[Endovascular treatment of coronary arterial fistulae in children and adults]. / Traitement endovasculaire des fistules artérielles coronaires de l'enfant et de l'adulte: à propos de 25 cas.

The authors report their experience of endovascular treatment of coronary fistulae in 25 patients aged 2 to 77 years (median 29 years) who underwent 30 interventional catheterisation procedures. The origin of the fistulae was variable: left coronary (14 cases), right coronary (6 cases) and bilateral (5 cases) as were the sites of drainage: right atrium (5 cases), right ventricle (8 cases) pulmonary artery (7 cases) and bronchial artery (5 cases). Different materials were used: releasable balloons (9 cases), coils (17 cases), microparticles (5 cases) and Amplatzer occluder and plug (2 cases). The result, judged by occlusion or sub-occlusion of the given pedicle, was a success in 92% of cases. Total or sub-total occlusion of the fistula was obtained in 22 patients (88%); 2 patients had residual fistulae due to non-embolisation of the pedicle; in one patient, it was not possible to embolise the pedicle despite two attempts. A single serious complication, ventricular fibrillation during the catheterisation, was observed but without a sequel. Follow-up ranged from 6 to 176 months; 4 patients died of other causes, 3 were lost to follow-up; one coronaro-pulmonary fistula recurred but no other recurrence was observed in the other patients. The authors conclude that embolisation is the treatment of choice for coronary fistulae providing the cases are managed by teams trained in the use of different materials. The choice of material of embolisation should be adapted to the anatomical conditions which determine the success rate and the absence of complications.

Branhamella catarrhalis. New methods of bacterial diagnosis.

A total of 176 strains identified as Branhamella catarrhalis were isolated from various clinical specimens, mainly sputum (71), pharynx (49), eye (24), nose (11), ear (6) and tracheal aspirate (7). B. catarrhalis appeared as Gram-negative cocci in white colonies which were oxidase- and catalase-positive and which did not produce acidification of sugars. The 3 related species, Neisseria caviae, N. ovis and N. cuniculi were also white but the 'true asaccharolytic Neisseria' studied presented a yellow pigment. Only a few strains of B. catarrhalis were able to grow on selective medium. However, when Catlin's chemically defined medium was used, all strains of B. catarrhalis had a unique requirement for arginine. This characteristic differentiated B. catarrhalis from N. caviae and N. ovis (non-requiring), N. cuniculi (required cystine, proline and arginine) and N. canis and N. elongata (both non-requiring). All strains of B. catarrhalis reduced nitrate and nitrite, possessed deoxyribonuclease activity and hydrolysed tributyrin to butyric acid. B. catarrhalis liberated high concentrations of butyric acid, N. caviae, N. ovis and N. cuniculi moderate concentrations and other species of Neisseria minimal concentrations. All strains of B. catarrhalis were resistant to acetazolamide and the absence of gamma-glutamyl transferase activity differentiated B. catarrhalis from atypical meningococci which were always positive.

Detection, distribution and inhibition of Branhamella catarrhalis beta-lactamases.

Beta-lactamase-producing isolates of Branhamella catarrhalis were first detected in France in 1977. The frequency of beta-lactamase producers has increased, especially since 1980. An agar iodometric test, a fast chromogenic test and an acidimetric test were used to assess the beta-lactamase-producing capabilities of 188 isolates of B. catarrhalis obtained mainly from sputum and the pharynx. Data from the first 2 procedures indicated positive beta-lactamase activity for all 49 strains of B. catarrhalis identified, but there were some discrepancies in the acidimetric test results. Evidence from a diffusion technique showed significant increases in the inhibition diameters surrounding filter discs impregnated with amoxycillin in the presence of clavulanic acid, or with ampicillin in the presence of sulbactam, compared with discs of the penicillins used alone. Two types of enzyme activity emerged from examination of isoelectric focusing patterns. Type I, having pI values of 5.35, 5.55 and 5.85, accounted for 87.2% of the enzyme-producing isolates. Type II, with pIs of 5.5, 5.9 and 6.25, occurred in 12.8% of isolates and appeared to be less widely distributed. The beta-lactamase inhibitors clavulanic acid and sulbactam in combination with benzylpenicillin produced potentiated effects, as demonstrated by significant reductions in MIC (33- and 44-fold decreases, respectively). Higher concentrations of each inhibitor similarly affected the MICs of amoxycillin. A weak synergy occurred with cefoxitin, a beta-lactamase-resistant beta-lactam antibiotic, and the 2 beta-lactamase inhibitors. Because B. catarrhalis has been shown to be a beta-lactamase-producing pathogenic organism, the addition of enzyme inhibitors, such as clavulanic acid and sulbactam, to standard therapy may be beneficial.

Pulmonary thromboendarterectomy for chronic thromboembolic obstruction of the pulmonary artery in piglets.

OBJECTIVE: The 2 main causes of death after thromboendarterectomy for chronic pulmonary thromboembolism are incomplete repermeabilization responsible for persistent pulmonary hypertension and acute high-permeability pulmonary edema. We wish to establish an experimental model of chronic pulmonary thromboembolism to replicate the conditions encountered during and after pulmonary thromboendarterectomy. METHODS: Multiple-curled coils and tissue adhesive were embolized in 6 piglets to induce complete obstruction of the left pulmonary artery, documented by angiography. After 5 weeks, the main pulmonary artery was repermeabilized by thromboendarterectomy during circulatory arrest. The left lung was reperfused ex vivo with autologous blood at constant flow, and patency of the pulmonary artery was evaluated on a barium angiogram. The endarterectomy-reperfusion procedure was also done in 6 nonembolized piglets that served as the controls. The severity of lung injury induced by 60 minutes of reperfusion was assessed on the basis of measurements of the lung filtration coefficient and of lung myeloperoxidase activity. RESULTS: Marked hypertrophy of the bronchial circulation was seen in the chronic pulmonary thromboembolism group. Thromboendarterectomy removed the organized obstructing thrombus that was incorporated into the arterial wall and restored patency of the pulmonary artery. Acute lung inflammation and high-permeability edema occurred after reperfusion, as indicated by a 1.5-fold increases in both lung filtration coefficient and lung myeloperoxidase values in the chronic pulmonary thromboembolism group; these 2 variables being correlated. CONCLUSIONS: Our model replicated the perioperative conditions of pulmonary thromboendarterectomy, suggesting that it may prove useful for improving the repermeabilization technique and for investigating the mechanisms and prevention of reperfusion injury.

Characterization of serogroup A Neisseria meningitidis strains by rRNA gene restriction patterns and PCR: correlation with the results of serotyping, subtyping and multilocus enzyme electrophoresis.

We studied 35 strains of Neisseria meningitidis serogroup A from different locations (France, Central African Republic, Sudan and Burkina Faso) using both ribotyping and a polymerase chain reaction (PCR). A non-radioactive probe label was used for ribotyping; detection consisted of an immunoenzymatic procedure using a bispecific antibody. The PCR was designed to amplify the 16S-23S rDNA internal transcribed spacer. These techniques were compared with other markers. The strains were identified as belonging to three clones (I, III-1, IV) by multilocus enzyme electrophoresis (MEE) and to three subtypes by serological methods. Ribotyping identified five groups and PCR identified four groups. Ribotyping gave more diversity between strains than either MEE or sero/subtyping, but confirmed the epidemiological data provided by the combination of these two techniques. The PCR provided a simple and convenient one-step procedure for the differentiation of strains of serogroup A.

Meningitis outbreaks and vaccination strategy.

Three outbreaks of meningitis caused by Neisseria meningitidis serogroup A (subgroup III) are described: Niger (1991), Burundi (1992), and Guinea (1993). These outbreaks showed unusual characteristics: a shorter inter-epidemic interval (Niger), unusual geographical location outside the meningitis belt (Burundi and Guinea), and high age-specific attack rates in all age groups (Burundi and Guinea). Mass immunization campaigns mobilized considerable human and financial means (US $322,000 and 3000 person-days of work for health personnel to immunize 629,000 people in Guinea). The vaccination coverage was over 80% in densely populated areas (Burundi and urban Guinea), but below 50% in less populated areas (24/27 and 26/30 sub-districts in Niger and Guinea, respectively). The preventive fraction (proportion of cases prevented by vaccination) was substantial in Guinea (35% for a vaccine efficacy of 85%) and was higher where the campaign was initiated earlier. An 'alert' threshold indicating the onset of an epidemic of 15/100,000 cases in one week showed good sensitivity (94%), specificity (98%) and positive predictive value (89%) in Burundi, permitting quick decision making outside the meningitis belt. These 3 meningococcal meningitis outbreaks show the need for epidemic emergency preparedness and for vigilance on the whole African continent.

Endocervical infection in a pregnant woman caused by Neisseria meningitidis: evidence of associated oropharyngeal colonization of the male partner.

A case of premature birth associated with an endocervical infection caused by Neisseria meningitidis is reported. Treatment of the mother with amoxycillin eradicated the bacteria from the endocervix and avoided newborn colonization or infection. Epidemiological investigation identified meningococcal oropharyngeal colonization of the male partner. The two strains were of the same antigenic formula B:4:P1.14 and exhibited identical rDNA restriction fragment patterns and outer membrane protein profiles. This phenotypic and genomic identity of strains is the first clear evidence for cross-colonization between sexual partners.

Surveillance of meningococcal disease in France, 1990-1997.

The surveillance of meningococcal disease in France is based on four complementary sources of data. 1. Meningococcal disease has been a notifiable disease since 1902. A case definition for surveillance was introduced in 1985, based on the isolation of Ne

[Coaxial catheterization with an ultra-flexible catheter (Tracker) in coronary angioplasty]. / Intérêt du cathétérisme coaxial à l'aide d'un cathéter ultra-souple (Tracker) en angioplastie coronaire.

After experiencing problems of catheterisation during coronary angioplasty, the authors tried using a 3.2 F ultraflexible catheter with a 2.2 F tapered tip. In 2 patients, initial attempts at coronary catheterisation were failures but when this new catheter was used, angioplasty could be performed without any difficulty. This catheter was then used in 4 other patients and in all cases the Tracker enabled the operators to catheterise the coronary arteries and to perform angioplasty in 3 of the 4 cases. Therefore, this new ultraflexible catheter would seem to be a valuable alternative for catheterising particularly sinuous coronary arteries in which angioplasty is often technically difficult.

[Survey of gonococcal and meningococcal infections. Results from a systematic study of patients from an urban dispensary and sexual partners (author's transl)]. / Bilan d'une recherche systématique de gonocoque et de méningocoque dans un dispensaire antivénérien. Résultats fournis par les prélèvements effectués chez les partenaires.

Over a period of 28 months, 605 strains of gonococci and 302 strains of meningococci have been isolated in an urban dispensary. The study was particularly concerned with the identification of gonococcal and meningococcal strains isolated from the patients sexual partners and with epidemiological distribution of the two species. There was only little seasonal variations in the occurrence of gonococcal infections. The frequency of meningococcal infections (which are only poorly transmitted, by the nasopharyngeal route) varied inconsistently during the period covered.

[Bacteriological diagnosis of species of the genera Neisseria and Branhamella]. / Diagnostic bactériologique des espèces des genres Neisseria et Branhamella.

Various technics of swabbing and isolation are described here in the search for bacteria of the genera Neisseria and Branhamella. The methods of staining the most commonly used for direct examination are mentioned, and the media of transport and isolation useful in particular for the gonococcus and meningococcus. Thus isolation of the bacteria permits during a second stage to culture and identify various species in the light of their cultural, biochemical and serological properties. The study of their sensitivity to antibiotics in vitro is easy to carry out, but it requires certain precautions and it will be described in detail in another publication.

[Inhabitual sites for Neisseria and Branhamella]. / A propos des Neisseria et branhamella trouvées en localisation inhabituelle.

The authors bring together a bibliographical study and their own personal results concerning inhabitual sites for Neisseria and Branhamella. Among various species, gonococci (N. gonorrhoeae) and meningococci (N. meningitidis) may either be manifest pathogenic agents or exist in asymptomatic carrier states and they are found in normal microflora. Other species of Neisseria and Branhamella may be opportunistic pathogenic bacteria isolated in diverse infections. The utility of complete bacteriological diagnosis is emphasized for all of these cases.

[Analysis of 190 strains of Neisseria gonorrhoeae isolated in Yaounde from 1984 to 1987: auxotypes, plasmidic contents, antibiotic sensitivity]. / Analyse de 190 souches de Neisseria gonorrhoeae isolées à Yaoundé de 1984 à 1987: auxotypes, contenus plasmidiques, sensibilité aux antibiotiques.

Gonococcal infections are always a public health problem in Cameroon. From January 1984 to December 1987, 2,074 strains have been isolated in the "Centre Pasteur du Cameroun". Among these strains, 190 had been studied in details concerning antibiotic susceptibility, auxotypes and plasmidic content. Penicillinase producing Neisseria gonorrhoeae (PPNG) were increasingly isolated: 32.28% (1984); 59.57% (1987). Auxotypes prototrophes and proline requiring were more often isolated. Plasmidic content showed essentially african type (with or without conjugative plasmid) but also asian type.

[Study of beta-lactamase in Neisseria gonorrhoeae by a gel adaptation of the iodometric method]. / Recherche de beta-lactamase chez Neisseria gonorrhoeae par une adaptation en gel de la méthode iodométrique.

A simple protocol for the demonstration of a beta-lactamase in the gonococcus has been adapted from the iodometric technique on agar medium developed by Labia and Barthelemy [13]. This protocol has been applied to 70 strains which produce this enzyme isolated in France and in three African countries.

Sero-subtyping of group B, C, Y and A meningococci isolated in France in 1988.

During 1988, 291 strains of various serogroups (B, C, Y and A) isolated in France, have been sero and sub-typed. 74.5 p. cent of the strains were isolated from CSF and blood of patients; 25.4 p. cent were isolated from carriers. The "whole cell ELISA" procedure was used with monoclonal antibodies. The distribution of serotypes among serogroup B strains was as follows: serotype 1 (8.1 p. cent); 2a (19 p. cent); 2b (16.2 p. cent); 4 (20.2 p. cent); 14 (13.5 p. cent); 15 (23 p. cent): 40 p. cent remained non typable (NT). Among serogroup C strains serotype 2a represented 74.5 p. cent of the strains. Serogroup A strains were only of the serotype 4. Serogroup Y strains belonged to serotype 14 or were NT. Some associations between serotypes and subtypes were predominant such as B:2a:P1.2 or B:2b:P1.2 or B:4:P1.15 or B:15:P1.7. Among serogroup C strains the antigenic pattern C:2a:P1.2 was most prevalent.

[Percutaneous treatment of iliac aneurysms with endovascular stented grafts]. / Traitement percutané d'anévrismes iliaques par endoprothèse couverte.

Two cases of iliac aneurysms treated percutaneously by endovascular stented graft are reported. The initial radiographic evaluation included arteriography and computed tomography with helical acquisition and three dimensional reconstruction. This enabled analysis of the flow path, the extent of the wall thrombus, the choice of stent graft's size. The procedure of implantation was technically trouble free. The post-procedure arteriography and 3D CT demonstrated occlusion of the aneurysm and restauration of a normal flow path. The three, six and twelve month check-ups confirm the good results. In weakened patients or those not requiring aorto-iliac surgery, percutaneous treatment of iliac aneurysm can be carried out easily. The contribution of 3D CT is essential in assessing the endo- and extra-luminal characteristics of aneurysm for indicating the percutaneous route and selecting size of the stented graft.

[Aneurysm of the persistent sciatic artery]. / Anévrisme de l'artère sciatique persistante.

The authors report a case of persistent sciatic artery presenting with limb ischemia and pulsatile mass in the buttock treated only by femoro tibio peroneal by pass graft since follow up helical CTA at six months showed spontaneous aneurysmal exclusion by thrombosis of the persistent sciatic artery above the aneurysm. Review of the literature confirms the rarity of this anomaly, which is frequently associated with aneurysmal transformation and its specific inherent complications. It is treated by femoro popliteal shunt with endovascular embolization.

[Endovascular embolization of a splenic aneurysm and of a false aneurysm of the splenic artery]. / Traitement d'un anévrisme et d'un faux anévrisme spléniques par embolisation artérielle percutanée.

Splenic artery aneurysms, once considered rare entities are now being reported with increasing frequency. Rupture may be the presenting and only symptom and can be fatal. The authors present two cases of splenic aneurysms treated by endovascular embolization. The initial imaging work-up included sonography, angiography and helical computed tomography with multiplanar and 3D reformations. This enabled comprehensive evaluation of the aneurysms, including their configuration, essential for coil selection. Embolization was uneventful. Post-embolization angiograms confirmed exclusion of the aneurysms. Follow-up CT at 9 months showed complete thrombosis of the aneurysms and no evidence of pancreatic or splenic complication. Endovascular management for definitive treatment of splenic aneurysms is technically possible and should be considered.

[Transradial approach for diagnostic angiography]. / Artériographie diagnostique par voie transradiale.

Seventy five arteriographies were performed via the transradial route using 5F 130cm - long catheter. Prior to puncture the radial artery was evaluated with Allen test. Satisfying quality examinations were obtained for the thoracic aorta, selective carotid arteries examinations, infra renal aorta, pelvic and legs arteries. The major advantages obtained for the technique were the very low rate complication and technical failure. Transradial route for arteriography is a reasonable alternative approach to transfemoral or brachial arteriography for out patient management (peripheral angiography) in case in which transfemoral route is not feasible but also with patients with important haemorragic-risks.

[Percutaneous treatment of a common iliac aneurysm extending to the hypogastric artery with embolization and a covered endoprosthesis]. / Traitement percutané d'un anévrisme iliaque primitif étendu à l'artère hypogastrique par embolisation et endoprothèse couverte.

A case of iliac aneurysm treated percutaneously by endovascular stent graft (Wallgraft - Boston) and transcatheter embolization of internal iliac artery in order to prevent retrograde filling of the aneurysm from the patent hypogastric artery is presented. The initial radiographic evaluation included arteriography, and 2D and 3D spiral CT angiograms. This enabled analysis of the extent of mural thrombus, flow direction, as well as selection of stent graft and coil size. The procedure of embolization and implantation was technically uneventful. Post procedure 3D CT and arteriography demonstrated exclusion of the aneurysm, and return to a normal flow pattern. Follow-up at 6 and 12 months confirmed the stability of the results. Percutaneous treatment of common iliac artery aneurysms involving the hypogastric artery can be performed easily, especially in elderly patients. 3D CT is essential in assessing the endo and extra luminal characteristics of the aneurysm to insure optimal results and to detect complications.