[Non necrotizing bacterial cellulitis and bacteriemia due to Shewanella putrefaciens]. / Dermohypodermite bactérienne non nécrosante et bactériémie à Shewanella putrefaciens.

Shewanella putrefaciens is a Gram negative opportunistic pathogen which causes skin and soft tissue infections and bacteriemia in immunocompromized patients. We report a 86-year-old man, who presented with an infectious cellulitis of the leg associated with Shewanella putrefaciens bacteriemia. This patient was treated by mycophenolate mofetil for a bullous pemphigoid resistant to corticotherapy.

[Central nervous system HIV-associated polyarteritis nodosa: long-term outcome]. / Devenir à long terme d'un cas de périartérite noueuse cérébrale associée au VIH.

INTRODUCTION: HIV-associated vasculitis is an infrequent entity, and only few data about its long-term evolution is available. EXEGESIS: We report the long-term outcome of a patient with central nervous system HIV-associated periarteritis nodosa and then discuss the therapeutic options for this class of vasculitis. CONCLUSION: This observation highlights the role of HAART in the treatment of HIV-associated vasculitis. Persistent remission can be obtained when viral replication is under control.

Long-term results of therapy with interferon alpha for cryoglobulinemia associated with hepatitis C virus infection.

We describe the long term results of treatment with interferon (IFN) in two patients with cryoglobulinemia and chronic hepatitis related to Hepatitis C virus (HCV). Our results suggest that interferon may induce long remission in cryoglobulinemia associated with HCV infection and that the effect of IFN is not dependent on the effect on liver function, but results of its antiviral activity.

Young woman's digestive arterial occlusion--a case report and literature review.

The authors report the observation of a 31-year-old woman who presented with total occlusion of digestive arteries and was successfully treated pharmacologically. A review of the literature shows that digestive arteries thrombosis is a rare condition in young women. Only 15 cases have been previously reported. Prognosis was poor with a mortality rate of 71%; 93% used oral contraception and more than 50% were smokers. All these cases were curiously similar. The authors accentuate the role of iloprost in the recovery of the patient. Digestive artery occlusion should be taken into consideration in the differential diagnosis of abdominal pain, especially in young women who smoke and take estrogen-containing birth control pills.

Analysis of hepatitis C virus isolates using molecular and serological typing methods.

This study comprised 100 persons with antibodies to hepatitis C virus (HCV), including 77 intravenous drug users (IVDUs). They were tested with serological HCV typing assays (Murex HCV serotyping 1-6 assay; Chiron RIBA HCV Serotyping SIA). Patients with a positive polymerase chain reaction (PCR) for HCV (n = 66) were tested with genotyping molecular assays (Inno-Lipa HCV II test; Sorin GEN-ETI-K HCV typing assay). Comparison of the results of these tests showed that (a) 92% of samples could be typed by one test at least; 44% could be typed by all four tests; 88% could be typed by one serological test at least and 66% by one molecular test at least; (b) 81% of the samples successfully tested with both serological tests gave comparable results; 95% of the samples successfully tested with both molecular tests gave comparable results; (c) when serological and molecular tests yielded different results, sequences in the 5'-non-coding (5' NC) or E1 regions always confirmed the results of the molecular tests; (d) in case of discrepancy between the results of the molecular tests the E1 region sequences confirmed the Sorin test results. It is concluded that the molecular tests compared gave similar results. The fact that the Murex serological test gave comparable results in more than 80% of cases indicates that it is an alternative to the molecular tests for routine diagnosis. However, comparison of the results of this test with those obtained in patients consulting a hepatology department showed that it gave the best results in a population of patients not exposed repeatedly to HCV.

[Hemoperitoneum of ovarian origin complicating antivitamin K treatment]. / Hémopéritoines d'origine ovarienne compliquant les traitements par antivitamine K.

INTRODUCTION: Ovarian hemorrhage with hemoperitoneum is a rare but serious complication of ovulation related to rupture of either the corpus luteum or functional cyst. It is due to treatment using oral indirect anticoagulant and specifically affects young women. CURRENT KNOWLEDGE AND KEY POINTS: We review cases that were reported since the initial description by Weseley in 1957. The main indications for oral indirect anticoagulant are thrombophlebitis and valvular cardiac prosthesis. Pelvic pain with peritoneal irritation is the most common symptom in more than one third of the patients. An initial collapse is reported in 22% of the cases. Surgery is the main treatment. Mortality is 3% and recurrences occur in nearly 25% of the patients. FUTURE PROSPECTS AND PROJECTS: Potential ovarian hemorrhage should be investigated when a woman taking oral indirect anticoagulant develops acute abdominal pain. Surgery should be conservative and whenever possible, should include celioscopy. Systematic ovarian blockade should be discussed in women taking long-term oral indirect anticoagulant.

[A comparative study of body temperature using rectal and tympanic measurement]. / Etude comparative de la température corporelle par mesure rectale et tympanique.

INTRODUCTION: Tympanic temperature measuring is more and more used currently. We wanted to test this method's accuracy in an internal medicine service. METHODS: First, we compared rectal and tympanic temperatures in 37 consecutive patients. Tympanic temperature was assessed by two examiners. Secondly, we compared, in 32 other patients, the readings given by tympanic thermometer used in the first part, with those given by nine other tympanic thermometers used in other hospital departments. RESULTS: We did not find any difference between right and left auricular temperature, nor between the temperatures assessed by the two examiners. However, there was a difference between the average tympanic and rectal temperatures (36.88 degrees C +/- 0.63 vs 37.36 degrees C +/- 0.57; P < 0.001). The correlation coefficient between tympanic and rectal temperature was only 0.77. If a threshold of temperature of > or = 38 degrees C were given for fever, only 29% of febrile patients would have been detected with a tympanic thermometer (Kappa coefficient = 0.406 [0.326-0.485]). Fever was especially underestimated for high temperatures. The comparison of different tympanic thermometers gives different averages for these ten thermometers between 36.5 degrees C and 37.2 degrees C. CONCLUSION: Though tympanic temperature measure is an easy method, it is not sensitive enough to detect fever.

[Lymphocytic colitis and Gougerot-Sjögren syndrome. Report of two cases]. / Colite lymphocytaire et syndrome de Gougerot-Sjögren. A propos de deux cas.

INTRODUCTION: Microscopic colitis describes a subset of patients with chronic watery diarrhea of unknown origin, and normal endoscopic findings and microscopic evidence of an inflammatory infiltrate in the colonic mucosa. We report two cases associated with sicca syndrome. EXEGESIS: A 56-year-old woman and a 76-year-old man presented with a history of lymphocytic colitis associated with sicca syndrome. Drugs or infectious agents were not implicated in the cause of lymphocytic colitis, suggesting that sicca syndrome may be involved in the pathogenesis of microscopic colitis. CONCLUSION: These cases suggest that sicca syndrome should be detected in patients with lymphocytic colitis.

[Resistance to activated protein C and portal vein thrombosis: two new cases and review of the literature]. / Résistance à la protéine C activée et thrombose portale: deux nouveaux cas et revue de la littérature.

INTRODUCTION: Resistance to activated protein C is the most common inherited factor at the origin of deep venous thrombosis. As portal vein thrombosis is rare, causes such as cirrhosis, intra-abdominal infection, primary hepatocellular carcinoma, myeloproliferative disorders or coagulation abnormalities must be investigated. EXEGESIS: We report two cases of portal vein thrombosis associated with resistance to activated protein C. This association is not frequent, as only 12 cases have been reported in the literature. These studies show that resistance to activated protein C was rarely the only factor, as other prothrombotic abnormalities were present in more than 70% of cases. CONCLUSION: Resistance to activated protein C is rarely associated with portal vein thrombosis. When present, other causes should not be overlooked. The potential existence of resistance to activated protein C should be systematically investigated in case of either portal vein thrombosis in patients with personal or familial thrombosis history, association with multiple thrombosis, or when the disease etiology remains unknown.

[Thymoma and disseminated lupus erythematosus. Two new cases and review of the literature]. / Thymome et lupus érythémateux disséminé. A propos de deux nouvelles observations et revue de la littérature.

INTRODUCTION: Thymoma is a tumour originating in the epithelial cells of the thymus, associated with several immunologic disorders. The association of thymoma with systemic lupus erythematosus has rarely been described. We report two cases of this association. EXEGESIS: Description of two cases and a review of the literature. Mr T. was 41 years old when the diagnosis of thymoma and lupus was made. The thymectomy did not influence the evolution of his lupus. Mrs G. had been treated because of a lupus for 8 years prior to developing a thymoma. One year later she presented with erythroblastopenia, which was only sensitive to cyclosporin. CONCLUSION: The association between lupus and thymoma has been reported in 36 cases in the literature. Thymoma is benign in 59% of the cases. The clinical presentation of lupus is nonspecific except for age, median 48 years, and sex ratio, 4:3. The clinical outcome of the lupus is not influenced by the thymectomy. Thymoma may precede lupus with a delay of several years or it may be diagnosed concurrently or several years later. This association is not accidental, though the pathogenic link between these conditions remains unknown. One could suppose that the decrease of the thymic function in the course of thymoma could enhance the expression of autoreactive T lymphocytes as well as the activation of B cells. Patients should be followed after thymectomy because autoimmune diseases, particularly lupus, may develop belatedly. On the other hand, thymoma may be suspected mainly when lupus occurs in patients around 50 years of age.

[Danger of anti-erythrocyte antibodies during pregnancy]. / Danger des anticorps antiérythrocytaires au cours de la grossesse.

INTRODUCTION: Red cell autoantibodies are very rarely observed in pregnant women. We report one case related to the presence of a lupus anticoagulant. EXEGESIS: A 32-year-old woman had a history of two intrauterine deaths that had occurred at weeks 32 and 33, respectively. Due to the presence of a lupus anticoagulant, prednisone (20 mg/day) and subcutaneous calcium heparin were administered during her third pregnancy. The direct antiglobulin test remained positive throughout the pregnancy; however, hemolysis could not be detected. Caesarean section was done in emergency at week 29, due to fetal bradycardia related to severe fetal hemolysis. CONCLUSION: When autoimmune hemolysis occurs during pregnancy, risks for the fetus increase with the severity of hemolysis in the mother. It is thought that child mortality reflects the existence of anemia, rather than the existence of hemolysis. Our observation suggests that severe fetal hemolysis may occur, despite the absence of hemolysis in the mother.

Malnutrition: a highly predictive risk factor of short-term mortality in elderly presenting to the emergency department.

OBJECTIVES: To identify independent risk factors of mortality among elderly patients in the 3 months after their visit (T3) to an emergency department (ED). DESIGN: Prospective cohort study. SETTING: University hospital ED in an urban setting in France. PARTICIPANTS: One hundred seventy-three patients aged 75 and older were admitted to the ED over two weeks (18.7% of the 924 ED visits). Of these, 164 patients (94.8%) were included in our study, and 157 (95.7%) of them were followed three months after their ED visit. MEASUREMENTS: During the inclusion period (T0), a standardized questionnaire was used to collect data on socio-demographic and environmental characteristics, ED visit circumstances, medical conditions and geriatric assessment including functional and nutritional status. Three months after the ED visits (T3), patients or their caregivers were interviewed to collect data on vital status, and ED return or hospitalization. RESULTS: Among the 157 patients followed at T3, 14.6% had died, 19.9% had repeated ED visits, and 63.1% had been hospitalized. The two independent predictive factors for mortality within the 3 months after ED visit were: malnutrition screened by the Mini Nutritional Assessment short-form (MNA-SF) (OR=20.2; 95% CI: 5.74-71.35; p<.001) and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score (OR=1.1; 95% CI: 1.01-1.22; p=.024). CONCLUSION: Malnutrition is the strongest independent risk factor predicting short-term mortality in elderly patients visiting the ED, and it was easily detected by MNA-SF and supported from the ED visit.

[Immune profile of elderly patients admitted in a geriatric short care unit]. / Étude du profil immunitaire de sujets âgés hospitalisés en unité de court séjour gériatrique.

INTRODUCTION: Immunosenescence embraces the whole of age-induced changes observed in the immunomodulatory functions of a living organism, and is mostly characterized by a decrease in cell-mediated immunity and important modifications of the immunological repertoire. The impact of the pathology on ageing immunity is poorly understood and few data are available on the immunological status of old polypathological patients. METHODS: We report the results of a prospective study aiming at characterizing several established immunological parameters in patients of 75 years old or more, and admitted for diverse pathologies in a unit of acute geriatric ward. RESULTS: Among the 51 included patients (35 women and 16 men), 90% displayed poly-pathologies. We found a prevalence of 86% of immunological abnormalities, with lymphopenia among 41% of the patients (<1500/mm(3)) and abnormal lymphocytes phenotypes among 95% of the oldest patients (>85 years). A strong skewing towards memory T lymphocytes (CD45RO+) over naive T lymphocytes (CD45RA+) was found in 80% of the cases and inverted CD4/CD8 T cells ratio was observed in 12% of our patients. Vitamin D insufficiency (<30ng/ml), which is frequent among the patients (94%), is a predictive factor for T and B cell lymphopenia. CONCLUSION: Immunological abnormalities are frequent in this frail population and lymphopenia, in particular, could constitute a reinforcing factor of fragility. Vitamin D deficiency could also affect elderly patients' immunity.

Early contacts between T lymphocytes and activating surfaces.

Cells continually probe their environment to adapt their behaviour. A current challenge is to determine how they analyse nearby surfaces and how they process information to take decisions. We addressed this problem by monitoring human T lymphocyte attachment to surfaces coated with activating anti-CD3 or control anti-HLA antibodies. Interference reflection microscopy allowed us to monitor cell-to-surface apposition with a few nanometre vertical resolution during the first minutes following contact. We found that (i) when a cell fell on a surface, contact extension was preceded by a lag of several tens of seconds. (ii) During this lag, vertical membrane undulations seemed to generate transient contacts with underlying surfaces. (iii) After the lag period, the contact area started increasing linearly with a rate of about 1.5 µm(2) s(-1) on activating surfaces and about 0.2 µm(2) s(-1) on control surfaces. (iv) Concomitantly with lateral surface extension, the apparent distance between cell membranes and surfaces steadily decreased. These results are consistent with the hypothesis that the cell decision to spread rapidly on activating surfaces resulted from the integration of information yielded by transient contacts with these surfaces generated by membrane undulations during a period of about 1 min.

[Immunosenescence and infections, myth or reality?]. / Immunosénescence et infections, mythe ou réalité?

The susceptibility of elderly people to infectious diseases is usually associated to increasing risk factors found in young adults. However, the role of immune function ageing is associated with the decline of immune function but this decline is not homogenous. Some functions such as the cellular immune system are altered but others are enhanced such as innate immunity. The important events of immune ageing are modifications of lymphocyte subsets with accumulation of memory cells, decrease in proliferative response, and a chronic inflammatory state. The chronic antigenic load throughout life is responsible for gaps in the antigenic system with a greater sensitivity to new antigens. These immune system changes are all the more important that diseases are severe and that denutrition is associated. These diseases will speed up the ageing process. The interaction between immunosenescence and pathology is an important phenomenon to consider. This review outlines the immune system changes due to ageing, their relationship with diseases of the aged patient, and the consequences of these modifications on vaccination effectiveness.