[Comparative serologic proteome analysis of Staphylococcus aureus and S. epidermidis exoproteins in prosthetic joint infections]. / Analyse immunoprotéomique comparative des sécrétomes de souches de Staphylococcus aureus et S. epidermidis chez les patients souffrant d'infections sur prothèses articulaires.

AIM OF THE STUDY: Staphylococci such as Staphylococcus aureus and S. epidermidis are the most frequently pathogens associated to prosthesis joint infections (PJI), counting for 75% among the isolated bacteria. In this study, we identified PJI-related antigens using two-dimensional immunoblots of S. aureus and S. epidermidis exoproteins probed with serum samples from patients with confirmed PJIs. We further analysed by ELISA tests the response of patients to the identified proteins. PATIENTS AND METHODS: Secreted proteins from Mu50 strain (S. aureus) and RP62A strain (S. epidermidis) were separated by 2D gel electrophoresis and analyzed by western blot with serum samples from patients with confirmed S. aureus and S. epidermidis PJIs. Recombinant proteins corresponding to the identified proteins were expressed and screened with an in-house ELISA to evaluate their interest for the diagnosis of S. aureus and S. epidermidis PJIs. RESULTS: Fifty-two antigenic exoproteins were identified: 42 belonging to Mu50 strain, and 10 to RP62A strain. Twenty-two proteins were identified as S. aureus specific. Among these proteins, five were most frequently recognized by patients with S. aureus PJI. CONCLUSION: Our results showed that few exoproteins were antigenic by RP62A strain compared to Mu50 strain. We identified five antigenic and S. aureus specific proteins, which may contribute to diagnosis, prevention and treatment of these infections.

Variations of the level of vigilance and of behavioural activities during simulated automobile driving.

During a monotonous activity, certain behaviours occur that are not necessary to the performance of the task. These are subsidiary or collateral activities. Our purpose was to find out if the number of these behaviours tends to increase during a monotonous and prolonged activity. A study was carried out with 17 subjects performing a 2-h car drive on the Vigilance Analysis Driving Simulator. An analysis of the drivers' behaviour and of their state of vigilance allowed us to confirm the existence of a relation between the occurrence of these behaviours and the variations of the level of arousal. In addition, we determined for all produced behaviours, those that preceded, those that coincided with, and those that followed low vigilance phenomena. These results were interpreted in terms of behavioural signs, precursory of low vigilance, indicative of low vigilance, or reactivating the driver.

Spatial reference frames and driver performance.

A survey of the relationship between visual reference frame dependence and driving performance is presented. Inter-individual differences in driving are related to three spatial reference frames: visual, gravito-inertial and egocentred. Their pertinence in driving is shown both in theory and experimentally. The experiment (with 36 subjects) presented here studied the basic activity of steering control in a simulated driving task. Results showed that steering control quality (estimated by time to line crossing) was significantly better among subjects who are relatively independent of visual or egocentred reference frames.

[Horton disease of pulmonary localization]. / Maladie de Horton avec localisation pulmonaire.

A case of Horton's disease with interstitial pulmonary involvement is reported. Transbronchial biopsy of the lung and biopsy of the temporal artery provided evidence of giant cell lesions. Outcome was favourable with general corticosteroid therapy with regression of the pulmonary disease.

The enkephalinase inhibitor, acetorphan, in acute diarrhoea. A double-blind, controlled clinical trial versus loperamide.

The antidiarrhoeal properties of acetorphan, an inhibitor of enkephalinase (EC 3.4.24.11) that prevents endogenous enkephalin degradation, and loperamide, a mu opiate receptor agonist, were compared. The double-blind study included 69 patients with acute diarrhoea of presumed infectious origin, allocated at random to two parallel groups. Acetorphan and loperamide were both rapidly and similarly effective, diarrhoea resolving in both cases in nearly 2 days. With acetorphan, however, abdominal distension vanished significantly more rapidly, and reactive constipation was less frequent (8% versus 31% with loperamide). These differences can be accounted for by the distinct mechanisms of antidiarrhoeal activity of the two drugs--that is, primary antitransit effect for loperamide and antisecretory activity for acetorphan.

[Nodular regenerative hyperplasia and primary biliary cirrhosis]. / Hyperplasie nodulaire régénérative et cirrhose biliaire primitive.

We report two cases of nodular regenerative hyperplasia of the liver associated with primary biliary cirrhosis. Cholestasis and presence of antimitochondrial antibodies were noted in both patients. In one patient, the diagnosis of nodular regenerative hyperplasia was supported by the demonstration of disseminated small hepatic nodules without perinodular fibrosis. Twelve years later, the histopathological picture was one of primary biliary cirrhosis. The other patient presented an histological picture of regenerative hyperplasia of the liver and primary biliary cirrhosis. The association of regenerative hyperplasia of the liver and primary biliary cirrhosis is discussed.

[Behçet's syndrome and the digestive tract]. / Syndrome de Behçet et tube digestif.

Gastrointestinal involvement represents only 14% of the anatomical sites of Behçet's syndrome in France. The various segments of the gastrointestinal tract may be affected. Episodes of mucosal aphthae are more frequent in the oesophagus than in the stomach or duodenum. Intestinal involvement constitutes the major gastrointestinal localisation. Colonic or ileo-colonic lesions may appear after several years of recurrent aphthosis and present in the form of acute complications (perforation, massive haemorrhage) or by prolonged haemorrhagic diarrhoea with marked deterioration in the general state. The radiological and endoscopic signs are similar to those observed in various forms of severe acute colitis such as haemorrhagic proctocolitis or Crohn's disease. The diagnosis of an intestinal localisation of Behçet's syndrome is based on the richness of the extra-intestinal signs and moreover on the presence of deep colonic ulcerations frequently situated in healthy mucosa, the presence of an adjacent non-specific inflammatory infiltrate affecting all of the colonic wall, lesions of vasculitis and perivasculitis with signs of leukocytoclasis and fibrinoid necrosis. Surgical treatment is frequently necessary. The high incidence of ulcerative recurrences in the anastomoses, in which fistulae may also develop, requires extensive intestinal resections or diversions by long-term ileostomies.

[Functional colonic disease and psychopathology. Importance of affective experiences]. / Colopathie fonctionnelle et psychopathologie. Importance du vécu affectif.

The responsibility of psychopathological disorders in the genesis of irritable bowel has led to recent interpretations which challenge the classical data concerning this disease. The present study was conducted from a questionnaire-interview in 102 patients suffering from functional colopathy. It shows that these patients presented specific psychopathologic and biographic data. The patients with colopathy were anxious psychasthenics confined by their obsessive and narcisistic nature into a successful productive activity at the expense of pleasure seeking and interpersonal relationships. The emotional deficiencies of childhood found in almost all cases, in addition to separation anguish, undoubtedly led to an alteration of self-image. The pursuit of a successful activity seems to correspond to a perpetual attempt of control of anguish and a rehabilitation of the self-image. The precarious resulting balance often risk to be challenged by stresses or conflicts and force the physician to take complete charge of such a disease, carefully and patiently.

Campylobacter-like organisms and surface epithelium abnormalities in active, chronic gastritis in humans: an ultrastructural study.

A prospective light and electron microscopic study of repeated endoscopic gastric biopsy specimens obtained from 10 patients presenting at the first examination for long-standing erosive gastritis was performed. In nearly all specimens from 7 patients, spiral bacteria were found in close contact to the surface epithelial cells and associated with active inflammatory changes. These organisms appeared similar to those recently described as gastric "campylobacter-Like organisms" (GCLO). It is possible that they are related to unusual anaerobic spirochetes. In the specimens obtained after antibiotic-therapy the bacteria were few in number and damaged. At the ultrastructural level, the presence of cell necrosis and autolytic intracytoplasmic vacuoles combined with damaged bacteria may suggest a relationship between GCLO surface colonization and erosive epithelial abnormality. Such colonization does not occur in normal mucosa.

[Intestinal involvement in Behçet's syndrome]. / Atteinte intestinale du syndrome de Behçet.

Intestinal lesions in Behçet's syndrome are much more common in Japan than in the Western World. Colonic or ileo-colonic lesions develop after several years of recurrent aphthae and are manifested by acute complications, such as perforation or massive haemorrhage, or by protracted haemorrhagic diarrhoea with progressive deterioration of the patient's general condition. Radiological and endoscopic findings are similar to those of severe acute colitis, such as ulcerative colitis or Crohn's disease. The diagnosis of Behçet's syndrome involving the bowel rests on the presence of numerous extra-intestinal lesions and of extensive colonic ulceration often located in otherwise healthy parts of the mucosa. Histology shows, beside a non-specific inflammatory infiltrate affecting the entire wall of the colon, lesions of vasculitis and perivasculitis with images of leucocytoclasia and fibrinoid necrosis. Surgery is often necessary, requiring wide intestinal resections and long-term derivation ileostomies because of the high incidence of recurrent ulcers at the site of anastomosis, where fistulae may also develop.

[Does the hepatitis of secondary syphilis exist? Two cases (author's transl)]. / L'hépatite de la syphilis secondaire existe-t-elle? 2 observations.

Two patients are presented as new cases of secondary syphilitic hepatitis. The closely resemble descriptions in the literature with the same clinical and laboratory "profile" and the same course spectaculary influenced by anti-syphilitic penicillin therapy. The presence of treponemes in the liver, which would definitely confirm the diagnosis, was not demonstrated. This is a particularly important diagnosis, which should not be missed since it leads to treatment of fundamental importance to the patient's future.