[Renal cell carcinoma in the department of Hérault: Results over a 30 year period]. / Le cancer du rein dans le département de L'Hérault : résultats de 30 ans d'enregistrement.

OBJECTIVE: The objective of the study was to determine the specificities of renal cell carcinoma (RCC) in the department of Herault using the Herault Tumor Registry over 30 years. METHODS: Data of this study were obtained from the Herault cancer database. We analysed the evolution of RCC from 1987 to 2016, including the incidence, mortality, cancer pathology and staging at the moment of diagnosis. We compared our results with national and international data. RESULTS: We identified 3769 newly diagnosed RCC: 2628 in men (69,7%) and 1141 in women (30,3%). In 2016, RCC was the 8th most frequent cancer, both genders combined, the 7th most frequent cancer in men and the 11th in women. New cases of RCC increased by 4.2 in men and 3.3 in women over the study period. The number of localised forms increased by 9% over 20 years. In 2016, the probability of having a RCC before the age of 75 was of 2.11% for a man and of 0.62% for a woman. CONCLUSION: Over 30 years, the incidence rate of RCC increased in the department of Herault; however, mortality decreased over the same period. This analytical data should be improved by the development of the Registry of Herault Specialised in Onco-Urology (RHESOU). LEVEL OF EVIDENCE: 3.

Plasmacytoid dendritic cells reduce HIV production in elite controllers.

HIV elite controllers (EC) are a rare group of HIV-infected patients who are able to maintain undetectable viral loads during a long period of time in the absence of antiretroviral treatment. Adaptive immunity and host genetic factors, although implicated, do not entirely explain this phenomenon. On the other hand, plasmacytoid dendritic cells (pDCs) are the principal type I interferon (IFN) producers in response to viral infection, and it is unknown whether pDCs are involved in the control of HIV infection in EC. In our study, we analyzed peripheral pDC levels and IFN-α production by peripheral blood mononuclear cells (PBMCs) in EC compared to other groups of HIV-infected patients, the ability of pDCs to reduce HIV production in vitro, and the mechanisms potentially involved. We showed preserved pDC counts and IFN-α production in EC. We also observed a higher capacity of pDCs from EC to reduce HIV production and to induce T cell apoptosis, whereas pDCs from viremic patients barely responded without previous Toll-like receptor 9 (TLR-9) stimulus. The preserved functionality of pDCs from EC to reduce viral production may be one of the mechanisms involved in the control of HIV viremia in these subjects. These results demonstrate the importance of innate immunity in HIV pathogenesis, and an understanding of pDC mechanisms would be helpful for the design of new therapies.

The novel allele HLA-B*35:167 differs from HLA-B*35:03:01 by the amino acid exchange Val152Glu.

HLA-B*35:167 allele differs from HLA-B*35:03:01 and HLA-B*35:70 by an amino acid exchange at position 152.

[Adenovirus infections in children: experience in the field of the allogeneic stem cell transplantation]. / Les infections à adénovirus chez l'enfant: expérience dans le domaine de l'allogreffe de cellules souches hématopoïétiques.

UNLABELLED: Adenovirus (Adv) infections are frequent in pediatric patients, sometimes serious, above all in immunocompromised children. We report the cases of 2 children who presented an Adv infection after allogeneic stem cell transplantation (SCT). CASE REPORTS: Case n(o) 1 concerns a boy who received SCT at the age of 6 years. He had a hemorragic cystitis, which resolved after antiviral treatment and successful engraftment. Case n(o) 2 concerns a boy who received SCT at the age of 2. He shortly presented a disseminated infection, and died in spite of antiviral treatment and re-infusion of an autologous transplant. DISCUSSION: T-cell depletion (mainly carried out in vivo at present) is the major risk factor of Adv infection after allogeneic SCT. It is important to be recognized, in order to proceed to a routine screening among transplanted patients. Moreover, the detection of viral genoma by molecular biology is a predictive factor of disseminated disease development, with mortality rates higher than 50%. Early treatment is thus crucial. Immunotherapy is to be developed, by tapering of immunosuppression, or by manipulating grafts and donor lymphocyte infusions, in order to improve Adv specific responses. The possibility of a prophylaxis is still to be investigated.

The existence of a second vesicular glutamate transporter specifies subpopulations of glutamatergic neurons.

Before their exocytotic release during stimulation of nerve terminals, nonpeptide neurotransmitters are loaded into synaptic vesicles by specific transporters. Recently, a protein initially identified as brain-specific Na(+)-dependent inorganic phosphate transporter I (BNPI) has been shown to represent a vesicular glutamate transporter (VGLUT1). In this study, we investigated whether a highly homologous "differentiation-associated Na(+)-dependent inorganic phosphate transporter" (DNPI) is involved in glutamatergic transmission. Vesicles isolated from BON cells expressing recombinant DNPI accumulated l-glutamate with bioenergetical and pharmacological characteristics identical to those displayed by VGLUT1 and by brain synaptic vesicles. Moreover, DNPI localized to synaptic vesicles, at synapses exhibiting classical excitatory features. DNPI thus represents a novel vesicular glutamate transporter (VGLUT2). The distributions of each VGLUT transcript in brain were highly complementary, with only a partial regional and cellular overlap. At the protein level, we could only detect either VGLUT1- or VGLUT2-expressing presynaptic boutons. The existence of two VGLUTs thus defines distinct subsets of glutamatergic neurons.

Presence of multiple non-B subtypes and divergent subtype B strains of HIV-1 in individuals infected after overseas deployment.

OBJECTIVE: To identify the genetic subtypes and characteristics of HIV-1 strains from individuals infected after overseas deployment. PATIENTS AND METHODS: Sixty-one HIV-1-positive individuals detected between 1986 and 1995 in the French army were included in the study. For each patient, the year and country of HIV infection are known. Genetic subtypes of HIV-1 were determined using the heteroduplex mobility assay (HMA) using ED5/ED12 as outer and ES7/ES8 as inner primers. Strains were further characterized by sequencing and phylogenetic analysis of the C2-V3 region. The amino-acid sequences corresponding to the V3 region were aligned on the basis of the subtyping results and were then compared to the consensus V3 sequences of the corresponding subtypes. RESULTS: Among the 61 patients studied, nine became infected in France, and 52 were HIV-negative before overseas deployment but HIV-positive at their return. The majority (n = 43) deployed in Africa and a limited number of patients deployed in Asia (Cambodia, n = 5) or South America (guyana, n = 4). The nine individuals who were not deployed overseas were all infected with subtype B strains. The majority of the other patients were infected with non-B strains; eight subtype A, 20 subtype B, 16 subtype C, one subtype D, six subtype E and one subtype F. Five of the six subtype E strains were contracted in Cambodia and one in Djibouti, and all subtype C strains were from Djibouti. Phylogenetic analysis revealed a large diversity among the different strains introduced into France. Analysis of the amino-acid sequences of the V3 loop revealed the introduction of uncommon V3-loop patterns. CONCLUSION: In the group of HIV-1-infected individuals that we studied and who were deployed overseas, 63.4% were infected with non-B strains. In addition, the subtype A, B and C viruses in this population were very heterogeneous. Due to the routine occurrence of international travel and deployment, the predominance of subtype B HIV-1 viruses may change in European countries. However, the possible implications on the dynamics of the HIV-1 epidemic needs further follow-up.

Localization of VGLUT3, the vesicular glutamate transporter type 3, in the rat brain.

We have recently identified a third subtype of glutamate vesicular transporter (VGLUT) named VGLUT3. In the present study, we provide a detailed account of the regional and cellular distributions of VGLUT3 in the rat brain, using specific nucleotide probes and antisera. The distribution of VGLUT3 protein was compared with that of the other vesicular transporters (VGLUT1 and VGLUT2). All the areas expressing VGLUT3 also contain high levels of VGLUT1 and -2 proteins, but, at a finer level of analysis, the distribution of the three subtypes differs. Unlike VGLUT1 and -2, VGLUT3 expression is limited to discrete cell populations. Neurons containing VGLUT3 transcript are essentially observed in the caudate-putamen, the olfactory tubercle, the nucleus accumbens, the hippocampus, the interpeduncular nucleus and the dorsal and medial raphe nuclei. More scattered populations of VGLUT3 expressing neurons are found in the cerebral cortex. The distribution of the VGLUT3 protein, as determined with specific antisera, overlaps with that of the transcript in the caudate-putamen, olfactory tubercles, hippocampus, cortex, interpeduncular nucleus, and raphe nuclei, suggesting that VGLUT3 is essentially present in local projection neurons in these regions. Microscopic examination reveals staining of terminals and perikarya. Furthermore, co-localization studies indicate that VGLUT3 is present in GABAergic interneurons in the hippocampus, as well as in the interpeduncular nucleus. However, other regions, such as the substantia nigra (pars compacta), the ventral tegmental area, and the parabigeminal nucleus, receive a dense VGLUT3 terminal labeling although they do not contain VGLUT3 expressing neurons. In these regions, VGLUT3 immunoreactivity may be present in terminals of long projecting neurons. This subclass of glutamatergic afferents differs from other "classical" excitatory terminals that express VGLUT1 or VGLUT2. The distribution of VGLUT3 in the rat brain suggests an unsuspected function of vesicular glutamate transport in subsets of interneurons and in neuromodulatory neurons.

The comparative efficacy and tolerability of CGP 56697 (artemether + lumefantrine) versus halofantrine in the treatment of uncomplicated falciparum malaria in travellers returning from the Tropics to The Netherlands and France.

CGP 56697 (Riamet) is a new oral anti-malarial drug composed of artemether and lumefantrine (benflumetol) which combines the fast, short-acting artemether for rapid parasite clearance with the prolonged action of lumefantrine for intended radical cure. In this double-blind, comparative trial, the efficacy and tolerability of CGP 56697, given as a course of 4 x 4 tablets over 48 h, was compared to halofantrine, given as 3 x 2 tablets over 12 h with a second course 1 week later. Patients (mostly non-immune) with acute, uncomplicated Plasmodium falciparum infection were randomly assigned to either CGP 56697 (n = 51) or halofantrine (n = 52). CGP 56697 proved superior with respect to parasite clearance time (median 32 vs. 48 h, P < 0.001) and parasite reduction at 24 h (median 99.7 vs. 89.6%, P < 0.001) with a non-significant difference in resolution of fever (median 24 vs. 32 h, P = 0.835). However, a 28-day cure rate of 82% was observed for CGP 56697 and 100% for halofantrine. Significant QTc prolongations (> 30 ms) were seen 6-12 h after halofantrine intake but not after CGP 56697 intake. CGP 56697 is an effective, well-tolerated treatment for uncomplicated falciparum malaria but for this dosing regimen the recrudescence rate is unacceptablyhigh (18%). For travellers contracting malaria abroad, we propose a six-dose regimen of CGP 56697 over 3 days.

[Contribution of real time echotomography to evaluation of cervico-encephalic atheromatous disease]. / Apport de l'échotomographie en temps réel dans le bilan de la maladie athéromateuse cervico-encéphalique.

Real time ultrasonography can now provide fine, easily reproducible images of the carotid arteries and to a lesser degree the vertebral arteries. The method is a simple one but requires an experienced operator. Care should be taken to visualize mainly the zones of predilection of the atheroma (carotid bifurcation and ostia). Even minimal sized atheromatous plaques can be detected, including those that are frequently asymptomatic to the doppler test, and their calcareous, regular, or ulcerated nature can be determined. The limits of the examination are described, demonstrating the need for complementary ultrasound and doppler tests. The two main poles of interest of this vascular imaging are early detection of carotid atheroma and supervision of medical and surgical treatments.

[Doppler ultrasonic evaluation of the embolism-causing potential of carotid artery plaques. Apropos of 113 macroscopic findings]. / Evaluation du potentiel emboligène des plaques carotidiennes par l'écho-Doppler. A propos de 113 confrontations macroscopiques.

Comparison was made between precise descriptions of gross pathology of 113 carotid artery atheromatous plaques (69 symptomatic, 44 asymptomatic) operated upon by thromboendarterectomy and results of ultrasound-Doppler examinations, to determine possible specific ultrasound criteria for precise anatomical lesions. Echographic criteria studied were: ultrasonic structure of plaques; relation of plaque to wall; existence or absence of a solution of continuity; regular or irregular nature of endoluminal border of plaque; and finally the notion of discordance between degree of stenosis as shown by Doppler (D) and ultrasound (E) imaging (E much less than D). Principal results were as follows. Images of the regular, homogeneous highly echogenic plaques (36 cases) corresponded in 69.4% of cases to simple fibrous or calcified plaques with regular endoluminal borders. Irregular heterogeneous plaques (31 cases) were suggestive of irregular, friable and/or ulcerated material in 64.4% of cases. Weakly echogenic plaques (9 cases) suggested mainly thrombus (44.4%) or soft, friable plaques (33.3%). Plaques with solution of continuity do not correspond to a precise lesion but, in contrast, are specific (with weakly echogenic plaques) of the emboligenic character of the plaques (100%). The criterion ultrasound "Doppler was specific for thrombus in 75% of cases. In contrast, the thrombus can also demonstrate very different ultrasound images. Finally, in this study ultrasound-Doppler findings produced 3 false negatives (2.6%). Combined ultrasound-Doppler imaging allows quantitative evaluation and particularly qualitative assessment of carotid artery atheromatous lesions, with sufficiently reliable criteria to detect lesions of high emboligenic potential.

[Current role of doxycycline in the chemoprophylaxis of Plasmodium falciparum malaria]. / Place actuelle de la doxycycline dans la chimioprophylaxie du paludisme à Plasmodium falciparum.

In countries where chemoresistance of Plasmodium falciparum is high (group III), mefloquine must be advocated for malaria prophylaxis for a stay less than 3 months. If it is more and particularly in Indo-china peninsular countries (Thailand, Birmania, Kamputchéa, Laos, Vietnam) and in Amazonia, advocated chemoprophylaxis is doxycycline 100 mg per day. Authors remind action mechanism, contraindication and side effects of this drug. Others publications underline the good tolerance of doxycycline now used by 1,400 french soldiers staying for 6 months with United Nations Organisation in Kamputchéa. An evaluation of tolerance and efficiency of this chemoprophylaxis is now in progress.

[An outbreak of Schistosoma mansoni bilharziasis. 113 cases in a military unit returning from Central Africa]. / Une épidémie de bilharziose à schistosoma mansoni. 113 observations dans une collectivité militaire au retour d'Afrique centrale.

The authors report on an outbreak of Schistosoma mansoni infestation involving 113 military men who had been contaminated together in a tributary of the Chari river in the Central African Republic. The patients were examined on their return to France 50 days after being contaminated and were compared with a control group of 25 subjects who had lived in Africa under the same conditions but were exempt of bilharziasis. All were subjected to a retrospective questionnaire, physical examination, examination of the faeces and serological test for bilharziasis by indirect haemoagglutination. All received two courses of praziquantel. Follow-up serology was performed after 1 year in 86 cases. The results of this study in both groups are presented and commented upon. With intestinal bilharziasis, prophylaxis against contamination is extremely difficult to carry out in endemic areas among people who visit and work "on the spot". Detection by routine serology must be performed upon return.

[Demonstration by x-ray computed tomography of renal involvement caused by NSAID poisoning]. / Mise en évidence par tomodensitométrie de l'atteinte rénale des AINS dans le cadre d'intoxication.

We describe the contribution of computed tomography in the determination of the renal damage after using tiaprofenic acid. Computed tomography realized six hours after injection of contrast medium revealed corticomedullary enhancement secondary to vascular and tubular stasis. This stasis is compatible with interstitial edema in relation with usually reversible lesions of tubulo-interstitial nephritis induced by of nonsteroidal anti-inflammatory drugs.

[Tropical sprue (author's transl)]. / La sprue tropicale.

Tropical sprue is a disease of the small intestine characterized by a malabsorption syndrome with a subtotal or partial mucosal atrophy. It is observed in Asia and Central America. It appears to be rare in Africa but its real frequency is unknown as small bowel biopsys are not routinely done. Bacterial overgrowth as well as giardiasis may be trigger factors of the disease the pathogenesis of which is still incompletely understood. The disease beginning as chronic diarrhea is later on characterized by an aphtoïd stomatitis and a macrocytic anemia. Treatment with antibiotics and folic acid is efficient and has a diagnostic value. If treatment is started lately, vitamin B 12 is then also necessary. In any intestinal syndrome observed in tropical areas without an ascertained etiologic diagnosis, peroral biopsie of the small intestine is requested. However, with the use of pediatric endoscope it will be possible to appreciate the respective incidence of tropical sprue and asymptomatic tropical sprue in Africa South of the Sahara.

[Therapy of deep mycoses]. / Thérapeutique des mycoses profondes.

In 1985, available drugs to cure deep mycosis are in fact limited to amphotericin B (Fungizone), 5-fluorocytosine (Ancotil) and ketoconazole (Nizoral). Potassium iodide is not much utilized. In diffuse aspergillosis and meningitic cryptococcosis, Fungizone by I.V. injection remains the high-grade antifungal drug--Ancotil is not actually used anymore in mono-therapy, but associated either with Fungizone in cryptococcosis and diffuse aspergillosis, or with Nizoral in systemic candidosis--Nizoral, which does not diffuse in C.S.F. and has a limited efficiency in immunosuppressive patients, is recommended in systemic candidosis and tropical deep mycosis, particularly histoplasmosis, blastomycosis, entomophtoromycosis, as well as in candidosis and diffuse aspergillosis prophylaxis in people at high risk. New antimycosis drugs are under studies: itraconazole efficient against aspergillus and fluconazole, which diffuses in C.S.F. and has a long time action.

[Hodgkin's disease in French Polynesia. 7 cases observed at the Territorial Hospital Center from 1985 to 1990]. / La maladie de Hodgkin en Polynésie Française. A propos de 7 cas observés au Centre Hospitalier Territorial de 1985 a 1990.

Seven Polynesians suffered from Hodgkin's disease were admitted in the territorial Hospital Center in 6 years. They came from different Polynesian archipelagos. Three of them are 30 years old and 3 are 40 years old. Diagnosis is based on an histological test, but has to be confirmed by a center specialized in lymphomae investigations since a scanner has been installed at the Territorial Hospital Center of Papeete (March 1987) results are satisfactory: echography and abdominal scanner lymphography and thoracic scanner osteoma medullare biopsy and liver biopsy puncture. Six patients presented a diffuse lesion (III B or IV) and one an intermediary phase (II B2). Treatment started by chemotherapy MOPP and ABVD alternatively. Four patients out of seven did not continue their treatment up to the end; one patient aged 34, after six treatments by MOPP and a recovering treatment by MIME got an autograft of bone marrow in Paris in October 1989, and he is actually in a good shape. Most of the patients are out of control. Application of complex therapeutic protocols during several months and inducing side effects, demands a large agreement of both patients and relatives. That is very rarely got nowadays.

[Hepatic amebiasis in French Polynesia. Study of 42 cases ]. / L'amibiase hépatique en Polynésie Française. Etude de 42 cas.

The authors aimed at describing and analysing retrospectively the clinical, serological, anatomical and evolutive aspects of 42 cases of hepatic amoebiasis treated and followed up in Papeete (French Polynesia) from 1984 to 1990. Painful hepatomegalia with fever, was a revealing sign once out of two. Complications started at initial stage only twice. Amoebic serology (by immunofluorescence or hemagglutination) was always positive, while pathogenic amoeba was absent in 95.2 p.c. of the cases. Hepatic amoebiasis always produces an intra-hepatic collection of pus: to that point of view, superiority of echotomography on other methods of investigation is evident, particularly to diagnose multiple collections (45.25 p.c. in this series). Recovery was always got, in most of the cases by only a medical treatment (39 cases) or in association with a puncture (2 cases). Nitro-imidazol compounds are the preferred treatment. They were efficient in all cases but one, and were always followed by a systematic colic parasiticidal treatment with a contact amoebicide.

[Leptospirosis in French Polynesia: 120 case reports]. / Les leptospiroses en Polynésie Française: etude de 120 observations.

Because of its clinical polymorphism and the difficulties to made a bacteriological and/or serological diagnosis, leptospirosis is an affection always non-detected. Nevertheless it is daily met affection in French Polynesia. Based on a homogenous series of 120 observations gathered from 1984 to 1990, all of them bacteriologically and/or serologically confirmed, we studied the different clinical and evolutive features of that disease. Fever is present in 91.6 p.c., cephalgia in 79.16 p.c. and myalgia in 70.83 p.c. Admission was necessary once out of four times. The four syndromes we observed in Tahiti are: infections syndrome, meningeal syndrome (30 p.c.) associated to an hyperproteinic grade in the C.S.F. (40 p.c.) and a lymphocytic reaction (60 p.c.). Liver syndrome, with hepatalgia (58.33 p.c.) and pain at the mass motion of liver (65 p.c.), that is an important sign in the local context; jaundice (28.33 p.c.) on the presence of which we must not based a diagnosis of leptospirosis: Biological renal syndrome displayed by transitory renal insufficiency with proteinuria, hematuria and leucocyturia. Neurological complications are mainly of encephalitic manifestations (5.8 p.c.). Hemorrhagic syndrome is expressed in digestive hemorrhage (8.33 p.c.) epistaxis (6.66 p.c.) and hemoptysis (6.66 p.c.). Cardiovascular manifestations are expressed in collapsus in 5.83 of the cases. Pulmonary abnormalities are frequent: cough (26.66 p.c.) and non specific X Ray image (19.16 p.c.). All patients are treated by Penicillin G (10 to 20 millions per day) by parenteral route with enteral alternative for an average of 10 days. Recovery was fast (7 to 10 days). In 65.8 p.c., slower in 15 p.c. (15 to 20 days); failure at first stage was observed in 10 p.c. of the cases, and relapse at medium or long term occurred under treatment in 8 cases (6.66 p.c.). Three dead were deplored (mortality 2.5 p.c.).

[Study of hyperuricemia in Tahiti. 31 cases hospitalized at the Territorial Hospital Center in Papeete (Tahiti)]. / Etude de l'hyperuricémie à Tahiti. A propos de 31 cas hospitalisés au centre hospitalier territorial de Papeete (Tahiti).

Frequency of gout in French Polynesia has induced us to define a type of "hyperuricemia Polynesian" from a population of patients admitted in a general Medicine Ward. Each admitted patient gets immediately a blood check-up. A figure higher than 70 mg/l in male and 60 mg/l in female is considered as pathological. In such a case, uricemia and uraturia are tested every 24 h for three days and we consider the mean value of these three tests. On the other side, some admitted patients non-hyperuricemic, are examined according to the same protocol. So, we have two groups: 31 hyperuricemics and 20 non-hyperuricemics, secondarily grouped according to age, sex, ethnic. We did not consider some secondary causes of hyperuricemia (chronic renal insufficiency diuretic treatment, psoriasis etc.). 1. Within the hyperuricemic population, mean uricemia is 85.35 mg/l versus 52.65 mg/l in the second sample. In the hyperuricemic group (21 males and 10 females) 48% are gouty and 13% of them are females. Articular manifestations are acute arthritis, affecting mainly inferior limbs, ankles, knees). We did not notice any significant divergence between uricemia and uraturia of gouty and non gouty people. Within the group of gouty people, percentage of individual hyper excretion is 53% (uraturia greater than 600 mg/24 h) with no significant divergence with the non-gouty group: Nephrolithiasis is rare (3%). There is no significant divergence between urinary pH of gouty and non-gouty people. Associated metabolic troubles are: diabetes (26%) high triglyceridemia (43%) three syndromes associated together (hyperuricemia + diabetes + hypertriglyceridemia) in 19.5%, total cholesterol is normal (2.07 g/l) but a low cholesterol (0.30 g/l).(ABSTRACT TRUNCATED AT 250 WORDS)

[Risk of AIDS for the occasional traveler in Africa]. / Le risque du S.I.D.A. pour le voyageur occasionnel en Afrique.

The authors first point out the importance of A.I.D.S. in Africa; then they appreciate the risk of contamination for occasional traveller in Africa. They recall some epidemic features of tropical A.I.D.S., its originality suggesting some risk factors different from the ones faced in temperate countries. Importance of risk of heterosexual transmission is emphasized, as well as possible parenteral contamination in connection with the frequent use of disposable needles and syringes again utilized without preliminary sterilization. Taking into consideration all these possibilities, the authors expose some prophylactic advises intended for people travelling briefly in endemic zones.