[Non-tuberculous mycobacterial cervical adenitis in children: 2 cases]. / Deux cas d'adénite cervicale à mycobactéries non tuberculeuses chez l'enfant.

BACKGROUND: Cervical lymphadenitis is the most common manifestation of infection with nontuberculous mycobacteria (NTM) in immunocompetent children. Nevertheless, it is poorly known by dermatologists. Its incidence, which is currently increasing since the cessation of BCG vaccination in 2007, raises several issues regarding its pathophysiology, diagnosis and management. PATIENTS AND METHODS: We report two cases of NTM adenitis: one in a 2-year-old girl vaccinated with BCG and one in an unvaccinated 22-month-old boy, in whom a misleading presentation led to delayed diagnosis. The condition progressed to fistula formation and the diagnosis was finally made on systematic cultures of lymph node samples. The time to diagnosis was 2 and 4months, respectively. The girl was treated with erythromycin for 3 weeks and with clarithromycin for 3 weeks; the boy received clarithromycin for 7 weeks and underwent complete surgical excision. DISCUSSION: NTM adenitis preferentially affects girls under 4 years and occurs more frequently in winter and spring. First, the other differential diagnoses, including tuberculosis, must be ruled out by chest radiography. The diagnosis is oriented by the clinical picture, a positive TST and resistance to conventional antibiotics. However, it is only certified by systematic culture or PCR of lymph node biopsies, with screening for atypical mycobacteria being specified. The decrease in child protection by BCG vaccination coincides with the current increase in NTM infections, of which the most frequent is Mycobacterium avium complex (MAC) for cervical adenitis. The reference treatment is surgery. However, alternative treatments (incomplete excision, antibiotics, watchful waiting, etc.) should be considered where surgery fails or there is excessive risk of injury to a branch of the facial nerve. CONCLUSION: Atypical mycobacterial adenitis in immunocompetent children has become an increasingly common infection since the abandonment of BCG vaccination. Improved knowledge of this disease would result in complete surgical excision at an early stage with a lower rate of aesthetic sequelae.

Diagnostic value of procalcitonin in acutely hospitalized elderly patients.

The aim of this study was to evaluate procalcitonin as an adjunct to diagnose bacterial infections in older patients. One hundred seventy-two patients admitted to an acute-care geriatric unit during a 6-month period were prospectively included, 39 of them with an invasive bacterial infection. The best cut-off value to rule in a bacterial infection was 0.51 microg/l with sensitivity 64% and specificity 94%. The best cut-off value to rule out a bacterial infection was 0.08 microg/l with sensitivity 97% and specificity 20%. Procalcitonin was inconclusive (between 0.08 and 0.51 microg/l) for 112 admissions. Procalcitonin over 0.51 microg/l was useless 22 times out of 33 (infection already ruled in on clinical grounds) and misleading in eight of the 11 remaining cases (no infection). Procalcitonin below 0.08 microg/l was useless 23 times out of 27 (infection already ruled out on clinical grounds) and misleading in one of the four remaining cases (infection). Despite a good overall diagnostic accuracy, the clinical usefulness of PCT to diagnose invasive bacterial infections in elderly patients hospitalized in an acute geriatric ward appears to be very limited.

[Ossiculoplasty with a partial Spiggle & Theis titanium prosthesis in cholesteatoma: functional results]. / Ossiculoplastie par prothèse partielle en titane Spiggle & Theis dans l'otite cholestéatomateuse: résultats fonctionnels.

OBJECTIVES: To report the functional results of ossicular reconstruction achieved with a specific partial prosthesis in tympanoplasty for cholesteatoma. MATERIALS AND METHODS: Forty-four patients presenting cholesteatoma of the middle ear were involved in a retrospective study. Tympanoplasties were performed by the same surgeon over a 30-month period. The patients underwent ossiculoplasty with the shortest nondivisible partial titanium Spiggle & Theis prosthesis. Twenty-eight procedures were canal wall-up tympanoplasties and 17 were canal wall-down procedures; 27 were primary tympanoplasties and 18 were revisions. Audiometric data were evaluated before and after surgery, with a mean follow-up of 13.4 months. RESULTS: Improvement of the air-bone gap was 6+/-12.2dB. The overall success rate was 56% and 67% using the Glasgow Benefit Plot and a postoperative air-bone gap lower than 20dB, respectively. There was no significant functional difference between canal wall-up and canal wall-down procedures. Hearing results were better in primary tympanoplasties than in revisions (p=0.004). The extrusion rate was 2.2%. CONCLUSION: The functional results observed in this study confirm that this partial titanium Spiggle & Theis prosthesis is a valuable biomaterial for ossicular reconstruction in primary tympanoplasty for cholesteatoma.

Charge heterogeneity of human mammary tumor estrogen receptors. Relationship with a hormonal sensitivity tumor marker.

A high resolution quantitative method for estrogen receptor analysis has been elaborated using isoelectric focusing in 0.5% agarose gel, without any prior trypsin digestion. The 23 cytosols analyzed were stabilized by molybdate and prepared from human mammary tumors with progesterone receptors (PR + cytosols) or without (PR - cytosols). Progesterone receptor was used as a tumoral hormonal sensitivity marker. The estrogen receptors usually resolved as 4 isoform peaks of close isoelectric points. In PR - cytosols, the mean pI values were 4.7, 5.5, 6 and 6.5. Significant differences between the two cytosol populations were observed concerning pI 4.7 and 6.5 isoforms. In PR - cytosols, the pI 4.7 isoform occurred in greater proportions than in PR + cytosols, whereas lower proportions of pI 6.5 isoform were seen. The comparison between high performance size exclusion chromatography profiles and isoelectric focusing patterns, before and after cytosol incubation at 28 degrees C with KCl (0.4 M), confirmed an oligomer structure for the pI 4.7 isoform and suggested a monomer structure (Stokes radius 2.9 mm) for the pI 6.5 estrogen receptor isoform. The results indicated that isoelectric focusing analysis of estrogen receptors could be useful in the prediction of breast cancer hormonal sensitivity.

Lp(a) is increased in hemodialysis patients according to the type of dialysis membrane: a 2-year follow-up study.

AIMS: Patients with chronic renal failure treated by hemodialysis develop lipoprotein abnormalities that may contribute to their increased risk ofatherosclerosis. This study shows lipid parameter follow-up procedure according to the type of dialysis membrane in an unselected population of 33 hemodialysis patients. PATIENTS AND METHODS: The study included 33 patients with end-stage renal disease and 110 healthy blood bank donors of Tenon Hospital. Cholesterol and triglycerides were determined by enzymatic methods, apoA-I, apoB by immunoturbidimetry and Lp(a) by immunonephelemetry. Apo(a) phenotyping was performed by agarose gel electrophoresis followed by immunoblotting. Patients and controls subjects were estimated by Student's t- and chi2-tests. RESULTS: Patients dialyzed with low-flux membranes had Lp(a) concentrations higher than patients dialyzed with high-flux membranes. Patients dialyzed with polyacrylonitrile membranes (AN 69) had an apoA-I concentration significantly lower than patients dialyzed with hemophane or polysulfone membranes. We also confirmed some of the lipid abnormalities and high Lp(a) concentrations in ESRD patients. CONCLUSION: These results may contribute to a more rational choice of the dialysis membrane in hemodialysis patients.

Effects of plasma lipoproteins on the production of superoxide anion by human polymorphonuclear leukocytes in vitro.

Polymorphonuclear leukocytes (PMN) generate highly reactive oxygen derived free radicals that may cause lipoprotein lipid oxidation and so contribute to the pathogenesis of atherosclerosis. On the other hand it has been shown that lipoproteins can alter cell functions in vitro. We therefore studied the effects of atherogenic lipoproteins, VLDL and LDL, on the production of superoxide anion by human PMN in the presence or absence of formyl-methionyl-leucyl-phenylalanine (fMLP). VLDL and LDL stimulate PMN superoxide production and potentialize PMN stimulation by fMLP. The lipid moiety of the lipoproteins might be mainly involved in these effects. The binding of radio-labelled fMLP to its specific membrane receptor was significantly enhanced in the presence of VLDL and only slightly in the presence of LDL. The study of the signal transduction suggests that modulation of phospholipase D and A2 activities could be involved in the modification by LDL of PMN response to fMLP.

[Isoform 4 of apolipoprotein E and Alzheimer disease. Specificity and clinical study]. / Isoforme 4 de l'apolipoprotéine E et maladie d'Alzheimer. Spécificité et étude clinique.

We studied apolipoprotein E (apoE) phenotype in 113 patients with possible and probable Alzheimer's disease (AD), 49 patients with Parkinson's disease (including 11 patients with dementia) and 23 patients with mixed and vascular dementia. Normal controls were 498 young, healthy blood donors previously recorded. All patients were assayed for blood lipid parameters. All AD patients underwent a neuropsychological evaluation (including a mini-mental status and 5 subtests of Cole and Dastoor hierarchic dementia scale) and a detailed interrogation of them and their caregivers about their familial and personal medical history. The recorded data included age at onset, clinical subtype (i.e. amnesic or aphaso-apraxic), occurrence of fits, cases of probable dementia in relatives, and ages of their parents at death. There was a significant association between the fourth isoform of apoE and AD, as in previous works. We did not found such an association for PD patients (even with dementia) nor mixed and vascular demented patients. We failed to find any association between any clinical characteristic of the patients and the biological subgroups defined by the number of epsilon 4 alleles, except with regard for the age of onset. Surprisingly, the mothers of epsilon 4 bearers had a significantly longer life than mothers of other patients. We failed to found any significant difference of apoE2 isoform frequency between AD patients and controls. AD patients had higher levels of cholesterol and apoAl than did MP and mixed and vascular demented patients. ApoAl level is known to constitute a protective factor against coronary heart disease, which is usually increased by the presence of apoE-epsilon 4.(ABSTRACT TRUNCATED AT 250 WORDS)

[Apolipoprotein E and its alleles in healthy subjects and in atherosclerosis]. / L'apolipoprotéine E et ses allèles chez le sujet sain et au cours de l'athérosclérose.

Apolipoprotein E (apo E) plays a central role in lipoprotein metabolism as a ligand for LDL-, VLDL- and remnant receptors. It is mainly synthesized by hepatocytes and also by monocytes-macrophages. There are three common codominant isoforms E2, E3 and E4. Apo E2 binds defectively to LDL- and to remnant-receptors. Apo E alleles frequency varies from population to population around the world. In Europe, E4 allele frequency increases from south to north along the cardiovascular disease frequency gradient. On the other hand, the association between E2 allele and these diseases remains to be proved except for type III hyperlipoproteinemia. Apo E4 role in atherosclerosis could be explained, at least in part, by its high solubility in apo B lipoproteins. The average cholesterolemia of E4/E3 subjects is higher than E3/E3 subjects and E3/E3 subjects' cholesterolemia is higher than in E3/E2 subjects, probably because of a faster uptake of chylomicrons and VLDL remnants in E4/E3 subjects. The E4 allele also seems to play a role not only in diet response in combination with other genetic factors such as the Eco RI polymorphism of apo B but also in hypolipemic treatment. Apo E plays also a role in triglyceridemia control in association with other genetic and environmental factors such as lipoprotein lipase, apo B, LDL receptor and diet. Models of apo E knockout mice suggest a protective effect of monocyte-macrophageapo E in the vessel wall and HDL-apo E probably induces a high cholesterol efflux from macrophages. This effect counteracts the proatherogenic effect of VLDL- and IDL-apo E. The balance between these effects could be influenced by apo E phenotype.

[A histological and hormonal study of 399 women near the menopause or with confirmed menopause (author's transl)]. / Etude histo-hormonale de 399 périménopauses et ménopauses confirmées.

This work is concerned with 399 women who were either near the menopause or had had the menopause and on whom 476 hormone levels and 169 examinations of the endometrium had been carried out. It is possible to put the women into three groups. 13 p. 100 showed a diphasic cycle, with more or less normal ovarian function. Among the group of women whose cycle was not diphasic an appreciable number had normal oestrogenic activity, or were indeed hyperoestrogenic. The others were hypo-oestrogenic. Several facts can be derived from this study. Raised levels of E.2 can be found even when there is no cyclical activity and even in women who have raised levels of FSH. Normal ovarian function may be resumed several months after the menopause, although when the levels of FSH are raised the occurrence of the postmenopausal state would seem to be confirmed. The presence of hot flushes does not seem to correspond to a particular hormonal state. Marked differences seem to exist between the levels of the plasma hormones and the endometrial biopsy results. It is possible to have an atrophic endometrium with a raised level of oestradiol-17 beta, or on the other hand a polypoidal endometrium in women who are hypo-oestrogenic. The presence of levels of progesterone such as are found in a normal luteal phase does not indicate that the endometrium will necessarily be secretory. These contradictions cannot be resolved by studying the intra-cellular concentrations of the hormone receptors. The approach of the menopause is not always characterized by a progressive and continuous state of oestrogen deficiency or by hypophysial overactivity. This classical picture can be heavily shaded. All kinds of hormone profiles and responses by the receptor organs may be met and the clinician should be aware of these facts when he chooses therapy.

Steroid receptors analysis in human mammary tumors by isoelectric focusing in agarose.

A high resolution and quantitative method for isoelectric focusing has been developed to separate the isoforms of estrogen and progesterone receptors in human mammary tumor cytosols stabilized by sodium molybdate. Agarose gels (0.5%) were used. Six samples can be analyzed on one gel in about 2 h, and 35-microliters samples are sufficient to determine the estrogen receptor isoform pattern. The constant yields and the reproducibility of data allow a quantitative analysis of these receptors. Four estrogen receptor isoforms have been observed (pI 4.7, 5.5, 6, and 6.5), isoforms with pI 4.7 and 6.5 being present in all tumors. After incubation at 28 degrees C in high ionic strength, the comparison of isoelectric focusing and high-performance size exclusion chromatography patterns of estrogen receptor confirms the oligomeric structure of the pI 4.7 isoform and suggests a monomeric structure for the pI 6.5 isoform. Under the same conditions of analysis, only one progesterone receptor isoform has been detected with pI 4.7.

Prevalence of apolipoprotein E phenotypes in ischemic cerebrovascular disease. A case-control study.

BACKGROUND AND PURPOSE: Apolipoprotein E polymorphism may influence the early development of coronary artery disease. We investigated the putative role of apolipoprotein E phenotypes in cerebral infarction. METHODS: The apolipoprotein E phenotypes of 69 patients (mean +/- SD age, 72 +/- 11 years) who had suffered completed stroke or a transient ischemic attack and 68 sex- and age-matched control subjects free of cerebrovascular disease were determined by isoelectric focusing. The relative frequency of the apolipoprotein E phenotypes in the general population was estimated in 498 healthy blood donors (mean age, 37 years). RESULTS: The prevalences of hypertension, diabetes mellitus, obesity, and intermittent claudication were significantly higher in patients than in control subjects. Serum lipid and apolipoprotein B concentrations and the composition of very low density lipoproteins were not significantly different between patients and control subjects. Apolipoprotein A-I and E levels were significantly lower in patients. Cholesterol levels were higher in male patients than in male control subjects (5.10 +/- 1.46 versus 4.41 +/- 0.80 mmol/L; p = 0.036), and the ratio of apolipoprotein A-I to B was lower (0.77 +/- 0.29 versus 1.03 +/- 0.37; p < 0.001). The E3/E3 phenotype was more frequent in control subjects (85%) than in patients (72.5%; p < 0.05) and healthy blood donors (64%; p < 0.02). The E3/E2 phenotype was more frequent in patients (10.1%) than in control subjects (1.4%; p < 0.05). A stepwise logistic regression showed that the presence of stroke was significantly related to high blood pressure (p < 0.0001), low apo E levels (p < 0.008), obesity (p < 0.041), the apo E phenotype (p < 0.05), and diabetes mellitus (p < 0.05). CONCLUSIONS: The E3/E3 phenotype may protect against early vascular morbidity, and the epsilon 2 gene may be a risk factor for cerebrovascular morbidity, possibly related to diabetes, hypertension, and/or obesity.

Direct phenotyping of human apolipoprotein E in plasma: application to population frequency distribution in Paris (France).

Apolipoprotein E (Apo E) is a component of VLDL and HDL and plays a significant role in the regulation of cholesterol concentration. An improvement in isoelectric focusing for Apo E phenotyping is presented: the plasma Apo E was dissociated from lipoproteins by the use of Tween 20; the optimal concentration of type V neuraminidase was determined (1 U/ml); up to 48 samples were analyzed per plate and revealed by immunoblotting. Using this method, we have determined Apo E phenotypes and estimated their association with total cholesterol and Apo B levels in 498 healthy blood donors in Paris (France). The relative frequencies of Apo E alleles epsilon 2, epsilon 3 and epsilon 4 in this population were 0.079, 0.801 and 0.120, respectively. The association between Apo E phenotypes and concentration of Apo B-containing lipoproteins was confirmed (Apo B (g/l): E4/E3 subjects, 1.10 +/- 0.29; E3/E2 subjects, 0.93 +/- 0.22; both significantly different from E3/E3 subjects, 0.99 +/- 0.28). Total cholesterol (mmol/l): E4/E3 subjects, 5.43 +/- 1.15; E3/E2 subjects, 4.79 +/- 0.83; both significantly different from E3/E3 subjects, 5.03 +/- 1.11.

Lipoprotein(a) in childhood: relation with other atherosclerosis risk factors and family history of atherosclerosis.

The relation between lipoprotein(a) [Lp(a)], apolipoprotein (apo) E phenotypes, cholesterol, triglycerides, apo A-I, apo B, and a family history of atherosclerosis or risk factors was studied in 2- and 4-year-old French Caucasian children (n = 499). Lp(a) concentrations were distributed in a typical skewed manner and were found to be an independent lipid variable. The distribution of apo E phenotypes did not differ by gender. Cholesterol and apo B were under apo E phenotype control; Lp(a) was not. A significant positive relation was found between Lp(a) concentrations and the number of parental risk factors. Children whose grandparents had a history of cardiovascular disease had Lp(a) concentrations shifted towards higher values. Measurement of Lp(a) in children may help to identify those at an increased risk of atherosclerotic disease, especially when their parents have at least two relevant risk factors.