Volume 1995, No. 5 March 15, 1995
Identifieur interne : 002704 ( Istex/Corpus ); précédent : 002703; suivant : 002705Volume 1995, No. 5 March 15, 1995
Auteurs :Source :
- Clin-Alert [ 0069-4770 ] ; 1995-01.
English descriptors
- Teeft :
- Anterior scalene muscle, Authors state, Authors stress, Carcinoma, Cardiac arrest, Cardiorespiratory arrest, Chemotherapy, Cutaneous, Cutaneous lesions, Cyanide poisoning, Cyproterone acetate, Daily cyclophosphamide, Depressive symptoms, Further seizures, Hepatocellular carcinoma, Home care nurse, Hospital admission, Hyaline membrane disease, Interstitial pneumonia, Intravenous, Intravenous administration, Lesion, Malpractice verdicts settlements experts, Massive brain damage, Methohexital anesthesia, Methotrexate, Pheochromocytoma, Poststenotic dilatation, Potassium chloride, Radical mastectomy, Renal artery, Resident doctor, Residual thrombus, Rheumatoid arthritis, Sodium bicarbonate, Subacute cutaneous lupus erythematosus, Subclavian, Subclavian artery, Urokinase therapy, Water intoxication.
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DOI: 10.1177/006947709503300105
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ISTEX:8FCDCD34714DA43F1FD7D8F41CD9DD25BC99B814Le document en format XML
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<publisher-name>Sage Publications</publisher-name>
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</publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.1177/006947709503300105</article-id><article-id pub-id-type="publisher-id">10.1177_006947709503300105</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Volume 1995, No. 5 March 15, 1995</article-title></title-group><pub-date pub-type="ppub"><month>1</month><year>1995</year></pub-date><volume>33</volume><issue>1</issue><fpage>33</fpage><lpage>40</lpage><custom-meta-wrap><custom-meta xlink:type="simple"><meta-name>sagemeta-type</meta-name><meta-value>Journal Article</meta-value></custom-meta><custom-meta xlink:type="simple"><meta-name>search-text</meta-name><meta-value>33 Volume 1995, No. 5 March 15, 1995 SAGE Publications, Inc.1995DOI: 10.1177/006947709503300105 No. 53 METHOHEXITAL ANESTHESIA AND PAROXETINE Spontaneous Seizure A 42-year-old woman, with a 2-year history of sustained depressive symptoms resistant to therapy was admitted to the hospital. She underwent six electroconvulsive therapies (ECTS) which produced an impressive improvement in her clinical findings. A second ECT series was started after renewed deterioration in the patient's depressive symptoms. There were no problems with the first five ECTs in this series. As in the first series, all anesthetizing was performed with methohexital 1 to 1.5 mg/kg and succinylcholine. In contrast to the first six ECTs, in this second ECT series the patient continued to receive paroxetine 40 mg daily because of her sustained suicidal tendency. The sixth ECT of the second series was started and immediately after intravenous administration of 120 mg of methohexital, but before succinylcholine administration or electrical stimulation, the patient suffered a 61-second generalized tonic-clonic seizure. The seizure was documented in the running bifrontalmastoid two-channel electroencephalogram (EEG). The EEG taken immediately afterward showed a moderate generalized slowing with individual, diffusely scattered, sharp slow wave complexes. Myoclonus persisted in the facial area and in the arm for several hours before being brought under control with clonazepam. Four weeks later, the patient was given three more ECTs, during which propofol was added to the two previous anesthesias; no further seizures occurred. The author states that paroxetine should be given with caution, at least to predisposed patients, during an ECT series or methohexital anesthesia.- Methohexital ['Brevital'] Folkerts H (Klinik fur Psychiatrie der Westfalischen Wilhelms-Universitat Munster Albert-Schweitzer Str. 11, 48149 Munster Germany) Spontaneous seizure after concurrent use of methohexital anesthesia for electroconvulsive therapy and paroxetine: A case report. J Nerv & Mental Dis 183:115-116 (Feb) 1995 34 No. 54 IODINE Hyperthyroidism In A Newborn \ Grunting and retractions with central cyanosis were noted in a newborn infant. An echocardiogram showed severe pulmonary stenosis with tricuspid insufficiency and a patent ductus arteriosus. The infant underwent surgical correction with a pulmonary valvectomy and right ventricular outflow tract reconstruction. Twelve days later, a purulent discharge was present in the superior end of the sternotomy incision; the patient underwent surgical debridement with primary closure and placement of mediastinal drains. The mediastinum was irrigated with full-strength povidone-iodine (10 per cent) at 3 ml/hour for 4 days. The solution was then changed to a 1:20 dilution of povidone-iodine at 3 ml/hour for an additional 24 hours. The patient received a total of 288 ml of povidone-iodine, or 28.8 g of iodine. Thyroid function status was studied and the patient was found to be biochemically hyperthyroid, with a markedly elevated total and free T4 and a normal T3 indicating T4 toxicosis. Hyperthyroidism resolved over 1 month after stopping iodine treatment. The authors state that while hypothyroidism is a common result of neonatal iodine excess, hyperthyroidism may occur, possibly primarily in cases of marked iodine excess.- Bryant WP & Zimmerman D (layo Clin 200 First St SW Rochester MN 55905 . [Dr Zimmerman]) Iodine-induced hyperthyroidism in a newborn. Pediat 95:434-436 (Mar) 1995 No. 55 TOPICAL CORTICOSTEROID OINTMENTS Cataracts . Glaucoma . Femoral Avascular Necrosis For approximately 5 years, a 30-year-old man had been treated continuously with various corticosteroid ointments for discoid eczema on his face, chest, and arms. He was referred to the ophthalmology department for treatment of a chalazion. He stated that his vision was blurred and that he often noticed haloes around lights. His corrected visual acuities were 6/9 right eye and 6/12 left eye. He had cataracts in both eyes. Intraocular pressure was 40 mmHg in both eyes; timolol drops were prescribed. He underwent successful cataract operations to both eyes with postoperative visual acuities of 6/6 in both eyes. Approximately 1 year later the patient was referred to an orthopedic surgeon with a 4-month history of a painful left hip. A diagnosis of steroid- induced femoral avascular necrosis was made, which to date, had been managed conservatively. The authors state that although there are warnings that corticosteroid tablets and eye drops can cause cataracts and glaucoma, there is no specific warning that topical steroid ointments may cause these side-effects also.- Clean CJ et al (Dept Ophthalmol Univ College London Hosps London WC1E 6AU UK) Cataracts glaucoma and femoral avascular necrosis caused by topical corticosteroid ointment. Lancet 345:330 (Feb 4) 1995 35 Neo. 56 METHOTREXATE Interstitial Pneumonia A 50-year-old woman with a 5-year history of severe seropositive rheumatoid arthritis was started on low-dose parenteral methotrexate 15 mg weekly. Her condition improved while taking methotrexate and after 4 weeks the dosage was reduced to 10 mg weekly. Five months after starting methotrexate therapy and at a cumulative dose of 230 mg, the patient presented with cutaneous eruptions on both hands, stomatitis, persistent nonproductive cough, increasing shortness of breath during exercise, mild cholestasis on liver function tests, and chronic gastritis. Chest x-ray examination showed interstitial pulmonary infiltrates and bilateral pleural densities at the base of both lungs. Findings on bronchoalveolar lavage fluid analysis were consistent with recent interstitial pneumonia. Cytomegalovirus was directly isolated from bronchial washings. Following an initial impression of methotrexate-induced pneumonitis, the drug was discontinued. At follow-up 12 months later, the patient remained well, taking low-dose prednisolone, ibuprofen, and chloroquine phosphate. The authors stress that discontinuation of methotrexate is most important in managing interstitial pneumonia caused by cytomegalovirus following low-dose weekly methotrexate in patients with rheumatoid arthritis.- Methotrexate ['Folex,' 'Mexate*] ] Aglas F et al (Karl Franzens Univ Graz Austria) Interstitial pneumonia due to cytomegalovirus following low-dose methotrexate treatment for rheumatoid arthritis. Arth & Rheum 38:291-292 (Feb) 1995 No. 57 NEBULIZED TRIBAVIRIN Water Intoxication Acute rhinitis followed by cough, wheezing, dyspnea, and fever prompted admission of a 6-week-old girl to the hospital. Respiratory syncytial virus (RSV) was suspected and the infant was treated with tribavirin nebulized in distilled water (6 g in 100 ml distilled water 4 times daily). Convulsions occurred on the second day of treatment. Apnea also occurred and the infant was treated appropriately. The infant was edematous and hypotonic without any spontaneous breathing. Serum electrolytes were in the abnormal range. Because there was no indication for inappropriate secretion of antidiuretic hormone, water intoxication was suspected. The infant was treated with fluid restriction and intravenous administration of extra sodium. The sodium level began to rise and after 24 hours was normal. The infant recovered completely within 48 hours. The authors usggest that electrolyte values be monitored closely in all infants who receive nebulized tribavirin.- Tribavirin ('Ribavirin') Van Bever HP et al (Dept Paediat Univ Hosp Antwerp 2650 Edegem Antwerp Belgium) Water intoxication after nebulised tribavirin. Lancet 345:451 (Feb 18) 1995 36 No. 58 CHEMOTHERAPY Thromboembolism Patient 1: A 25-year-old woman presented with ischemia of the right arm of 30 hours' duration. Four months previously she had undergone left-sided modified radical mastectomy for intraductal carcinoma. She received adjuvant chemotherapy consisting of daily cyclophosphamide and tamoxifen citrate with monthly methotrexate sodium and fluorouracil. She had completed 35 days of oral therapy and, the week before admission, had started her third cycle of intravenous methotrexate and fluorouracil. An arteriography showed stenosis of the midsection of the right subclavian artery, with poststenotic dilatation and brachial artery obstruction. Intra-arterial urokinase therapy was administered and resulted in dissolution of the thrombus. After receiving heparin sodium the patient was taken to surgery where the subclavian artery was opened into the area of poststenotic dilatation; no residual thrombus or intrinsic fibrous stenosis was found, and the artery was closed primarily. Chemotherapy was discontinued and the patient treated with warfarin sodium for 3 months. Patient 2: A 51-year-old woman presented with recurrent ischemia of the left fifth finger. She had under left breast lumpectomy seven months previously for poorly differentiated carcinoma. She had completed radiation therapy and had started chemotherapy consisting of daily cyclophosphamide and tamoxifen and cyclic intravenous methotrexate and fluorouracil. She presented 5 days following the fourth cycle. Angiography showed left-sided stenosis of the subclavian artery in the region of the anterior scalene muscle and complete occlusion of the ulmar artery. Intra-arterial urokinase therapy resulted in disobliteration of the ulnar artery and hand. At surgery, residual thrombus just proximal to the stenotic region necessitated thrombectomy, followed by vein patch closure. Chemotherapy was not re-started; she was .treated with warfarin anticoagulation therapy for 3 months. Recovery was uneventful. Patient 3: A 52-year-old woman presented with abrupt digital ischemia of the left hand. Eight years previously, the patient had undergone modified radical mastectomy for infiltrating ductal carcinoma of the left breast. She was treated with doxorubicin hydrochloride, and cyclophosphamide, followed by radiation. One month previous to hospital admission, a pleural effusion developed, and the patient was given daily cyclophosphamide followed by a single dose of methotrexate and fluorouracil 7 days before admission. An arteriogram showed stenosis of the lateral portion of the left subclavian artery with occlusion of two digital arteries. Intra-arterial urokinase improved the subclavian lesion and restored flow to the fingers. At surgery, the anterior scalene muscle was divided, releasing the subclavian artery. Palliative chemotherapy was re-instituted without difficulty. Cyclophosphamide ('Cytoxan') ' Doxorubicin ('Adriamycin') Tamoxifen ['Nolvadex'] Methotrexate ['Folex,' 'Mexate'] Fluorouracil ['Adrucil,' 'Efudex'] Donaldson FIC & Whittemore AD (Brigham & Women's Hosp 75 Francis St Boston MA 02115) Thromboembolism from occult subclavian arterial stenosis during chemotherapy for breast carcinoma. Arch Surg 130:224-226 (Feb) 1995 37 No. 59 CILAZAPRIL Subacute Cutaneous Lupus Erythematosus A 64-year-old woman developed symptomless skin lesions on her face, upper trunk, and extensor surfaces of her arms 1 month after starting treatment with captopril for hypertension. The lesions persisted for 5 months at which time her physician withdrew captopril; her cutaneous lesions disappeared within 2 weeks. Cilazapril 5 mg daily was prescribed 2 weeks later. The patient noticed a facial rash, similar to the one previously described. The rash worsened with exposure to the sun and lasted over 5 months. She was referred to the dermatology unit where skin examination showed fine scaling erythematous papules over her forehead and cheeks. A skin biopsy specimen from a lesion confirmed the diagnosis of subacute cutaneous lupus erythematosus. Cilazapril was discontinued and within 2 weeks the skin lesions had cleared. The patient remained free from cutaneous lesions six months later; however, the positive anti-Ro antibodies still persisted. The authors speculate that angiotensin-converting enzyme inhibitors might stimulate anti-Ro/skin-sensitizing antibodies to produce subacute cutaneous lupus erythematosus in genetically predisposed individuals.- Fernandez-Diaz ML et al (Servicio de Dermatologia Hospital La Paz P Castellana 261 28046 Madrid Spain) Subacute cutaneous lupus erythematosus associated with cilazapril. Lancet 345:398 (Feb 11) 1995 No. 60 SODIUM NITROPRUSSIDE Cardiorespiratory Arrest . Brain Damage . Quadriplegia Legal Action The patient was hospitalized for renal artery bypass surgery. During recovery the patient received intravenous sodium nitroprusside (SNP) for blood pressure control. On the third postoperative day, the patient suffered a cardiorespiratory arrest, resulting in massive brain damage, quadriplegia, blindness, and bowel and bladder incontinence. Each molecule of SNP is 44 per cent cyanide by weight and the plaintiff contended that the patient's injuries were caused by cyanide poisoning, resulting from over-administration of SNP. The defendant laboratory, the manufacturer of SNP, has since been required by the FDA to change its package insert to reflect the hazards of giving the drug because of the risk of cyanide poisoning. The parties settled for $1.3 million.- John D. Breen for Irene C. Breen v. Anonymous Physicians and Abbott Laboratories, Hennepin County (MN) District Court No. MP 91-016908. Administration of sodium nitroprusside (SNP) to control post-operative blood pressure blamed for cardiorespiratory arrest, brain damage, and quadriplegia after renal artery bypass - Cyanide poisoning from SNP alleged - Manufacturer Abbott Laboratories settles for $1.3 million, is forced to change package insert. Med Malpractice Verdicts Settlements & Experts 11:13-14 (Feb) 1995 38 No. 61 BETA-ADRENERGIC-BLOCKERS Danger In Patients With Pheochromocytoma Patient 1: A 66-year-old woman with a confirmed left adrenal pheochromocytoma was referred for operation. She was also prescribed a delayed-release formulation of propranolol for hypertension as an out-patient. Within 24 hours of taking propranolol, the patient developed severe night sweats, vomiting, and abdominal pain. After 48 hours the patient had collapsed; however, the family continued to administer the propranolol. After 72 hours, the patient was delirious and was admitted to the hospital. She was cold, clammy, and confused; her blood pressure (BP) varied between 150/90 and 230/140 mmHg. An electrocardiogram (EKG) showed a pattern compatible with myocardial infarction. She was immediately treated for pheochromocytoma crisis with alpha-adrenoceptor blocking agents; her condition continued to deteriorate and within 48 hours of admission she had sudden loss of consciousness associated with a dense right hemiplegia. She never fully regained consciousness and eventually died of a nosocomial infection. Patient 2: A 37-year-old man had received antihypertensive treatment for 6 years, most recently with atenolol 50 mg daily and nifedipine 40 mg daily. He had had several episodes of palpitations, anxiety, and headaches while taking these medications. On examination, his BP was 180/80 mmHg. During the second day of hospital admission an episode of chest pain occurred with T-wave inversion on the EKG. His BP was 220/120 mmHg. An infusion of labetalol was started; five minutes later the patient's BP was 230/130 mmHg and he suffered a grand mal seizure. A pheochromocytoma was suspected and labetalol was discontinued and the patient was treated conservatively. His BP became well controlled and he did not experience any further seizures. A CT scan showed a 6-cm left adrenal mass which was resected and confirmed histologically to be a pheochromocytoma. Two years after operation the patient remains normotensive and requires no medication. The authors stress that while beta-blockers do play a role in the management of pheochromocytomas, they should be used only after full alpha-adrenoceptor blockade. Pheochromocytomas are rare, and propranolol is a widely used, cheap, and effective drug for treating essential hypertension. However, if a patient deteriorates after starting a beta-adrenergic blocker, the drug should be discontinued and the patient tested immediately. If a pheochromocytoma is diagnosed, a beta-blocking drug should only be given after full alpha-adrenoreceptor blockade.- Atenolol ['Tenormin'] L~betalol ['Trandate'] Nifedipine ['Adalat,' 'Procardia'] ] ~~ Propranolol ['Inderal'] Sheaves R et al (Dept Endocrinol St Bartholomew's Hosp London EC1A 7BE UK) The dangers of unopposed beta-adrenergic blockade in phaeochromo- cytoma. Postgrad Med J 71:58-60 (Jan) 1995 39 No. 62 SODIUM BICARBONATE Massive Hemorrhages . Hypoxia . Brain Damage Legal Action The infant plaintiff was born prematurely at thirty-one weeks' gestation. The defendant pediatrician confirmed development of hyaline membrane disease at the age of one hour. Serial blood gases showed moderate respiratory acidosis ; the defendant doctor administered sodium bicarbonate by intravenous push. At the age of three hours the plaintiff's temperature was 930, and she experienced an episode of bradycardia at three and a half hours. She suffered a bilateral pulmonary hemorrhage, and resulting hypoxia. A CAT scan showed a massive bilateral intraventricular hemorrhage. The plaintiff suffered massive brain damage, resulting in mental retardation, spastic quadriplegia, and seizure disorder. The plaintiff's mother claimed that the child's pulmonary and intraventricular hemorrhages were caused by the stress of the episode of hypothermia, the failure to use intubation and mechanical ventilation to maintain adequate blood gases, and the excessive use of sodium bicarbonate to counteract acidosis. The defendant hospital settled for $20,000.- Kathleen Smith, m/n/g of Allison Smith, Infant v. Good Samaritan Hospital and Stanley Oransky, M.D. Rockland County (NY) Supreme Court, Index No. 3215/84. Hyaline membrane disease in infant born prematurely in New York Hospital - Bradycardia follows hypothermia and use of sodium bicarbonate for respiratory acidosis - Child suffers massive hemorrhages, hypoxia, brain damage - $20,000 settlement with hospital - Defense verdict for pediatrician. Med Malpractice Verdicts Settlements & Experts 11:26 (Feb) 1995 No. 63 CYPROTERONE ACETATE AND ETHINYL ESTRADIOL Hepatocellular Carcinoma A 45-year-old woman who had taken the combination of ethinyl estradiol and cyproterone acetate throughout the past 14 years for contraception, was to undergo elective varicose vein stripping. During a premedication consultation with the anesthesiologist, hepatomegaly was detected. She was admitted to the hospital; abnormal liver function test values were noted. Sonography and computed tomography showed a multinodular tumor in the right liver lobe. Laparotomy showed, in addition to this tumor, two nodules in the left lobe identified histologically as hepatocellular carcinoma. The patient was treated with various anti-tumor medications; however, the tumor continued to progress and the patient died. The authors believe that further preclinical and epidemiological studies are needed to clarify potential associations between hepatocellular carcinoma and the use of cyproterone acetate.- Ethinyl Estradiol ['Feminone,' 'Menolyn,' 'Ovogyn'] Rudiger T et al (Fed Inst Drugs & Med Devices D-13353 Berlin Germany; Oncol Faculty Clin Med Univ Heidelberg & Clin Centre Mannheim) Hepatocellular carcinoma after treatment with cyproterone acetate combined with ethinyloestradiol. Lancet 345:452-453 (Feb 18) 1995 40 No. 64 POTASSIU}1 CHLORIDE . Overdose . Cardiac Arrest . Death Legal Action The plaintiff was a premature infant who had been hospitalized in a level 3 neonatal intensive care unit since birth. At the present time he was nine months old and had bronchopulmonary dysplasia. His heart rate dropped and he was placed back on a ventilator. He had a seizure that same day; he was treated with diazepam and phenobarbital. That night the plaintiff's potassium level had dropped below normal limits. The defendant nurse notified the resident doctor, received an order for 2 mEq of potassium chloride and gave the medication by intravenous push. The resident doctor ordered an additional . 3 mEq of potassium very early the next morning, to be given by intravenous bolus. The nurse, however, inadvertantly gave the plaintiff 12 mEq; the infant went into cardiac arrest within an hour. Vital signs were re-established almost 50 minutes later. The child exhibited extreme brain damage and remained in a persistent vegetative state. A potassium blood level drawn almost two hours after the overdose of potassium chloride showed an abnormally elevated level. It was also learned that potassium chloride was not on the hospital's list of drugs that could be given intravenously by nurses. The child was taken home; a few days before a settlement draft was delivered to the plaintiff's parents, the child, then six years old, had a cardiac arrest while under the care of a home care nurse. Autopsy showed that the child died from a blocked airway. A suit against the home care agency and home care nurse has been filed.' Jesse Ballon v. St. Joseph Hospital and Janet Reyes, R.N., Passaic County (NJ) Superior Court, Case No. PAS-L-3271-90. Neonatal nurse gives overdose of potassium chloride to infant - Cardiac arrest with resuscitation fifty minutes later - Hospital's nurses were not authorized to give potassium chloride intravenously - Child dies just after $2.75 million settlement for more negligence. Med Malpractice Verdicts Settlements & ' Experts 11:18-19 (Feb) 1995 Correspondence To: Clin-Alcrt, Inc., 143 Old Marlton Pike, Medford, NJ 08055. Phone: (609) 654-6266. i Photocopy Permission: Where necessary, permission is granted by Clin-Aiert, Inc. for libraries and others registered with the Copyright Clearance Center (CCC), 21 Congress St., Salem, MA 01970, to photocopy articles herein for the fee of $2.00 per copy of each page. Payment should be sent direct to CCC with a photocopy of the page copied. Copying prohibited. Special requests should be addressed to the publisher. ISSN 0(~9-4770J83 $2.00 per page.</meta-value></custom-meta></custom-meta-wrap></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Volume 1995, No. 5 March 15, 1995</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Volume 1995, No. 5 March 15, 1995</title></titleInfo><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>Sage Publications</publisher><place><placeTerm type="text">Sage CA: Thousand Oaks, CA</placeTerm></place><dateIssued encoding="w3cdtf">1995-01</dateIssued><copyrightDate encoding="w3cdtf">1995</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><relatedItem type="host"><titleInfo><title>Clin-Alert</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><identifier type="ISSN">0069-4770</identifier><identifier type="eISSN">1530-812X</identifier><identifier type="PublisherID">CLA</identifier><identifier type="PublisherID-hwp">spcla</identifier><part><date>1995</date><detail type="volume"><caption>vol.</caption><number>33</number></detail><detail type="issue"><caption>no.</caption><number>1</number></detail><extent unit="pages"><start>33</start><end>40</end></extent></part></relatedItem><identifier type="istex">8FCDCD34714DA43F1FD7D8F41CD9DD25BC99B814</identifier><identifier type="ark">ark:/67375/M70-9DQFC7G4-9</identifier><identifier type="DOI">10.1177/006947709503300105</identifier><identifier type="ArticleID">10.1177_006947709503300105</identifier><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-0J1N7DQT-B">sage</recordContentSource></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/ark:/67375/M70-9DQFC7G4-9/record.json</uri></json:item></metadata><author></author><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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