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Our study, based on microsimulation models, evaluates the redistributive impact of health care insurance in France on income distribution between age and social groups. This work sheds light on the debate concerning the respective role of the public health care insurance (PHI) and the private supplemental health care insurance (SHI) in France. The analysis points out that the PHI enables the lowest-income households and the pensioners a better access to health care than they would have had under a complete private SHI. Due to the progressivity of taxes, low-income households contribute less to the PHI and get higher benefits because of a weaker health. Pensioners have low contributions to public health care finance but the highest health care expenditures., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

In the differential diagnosis of colonic obstruction, the endometriosis is an uncommon disease, rarely reported. The endometriosis of the bowel should be suspected on young women with a history of colonic symptoms and gynecologic complaints. The preoperative diagnosis is difficult, based on the clinical history, the imaging modalities and the endoscopic explorations.

A double-blind, placebo-controlled therapeutic trial of ketoconazole presented as a foam and applied only once was carried out on 61 patients by a group of 15 private dermatologists practising in the Paris region. All patients had tinea versicolor clinically diagnosed, then confirmed by a positive patch test, as assessed by a single mycologist. The main criterion of therapeutic effectiveness was negativation of the patch test 30 days after a single topical application of the ketoconazole foam. On day 30, the test was negative in 22 of the 28 patients in the ketoconazole group and in 5 of the 29 patients in the placebo (i.e. excipient) group (p less than 10(-5). Clinical and mycological cure was observed in only 11 of the 28 patients treated with the active substance, but among the 11 patients who still showed skin lesions despite a negative mycological examination 10 had achromic lesions which could be regarded as residual. This clearly indicates that the only criterion that can be used in a therapeutic trial on tinea versicolor is the mycological result. The active substance and the excipient were well tolerated; two patients in the ketoconazole group reported tingling of the skin at the site of application. We conclude that a single application of ketoconazole foam in effective and well tolerated in tinea versicolor. The single application technique unquestionably has advantages over repeated applications and should result in better patient's compliance and greater effectiveness in the long term.

Mezlocillin is a semi-synthetic antibiotic belonging to the ureidopenicillin group. A study of its activity against a wide range of organisms shows that it is a broad-spectrum antibiotic. However, mezlocillin differs from aminopenicillins and carbenicillin by its activity against numerous strains of klebsiella spp. (modal MIC 4 micrograms/ml). It is also slightly more active than carbenicillin against Pseudomonas spp. (modal MIC 16 micrograms/ml). The regression line relating MICs and disc zone diameters was calculated by the least square method. The correlation coefficient was 0.85.

Two cases of epidermoid cyst of the spleen are reported. A splenectomy was necessary because the topography of the lesions was not consistent with a conservative procedure for this children fourteen and ten years old. The histological criteria and pathogenic hypotheses of this infrequent lesion are analysed. Ultrasonography and eventually computerized tomography bring the best findings concerning the topography and are useful for the surgical treatment. When it is possible, the partial conservation of the spleen is to be wished.

A successfull bone marrow transplant was achieved in a case of post hepatitic aplastic anemia after cyclophosphamide immunosuppression. Caryotype analysis, erythrocytic phenotype and IgG Gm allotype demonstrated evidence of complete chimerism. Anti-thymocyte serum undoubtly was able to suppress a life threatening episode of graft versus host reaction. Severe long lasting skin lesions are now persisting 2 years after the graft.

We studied 64 cases of bacterial endocarditis which required heart surgery for hemodynamic defects and/or failure of the antibiotic therapy. We performed a bacteriologic and histologic investigation of the removed valves. The organisms were evidenced through culture and specific stainings. According to the different organisms we evaluated the best duration of antibiotic therapy to achieved sterilization, and suggest a helpful medical and surgical treatment for the bacterial endocarditis.

Two hundred bacterial septicemia occurring in neutropenic patients (PMN less than 1,000 microliter) were analyzed. Most of these patients had hematologic malignancies. The underlying disease, the degree of neutropenia the association of septic focus with the bacteremia, the responsive microorganisms and their evolution during hospitalization were studied as prognosis factors. The overall mortality was 32.5 p. 100. The mortality was higher in patients whose granulocyte count was lower than 500 microliter. The occurrence of major septic focus (pulmonary, perineal infection, diarrhea with abdominal distension, ORL, or cutaneous extensive focus) during bacteremia was a highly significant factor of bad prognosis. The mortality of bacteremias with and without major septic focus was respectively 62 p. 100 and 15 p. 100. A study of the distribution of the bacterias was performed in terms of mortality and duration of hospitalization. "Escherichia coli" and gram positive cocci were predominant during the two first days and mortality was then low. After that time, others Gram-negative bacterias appeared, especially "Pseudomonas aeruginosa" and the mortality was increasing until the twentieth day. Therefore, the authors raise the opportunity of antibiotic therapy according to the duration between the beginning of the hospitalization and the occurrence of sepsis in neutropenic patients. The role of the extensive use of a curative antibiotic association using colistine and nalidixic acid between 1974 and 1976 is discussed in the emergence of more gram positive cocci bacteremias between 1976 and 1978 than between 1974 and 1976 in the same intensive care unit.

The authors report 10 cases of ante-natally diagnosed ovarian cysts. Ultrasonography greatly contributed to the diagnosis of this condition rarely described before. These cysts are usually follicular cysts. Physiopathological explanation still remain unclear: excessive fetal gonadotrope activity, enzymatic abnormality of the theca interna, abnormal stimulation by the mother's HCG are the main hypothesis. Ultrasonographic prenatal diagnosis is based on the discovery of an intra-abdominal round liquid area in a female fetus with normal kidneys and bladder. Obstetrical management is very simple: observation and vaginal delivery. After birth, diagnosis is assessed by clinical examination and ultrasonography which may be able to recognize a possible torsion (intracystic fluid septation). Treatment is conditioned by two facts: first these cysts are usually follicular benign lesions, second there is a high risk of complications, mainly torsion or rupture. Non-operative treatment and observation can be justified for very small cysts which have low risk of torsion. Laparotomy confirms the diagnosis: regarding non complicated cysts, surgery must be as conservative as possible: cystectomy is often feasible, leaving a laminated but functional ovary. Percutaneous puncture under ultrasonography could be considered.

Dibekacin is a new aminoglycoside derived semi-synthetically from kanamycin B. Its in vitro antibacterial activity, evaluated by the study of 43 reference strains and 1,177 clinical isolates, was found to be very similar to that of gentamicin, tobramycin, sisomicin and netilmicin on strains sensitive to these aminoglycosides; in the case of strains carrying plasmidic resistance factors, dibekacin behaves like tobramycin; it is inactivated by the same bacterial enzymes.

The in vitro action of hydro-alcoholic extracts of plants from Ivory Coast pharmacopoeia was analyzed on cultured rat pituitary cells. Cells were treated for 24 hours with various doses of extracts and then stimulated for 4 hours with 10(-8) M LHRH. Extracts from Afrormosia laxiflora, Cola nitida, Pterocarpus erinaceus and Tetrapleura tetraptera inhibit the LHRH-induced release of LH. On the contrary, extract from Combretodendron africanum stimulates the basal release of LH and this increase is added to the LHRH-induced release. Therefore, the natural substances contained in these plants may in vitro exert a regulation of the gonadotropin release.

Nosocomial septicemias supervened during the 15 trimesters following the opening of a new built critical care unit were reviewed. During the five first trimesters the incidence of nosocomial septicemias was 5.9 p.cent. It increases to 10.7 p.cent (p smaller than 0.001) during the five following trimesters. Then a drastic restriction in antibiotic administration was performed, including withdrawal of any prophylactic antibiotherapy, preferential use of penicilline G to prevent infection by Clostridium and cocci Gram positive species surinfection, and, in case of bacterial proved infection, use of a narrow spectrum adapted antibiotic for a time as short as possible. During the 5 trimesters following the application of this antibiotic restriction, the incidence of nosocomial septicemias dropped to 5.7 p.cent (p smaller than 0.001). This phenomenon was related to the lowered incidence of the Gram negative bacilli septicemias from 11.1 p.cent to 4.8 p.cent (p smaller than 0.001) while the incidence of Gram positive cocci septicemias remained unchanged. These results strongly suggest the responsibility of the overuse of antibiotics in the determination of nosocomial septicemias and the efficiency of a drastic antibiotic restriction upon the surinfection of patients hospitalized in a critical care unit.

The involvement of cyclic adenosine 3'-5' monophosphate (cAMP) in the regulation of human monocyte phagocytosis of staphylococcus aureus in vitro was demonstrated by assay of adenylate cyclase (AC) and cAMP phosphodiesterase (PDE). Phagocytosis was associated with diminished AC activity (p less than 0,05) and concurrently increased PDE activity (p less than 0,005). Transmission electron microscopy provided evidence that these changes coincide with peak phagocytic activity occuring 10-20 minutes after the start of phagocytosis.

The authors describe the extra- and intra-hepatic echographic images of the portal system in the foetus and the adult on the basis of data from literature and their personal experience with angiographic comparisons and investigation of anatomical specimens. The knowledge gained by echography provides the means for a sure approach to systematisation of the liver and thus accurately identifies the site of focal processes (tumour, abscess, etc.) furnishes very useful information in a large number of pathological cases (foetal hypotrophy, portal hypertension, etc.), facilitates diagnostic and therapeutic instrumental exploration and will soon make it possible to carry out haemodynamic studies of the portal system through the addition of pulsed Doppler to the present echographs.

The comparative activity of cefotaxime, cefazolin, cefamandole and cefoxitin was studied on 80 strains of anaerobic bacterial species: 14 Clostridia, 60 Bacteroides fragilis, 6 Peptococcus. The new cephalosporins showed an increase in the in vitro activity against Bacteroides fragilis, but their efficacy was still inferior to that of the 5-nitro-imidazole derivatives.

Recently, strains of Staphylococcus aureus resistant to gentamicin, tobramycin and amikacin have been discovered in several hospitals in France. These new resistances, of two different types, are of plasmid origin and of enzyme mechanism. This study describes their current incidence.