in 1950 to 6.3 g in 1976. For cancer sites associated with alcohol and tobacco, namely oesophagus, pharynx, larynx, tongue and mouth, mortality is increasing similarly for males and for females, although these cancers are much less frequent among females. For females, the overall moderate decrease is mostly due to the decrease in cervix and stomach cancer mortality, uncompensated by the observed increase in breast cancer; there is no marked increase in lung cancer mortality for women, contrary to what is observed in other Western countries.

Summary Among the conditions which need to be filled when generalizing the mass screening of polyps in view of the secondary prevention of colorectal cancers, three are already present: 1) it is a frequent and serious cancer; 2) there is an affiliation between benign tumours and cancer; 3) an effective non-mutilating treatment of benign tumours is available.

Background Childhood cancer survival has increased considerably during the last 3 decades. Until now, little has been known about the risk factors for death due to cardiovascular diseases in long-term survivors of a childhood cancer. Methods We investigated long-term mortality in a cohort of 4 122 5-year survivors (aged 0-15 years) of a childhood cancer treated between 1942 and 1986 in 8 centres in France and Great Britain as having a solid cancer and followed up over an average of 26 years. 98% of vital status were obtained from INSEE and 95% of causes of death from Cepi-Dc. Information about chemotherapy was collected, and the radiation dose received in all except for 159 of the 2 870 patients, who had received radiotherapy was estimated, The radiation dose received at 188 anatomical sites are estimated for each radiotherapy course of every child. The classification of causes of death was based on a comparison between the code topographic first cancer and the leading cause of death. The causes of death from heart disease the most common are: heart disease, heart failure and acute myocardial infarction Results A total of 603 patients died during the follow-up, i.e. 8.3-fold (95% CI 7.6-9.0) more than that expected in the general population. A total of 32 patients died of cardiovascular diseases, i.e. 4.8-fold (95% CI 3.3-6.7) more than expected, 21 of which were cardiac diseases, i.e. 6.0-fold (95% CI 3.8-9.0) more than expected. Patients who had received radiotherapy had a 5.4-fold (95% CI 1.6-33.0) higher risk of mortality due to cardiovascular disease than those who had not. Mortality due to cardiac disease was related to the administration of anthracyclines, alkylating agents and/or vinca alkaloids. Patients who had received between 5 to 14.9 Gy to the heart during radiotherapy had a 14.5-fold (95% CI 2-291) higher risk of mortality from cardiac diseases than patients who had not received radiotherapy. Patients who had received on average, more than 5 Gy to the brain were at a higher risk of developing vascular diseases (n=11). Conclusions Childhood cancer survivors are at a high long-term risk of mortality from cardiac diseases when treated with radiotherapy if the average radiation dose to the heart is higher than 5 Gy, or with anthracyclines, alkylating agents and/or vinca alkaloids. The cardiovascular diseases are the causes non-cancerous most frequent in the very long term after treatment for cancer of the child.

Background and purpose A cohort study was performed to investigate the carcinogenic effect of treatment with ionizing radiation of skin hemangioma in early childhood. This study presents the incidence of differentiated thyroid and breast cancers after radiotherapy in this cohort.