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Syncope is defined as the transient loss of consciousness. It is a somewhat unique diagnosis in that it is typically a symptom with an underlying etiology. Increased length of stay, extensive testing, and specialty referrals contribute to high treatment costs. This is the first reported study to show how a multidisciplinary case management model was utilized to enhance care for patients admitted with syncope. Quality of care was improved through the development of patient education materials and the modification of clinical policy. This effort also resulted in a reduced length of stay with a corresponding cost savings.

The prevalence of Helicobacter pylori infection in Zaire was determined by means of a [14C] urea breath test in 133 asymptomatic subjects, by culture and histological examination of biopsies in 324 consecutive endoscopy patients with chronic epigastric complaints, and by both the breath test and culture/histology in a subset of 92 patients. Sixty healthy Belgian students or hospital laboratory workers were also included for comparison. The prevalence of Helicobacter pylori was significantly higher in asymptomatic Zairian subjects (77.4%) than in the Belgians (30%; p less than 10(-6)). Infection was also acquired much earlier in life in Africans, 66% of the children aged 5 to 9 years already being infected versus none of the Belgian subjects below the age of 20 years. In Zaire, however, the prevalence of Helicobacter pylori in patients with gastroduodenal disorders (87.5%) was similar to that in the group of asymptomatic subjects (77.5%) after adjustment for age and other epidemiological parameters (gender, place of residency, education level, smoking and drinking habits) in a multivariate analysis. The high rate of acquisition of Helicobacter pylori infection in Zaire emphasizes the need to consider the baseline prevalence of Helicobacter pylori in a defined population when studying its association with various diseases.

Perforation of the thoracic oesophagus sets a difficult surgical challenge because suture and drainage are rarely sufficient by themselves. The authors describe two artifices likely to help in such circumstances: endothoracic fundo-plicatio and pediculated flap of the greater omentum. Their use in 4 clinical cases is reported.

Isolated rupture and thrombosis of the renal artery is a rare form of traumatic injury : two cases are added by the authors to the seventy reports found in the English and French literature. Clinical signs calling for the diagnosis like hematuria or high blood pressure may be absent. To make an early diagnosis, every patient suffering from acute blunt trauma of the abdomen should be submitted immediately to intravenous urography. Angiography should follow immediately when no secretion is produced on one or both sides. If a lesion of the renal artery is discovered, surgical repair can be attempted when the delay does not exceed 12 to 24 hours from the time of the accident. The best technical modalities include segmental resection with thrombectomy, aortorenal by-pass or eventually renal autotransplantation.