[Management of 90 patients presenting with suspected severe acute respiratory syndrome. Experience of a collaboration between epidemiologists and clinicians facing an emerging infectious disease health alert]. / Prise en charge de 90 patients suspects de syndrome respiratoire aigu sévère. Expérience d'une collaboration épidémioclinique en situation d'alerte sanitaire liée à une infection émergente.

OBJECTIVE: The characteristics of patients with a suspected SARS hospitalized in a Paris hospital were studied to analyze the hypothetic differences between epidemiologic and clinical teams in the management of an epidemic emerging disease, and to gather experience for the management of the next outbreak. STUDY DESIGN: All 90 patients hospitalized between March 16 and April 30, 2003, were included. Epidemiological and clinical data were shared with the French National Institute for Health. Cases were classified according to both the official definition ("possible", "probable", "excluded") and a local one, adapted from the official definition but including an additional level of suspicion ("equivocal"), intermediate between "possible" and "excluded". RESULTS: The initial assessment was different in 39% of the cases (n=35), according to epidemiological (n=24) or clinical (n=11) elements. The final assessment diverged in 54% of the cases (n=47). All patients were officially considered as "excluded" for epidemiologists, while 47 remained as "possible" or "equivocal" cases of SARS according to the clinicians. CONCLUSION: The risk assessment was different in almost 40% of the cases, with no impact on epidemic diffusion or hospital-borne exposure as no probable case of SARS was diagnosed among these patients or their households. The confrontation of these different but complementary points of view will thus enrich the interdisciplinary management of eventual future outbreaks.

Absence of infection in asymptomatic contacts of index SARS case in France.

The first case of severe acute respiratory syndrome (SARS) in France was diagnosed in March 2003. We conducted a serological survey to assess whether or not asymptomatic persons who had been in contact with this patient during his infectious stage had been infected. They were interviewed and asked to provide a blood sample for SARS coronavirus immunoglobulin G antibody testing. Despite the likely high infectivity of the SARS patient, no asymptomatic SARS infection was found in any of the 37 contacts included. These findings support a SARS case definition that is essentially based on clinical and epidemiological assessment, should SARS re-emerge.

Absence of infection in asymptomatic contacts of index SARS case in France.

The first case of severe acute respiratory syndrome (SARS) in France was diagnosed in March 2003. We conducted a serological survey to assess whether or not asymptomatic persons who had been in contact with this patient during his infectious stage had been infected. They were interviewed and asked to provide a blood sample for SARS coronavirus immunoglobulin G antibody testing. Despite the likely high infectivity of the SARS patient, no asymptomatic SARS infection was found in any of the 37 contacts included. These findings support a SARS case definition that is essentially based on clinical and epidemiological assessment, should SARS re-emerge.

[Limited impact of the harm-reduction policy on HCV among drug-users. The ANRS-Coquelicot survey example]. / L'impact limité de la réduction des risques sur la transmission du VHC chez les usagers de drogues. L'exemple de l'étude ANRS-Coquelicot.

BACKGROUND: In France, a harm-reduction policy was implemented in the late 1980s with the aim of reducing the prevalence of HIV and hepatitis C virus infection among drug users. The ANRS-Coquelicot survey was designed to measure the prevalence of HIV and HCV infection among drug users, and to examine determinants of at-risk behaviors. METHODS: In 2002, information was collected from 166 drug users recruited in all types of services specializing in drug use and harm reduction in Marseille, France. Self-reported HIV and HCV serostatus was compared with the results of serological tests done on capillary blood collected on filter paper. RESULTS: The self-reported and biologically documented prevalence rates of HIV infection were identical (22 %). In contrast, the self-reported prevalence of HCV infection was 52 %, while the biologically documented prevalence was 73 %. Overall, 30 % of HCV-infected drug users were unaware of their status. Forty-four per cent of drug users under 30 years of age were HCV-seropositive, suggesting that they had been infected early during drug use. CONCLUSION: The harm-reduction policy seems to have had a marked impact on HIV transmission among drug users, but a much more limited impact on HCV transmission.

[Incidence and risk factors of HCV infection in a cohort of intravenous drug users in the North and East of France]. / Incidence et facteurs de risque de la séroconversion au virus de l'hépatite C dans une cohorte d'usagers de drogue intraveineux du nord-est de la France.

BACKGROUND: In order to evaluate the incidence and risk factors of infection by hepatitis C virus (HCV) among intravenous drug users we conducted a prospective cohort study of HCV and HIV negative IVDU in the North and East of France. METHODS: Two hundred and thirty-one IVDU who had injected drug at least once in their lifetime and were negative for anti-HCV and anti-HIV were followed-up every three months over a 12-month period. Serum anti-HCV and anti-HIV antibodies were tested at inclusion in the study and at the end of the follow-up. Data on injection practices and behaviours were collected at inclusion and at each visit, and a test for anti-HCV antibodies was performed on a saliva sample. When this proved positive, an ELISA test for serum anti-HCV antibodies was carried out. RESULTS: Of the 231 participants included, 165 (71.4%) underwent a final HCV and HIV serum test. The incidence was nil for HIV infection and 9% (95% CI: 4.6-13.4) person-years for HCV infection. Among IVDU who injected at least once during the last 6 months HCV infection incidence was 11% (95% CI: 4.7-17.1) person-years. The multivariate analysis carried out on the inclusion data found female sex alone to be an independent predictive factor of HCV seroconversion. In a Cox proportional hazard multivariate analysis that took into account time-dependent exposures and covariates, we found that syringe and cotton sharing were, after adjusting for other covariates, the only independent predictive factors of HCV seroconversion: hazard ratio: 6.3 [corrected] (95% CI: 1.1-35.4; [corrected] p<0.05) and 16.4 (95% CI: 1.4-190.6; [corrected] p<0.05), respectively. CONCLUSION: The transmission of the HCV virus persists among French IVDU despite an ongoing national harm reduction program. Injecting material and cotton sharing are the two major determinants of transmission in this cohort.

Unsafe injecting practices among attendees of syringe exchange programmes in France.

AIMS: To describe syringe exchange programme attendees and their injection practices. DESIGN: Cross-sectional study (one week in 1998). Data were collected through a standardized questionnaire. SETTING: 60/74 syringe exchange programmes (SEPs) in France. PARTICIPANTS: Clients requesting syringes in 60 SEPs. MEASUREMENTS: Self-reports of drug use, injecting behaviour, sexual behaviour, serological status (HIV, HBV, HCV). Prevalence of unsafe injecting practices in the previous month such as: syringe sharing; and sharing other injection paraphernalia. FINDINGS: 1004 questionnaires were collected (response rate: 50%). The mean age of respondents was 30 years, and 70% were males. Among individuals tested, HIV reported prevalence was 19.2%, HCV 58.4% and HBV 20.8%. The mean duration of drug use was 11 years. Eighty-five percent were polydrug users and buprenorphine high-dosage was the substance most used (73%). In the previous month, 45% of the participants had re-used a syringe, 93% injected at least daily (mean 3.6 injections per day), 18% shared a syringe and 71% shared injection paraphernalia. In multivariate analyses, unsafe injecting practices were associated with heroin and cocaine use and with living in a couple. The cluster analysis identified five categories of IDUs: users of buprenorphine-HD (45% of the responders), morphine-sulphate (17%), benzodiazepines and other legal drugs (13%), methadone associated with other legal drugs (13%) and crack-cocaine (13%). The buprenorphine-HD group had better social status and safer injection practices. CONCLUSIONS: In France, despite an increase in the accessibility to syringes and substitution treatments, unsafe injecting practices persist among SEP attenders. Interventions should stress the importance of using sterile material for each injection, even with a steady sex partner.

Measurement of intraocular lens decentration and tilt in vivo.

A method for measuring the tilt and decentration of intraocular lenses (IOLs) in the static eye using the Purkinje image locations is presented. The patient fixates on a target that is coaxial with the camera or is at a predetermined angle with the camera axis. A telecentric stop is introduced in the camera so the positions of the Purkinje images on the film are independent of their distance from the camera. Measurements of the image locations on the film are used with anterior chamber depth and corneal curvature measurement to calculate the tilt and decentration of the IOL. In a group of 14 randomly selected patients with posterior chamber IOLs, 13 gave Purkinje images that could be measured. The average tilt was 7.8 degrees and the average decentration was 0.7 mm.

Cryosurgery of the inferior nasal turbinates.

Forty-seven patients with irreversible nasal obstruction due to inferior turbinate hypertrophy were treated by cryosurgery, the short and medium term results having been clinically evaluated. Permanent good results in nasal breathing were achieved in 83% of the patients. Failures are mostly related to turbinates hypertrophy due to nasal allergy. The combination of cryosurgery and nasal septoplasty, in cases of hypertrophy associated with deformities of nasal septum, gives an excellent result. Cryosurgery of hypertrophic nasal turbinates is a simple, safe, and reliable procedure to improve nasal breathing in cases of nasal turbinate hypertrophy.

[Screening for colorectal cancer. Study of a population attending a public health clinic]. / Dépistage du cancer colorectal. Etude dans la population consultant un centre d'examens de santé.

OBJECTIVES: Screening for colorectal cancer with fecal occult-blood test has been performed in health centers for several years. The aim of this study was to describe participation rate and results in a population attending the Center for preventive medicine at Vandoeuvre-lès-Nancy, France in 1996 and 1997. PATIENTS AND METHODS: Among 19,325 people aged 50-75 years, the screening test was proposed to 17,917 and performed in 15,527. RESULTS: Participation rate was 86.7%. Overall positivity was 3.6% higher in men than in women (4.1% versus 3.0%). In the 440 colonoscopies performed, 22 cancers and 84 adenoma polyps were identified (PPV = 24%). DISCUSSION: These results show good participation rates in a screening program for colorectal cancer during periodic health check-ups. Follow-up for positive subjects was satisfactory but requires good cooperation between specialists and general practitioners to obtain complete information to evaluate the program.

Impact of a harm-reduction policy on HIV and hepatitis C virus transmission among drug users: recent French data--the ANRS-Coquelicot Study.

In France a harm-reduction policy was implemented in the late 1980s with the aim of reducing the prevalence of HIV and hepatitis C virus (HCV) infection among drug users. The ANRS-Coquelicot survey was designed to measure the prevalence of HIV and HCV infection among drug users and to examine determinants of at-risk behaviors. In 2002, information was collected from 166 drug users recruited in all types of services specializing in drug use intervention and harm reduction in Marseille, France. Self-reported HIV and HCV serostatus was compared with the results of serological tests done on capillary blood collected on filter paper. The self-reported and biologically documented prevalence rates of HIV infection were identical (22%). In contrast, the self-reported prevalence of HCV infection was 52%, whereas the biologically documented prevalence was 73%. Overall, 30% of HCV-infected drug users were unaware of their status. Forty-four percent of drug users under 30 years of age were HCV seropositive, suggesting that they had been infected early during drug use. The harm-reduction policy seems to have had a marked impact on HIV transmission among drug users but a much more limited impact on HCV transmission. The limitations and implications of the study are discussed.

Infectious granulomatous diseases of the head and neck.

Infectious granulomatous diseases of the head and neck are very important entities that can mimic or hide malignant tumors and a wide variety of diseases. The frequency of these diseases is increasing with the wider use of immunosuppressive drugs and the increasing incidence of AIDS. The diagnosis is simple, and does not require sophisticated diagnostic procedures, but a high index of suspicion is necessary. Although other studies are helpful to suggest the diagnosis or define the extent of the disease, the microbiological and histopathological analyses are the most specific studies for the diagnosis. The therapy is usually combined: medical and surgical. The medical therapy involves treatment for a long period of time, usually between 3 and 6 months. The follow-up should be kept for at least 3 years. The tendency of some of these diseases to relapse makes the therapy discouraging, and some patients will need multiple therapies throughout their life. An accurate diagnosis and specific therapy for adequate amount of time is the best way to achieve a complete cure or at least a better chance for a good prognosis.

Incidence and risk factors of HCV and HIV infections in a cohort of intravenous drug users in the North and East of France.

In order to evaluate the incidence and risk factors of infection by hepatitis C virus (HCV) among injecting drug users (IDUs), we conducted a prospective cohort study of HCV- and human immunodeficiency virus (HIV)-negative IDUs in the North and East of France. A total of 231 HCV and HIV IDUs who had injected drugs at least once in their lifetime were followed up every 3 months over a 12-month period. Serum anti-HCV and anti-HIV were tested at inclusion in the study and at the end of the follow-up. Data on injecting practices were collected at inclusion and at each visit. Of the 231 participants included, 165 (71.4%) underwent a final HCV and HIV serum test. The incidence was nil for HIV infection and 9/100 person-years (95% CI 4.6-13.4) for HCV infection. In a multivariable analysis, we found that syringe and cotton sharing were the only independent predictive factors of HCV seroconversion.

Celulitis post septal bilateral consecuente a arrollamiento por alúd de lodo: a propósito de un caso / Post bilateral septal cellulitis consequent to winding by mud avalanche: to porpouse of case

Las complicaciones arbitrarias de la sinusitis se deben a la íntima relación entre los senos paranasales y la región arbitraria. Son de evolución rápida y según Chandler, pueden progresar a través de cinco grados hasta la trombosis del seno cavernoso. Una vez instaurada la antibiotecoterapia el drenaje quirúrgico, según sea la severidad del cuadro, responde positivamente. Se presenta el caso de un paciente masculino de 16 años de edad quien fue arrastrado por alud de lodo posterior a desastre natural e ingreso al Hospital" Domingo Luciani" a la Unidad politraumatizados con 48 horas de evolución. Se le realizó amputación supracondilea izquierda por fractura abierta y días después presenta pansinusitis, ameritando maxiloetmoidectomía y esfenoidotomía, posteriormente se asocia a celulitis orbitraria bilateral con proptosis y exposición corneal total (Chandler 2,) realizándosele una segunda maxiloetmoidectomía y por persistir el cuadrado, una tercera intervención días después. Se aislaron gérmenes Gram (-), Gram (+), y hongos. No se realizó drenaje quirúrgico orbitario y recibió tratamiento con Imipenem, Fluconazol y esteroides con respuesta lentamente favorable. Luego de un período de acalmia durante un mes, presentó osteomielitis de la base del cráneo