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The epidemiology, risk factors, maternal and neonatal outcomes of nosocomial Pseudomonas aeruginosa acquisition in preterm premature rupture of membranes were analysed. Of 63 women receiving antibiotic prophylaxis with co-amoxiclav, 11 acquired P. aeruginosa vaginal carriage with a median delay of 15 days (6-42) i.e. an incidence of 8.94 per 1000 days of expectant management. Five neonates born to 11 positive mothers were colonized or infected, three of whom died of fulminant sepsis. The duration of antibiotic treatment and multiple pregnancy were identified as independent risk factors. The epidemiological investigation revealed a vertical transmission between mothers and neonates, and suggested selective pressure of antibiotic treatment.

Resume L'attente et l'angoisse des malades et/ou de leur famille peuvent retentir sur le vecu des consultations urgentes. Le degre de satisfaction de tous les consultants d'un departement d'urgences d'un hopital universitaire a ete evalue pendant une periode de sept jours, par une etude prospective a l'aide d'un questionnaire (16 items) remis au patient ou a sa famille. Le ressenti de cette consultation a ete analyse en fonction des delais et des informations medicales fournies aux consultants. Sur 547 consultants 497 ont recu un questionnaire et 351 ont repondu, dont 348 immediatement. Les consultants sont globalement satisfaits (65,6 % tres satisfaits ; 32,1 % assez satisfaits). L'accueil infirmier est mal ressenti par 2,5 % des consultants, l'attente du medecin ou de l'hospitalisation par un malade sur quatre. Le vecu de la consultation est independant de la duree de celle-ci, mais est correle au temps d'attente du medecin (r : 0,509 − p

Resume Cette etude retrospective a pour but de determiner sur une periode d'un an la prevalence des consultants âges (> 65 ans) dans un service d'urgences medicales d'un CHU (23,5 %), leur pourcentage d'admissions immediates (88,4 %), et la prevalence des cas sociaux purs (7 %). L'hypothese selon laquelle la specialisation de plus en plus importante des services medicaux d'un CHU risque d'orienter preferentiellement ces patients âges vers le service Porte et d'y induire une hospitalisation prolongee, n'a pas ete confirmee. En effet, 63,2 % des patients âges ont ete admis directement dans les services de specialite, avec une bonne adequation motif — lieu d'hospitalisation (56,5 % des malades cardiologiques admis en cardiologie). En cas de diagnostic mal defini (malaise, alteration de l'etat general) ou de pathologie dependant d'une specialite non representee dans l'etablissement, l'admission se fait preferentiellement vers le service Porte ou la duree moyenne de sejour des malades de plus de 65 ans (32,8 % des hospitalises) (2,5 ± 1,7 jours) depasse d'un jour celle des sujets plus jeunes (p

Resume Les auteurs rapportent un cas complexe associant une leucemie lymphoide chronique, un leiomyoblastome digestif et une vascularite cutanee thrombosante avec anticorps anticardiolipine serique faisant discuter un nouveau mecanisme physiopathogenique des vascularites au cours des hemopathies.

An hemophagocytic syndrome occured in 3 patients with active Lupus Erythematosus. None of them exhibited any evidence of infectious pathology. Steroid therapy was effective. Relapse was observed in 2 patients and again resolved under steroid therapy. Moderate levels of TNF were observed in the 3 patients. Lupus must be considered as a possible cause of hemophagocytic syndrome in the absence of underlying infection.

Eclampsia and preeclampsia are still a frightening diagnosis for mothers and infants. We retrospectively studied the vascular and obstetrical prognosis in 55 pregnant women hospitalized for eclampsia or preeclampsia in an intensive care unit. Permanent hypertension persisted in 29% women after delivery. Gravidic hypertension reccure in 28% of subsequent pregnancies. There were no differences between the groups of eclamptic and preeclamptic women.

HELLP syndrome is a severe complication of gravidic arterial hypertension. We retrospectively studied prognostic factors of 87 eclampsia or preeclampsia with or without HELLP syndrome. The HELLP syndrome is an important factor of prognosis in gravidic hypertension.

The association between thrombocytopenic thrombotic purpura (TTP) and infectious or multisystem disease, pregnancy, transplantation, drugs and toxins is well known. The onset of TTP in the course of neoplasm is rarely described : only 7 cases have been reported (5 cases of gastric adenocarcinoma, 1 case of breast carcinoma and 1 case of carcinoma with unknown primary site). The authors report the first case of TTP associated with prostatic tumor.

Plasma linoleic acid levels were found to be low in the atherosclerosis patients investigated. In contrast, platelet arachidonic acid levels were decreased only when atherosclerosis was combined with diabetes or mixed hyperlipidemia. In acute vascular thrombosis, a marked decrease in platelet arachidonic levels occurrrd, irrespective of whether the patient had atherosclerosis or not.