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Incontinence is anything that inhibits the expression of sexuality. Male problems like premature ejaculation and erectile dysfunctions are forms of incontinence. The inability to retain ejaculation or maintain erection long enough to give pleasure to the partner generates feelings of shame and guilt which weaken virility. Feminine sexual dysfunctions like loss of desire, anorgasmia and vaginismus are results of excessive continence due to negative familial and religious education, moral and social values. The sexologist's task is first to find out the origins of the sexual trouble then to propose an adequate treatment.

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It is not easy for physicians to investigate genuinely sexual problems because of our personal conceptions about sex related to our familial and religious upbringing. Lack of medical education or information and bad personal experiences inhibit us from speaking freely with our patients. And they, before daring to talk to us about a sexual problem, must already be suffering from severely handicapped relations. Being able to explore in details what causes them problem, to investigate if there is a real sexual dysfunction and how it occurs, will help patients a great deal by providing them a precise diagnosis. We must therefore determine whether the sexual problem is the symptom of a somatic or a psychiatric disease, or a secondary effect of a medication or a drug, before identifying it as a psychosomatic or emotional dysfunction.

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Unemployment is a severe problem in Europe since 1980-1990, which is not only economic but also social and medical. European studies show that morbidity and mortality rates of unemployed persons and their families are consequently higher than in the general population. The longest the unemployment period, the more you troubles in physical and psychological health. Depression and psychosomatic trouble are the most frequently observed, secondary to stress, emotional perturbations and psychological burn-out. It is necessary to develop information and prevention strategies to identify sick unemployed persons, to treat them early to help them to recover their health and to try to reduce socioeconomics costs, pain and sicknesses in this specific fragile population. We should also try to inform public opinion and reach all the professionals concerned by unemployment to work together and look for the best solutions to this medical, psychological, social and economical problem.

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The authors report a new case of respiratory distress syndrome which occurred as complication of varicella in an otherwise healthy adult patient. The case is well documented by images and immunological studies which are discussed in the light of recently published data.

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A case of malignant phaeochromocytoma is reported. Computerized tomography and scintigraphy using metaiodobenzylguanidine localized the tumour and metastases. The anesthetic management included invasive monitoring of pulmonary pressures with a Swan-Ganz catheter and arterial pressure with a radial arterial cannula. Plasma catecholamine concentrations were measured before and during adrenalectomy and resection of a metastatic lesion on the fourth right rib. Induction of anaesthesia was carried out with droperidol, phenoperidine, thiopentone and pancuronium. After intravenous administration of droperidol, blood pressure increased together with the heart rate, vascular resistances and pulmonary pressure, whilst cardiac output decreased. Plasma noradrenaline levels were also greatly increased at the same time. The mechanism of this paradoxic pressor effect of droperidol is discussed.

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Eleven patients, between 70 and 85 years old, with acoustic neurinoma, were operated by translabyrinthic approach. The size of the tumor was between 2 and 4 cm in five cases, 4 cm or more in six cases. Complete tumor removal was possible in six cases (55%), in five cases (45%) residual tumor was left behind. Complications included cerebrospinal fluid leakage (2 cases), meningitis (1 case), and hemorrhage (1 case, fatal four days later). Anesthetic management is described.

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This study describes our experience from 1960 onwards of 222 patients suffering from terminal chronic respiratory failure; we report our results of domiciliary mechanical ventilation for 11-17 hours per day using tracheotomy. The method was easy to use at home at a reasonable cost and was far less than in a medical environment. The results were excellent both for length of survival and quality of life for all cases where respiratory failure was due to chest wall problems (neurological, muscular or restrictive syndromes due to chest deformity). The majority of cases were sequelae of polio, myopathies, kyphoscoliosis or tuberculosis. The results were less good for patients with intrinsic pulmonary disease such as chronic airflow obstruction; for this the superiority of mechanical ventilation compared to long term oxygen therapy is not proven. The results were very poor for patients suffering from bronchial dilatation. However, a positive correlation between the efficacy of the method and the duration of a normal PaO2 during a 24 hour period seemed to exist, both during periods of mechanical ventilation and weaning from the machine.

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With 200 patients during the last 15 years the daily use of apparatus and supervision modalities, as described in the present work, has shown that H.A.V. is entirely possible in tracheostomized C.R.I. patients. Rather strict conditions must be respected (as with hemodialysis at home) if H.A.V. is to be medically and materially successful. The expenses involved can vary greatly according to the medical and material management (choice of study material, economic maintenance, minimal oxygen consumption through proper adjustment...). Finally, the use of assisted ventilation requires a choice amont several adjustment possibilities which are still subject to evolution.

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