Use of a Multiplex PCR Assay To Assess the Presence of Treponema pallidum in Mucocutaneous Ulcerations in Patients with Suspected Syphilis.

We evaluated the utility of the commercial Allplex genital ulcer real-time PCR multiplex assay for detecting Treponema pallidum, herpes simplex virus 1 (HSV-1) and 2 (HSV-2), and Chlamydia trachomatis serovar L (lymphogranuloma venereum [LGV]) DNA in mucosal and genital ulcers in the context of suspected syphilis. In total, 374 documented genital and mucosal ulcers from patients with and without syphilis presenting at several sexually transmitted infection (STI) centers in France from October 2010 to December 2016 were analyzed at the National Reference Center (CNR) for Bacterial STIs at Cochin Hospital in Paris. T. pallidum subsp. pallidum detection results were compared with the final diagnosis based on a combination of clinical examination, serological results, and in-house nested PCR (nPCR). Detections of HSV and LGV were validated against reference methods. We found that 44.6% of the 374 samples tested were positive for T. pallidum subsp. pallidum, 21% for HSV, and 0.8% for LGV. No positive results were obtained for 30.7% of samples, and 4.8% presented coinfections. For T. pallidum subsp. pallidum detection, the overall sensitivity was 80% (95% confidence interval [CI], 76.1 to 84.1%), specificity was 98.8% (95% CI, 97.7 to 99.9%), positive predictive value was 98.8% (95% CI, 97.7 to 99.9%) and negative predictive value was 80.2% (95% CI, 76.2 to 84.2%), with a rate of concordance with the reference method of 92.5% (k = 0.85). This PCR multiplex assay is suitable for T. pallidum subsp. pallidum detection in routine use and facilitates the simultaneous rapid detection of a broad panel of pathogens relevant in a context of suspected syphilis lesions.

[CONDYDAV: A multicentre observational study of patients presenting external genital warts in France]. / CONDYDAV : étude observationnelle multicentrique des patients présentant des condylomes dans les dispensaires antivénériens en France.

BACKGROUND: Since 2007 in France, human papilloma virus (HPV) vaccination has been licensed for use as a vaccine against HPV 6, 11, 16 and 18. The impact on the epidemiology of external genital warts (EGWs) in a large population remains unclear. OBJECTIVES: To determine epidemiologic and clinical features of patients presenting EGWs in France in the era of HPV vaccination. PATIENTS AND METHODS: In this prospective, observational study, we analyzed clinical features and treatments between January 1st, 2012 and March 31, 2012 for patients consulting for EGWs at 15 STI clinics throughout France. RESULTS: A total of 372 men and 111 women were included; mean age 31.2 years. The women were younger than the men (31.7 and 28.9 years respectively P<0.05). Among the patients, 416 (85.7%) were heterosexual, 13 bisexual and 54 (11.2%) homosexual, including one female. Males reported more sexual partners in the last 12 months (more than 3 partners in 32.6% versus 11.9%, P<0.01). Among the men, 230 had involvement of the penis alone and 46 had involvement of the anus alone. Seventy-six patients had EGWs of the anus, and of these 26 were MSM. In females, 76 had an infection of the vulva alone and 22 co-infection of the vulva and anus. MSM and females were at higher risk than heterosexual males for anal involvement (P<0.0001 and P=0.004, respectively). Three women had been vaccinated: two with Gardasil® and one with Cervarix®. Cryotherapy was the preferred treatment. CONCLUSION: With the advent of HPV vaccination, a global strategy for the prevention and treatment of EGW should be implemented.

[Management of smoking in the perioperative period: survey of practices amongst anaesthetists in Lorraine]. / Prise en charge du tabagisme périopératoire : enquête de pratiques en région Lorraine.

INTRODUCTION: Evidence shows that smoking leads to more perioperative complications. Smoking cessation before surgery reduces this postoperative morbidity. The French Society of Anaesthesia and Intensive Care published recommendations on this subject in 2005. We wanted to assess knowledge and practice amongst anaesthetists in Lorraine as regards the management of smoking in the perioperative period. METHODS: We conducted an internet-based survey of 365 anaesthetists in the Lorraine region during November and December 2011. At the same time, we also surveyed patients attending pre-assessment clinic at the CHU hospital, Nancy. RESULTS: Half the practitioners surveyed were aware of the 2005 guidelines. Most pre-assessment clinics do not display posters warning of the perioperative hazards of smoking. The need for smoking cessation advice as a bare minimum is acknowledged by 47.9% of experienced practitioners; 76.3% of anaesthetists claim to offer advice occasionally, frequently or systematically. On the other hand, only 17% of the patients surveyed report receiving such advice. CONCLUSION: Despite published guidelines on the benefits of smoking cessation prior to surgery, Lorraine anaesthetists fail to systematically advise their patients in this regard. We believe there is a need to improve the management of these patients, either through the development of smoking cessation protocols locally or through patient referral to a specialised clinic.

Neuropathic arthropathy: a forgotten diagnosis? Two recent cases involving the hip.

Two cases of neuropathic arthropathy of the hip are reported. One was the first manifestation of tabes dorsalis in a 74-year-old man, whereas the second occurred in a 47-year-old woman with a history of spina bifida and L2-L5 epidural lipoma. Radiographic joint destruction occurred within five and three months, respectively. The main clinical and radiological features of neuropathic arthropathy are reviewed, and diagnostic pitfalls are discussed. There are no specific laboratory tests or histologic findings. This now rare condition should be routinely considered in patients with severe joint destruction contrasting with minimal pain. The reasons for the decision to use trochanteric-iliac coaptation in one of our patients and a wait-and-see approach in the other are explained. The literature is reviewed. Ten cases treated by joint replacement have been reported. However, neither joint replacement nor arthrodesis seem capable of restoring satisfactory hip function.

[Forum: reconstruction of the traumatised thumb. Reconstruction of the amputated thumb by progressive lengthening of the 1st metacarpal using mini-fixator. Apropos of 2 clinical cases]. / Forum: la reconstruction du pouce traumatique. Reconstruction du pouce amputé par allongement progressif du premier métacarpien, à l'aide d'un mini-fixateur. A propos de deux cas cliniques.

The authors report two cases of reconstruction of a mutilated thumb by progressive elongation of the first metacarpal without the need for bone grafts, using a minifixation elongation device, which is very easy to use. It allows distraction which can be performed by the patient himself and adjustment to the desired length, up to 40 mm.