[Feto-maternal metabolism in human normal pregnancies: study of 73 cases]. / Métabolisme foeto-maternel au cours de grossesses humaines normales: étude de 73 cas.

From 73 normal pregnancies of gestational age between 17 and 41 weeks of gestation (WG), the concentrations of glucose, pyruvate and lactate, free fatty acids, ketone bodies (aceto-acetate and beta-hydroxybutyrate) and cholesterol were assessed on maternal venous blood (MVB) and umbilical venous blood (UVB), sampled by cordocentesis. The objective of this work was to study feto-maternal metabolism, as well as nutritional exchange between maternal blood and fetal blood during the second and third trimesters of pregnancy. Maternal and fetal glycemias, as well as maternal-fetal glucose concentration gradient, were found stable during the studied gestational period; maternal glucose is always higher than fetal glucose, with a mean concentration delta of 0.69+/-0.34 mmol/L. Maternal lactate level (1.26+/-0.38 mmol/L) is lower than fetal lactate level (1.48+/-0.46 mmol/L), whereas maternal blood pyruvate concentration (0.042+/-0.020 mmol/L) is higher than fetal blood pyruvate concentration (0.025+/-0.010 mmol/L). Consequently, mean lactate / pyruvate ratio is found twice lower in maternal blood (31.77+/-9.89) than in fetal blood (64.10+/-17.12). Free fatty acids concentration is approximately three times higher in maternal blood than in fetal blood (respectively 0.435+/-0.247 mmol/L and 0.125+/-0.046 mmol/L). Maternal venous aceto-acetate (0.051+/-0.042 mmol/L) and beta-hydroxybutyrate (0.232+/-0.270 mmol/L) concentrations are significantly lower than those in UVB (respectively 0.111+/-0.058 and 0.324+/-0.246 mmol/L) and the beta-hydroxybutyrate/aceto-acetate ratio is on average 1.7 times higher in MVB (4.75+/-2.5) than in UVB (2.82+/-1.18). Cholesterol concentration is significantly higher in maternal blood (6.26+/-1.40 mmol/L) than in fetal blood (1.66+/-0.34 mmol/L). Our results show the characteristics of oxidative metabolism of the fetus compared with that of the adult. Blood concentration in energy substrates, measured with glucose and free fatty acids levels, is low in UVB and suggests increased energy needs of the growing fetus. Mean high concentrations in aceto-acetate and beta-hydroxybutyrate in UVB, indicate probably fetal ketogenesis. UVB low cholesterolemia suggests high cholesterol consumption in the fetal compartment for cellular membrane synthesis and steroid biosynthesis.

[An abnormally formed Ctenophthalmus assimilis assimilis (siphonapteres hystrichosyllidae)]. / Un Ctenophthalmus assimilis assimilis monstrueux (siphonaptéres hystrichopsyllidae)

A female flea is described the body of which is abnormally formed and compressed. It is characterized by a split along its back, raised up abdominal segments and by a shortening of its head. These anomalies might be explained by longitudinal compression of the body during pupation. The possibility of a mutation is not excluded.

[The colonization of forested areas by Ixodes ricinus (Linné, 1758) in France: use of the roe deer, Capreolus capreolus (L. 1758) as a biological marker]. / La colonisation des massifs forestiers par Ixodes ricinus (Linné, 1758) en France: utilisation du chevreuil, Capreolus capreolus (L. 1758) comme marqueur biologique.

The roe-deer is a wild animal for which Ixodes ricinus has a particular fondness. Its territory is similar to that of the ticks and it is a species which is found throughout France yet which rarely leaves its territory. Given these conditions, a systematic parasitological examination of the ungulate can provide pertinent information concerning the forests inhabited by the tick. Since it is difficult to conduct a thorough examination of a large number of roe-deer over a limited space of time and on a large territory, the best solution is to examine the hind feet (hooves and tarsus) of the animal which are widely covered by the preimaginal stages of the tick. This biological material is easily available to the extent that the measurements of the animals are often used for game management. A preliminary study was conducted in Dordogne (southwestern France). Out of the 137 pairs of feet examined more than 50% carried the tick species (larvae or nymphs). The critical analysis of the results obtained throughout the investigation enables us to be more specific about the conditions of application of the advocated method.

[Ecoepidemiology of Lyme borreliosis in the Rhône-Alps region. Distribution, ecological context, relationship to the distribution of Ixodes ricinus (Linnaeus, 1758)]. / Ecoépidémiologie de la borréliose de Lyme dans la région Rhône-Alpes. Répartition, contexte écologique, relations avec la distribution d'Ixodes ricinus (Linné, 1758).

The aim of the study was to precise the geographical repartition of Lyme borreliosis in the Rhône-Alpes district, to describe the ecological characteristics of the areas propitious to the disease, and to verify the vectorial competence of I. ricinus. The cases of Lyme disease were located by means of a questionnaire sent to 1156 physicians. The vector role of I. ricinus was studied by two ways: firstly by searching a correlation between the geographical repartition of the tick and that of cases, secondly by proving the Borrelia infection of the tick. Lyme disease is widely spread in the study area, mainly at the foothill level, its repartition is largely coinciding with that of I. ricinus which was found infected by B. burgdorferi (s.l.). However a few cases, located near the Mediterranean area, set an unanswered problem.

[Hereditary bisalbuminemia. Study of a new familial case in France (author's transl)]. / Bisalbuminémie héréditaire. Etude d'un nouveau cas familial français.

A case of bisalbuminemia of slow type was discovered in a 41 year old woman with obesity, diabetes mellitus and hypertension. This abnormality was discovered in six other members of the family and was thus hereditary. After a description of the laboratory tests used, the various forms of bisalbuminemia are described together with the circumstances of onset of the acquired forms, the biochemical and metabolic characteristics of the hereditary forms and their mode of transmission. Bisalbumin is present in all races. The mother of our case was of Italian origin, which permitted us to classify this case with others of Italian origin.

[Values and limitations of the detection of circulating Candida antigen (Cand-Tec) in the diagnosis of deep candidiasis]. / Intérêts et limites de la détection d'antigène Candida circulant (Cand-Tec) dans le diagnostic des candidoses profondes.

Diagnosis of systemic candidiasis is difficult and often performed lately. It can be improved by Candida antigen detection, using agglutination of latex particles sensitized with anti-Candida albicans antibody. Candida antigen search was made in 407 sera obtained from 123 patients, in Hematology and in intensive care units. Fourty three patients had, at least, one serum positive for antigen. The titer was 1/2, 1/4 and 1/8. Twenty seven of the 43 patients had C. albicans in one or several localizations. Eight of these 27 patients had a systemic candidiasis: C. albicans grown from three blood samples, at least, and/or from organ biopsy. In these eight patients, the antigen titer was 1/4 ou 1/8. Eighty patients were Candida antigen negative. Thirty eight out of 80 had C. albicans in one or more sites and two of these 38 had systemic candidiasis. Five other patients had other Candida species. Two out of five had C. tropicalis and C. guillermondii septicemia.

[Decarboxyprothrombin: importance in the diagnosis of hepatocellular carcinoma]. / La décarboxyprothrombine: intérêt dans le diagnostic du carcinome hépatocellulaire.

We have studied the value of decarboxyprothrombin assay, in association with that of alpha-foeto-protein (AFP), for the biological diagnosis of hepatocellular carcinoma. Levels of decarboxyprothrombin and AFP were measured in 60 patients divided into two groups: 37 patients with hepatocellular carcinoma from liver cirrhosis, confirmed by histology; 23 patients with liver cirrhosis, but having not developed hepatocellular carcinoma. The cirrhosis was in most of cases consecutive to hepatitis B or hepatitis C infection, or of alcoholic origin. Levels of decarboxyprothrombin were also determined in a control group of 50 healthy subjects. Plasma decarboxyprothrombin concentrations were measured by enzyme immunoassay. All normal subjects had levels of decarboxyprothrombin below 2 micrograms/l. Out of 37 patients with hepatocellular carcinoma, 24 (64.9%) showed elevated decarboxyprothrombin levels, while this marker was increased only in 26% of cirrhotic patients. Decarboxyprothrombin and AFP levels are elevated in 48.6% of hepatocellular carcinoma, normal in 16.2% of hepatocellular carcinoma and dissociated in 35.2% of cases; respectively 18.9% and 16.2% of patients with hepatocellular carcinoma have either high AFP level or high decarboxyprothrombin level. The simultaneous determination of decarboxyprothrombin and AFP appear to be useful, since the combination of the two markers allows the detection of 83.8% of hepatocellular carcinoma, while the detection rate is only 67.5% with using AFP alone. No significant correlation was observed between plasma decarboxyprothrombin and serum AFP levels.

[Acid-base equilibrium and oxygenation of the human fetus. Study of 73 samples obtained by cordocentesis]. / Equilibre acido-basique et oxygénation du foetus humain. Etude de 73 prélèvements obtenus par cordocentèse.

Acid-base state and oxygenation of fetal blood were evaluated in a group of 73 appropriate for gestational age fetuses between 17 and 41 weeks of gestation; fetal blood was obtained by cordocentesis. We measured, on umbilical venous blood, pH, pCO2, bicarbonates and total CO2, pO2 and percent oxygen saturation; we obtained following results: pH = 7.309 +/- 0.054; pCO2 = 5.99 +/- 0.85 kPa; HCO3 = 22.16 +/- 1.90 mmol/l; total CO2 = 22.53 +/- 1.97 mmol/l; pO2 = 6.02 +/- 1.68 kPa; SaO2 = 0.71 +/- 0.18. In comparison with adult normal values, our results report in fetuses a frequent state of mild and mixed acidosis (in about 80% of cases), rather gazeous; pH is significantly correlated with pCO2 (r = -0.799), moreover there is also a metabolic origin in acidosis. We observed progressive modifications of acid-base state and oxygenation in fetal blood with advancing gestational age: decrease of pH and pO2, increase of pCO2 and bicarbonates; these changes appear mainly from 35th week of gestation, except for bicarbonates, which increase regularly during gestational period we have studied. Fetal acid-base state may be explained by physiological differences due to fetal life conditions, in comparison with adult life conditions. Results obtained in this population of normal fetuses can be considered as reference values for studied parameters.

[Microalbuminuria and pregnancy. Is microalbuminuria predictive of pregnancy toxemia?]. / Microalbuminurie et grossesse. La microalbuminurie est-elle prédictive d'une toxémie gravidique?

Several authors have suggested that estimating the levels of microalbuminuria will help in early screening for pre-eclampsia. The purpose of this work has been to look for the absence of microalbuminuria in normal pregnancies and to work out its predictive value for the risk of toxaemia of pregnancy when it does appear. The study was carried out on 257 women of whom 43 were controls and 214 women who were pregnant and had neither diabetes nor hypertension and had no kidney infections. The samples of urine were gathered in a 12 hour period of night and those that gave a positive reaction for albumin were rejected. RIA techniques were used to work out the levels of albuminuria and these were confirmed by immunoassay. We have compared microalbuminuria, the relationship between urine albumin and creatinine and the clearance of albumin in relationship to albuminuria (as defined by the relationship of albumin and creatinine clearance). We have calculated the sensitivity and the specificity and the prognostic value both positive and negative for these four parameters. Our results show that in a normal pregnancy there should not be any microalbuminuria, and on the other hand that if microalbuminuria does appear according to the four parameters studied, they are all equally sensitive for predicting pre-eclampsia. The relative clearance of albumin from the urine seems to be the most interesting parameter as far as we are concerned, and it could lead to early screening for toxaemia.

[Biochemical profile of fetal blood sampled by cordocentesis in 35 pregnancies complicated by growth retardation]. / Etude biochimique du sang foetal prélevé par cordocentèse au cours de 35 grossesses compliquées de retard de croissance.

AIM OF THE STUDY: Intra-uterine growth retardation (IUGR) is a frequent pathology in obstetrics characterized by high heterogeneity. Fetal smallness is sometimes constitutional, but can also be accompanied by fetal distress and vital risks for the infant. In 35 pregnancies complicated by IUGR of different etiologies, we measured on fetal blood obtained by cordocentesis, biochemical variables characteristic of the fetuses' respiratory and metabolic status. The aim of the study was to identify the discriminative biological alterations, related to growth retardation and fetal distress. PATIENTS AND METHODS: The studied population includes 27 cases of severe IUGR, of gestational age 30,2+/-4,6 weeks of gestation (WG) (divided into 20 cases of isolated IUGR and 7 cases of IUGR associated with malformative syndrome), as well as 8 cases of moderate IUGR, of gestational age 26+/-4,5 WG; all fetuses had normal karyotypes. A group of 73 normal fetuses, of gestational age 26,3+/-5,7 WG, constituted a reference population. PH, pCO(2), bicarbonate concentration, pO(2) and SaO(2), as well as glucose, pyruvate, lactate, free fatty acids, aceto-acetate, beta-hydroxybutyrate and cholesterol concentrations were measured on umbilical venous blood (UVB). RESULTS: In case of severe but isolated growth retardation, UVB analysis showed the frequency of acid-base and gasometric disturbances: acidemia and hypoxemia (65% of cases), hypercapnia (60% of cases). Metabolic abnormalities were shown: decrease in glycemia (35% of cases), increase in pyruvatemia and lactatemia (40% of cases), increased free fatty acids serum concentration; a diminution of umbilical venous cholesterol level, the most frequent abnormality, can be seen in 70% of fetuses. In case of severe IUGR associated with malformative syndrome, UVB acid-base and metabolic changes were rarely seen; however, UVB cholesterol level is low in some cases. In case of growth retardation classified as moderate, modifications are relatively not frequent and essentially gasometric. CONCLUSION: In about 60% of cases of severe and isolated IUGR, there is a risk of fetal distress, related to an alteration of the transplacental transfer of respiratory gases and nutritional substrates; chronic fetal malnutrition can be involved, with an impact on the growth of the fetus. In case of IUGR associated with malformative syndrome, fetal smallness is probably a result of intrinsic fetal damage, without nutritional origin.

Stimulant use in sports.

The authors provide an overview of the topic of stimulant use in psychiatric sports medicine. They address the following areas: 1) the history of stimulant use in sports; 2) recent events related to the use of stimulants in sports, including a new stimulant used at the 1996 Olympic competition in Atlanta, GA; 3) ergogenic or ergolytic (i.e., performance-impairing) potential of several major categories of stimulants, including amphetamines, beta2 agonists, caffeine, and cocaine; 4) review of how the brain reward circuit is affected by stimulants; 5) individual factors that induce athletes to utilize stimulants; and 6) sports organizational factors that induce athletes to use stimulants.

Evaluation of the E test for fluconazole susceptibility testing of Candida albicans isolates from oropharyngeal candidiasis.

The aim of the present study was to evaluate the utility of the E test in determining the antifungal susceptibility of Candida albicans. Reproducibility of the E test was determined for amphotericin B, fluconazole, and itraconazole using three different solid media: RPMI 1640, Casitone, and yeast nitrogen base agar. Minimum inhibitory concentrations (MICs) were comparable (results at +/- 2 dilutions) in 92% of the tests for amphotericin B and in 100% for fluconazole and itraconazole. Determination of MIC endpoints was easiest on Casitone agar. Candida albicans isolates from 23 patients undergoing fluconazole therapy for oropharyngeal candidiasis were tested for fluconazole susceptibility. Good correlation was obtained between the MICs of fluconazole and clinical outcome. Clinical failure was associated with strains for which MICs were > or = 48 micrograms/ml. These results suggest that the E test has potential utility for fluconazole susceptibility testing of clinical yeast isolates.

[Fluorimetric assay of serum 5-fluorocytosine]. / Dosage fluorimétrique de la 5-fluorocytosine sérique.

A manual and fast procedure for the fluorimetric determination of 5-fluorocytosine in the serum, after extraction by chloroform is described. The intra-assay variation was between 3,1 and 4,1%; the inter-assay variation was 4,8%. The results obtained are in good agreement with those obtained by the microbiological method. The determination of 5-fluorocytosine by this method is not possible if the sample contains ketoconazole or 5-fluorouracil.

Relationships between the Rhipicephalus sanguineus complex ecology and Mediterranean spotted fever epidemiology in France.

The authors examine the epidemiologic features of Mediterranean spotted fever in France in light of the bioecological peculiarities of each of the three known member of the Rhipicephalus sanguineus tick group (R. sanguineus, R. turanicus, R. pusillus). The results show that R. sanguineus is the main vector. Certain aspects of this tick species are of interest: affinity for man, close contact with humans for a long periods, peak of tick population (preimaginal stages) at the same time as the peak of the disease. The largest populations of R. sanguineus are noted in the endemic zone of human rickettsiosis. The fact that immature stages are more prevalent during the hot season and these forms' ability to bite humans is important and may suggest a role for them in the epidemiology of the disease. The sporadic isolation of this species outside the endemic zone may explain the occurrence of isolated cases of the disease in these areas. We cannot currently exclude vector roles for the two other species, which can parasitize humans, though none of our data supports this hypothesis.

[Research of keratinophiles in the soil and their effects on human cutaneous pathology in the Lyons area]. / Recherche sur les kératinophiles du sol et leur incidence sur la pathologie cutanée humaine dans la région lyonnaise.

Between 1967 and 1977, the systematic research of keratinophiles of the ground in a radius of 30--50 km around Lyon, has shown the ubiquitarian predominance of Microsporum nanum, which is probably the most ancient occupant of the ground. The most intensive areas of human and animal occupation in the Rhodanian tract show the predominance of Microsporum gypseum, which is scarcely found in man. Sporadic localizations, tightly limites, bound to cirulcation axes and international gathering, let us detect Microsporum cookei, Trichophyton verrucosum, Trichophyton mentagrophytes, Chrysosporium keratinophilum, and Keratinomyces ajelloi. However, in the last years, a progressive extension of recently imported kinds and a decrease in native kinds appears to have occurred.

Prevalence of Borrelia burgdorferi (sensu lato) in Ixodes ricinus (L.) populations in France, according to a phytoecological zoning of the territory.

Ixodes ricinus is considered as the main vector of Lyme Borreliosis in France. The aim of our investigations was to obtain a comprehensive view of the spatial risk linked to the distribution of the species in our country. Previous studies [1] have provided strong evidence that the species populations are widely distributed, so the objective of the present work was to ascertain the bacteriological infection of the tick by the agent of the zoonosis (Borrelia burgdorferi, sensu lato), over the French territory, whatever the ecological conditions may be. For this purpose, we kept the same framework as that used in our acarological investigation, a phytoecological zoning of the territory into 54 geographically separate and ecologically distinct units distributed into three climatic zones. Batches of ticks, picked up in these different phytoecological units (only two thirds of which were sampled), were submitted for bacteriological investigation. A total of 4,673 ticks were examined, individually, for the presence of Borrelia burgdorferi, by immunofluorescence. Percentages of infection according to the various stages of Ixodes ricinus free stages, collected by flagging, were as follows: 4.95% in 3,247 nymphs, 11.2% in 699 males, 12.5% in 727 females. Larvae were ignored. Practically all the tested units harboured the bacterium. The percentage of tick samples (25 ticks or more) absolutely free of Borrelia, wherever they came from, is very low (not exceeding 10 percent of the sampled forests). Our study confirms the assessment of a widespread distribution of the zoonosis in France which was, until now, exclusively based on an approximate distribution of limited human cases observed in the country.

Determination of serum ferritin by a one-step immunoenzymoassay, and comparison of four liver-ferritin standards.

We describe a one step "sandwich"-type immunoenzymoassay for ferritin in human serum. The solid-phase consists of glutaraldehyde-treated polypropylene tubes coated with rabbit antibody to human ferritin. Liver ferritin is the standard. Peroxidase-conjugated antiserum to ferritin and a sensitive chromogen, o-phenylenediamine, are used. The assay requires 90 min. The standard curve is linear up to 400 micrograms of ferritin per liter of serum. Within- and between-run CVs are less than 6% for low, high, and medium concentrations and are about 13.0% at the decision level for iron deficiency. Results by a two-step "sandwich" procedure (New England Immunology Associates kit) correlated well, r = 0.98. We assessed four liver ferritin standards from different manufacturers with the described method. The mean absorbance for the 40 micrograms/L ferritin standard was 1.5 for that from Diagnostics Biochem and National Institute for Biological Standards and Controls, 1.0 for that from Dako, and 0.4 for that from Sigma. Consequently, to standardize results, all liver ferritin standards should be calibrated vs the National Institute for Biological Standards and Controls reference standard.

[Carcinoembryonic antigen. Evaluation in intestinal lavage fluids and in the tissue of colorectal tumors]. / Antigène carcinoembryonnaire. Evaluation dans les liquides de lavage intestinal et dans le tissu des tumeurs colorectales.

Carcinoembryonic antigen in pre-operative or pre-endoscopic intestinal lavage rinsing fluids was assayed in 21 healthy subjects, 15 presenting polyps and 12 presenting colorectal cancer. Comparison of the results with those of histological and immunohistological studies showed that this assay did not allow detection of intestinal cancer or evaluation of its developmental stage.