La Nouvelle presse médicale
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Since it is relatively rare, spontaneous pneumomediastinum is often little known to clinicians. Making the diagnosis, however, presents no problem if the three essential signs are present, that is to say: -subcutaneous emphysema of the base of the neck (7 cases), -Hamman's sign, (6 cases), -a paramediastinal air shadow on chest roentgenograms, (8 cases). ⋯ The principal advantage of making the diagnosis is that it enables one to eliminate other pain-causing thoracic syndromes, especially myocardial infarction, pulmonary embolus and acute pericarditis. The clinical course is usually benign necessitating no treatment.
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Fourteen patients suffering from bacterial endocarditis due to a streptococcus or staphylococcus were treated using a combination of amoxicillin per os in a dose of 1 gram every 2 or 3 hours and gentamicin in a dose of 60 mg intramuscularly every 6 or 8 hours. Two patients failed to tolerate amoxicillin, which had to be replaced by penicillin G. Two others, after a period of improvement, relapsed and were cured by the substitution of penicillin G given intravenously, in place of amoxicillin. ⋯ Bactericidal powers of serum obtained by the combination were satisfactory at between 1/16 to 1/4096 one hour after the administration of the antibiotics. This therapeutic protocol is thus effective, and has the advantage of improving the patient's comfort. It should nevertheless be reserved for use against sensitive organisms in patients without digestive problems, the bactericidal power of the serum being verified.
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In capable hands, measurement of the uterine isthmus in early pregnancy is without danger. Apparent incompetence of the isthmus as determined by examination other than during pregnancy or a previous cervical cerclage do not necessarily represent a formal indication for a cerclage in a subsequent pregnancy. Calibration of the isthmus during pregnancy was carried out in 129 patients who were "candidates" for a cerclage. ⋯ Since beginning this study, the number of cervical cerclages in our department has decreased and we have observed a parallel decrease in premature deliveries, since with the elimination of problems related to the isthmus we have directed our efforts towards other causes of premature labour. Thus we have been led to include calibration of the isthmus in routine examinations in pregnancies occurring on the one hand in women with previous infertility as well as in those in which pregnancy follows a period of involuntary sterility. Calibration reveals early incompetence of the isthmus, making cerclage possible at the appropriate time.