[Incidence of erysipelas of the lower limbs in a spa resort. Efficacy of a strategy of sanitation education (La Lechere: 1992-1997)]. / Incidence de l'érysipèle des membres inférieurs en milieu thermal phlébologique. Efficacité d'une stratégie d'éducation sanitaire (La Léchère: 1992-1997).

OBJECTIVE: Erysipela is a common skin infection readily found in patients with venous insufficiency or lymphedema. The aim of this work was to measure the incidence of erysipela in a spa resort specialized in the treatment of venous and lymphatic diseases and to evaluate the influence of a preventive strategy principally based on education of patients at risk. PATIENTS AND METHODS: The measurement of incidence was based on the detection of the reasons for which the patients did not attend their thermal care sessions. Quality control was obtained from the reports of cases diagnosed by local private and public health care centers. RESULTS: The incidence of erysipela in this high risk population was 40.2 and 48.5 cases for 1000 persons per exposure-year in 1993 and 1994 respectively. The preventive strategy carried out was able to induce a reduction of 65% during the next years (p<0.01). CONCLUSION: This study confirms the high incidence of erysipela in subjects with severe venous insufficiency or lymphedema and the efficacy of an active educational preventive strategy.

[Acrocyanosis: changing concepts and nosological limitations]. / Acrocyanose, évolution des concepts et limites nosologiques.

Acrocyanosis is undoubtedly the most commonplace acrosyndrome, both in terms of pathogenesis and prognosis. Patients experience functional impairment and an esthetic prejudice that must not be neglected. Adopting the nosological classifications described for Raynaud's syndrome, primary acrocyanosis must be distinguished from exceptional secondary phenomena that have a radically different clinical course. Primary acrocyanosis is generally observed in a young woman who appears thin or has recently lost weight. No paroxysmal episode (syncope, cyanosis, suspicious event involving the fingers) is found. The physical examination is negative and no complementary explorations are needed. Current pathophysiological hypotheses remain insufficient but suggest that vasospasticity rather than hemorheology is involved. The hypothesis that a thermoregulation disorder could be associated with weight loss deserves further study. Symptomatic care relies on dietary and hygiene counseling, emphasizing the importance of warm clothing. The psychological element must also be considered even in the most common forms.

Anomalous X-ray diffraction with soft X-ray synchrotron radiation.

Anomalous diffraction with soft X-ray synchrotron radiation opens new possibilities in protein crystallography and materials science. Low-Z elements like silicon, phosphorus, sulfur and chlorine become accessible as new labels in structural studies. Some of the heavy elements like uranium exhibit an unusually strong dispersion at their M(V) absorption edge (lambdaMV = 3.497 A, E(MV) = 3545 eV) and so does thorium. Two different test experiments are reported here showing the feasibility of anomalous X-ray diffraction at long wavelengths with a protein containing uranium and with a salt containing chlorine atoms. With 110 electrons the anomalous scattering amplitude of uranium exceeds by a factor of 4 the resonance scattering of other strong anomalous scatterers like that of the lanthanides at their L(III) edge. The resulting exceptional phasing power of uranium is most attractive in protein crystallography using the multi-wavelength anomalous diffraction (MAD) method. The anomalous dispersion of an uranium derivative of asparaginyl-tRNA synthetase (hexagonal unit cell; a = 123.4 A, c = 124.4 A) has been measured for the first time at 4 wavelengths near the M(V) edge using the beamline ID1 of ESRF (Grenoble, France). The present set up allowed to measure only 30% of the possible reflections at a resolution of 4 A, mainly because of the low sensitivity of the CCD detector. In the second experiment, the dispersion of the intensity of 5 X-ray diffraction peaks from pentakismethylammonium undecachlorodibismuthate (PMACB, orthorhombic unit cell; a = 13.003 A, b = 14.038 A, c = 15.450 A) has been measured at 30 wavelengths near the K absorption edge of chlorine (lambdaK = 4.397 A, EK= 2819.6 eV). All reflections within the resolution range from 6.4 A to 3.4 A expected in the 20 degree scan were observed. The chemical state varies between different chlorine atoms of PMACB, and so does the dispersion of different Bragg peaks near the K-edge of chlorine. The results reflect the performance of the beamline ID1 of ESRF at wavelengths beyond 3 A at the end of 1998. A gain by a factor 100 for diffraction experiments with 4.4 A photons was achieved in Autumn 1999 when two focusing mirrors had been added to the X-ray optics. Further progress is expected from area detectors more sensitive to soft X-rays. Both CCD detectors and image plates would provide a gain of two orders of measured intensity. Image plates would have the additional advantage that they can be bent cylindrically and thus cover a larger solid angle in reciprocal space. In many cases, samples need to be cooled: closed and open systems are presented. A comparison with the state of art of soft X-ray diffraction, as it had been reached at HASYLAB (Hamburg, Germany), and as it is developing at the Brookhaven National Laboratory (USA), is given.

Seizure-related opening of the blood-brain barrier produced by the anticholinesterase compound, soman: new ultrastructural observations.

Previous macroscopic and light microscopic observations established that the organophosphate soman, an irreversible inhibitor of cholinesterases, produces seizure-related opening of the blood-brain barrier (BBB) to proteins. In Wistar rats, this BBB alteration was found to be reversible. This alteration was greatest during the first hour of seizures, and was topographically limited to sensitive areas such as the thalamus. In contrast, the hippocampus remained free of any vascular leakage. The present study is an attempt to elucidate, in rat thalamus, the subcellular mechanisms involved in soman-induced BBB alteration. A combination of three ultrastructural approaches was used: examination of ultra-thin sections, freeze-fracture, and post-embedding protein A-gold immunocytochemistry of the endogenous, normally exclusively blood-borne, albumin. Our findings show that soman-induced seizure activity produced no discernible structural change in the endothelial tight junctions, whereas it unambiguously increased the number of endothelial vesicles. Finally, immunolabelled albumin clearly crossed the endothelium, but was not systematically found inside the endothelial vesicles. Altogether, the present ultrastructural study confirms that soman can alter the integrity of the BBB, and demonstrates that the blood-to-brain passage of proteins does not mainly derive from the opening of tight junctions. Although transcytosis is clearly increased through the cerebral endothelium, there is little evidence that blood-borne proteins penetrate the brain in this way. The actual mechanisms of transport thus remain to be clarified.

A European Organization for Research and Treatment of Cancer--Genitourinary Group phase 2 study of chemotherapy in stage T3-4N0-XM0 transitional cell cancer of the bladder: evaluation of clinical response.

From 1986 to 1990 the European Organization for Research and Treatment of Cancer--Genitourinary Group conducted a phase 2 trial of neoadjuvant chemotherapy in patients with stage T3-4N0-XM0 transitional cell carcinoma of the bladder. The objectives were to evaluate the clinical response in relation to the pathological response, and to measure the side effects of chemotherapy. Of 171 patients entered 136 were fully evaluable: 18% had clinical complete remissions, 36% had clinical partial remissions, 39% had no clinical remissions and 10% had unknown response. A selected subgroup of 76 patients underwent cystectomy after 2 or 4 courses of chemotherapy: 2 were not evaluable for pathological response because of preoperative radiotherapy after neoadjuvant chemotherapy, 16 had a pathological complete remission, 7 had a pathological partial remission and 51 had no pathological remission. Comparison of the clinical response or T category only after 2 courses of chemotherapy with the pathological response after 2 or 4 courses of chemotherapy showed that in a number of patients the disease status could be downstaged to pathological complete or partial remission by additional courses of chemotherapy. If the discrepancies between clinical and pathological responses, or between T and P categories, induced by further downstaging after additional chemotherapy were left out, it was shown that clinical complete and partial remissions were a heterogeneous group but nonresponders could be delineated with a 100% accuracy by clinical response evaluation and transurethral resection biopsy only. Furthermore it seems important to establish the number of chemotherapy courses to induce a maximal response of the primary tumor.

[Alveolar anesthesia]. / L'anésthesie tubérositaire.

Tuberosity anesthesia is a loco-regional anesthesia aiming at anesthetizing with a single injection the superoposterior alveolar nerves, by approaching the maxillary tuberosity through a direct anteroexternal pathway. This anesthesia involves an area located behind the pyramidal process of the maxillary bone which includes the molars, gingival buccal mucosa, sinus bone and mucosa. Well-tolerated by the patient, since it is practically a painless procedure, tuberosity anesthesia is the preferred method to perform surgery in the posterior maxillary area. Its administration may be extended without condition to treatment of the upper molars: custy + crown + bridge preparations on vital teeth, pulpectomies, thanks to the rapid onset and efficacy of the anesthesia obtained. The only contraindication involves patients with vascular or hematologic disorders, ruling out procedures where a blood vessel might be injured with a needle. In that case, intraligamentary or transcortical instillation is indicated since para-apical anesthesia is not a valid alternative due to the proximity of the external alveolar artery.

[Clinical and bacteriological evaluation of sisomicin in sixteen cases of severe bronchopulmonary infection (author's transl)]. / Evaluation clinique et bactériologique de la sisomicine dans seize cas d'infections broncho-pulmonaires sévères.

Sisomicin, an aminoglycoside antibiotic, was used as sole bactericidal therapy in sixteen cases of severe bronchopulmonary infection for an average of 11,5 days (range 7 to 14) with a dose of 3,5 mg/kg per day in three intramuscular injections. Fifteen of these hospitalized patients presented with chronic airway obstruction which resulted in lowered O2 saturation (SaO2 congruent to 86,1%, range 74 to 93) and, in twelve patients, hypercapnia (PaCO2 = 55,7 torr, range 33--73). Two of these patients were under continuous assisted ventilation. Two patients had a lower lobe infiltrate and a lung abscess respectively. Proteus (n = 3), Pseudomonas (n = 9), K. pneumoniae (n = 2), E. Coli (n = 1), Enterobacter (n = 1), S. aureus (n = 1) and D. pneumoniae (n = 1) were the dominant organisms in the bronchial secretions isolated by Mulder's method; P. aeruginosa was associated with K. pneumoniae, P. rettgeri and E. coli respectively in three cases. In thirteen cases, either a clinical cure (n = 2) or a definite improvement was observed (sputum volume and purulence, auscultatory signs, temperature). However, among these patients were three cases of superinfection/colonization and two cases of persistent organisms. In addition, in two of the three cases showing no improvement colonization occured. The favorable results of this study appear to be due to vigorous antibiotic therapy combined with intensive adjunct therapy. No adverse local or systemic reactions clearly attributable to the drug were observed.