Magnetic resonance imaging in adults presenting with severe acute infectious cellulitis.

BACKGROUND AND DESIGN: Early categorization of some acute soft-tissue infections, such as severe infectious cellulitis (IC) without or with secondary abscess formation, necrotizing fasciitis (NF) or pyomyositis, is frequently difficult. The first one requires only medical treatment, the remaining ones require either surgery or closed drainage. To determine the presence and the extent of these infections early, we have prospectively studied the value of magnetic resonance imaging in patients admitted for IC with local or general criteria of severity. Images were analyzed on a blind basis. Definite diagnosis was obtained by reviewing clinical records and, in most patients, the results of an invasive procedure. RESULTS: Twenty-six patients (56 +/- 23 years old) were included in this study. Among them, 13 received gadolinium-diethylene-triaminepenta-acetic acid intravenously. The final diagnosis was pyomyositis (five patients), NF (three patients), or IC with (seven patients) or without (11 patients) subcutaneous abscess. Images specific for these diseases were best outlined with T2-weighted sequences. In patients with pyomyositis or subcutaneous abscess(es), we observed spindle-shaped or round, well-defined areas of high signal intensity within the muscles or subcutis, respectively. Patients with NF exhibited numerous homogeneous, well-defined dome-shaped areas of hypersignal in the deep hypodermis. In patients with uncomplicated IC, these dome-shaped areas of hypersignal appeared ill-defined, heterogeneous, smaller, thinner, and less numerous than those in patients with NF. CONCLUSIONS: In patients presenting severe IC, magnetic resonance imaging provided an early clue in the diagnosis of pyomyositis, NF, and abscess-complicated IC. By precisely defining the extent of these infections, it helped to plan surgical treatment.

[Infectious complications of implantable infusion ports in patients with HIV infection]. / Complications infectieuses des chambres implantables chez les patients VIH.

Thirty-four implantable ports were consecutively implanted in 27 AIDS patients (mean CD4 lymphocyte count: 39/mm3) from January 1993 to December 1995. We observed 33 complications in these patients. Perioperative complications included: one pneumothorax (3%), one haematothorax (3%) and one septic shock (3%). Later complications included one venous thrombosis (3%) and 26 infectious complications (79%). Fever of unknown origin was observed in three patients (9%). A total of 19 bacteremias occurred in 12 patients. The global rate of infection for 100 catheter-days was 0.51 for a total of 5,096 catheter-days. The following microorganisms were isolated: Staphylococcus (n = 21; 72%), Pseudomonas (n = 3; 11%) and others (n = 5; 17%). Thirty-eight percent of the ports (n = 13) were removed, after a mean of 89 days. During the study, 21 patients died. Two patients died from a catheter infection with septic shock (8%). It seems to be important to clearly define the indications of implantable infusions ports in AIDS patients with respect to their life expectancy.

[Value of the study of plasma estrogens in the exploration of gynecomastia. Apropos of 48 cases]. / Intérêt de l'étude des oestrogènes plasmatiques dans l'exploration des gynécomasties.

Starting from 48 cases of gynecomastia, the authors report the following findings: -- Impairment of the testis function, as assessed by a low plasma level of testosterone, is rare. -- Basal values of gonadotropins are generally normal. -- Increased oestrogen urinary excretion and blood level are rarely found but, when present, they tend to decrease at successive evaluations. -- In six cases, plasmatic oestradiol can be suppressed by dexamethasone; although the small number of cases does not allow a definite conclusion, one might suggest a predominant adrenal source of plasmatic oestradiol.

[Inter-alpha-trypsin inhibitor and its derivatives in inflammatory syndromes]. / Inter-alpha-trypsine inhibiteur et ses dérivés dans les syndromes inflammatoires.

Modifications of inter-alpha-trypsin inhibitor (ITI) in inflammatory syndromes were determined by studying its serum components: ITI 80 (the native form) and serum derivatives (SD), as well as urinary ITI derivatives (UID) excretion in 31 controls and 128 patients with inflammatory of various origins. The patients were divided into 4 groups: Group I bacterial infections (n = 29); Group II cancers (n = 50); Group III inflammatory diseases (n = 14); Group IV inflammatory syndromes due to other causes (n = 35). Other markers of inflammation were also studied. In bacterial infections and cancers ITI 80 concentrations were significantly decreased, with values of 0.55 +/- 0.15 g/l and 0.54 +/- 0.15 g/l respectively vs 0.65 +/- 0.11 g/l in controls. SD concentrations were significantly increased in all 4 groups: Gr I: 0.31 +/- 0.12 g/l; Gr II: 0.30 +/- 0.11 g/l; Gr III: 0.25 +/- 0.08 g/l; Gr IV: 0.24 +/- 0.10 g/l, as compared with 0.16 +/- 0.09 in controls. UID excretion was increased in all cases, particularly in bacterial infections and cancers (10.8 +/- 13.4 and 6.0 +/- 8.8 mg/mmol of creatinine vs 1.5 +/- 1.7 g/mmol). A significant correlation was observed between CRP levels and SD levels. In bacterial infections and cancers, a fall in ITI associated with a rise in SD and an increase in UID excretion is suggestive of degradation of the native form. In inflammatory diseases and inflammatory syndromes of other causes, the rise in SD without significant variations in ITI 80 suggests and increase in SD synthesis. The correlation between CRP and SD seems to indicate that SD are produced in the early stage of inflammatory syndromes.