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Actinomycosis is a rare disease and may be discovered at operation. It may produce numberous thoracic or abdominal signs; the diagnosis is very difficult and requires histological examination.

Cefsulodine, a new B-lactamase-resistant cephalosporin, was used parenterally in combination with systemic and topical tobramycin to treat a patient with meningitis and ventriculitis due to Os, aeruginosa. Cefsulodine concentrations were measured simultaneously in serum and in cerebral ventricles. With doses of 500 mg four times a day, diffusion of the drug into meningeal spaces was rather poor, but with doses of 2 grams 8-hourly (100 mg/Kg/day cefsulodine concentrations in the ventricles were equal or superior to the average MICs against most Pseudomonas species. However, concurrent systemic and local administration of an aminoglycoside is required to ensure full bactericidal effect.

A case is reported of subacute carciac failure during the course of a non-obstructive cardiomypathy in an adolescent. When the exacerbation of cardiac failure, which was accompanied by severe arrhythmias, failed to respond to medical treatment, the combination of a veno-arterial bypass and membrane oxygenator with diastolic counter-pressure from an intra-aortic balloon was tried with success. A reasonable remission was obtained by this means, but the young patient died 8 months later from cardiac failure which proved resistant to treatment.

The authors report a case of postoperative arteriovenous fistula between the inferior mesenteric vessels. This fistula was revealed by portal hypertension, with bleeding esophageal varices, ascites, and encephalopathy, and by acute ischemic colitis. Histologic examination of the liver was normal. All of the symptoms disappeared after transcatheter embolization of the fistula with stainless steel coils. This case report favors the reality of the so-called "forward" portal hypertension and suggests that inferior mesenteric arteriovenous fistula might be a factor predisposing to nonocclusive ischemic colitis.

The authors report 5 cases and study the thoracic and abdominal lesions of actinomycosis. This is a rare bacterial disease but not exceptional, discovered usually by chance on operative specimen on autopsy. The clinical and bacteriological diagnosis is very difficult although the lesions are characteristic. Thus it is always necessary to carry out biopsy and seek sulphur granules in the actinomycotic follicle. The differential diagnosis is usually easy with granulomycoses, but it is sometimes more difficult to distinguish the disease from nocardioses.

The authors report a case of special anatomical interest and emphasize the frequency of post-traumatic pancreatitis, the importance of cutaneous and joint manifestations revealing certain pancreatic diseases.

Lyme disease is a systemic bacterial infection involving several organs. Cardiac involvement predominantly consists of disorders of conduction which may be associated with pericarditis, although this rarely occurs. Cardiac lesions in Lyme disease (disorders of conduction, myocarditis, pericarditis) are usually observed during the second stage of the disease. In the two cases reported here, the myocardial and pericardial signs suggested Lyme disease and in view of the context, pointed to the diagnosis.

Primary mycotic aneurysm of the common carotid artery is exceptional. The clinical characteristics are dominated by the absence of a detectable infectious cause, by the macroscopic, nonsuppurative aspect and the sudden increase in volume requiring emergency operation. The treatment of these aneurysms is surgical, but little known owing to the rareness of these cases. Reconstructive surgery gives satisfactory results. Its details are discussed in relation to the operative appearance.

Fluoroquinolones are new synthetic derivatives with a broad spectrum and a potent antibacterial activity this permits to assimilate these molecules as antibiotics. These compounds are characterized by a quinoline or a naphthyridine nucleus with a fluorine atom in position 6 and a piperazine or a pyrrole nucleus in position 7. The combination of their antibacterial properties and the good absorption and tissue distribution allows their use in the treatment of the main infections caused by sensitive strains. The clinical and biological tolerance of these drugs are usually excellent.

Sixty patients including forty two males and eighteen females, age range: 18-87 years, received antibacterial single drug treatment with latamoxef for septicemia. Forty nine patients had underlying conditions including multiple trauma, neoplasm, cardiovascular, metabolic and respiratory tract diseases. Causative pathogens were isolated in all cases. The predominant isolates were E. coli (thirty), Klebsiella pneumoniae (tent) and Enterobacter (seven). A single organism was isolated in fifty seven cases; in the other three cases two organisms were isolated from blood cultures. Mean daily dosage was 46.6 +/- 6.1 mg . kg-1 (range: 14-113 mg . kg-1). In the majority of cases (fifty two) dosage was 3 g . d-1 or less; in thirty cases it was no higher than 2 g . d-1. Duration of therapy ranged from six to thirty eight days. Serum titer was measured in many cases and latamoxef blood levels were assayed in nine patients. A satisfactory clinical response was achieved in fifty eight cases and fifty eight bacteriological cures were also obtained. There was no statistically significant difference in therapeutic response between the 2 g and 3 g daily dosage groups. Tolerance was very good; untoward effects were few and required drug discontinuation in one case only.

Cefmenoxime (SCE 1365), a new broad-spectrum, third generation cephalosporin was used in the treatment of 68 patients with bacteremia. Cefmenoxime was given as monotherapy to 63 patients in a mean daily dosage of 3 g (range: 1 to 6 g). 63 successes were recorded. Results were inconclusive in the remaining five cases. General and biological tolerance of cefmenoxime was excellent.

A retrospective study of the diagnosis and causes of malaise and loss of consciousness has been conducted under the aegis of the French National Society of Internal Medicine. This multicentric and retrospective enquiry, which involved 512 patients, revealed that up to 44% of the malaise had no diagnostic label and that those of known aetiology were frequently due to cardiovascular disorders, such as postural hypotension (11.7%) or arrhythmia (9.5%). The study also demonstrated that the clinical enquiry was more important than complementary examinations which yielded few useful data.

Lyme disease can be divided into three phases; (1) a primary phase where the inconstant erythema migrans predominates; (2) a secondary phase, sometimes revealing the disease, with isolated or associated cutaneous and cardiac signs and articular or neurological manifestations responding to antibiotics, and (3) a tertiary phase with cutaneous, articular and above all neurological signs which are chronic and sometimes severe. A better knowledge of this infection has enabled some rheumatological or neurological manifestations to be explained. Clinicians should be aware of this, since these disorders are amenable to antibiotic therapy. Conversely, multivisceral symptoms should not be ascribed to Lyme disease without strong positive arguments.

In two patients suffering from chronic neurobrucellosis with negative Wright's reaction the diagnosis could be made by other serological methods: complement fixation, demonstration of blocking antibodies by indirect immunofluorescence or Coombs'test. The therapeutic problems raised by chronic neurobrucellosis are discussed.

The authors compared 9 cases of myeloma and 2 cases of Waldenström's disease with 10 cases of benign monoclonal gammapathies. None of the patients (except one) had neurological involvement; one patient hab diabetes. The study was focused on the immunoglobulins and proteins in the CSF. The following observations were made: - The CSF protein was raised in 8 out of the 11 malignant gammopathies and in 5 out of the 10 benign gammopathies; - An identical monoclonal protein was found in the CSF and serum in all the cases of malignant gammopathies. In the cases considered to be benign, the results were less concordant: one IgM lymphoma had normal CSF; three IgG dysglobulinemias had different immunoglobulins proteins in their CSF: - The mean CSF immunoglobulin level was much higher in the myeloma patients than in the benign gammopathies; - A number of findings suggest intrathecal secretion (at least in the malignant gammopathies). This is also true in a good number of the benign gammopathy cases. Direct tumoural invasion of the CSF may be more common than generally supposed. However, the study of CSF immunoglobulins alone does not establish the diagnosis of malignant dysglobulinemia. Nevertheless, the authors consider that the finding of intrathecal secretion of immunoglobulin, especially in patients with a discordance in FAB and FC fractions, should lead to a closer follow-up of these patients.