Epidémie de dysentérie bacillaire.

An outbreak of bacillary dysentery in 1978 affecting 928 persons, most of whom were living in the village of St-Jacques, PQ, is described. An epidemiologic study suggested the water supply as the source of the infection, and it was established that the water carried by the municipal aqueduct was contaminated by feces containing the causal agent, Shigella sonnei. This epidemic, the largest mentioned in he Canadian medical literature, demonstrates how contagious this infection is.     

Prévalence d'Aeromonas spp. dans les gastro-entérites de l'enfant.

A selective medium and biochemical tests were used to search for Aeromonas spp. in the stools of 536 children, more than 90% of whom had "gastroenteritis", seen at Sainte-Justine Hospital, Montreal, in June or July 1986. The organism was found in seven children, six of whom had bloody diarrhea. One of the six, a 6 1/2-year-old boy, required intravenous alimentation and later manifested ulcerative colitis; the other five recovered. The remaining child, a 14-year-old boy, had synovitis of the knee and spondylarthritis. Two of the seven carried other enteric pathogens. The authors discuss the pathogenicity of Aeromonas spp., which is not very marked in temperate climates, in human summer diarrhea and its possible role in the development of ulcerative colitis.     

Epididymite,M. S. T. et Fertilité

Before the antibiotic’s era, the clinicians have shown the relation between epididymitis and Infertility. At the moment, venerial diseases are the principal cause of Epididymitis by the young man. The early diagnosis of the urethral infection (acute or not) associated with a suitable antibiotherapy will allow to protect the fertility.     

Hypoglycémie spontanée et insuffisance rénale chronique.

Although glucose intolerance occurs as a consequence of chronic renal failure, improvement of a diabetic state by deterioration of renal function is a well known phenomenon. Recently occasional cases of spontaneous hypoglycemia in patients with chronic renal failure have been reported; two such cases and the results of metabolic studies are described in this paper. Pituitary, thyroid and adrenal function appeared to be normal. The results of an oral glucose tolerance test were normal; an appropriate insulin response was demonstrated in one patient, and a slightly elevated basal insulin value with a delayed insulin response to oral administration of glucose was demonstrated in the other. An insulin tolerance test did not support the hypothesis of increased insulin sensitivity as a factor, and the growth hormone response to hypoglycemia was normal. An intravenous glucagon test caused a subnormal increase in plasma glucose concentration, and the intravenous administration of tolbutamide produced hypoglycemia without an increase insulin sensitivity as a factor, and the growth hormone response to hypoglycemia was normal. An intravenous glucagon test caused a subnormal increase in plasma glucose concnetration, and the intravenous administration of tolbutamide produced hypoglycemia without an increase in insulin values. The plasma alanine concentration was low and the proinsulin/insulin ratio was increased. The origin of this hypoglycemia is not clear but is probably multifactorial. However, low hepatic glycogen stores and inadequate gluconeogenesis due to substrate deficiency seem to be involved.     

L'éléphantiasis péno-scrotal. A propos d'un cas

Massive scrotal lymphoedema with gross genital deformation is called penoscrotal elephantiasis. It is a rare syndrome outside of filariasis endemic regions. It is usually idiopathic and rarely congenital or secondary. It is both physically disabling and emotionally distressing for the patient. Surgical treatment is often necessary. The authors report a case of a patient with penoscrotal elephantiasis in whom no aetiology could be found. Complete surgical resection of the diseased tissue and scrotum and penile reconstruction were performed with good cosmetic and functional results.     

Psychothérapie des cas difficiles. Perspectives phénoménologiques

The author provides a brief overview of clinical anthropology. To achieve better understanding of clinical anthropology, it is very important to grasp its close relationship with the development of phenomenology, most notably existential analysis. This paper mainly references L. Binswanger, S. Freud, V. von Weizsäcker and J. Schotte, arguing that the anthropological perspective is up to date in the psychotherapy of difficult cases. Four fields of application and a clinical case of a psychotic patient’s replacement of medications by psychotherapy after 30 years of use show how the anthropological perspective can create a new way of looking at pathology, help achieve a better relationship with the patient and revitalise the representation of what we call a clinical fact.