[Bisalbuminemia: A case report]. / Les bisalbuminémies : à propos d'un cas.

INTRODUCTION: Bisalbuminemias consist in rare qualitative modifications of several aspects in the albumin pattern. Bisalbuminemias, most of which are not pathological, can be observed using capillary electrophoresis. CASE REPORTS: We report a case of hereditary bisalbuminemia diagnosed by chance while exploring chronic unexplained hypereosinophilia in a 42-year-old patient. The patient's normal lipid profile, the lack of an antibiotic treatment or pancreatic pathology, and the persistence of the bisalbuminemia after one month, suggested a diagnosis of genetic bisalbuminemia. In light of other such cases, we review the main causes of bisalbuminemia, both genetic and acquired. CONCLUSION: The diagnosis of genetic bisalbuminemia is made by first eliminating the usual acquired etiologies: analytical or drug interference, acute pancreatitis and binding of immunoglobulins. Then, after having checked the lipemic index, reviewed the patient's medical history, comorbidities, and treatments, repeating the electrophoresis will help identify the cause of the bisalbuminemia.

Peri-infarct ischaemia assessed by cardiovascular MRI: comparison with quantitative perfusion single photon emission CT imaging.

OBJECTIVE: To develop a new method for the cardiac MR (CMR) quantification of peri-infarct ischaemia using fused perfusion and delayed-enhanced images and to evaluate this method using quantitative single photon emission CT (SPECT) imaging as a reference. METHODS: 40 patients presenting with peri-infarct ischaemia on a routine stress (99m)Tc-SPECT imaging were recruited. Within 8 days of the SPECT study, myocardial perfusion was evaluated using stress adenosine CMR. Using fused perfusion and delayed-enhanced images, peri-infarct ischaemia was quantified as the percentage of myocardium with stress-induced perfusion defect that was adjacent to and larger than a scar. This parameter was compared with both the percent myocardium ischaemia (SD%) and the ischaemic total perfusion deficit (TPD). The diagnostic performance of CMR in detection of significant coronary artery stenosis (of ≥70%) was also determined. RESULTS: On SPECT imaging, in addition to peri-infarct ischaemia, reversible perfusion abnormalities were detected in a remote zone in seven patients. In the 33 patients presenting with only peri-infarct ischaemia, the agreement between CMR peri-infarct ischaemia and both SD% and ischaemic TPD was excellent [intraclass coefficient of correlation (ICC) = 0.969 and ICC = 0.877, respectively]. CMR-defined peri-infarct ischaemia for the detection of a significant coronary artery stenosis showed an areas under receiver-operating characteristic curve of 0.856 (95% confidence interval, 0.680-0.939). The best cut-off value was 8.1% and allowed a 72% sensitivity, 96% specificity, 60% negative predictive value and 97% positive predictive value. CONCLUSION: This proof-of-concept study shows that CMR imaging has the potential as a test for quantification of peri-infarct ischaemia. ADVANCES IN KNOWLEDGE: This study demonstrates the proof of concept of a commonly known intuitive idea, that is, evaluating the peri-infarct ischaemic burden by subtracting delayed enhancement from first-pass perfusion imaging on CMR.

[Pneumocystis jiroveci: epidemiological, pathophysiological and biological update]. / Pneumocystis jiroveci : mise à jour épidémiologique, physiopathologique et biologique.

One century after its discovery, Pneumocystis jiroveci is an infectious agent still responsible of a high mortality rate among immunocompromised patients. Molecular biology advances have authorized some important progress mainly concerning epidemiology, pathophysiology and biological diagnosis. It has also brought a lot of publication on the subject. They describe a large panel of different biological diagnosis method. The purpose of this article is to synthesize these knowledges and to update the laboratory diagnosis strategy.

[New use of primaquine for malaria]. / Le nouvel âge de la primaquine contre le paludisme.

Primaquine is the only available drug to treat Plasmodium vivax liver stages (hypnozoites). It has been used for more than five decades and is now included in an increasing number of clinical guidelines. The major concern is induced hemolysis when administered to glucose-6-phosphate-dehydrogenase deficient patients. Primaquine could be used for causal prophylaxis during and after exposure or for presumptive antirelapse therapy (PART) in case of high exposure to P. vivax. A radical cure is used to avoid relapse for patients with a confirmed bloodstream infection with P. vivax or P. ovale. In France, primaquine is not approved for prevention and treatment and its use requires a specific temporary authorization.

[Analytical interference caused by monoclonal immunoglobulin M with cryoglobulin effect: a case report]. / IgM monoclonale cryoprécipitante: un piège au laboratoire.

In biochemistry laboratory, monoclonal immunoglobulins are frequently found. They can lead to analytical interferences which are difficult to anticipate. In this case reports, a monoclonal immunoglobulin M with cryoglobulin effect has been responsible of false result of protein electrophoresis because of the whole precipitation of the monoclonal immunoglobulin. This case report allows us to remember the interferences caused by monoclonal immunoglobulins and that clinicians should be aware of these aspects of paraproteins and contacting the laboratory when encountering unexpected results.

[Cryoglobulins: detection, type determination and quantitation. A study of healthy subjects and patients with chronic hepatitis C]. / Cryoglobuline: recherche, typage et quantification. Etude chez le sujet sain et chez des patients atteints d'une hépatite C chronique.

Cryoglobulins are immunoglobulins or immune complexes which precipitate at a temperature lower than 37 degrees C and re-dissolve when rewarmed. So their collection and processing are critical. We describe the methodology used in the biochemical laboratory of Military hospital Laveran (Marseille) for detection determination of type and quantitation of cryoglobulins. In this study, we have found cryoglobulins in 53% of healthy subjects and in 77% of patients with chronic hepatitis C.

[Rapid immunochromatographic tests for detection of malaria: principles and strategies for use]. / Tests immunochromatographiques rapides de détection du paludisme, principes et stratégies d'utilisation.

Malaria is a parasitological emergency requiring safe quick accurate diagnosis so that appropriate therapy can be implemented. A number of rapid diagnostic tests based on detection of HRP2 Ag, enzymes, LDH or aldolase are now available. However the use of these tests is restricted to trained, experienced staff in special situations. The purpose of this report is to describe the different tests on the market and clarify the limitations for their use.

[Cryoglobulinemia]. / Les cryoglobulinémies.

Cryoglobulins are immunoglobulins or immune complexes which precipitate at a temperature lower than 37 degrees C and redissolve when rewarmed. Cryoglobulins can be asymptomatic. When not, clinical features are in most cases cutaneous, renal or neurological. Cryoglobulinemia are associated with malignant haematological disorder, connective tissue disease or infection process especially infection with hepatitis C virus. In some case, no aetiology can be found, in theses cases cryoglobulinemia are called primary or essential cryoglobulinemia. For the last ten years it has been widely demonstrated that virus C infection causes the most part of essential cryoglobulinemia.

[Coma in type 2 diabete mellitus on metformin treatment]. / Coma chez un diabétique de type 2 traité par la metformine.

Non traumatic coma in diabete mellitus has two origins : hypo- or hyperglycemia. Coma with hyperglycemia can be due to ketoacidosis, hyperosmolar state or lactic acidosis. The present observation reports on a type 2 diabete mellitus patient presenting with a coma while the patient was on metformin and glibenclamide treatment. On admission, biologicals tests showed major acidosis, hyperglycemia and hyperosmolarity. No metformine accumulation was demonstrated by analytical measure. In this case, the association of hyperosmolar state and metabolic acidosis prove the difficulty of the differential diagnosis.

Prevalence of Escherichia coli O157:H7 in industrial minced beef.

AIMS: The lack of baseline data on the prevalence of Escherichia coli O157:H7 in retail minced beef in France prompted this survey of industrial minced beef production. METHODS AND RESULTS: An automated enzyme-linked fluorescence immunoassay (ELFA), the VIDAS E. coli O157 method, was used to detect E. coli O157 in industrial minced beef samples. Confirmation of samples positive according to the ELFA was performed using an automated immunoconcentration (ICE) system, VIDAS ICE, which allows the selective capture and release of target organisms. The ICE was followed by culture on cefixime tellurite sorbitol MacConkey agar and a chromogenic medium, O157:H7 ID. Of the 3450 minced beef samples tested, 175 samples were positive with the ELFA method and, of these, four were confirmed by the ICE method. They were identified as sorbitol-negative, O157-positive, H7-positive, mobile, verotoxin-producing E. coli. CONCLUSIONS: The prevalence of E. coli O157:H7 in industrial French minced beef was 0.12%, consistent with many other reports. SIGNIFICANCE AND IMPACT OF THE STUDY: The low infective dose of E. coli O157:H7 presents a major threat. The main means of combating this organism are thermal destruction and good food hygiene covering activities on-farm, in the abattoir and in minced beef industries.

[Interference of hydroxocobalamine treatment on commun biochemical determinations]. / Interférence de l'hydroxocobalamine sur les résultats des dosages biochimiques usuels.

Hydroxocobalamin, antidote of the cyanide poisoning, is a red and water soluble pigment, which colors biological mediums. The interferences caused by this molecule are studied for plasma pools overloaded with hydroxocobalamin for concentrations from 0 to 1,125 mg.L-1. The results of 16 biochemical parameters on Vitros 750 XRC (Ortho-clinical Diagnostics) and of 23 biochemical parameters on Cobas Integra 700 (Roche Diagnostics) are examined. With this analytical system, unconjugated and conjugated bilirubin, creatinin, and CK results are changed as soon as plasma concentration of hydroxocobalamin reachs 124 mg.L-1. For the Vitros 750 XRC, ASAT, iron, creatinin, phosphorus are more sensitive to this interference. But, other results are changed for the two analytical systems for superior hydroxocobalamin concentrations.

[Bacterial biofilms and resistance to disinfectants]. / Biofilms bactériens et résistance aux désinfectants.

When bacteria grow in close association with solid surface, they constitute a microbial community tight included in the exopolymer glycocalyx. Many laboratory studies have shown that these bacteria are 10 to 100 folds more resistant to disinfectants than the bacteria of the same strain in suspension. Several factors are responsible for this resistance: the glycocalyx which limits the diffusion and reacts with the disinfectant, the more or less dense repartition of the bacteria inside the biofilm, their physiologic state with reduced metabolism, and the surface on which is the biofilm. The activity assessment of disinfectant agents is achieved with standardized methods. They must take into account not only the conditions in which the disinfectants are employed, but also the micro-organism state. Experimental results showing the resistance of biofilm bacteria must lead to elaborate methods allowing the assessment of bactericide activity of disinfectants against biofilm bacteria.