Risk factors for false-positive serological reactions for bovine brucellosis in Saône-et-Loire (France).

Since 1990, unusually high rates of false-positive serological reactions (FPSR) in bovine brucellosis screening have been observed in some countries of the European Union. The aim of this survey was to describe this phenomenon in a highly affected French Department, and to evaluate the links between some individual or herd factors and the occurrence of these FPSR. Before 1990, low backgrounds of FPSR were recorded (individual prevalence rate: less than 0.5 per 10,000). The phenomenon burst during the 1990-91 screening campaign, reached a peak in 1992-93 (50.5 per 10,000), and then decreased until the last studied campaign, 1995-96 (9.1 per 10,000). The phenomenon was transient and sporadic within a herd. At the herd-screening level, four assumed risk factors were isolated: (i) the probability of a herd-screening to be positive was closely and positively linked with the herd screening size; (ii) during a given screening campaign, the prevalence of FPSR decreased from December to November; (iii) the presence of at least one goat on the premises increased the risk for the 1992-93 and 1993-94 screening campaigns; and (iv) a previous FPSR in a given herd appeared to be a weak but significant risk factor. At the individual-animal level, herd size, sex and breed did not seem to be linked with FPSR appearance, while young animals were significantly more affected than older ones. However, global variations in herd or individual prevalences remained unexplained. The lack of link between FPSR and brucellosis is strengthened. The hypothesis of a widely spread causal agent with a low individual host susceptibility and/or a low probability of detecting FPSR animals can be supported by these results.

[Role of economic studies in animal health decisions: Example of the cost-benefit ratio of eradication of bovine viral diarrhea in France]. / Place des études économiques dans les décisions de santé animale: exemple du rapport coût/bénéfice de l'éradication de la diarrhée virale bovine en France.

To help livestock production groups to rationalise health decisions, and at the request of the Association for the certification of livestock health (Association pour la certification de la santé animale en élevage: ACERSA), an economic study was conducted to assess the possible cost-effectiveness of the eradication of bovine virus diarrhoea in France. The study was performed using a fictitious average region comprising 235,000 cattle belonging to 3,300 farms, which corresponds to one-eighty-fifth of the total cattle population of France. In the first phase of the study, the cost of the disease in this region was estimated to be approximately six million French francs (US$989,937) per year. Subsequently, the cost of an eradication strategy based on the inspection of all animals when introduced into a herd, the screening of permanently-infected immunotolerant animals (IPI) and the elimination of these animals, was evaluated at nearly eleven million francs (US$1,814,884) during the first year. Theories were then formulated regarding the time required to achieve eradication (twenty years) and to reduce the epidemiological parameters (development curve of the eradication of IPI animals and of animals which had given positive results to serological tests). The reduction in the cost of the disease as a result of the eradication policy was then simulated in accordance with the evolution of the epidemiological parameters. Finally, the cost of controlling the disease, together with the residual cost of the disease, were compared with the cost of the disease without control measures. This demonstrated that such an eradication policy would, in theory, only begin to become cost-effective after approximately fifteen years. In view of the long period required to achieve cost-effectiveness, the considerable complexity of implementing an eradication programme and imponderables (particularly concerning virus spread), the recommendation of such a course of action to cattle-breeder groups is questionable. This research demonstrates that a relatively simple economic approach can serve as a useful decision-making aid.

[Surgical treatment of genitourinary prolapse by the abdominal approach. Apropos of a series of 232 cases]. / Traitement chirurgical des prolapsus génito-urinaires par voie abdominale. A propos d'une série de 232 cas.

Two hundred and thirty two patients with genitourinary prolapse were operated via an abdominal incision between 1981 and 1994. The technique consisted of retroperitoneal promontofixation, systematically associated with a retropubic colposuspension, levator myorrhaphy, Douglassectomy and uterosacral ligamentoplasty. The mean age of operated patients was 52.57 years (30-85 years), the mean follow-up was 17.8 months (1-105). 65 patients (27.7%) had a history of foetal macrosomy, 125 women (53.4%) were delivered without forceps or expression, and 2 patients (0.8%) had never procreated. The main presenting complaint was prolapse in 197 patients (84.4%), while 140 patients complained of urinary incontinence (60.3%). A urodynamic assessment was systematically performed before the operation and revealed defective transmission in 160 cases (71%); sphincter incompetence in 62 cases (62/228 cases, i.e. 27%); a combination of sphincter incompetence and defective transmission in 40 cases (17.7%). The results were assessed in terms of anatomical and functional parameters. The anatomical results revealed 21 recurrences, the majority of which were posterior recurrences, and the functional results were marked by urinary functional disorders such as urinary incontinence (30%), urgent micturition (14%) and dyspareunia (21%).

[Recourse to particular arterial embolization in the treatment of some uterine leiomyoma]. / Recours à i'embolisation artérielle particulaire dans le traitement de certains fibromyomes utérins.

UNLABELLED: In 88 women between the ages of 34 and 51 years with one or several symptomatic uterine leiomyomata (menometrorrhagia, mass syndrome) after failure of medical treatment, particulate arterial embolization was proposed as an alternative to the scheduled surgical operation. Free-flow embolization with Ivalon particles (150 to 600 microns) was performed under local anaesthesia after femoral artery puncture and catheterization of the hypogastric then uterine arteries (5 F catheter) including occlusion Pelvic pain was frequently observed immediately after embolization, lasting 12 to 18 hours, and required analgesia. Necrobiosis syndromes can be observed in the case of very large leiomyomata. No immediate complications directly related to vascular catheterization were observed in this series, but complete necrosis of a very large leiomyomatous uterus required hysterectomy. Five embolization failures were observed. The following results were observed in the 80 interpretable cases with a follow-up of 6 to 60 months: the menstrual periods returned to normal in 60 (89%) of the 67 menorrhagic patients, after six months a volume reduction of myomata equal to 69% of initial volume was observed. CONCLUSION: in of 80 interpretable cases, embolization constituted an alternative to surgical treatment, which was avoided in 71 cases, 9 failures were observed. The results of this preliminary series must be valited by further studies.

Secondary postpartum hemorrhage: treatment with selective arterial embolization.

PURPOSE: To evaluate the efficacy and safety of selective arterial embolization of the uterine arteries in the management of intractable delayed postpartum hemorrhage. MATERIALS AND METHODS: Fourteen consecutive women with secondary postpartum hemorrhage were treated with selective embolization of the uterine arteries. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be controlled with the administration of uterotonic drugs or with uterine curettage. RESULTS: The causes of bleeding included genital tract tears in four women and endometritis in eight women; the endometritis was associated with proved, retained portions of placenta in four women. In two women, no evident cause of bleeding was found before angiography. Angiography revealed extravasation in three women. A false aneurysm of the uterine artery was found in two women. In one patient, an arteriovenous fistula was observed. Immediate resolution of external bleeding was observed in all women. No complication related to embolization was found. Normal menstruation resumed in all women. CONCLUSION: Selective arterial embolization of the uterine arteries is a safe and effective means of controlling secondary postpartum hemorrhage.

Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization.

PURPOSE: To prospectively evaluate the efficacy and safety of emergency selective arterial embolization in the management of intractable primary postpartum hemorrhage. MATERIALS AND METHODS: Twenty-seven consecutively seen women with life-threatening primary postpartum hemorrhage underwent uterine embolization. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be controlled with vaginal packing and administration of uterotonic drugs. The mean hemoglobin level before embolization was 7.48 g/dL +/- 2.39 (74.8 g/L +/- 23.9) (1 standard deviation). Hysterectomy performed in two patients before embolization failed to stop the bleeding. RESULTS: Angiography revealed extravasation in nine patients and spasm of the branches of the internal iliac artery in five. The procedure consisted of embolization of uterine (n = 46), vaginal (n = 5), or ovarian (n = 2) arteries or anterior division of internal iliac arteries (n = 8). Immediate disappearance or dramatic diminution of external bleeding was observed in all cases. Two patients needed repeated embolization the next day. No major complication related to embolization was found. In one patient with placenta accreta, delayed hysterectomy was necessary. Normal menstruation resumed in all women except the two who underwent hysterectomy. One woman became pregnant after embolization. CONCLUSION: Emergency arterial embolization is a safe and effective means of control of primary postpartum hemorrhage. The procedure obviates high-risk surgery and allows maintenance of reproductive ability.

Epidemiologic and genomic study of rotavirus strains infecting young children and calves in the same rural environment.

The epidemiological profile of rotavirus infection in young calves and young children form the same rural environment in France was studied during autumn-winter 1983-1984. Viruses were isolated from calves on each farm and were identified by their electropherotype for 8 out of the 9 farms under study. Among 13 children regularly checked on 9 farms for 25 weeks, 7 were found to be rotavirus positive. Nevertheless, no transfer of virus between child and bovine was documented by the electropherotype migration. In the case of the calves, the predominance of the Ib IIa IIIe IVa electropherotype at 5 of the 9 farms is similar to the epidemiological situation observed among newborn in some maternity wards.