Cutaneous and mediastinal lymphadenitis due to Mycobacterium kansasii.

Mycobacterium kansasii most commonly causes a slowly progressive pulmonary disease. Skin and disseminated infections are seen less frequently and only in immunocompromised hosts. To our knowledge, no case of Mycobacterium kansasii infection or skin infection associated with additional organ involvement in an immunocompetent patient has been reported.

Dioxins in adipose tissue of non-occupationally exposed persons in France: correlation with individual food exposure.

We evaluated individual adipose tissue (subcutaneous lipomas) dioxin contamination in non-occupationally exposed persons living in France (adult patients undergoing a surgical ablation of benign lipomas), in relation to the corresponding individually evaluated mean daily dietary dioxin intake (DDDI). The diet survey (questionnaire) included information on consumption of meat, fish, milk and dairy products, from which the individual DDDI was calculated. Sixteen subjects participated in this study. DDDI ranged between 1.06 and 3.31 pg I-TEQ/kg body weight, bw (mean value: 2.05+/-0.72). Adipose tissue polychlorinated dibenzo-p-dioxins (PCDD)/polychlorinated dibenzofurans (PCDF) levels ranged between 18.5 and 76.9 pg I-TEQ/g lipids (mean value: 35.6+/-14.8). No relation was found between the DDDI and adipose tissue PCDD/PCDF concentrations. The mean DDDI in France does not fundamentally differ from those found in other industrialised countries, is within the range of 1-4 pg I-TEQ/kg/day recently suggested by WHO-ECEH/ICPS for the tolerable daily intake of dioxins. Adipose tissue PCDD/PCDFs levels are similar to levels in other European countries and USA without relation to sex or age, and can be considered representative European background concentrations. Globalisation of alimentary production leads to a similar food exposure in Western European countries, in spite of dioxins accidental selective contaminations that are epiphenomenon and thus do not have any impact in human dioxin background levels.

[General population exposure to dioxins, human ubiquitous pollutants]. / Exposition de la population générale aux dioxines, contaminants ubiquitaires.

This paper gives an overview of the environmental or background exposure of general population to dioxins, polychlorinated dibenzo-para-dioxins (PCDD) and polychlorinated dibenzofurans (PCDF), originating from a variety of industrial and thermal processes and recognized as cancerous and toxic substances. The daily consumption of low-level contaminated food, mainly of animal origin, leads to the accumulation of dioxins in the human body. To determine the background exposure, human milk, adipose tissue or blood from many geographical locations (except France) have been used as bioindicators for body burden of dioxins. Human milk also allows the daily intake estimation of dioxins for breast-fed babies. Efforts should be made to minimize or avoid PCDD/PCDF emission in the environment.

[Dermatologic consultation in a precarious situation: a prospective medical and social study at the Hôpital Saint-Louis in Paris]. / Consultation dermatologique en situation de précarité: étude prospective médicale et sociale à l'Hôpital Saint-Louis à Paris.

INTRODUCTION: The aim of our study was to evaluate the outcomes and the cost of the dermatological consultation for poor and destitute patients, in Saint-Louis Hospital. PATIENTS AND METHODS: We carried out a prospective study from May to October 1996. One hundred and eighty-nine patients (237 consultations) who had no social welfare, were examined. RESULTS: They revealed that 82 p. 100 were male, 63.7 p. 100 were French, 13.9 p. 100 came from Maghreb, 9.7 p. 100 from Sub-Saharan Africa, 73 p. 100 were homeless and 25.7 p. 100 were alcoholic. The average age was around 37.6. The main medical disorders: scabies (56.5 p. 100), lice (22.4 p. 100) and cutaneous infections (7.2 p. 100) were related to the patients' living conditions and their social and economic situation. The other diseases observed were identical to the ones detected in regular health care centers. Complementary laboratories were necessary in 9.3 p. 100 consultations. Only 2 p. 100 of patients were admitted in Hospital. Local treatment was applied by nurses in 67 p. 100 of cases. Drugs were delivered free of charge by the Hospital's pharmacy in 64 p. 100 of cases. The cost of drugs was 83 FF per patient. The mean of duration of treatment was 10.5 days. DISCUSSION: Social workers are a key element in helping the patients to recover their social rights (49 p. 100 of patients have recovered social rights after 6 months). The frequency of skin diseases is higher in this population than in general population, especially in homeless persons. Access to health care is a problem of public health.

[A malarial attack on return from a voyage to the French Antilles. Discussion of the mode of transmission]. / Accés palustre au retour d'un voyage aux Antilles françaises. Discussion du mode de transmission.

Malaria has been considered to be eradicated from the French West Indies for over 25 years. In this report we describe a patient who was hospitalized and successfully treated in Paris for severe Plasmodium falciparum malaria after returning form a brief trip to Guadeloupe. Several modes of transmission are possible. Given the presence of a reservoir of Plasmodium falciparum gametocytes in the Haitian immigrant community and persistent breeding of Anopheles albimanus in the French West Indies, the most likely explanation is local transmission. This is the second case of malaria involving travelers to Guadeloupe to be reported within the last ten years and the first time that autochtonous transmission has been considered. Falciparum malaria should be included in differential diagnosis for patients presenting fever after returning from travel in the French West Indies, a highly popular tourist destination.

The conservative management of corynebacterium group D2 encrusted pyelitis.

OBJECTIVE: To evaluate the conservative management of encrusted pyelitis (EP), an infectious disease caused by urea-splitting micro-organisms (Corynebacterium group D2 being the most common), and characterized by stone encrustation of the collecting system. PATIENTS AND METHODS: Four patients (aged 17-62 years) with EP caused by Corynebacterium group D2 were treated conservatively with intravenous vancomycin and percutaneous acidification of the renal collecting system. Percutaneous nephrostomy tubes were placed to allow irrigation with Thomas' acid solution, the outflow being ensured by ureteric catheters. Patients were monitored and the results of and tolerance to treatment evaluated clinically, by biological assays, and by imaging techniques (ultrasonography, computed tomography and pyelography). RESULTS: No kidneys were lost and in all patients with initial renal failure, creatinine levels recovered to previous values. The adverse effects were moderate, consisting of flank pain or discomfort, and low-grade fever. Three patients developed asymptomatic fungal urinary tract infections requiring antifungal agents. The encrustations were treated effectively and almost disappeared in two patients, while the other two had no residual calcification. One transplanted-kidney recipient developed a ureteric stricture requiring surgical repair. Within a mean follow-up of 16 months, there was no recurrence of EP and the residual encrustation remained small. CONCLUSION: The conservative treatment of EP can avoid surgery in many cases, although there are some adverse effects of irrigation. The long-term follow-up and prevention of recurrent EP are nevertheless required.

Case report: French West Indies - a tourist destination at risk for Plasmodium falciparum transmission?

We report a case of P. falciparum infection observed in Paris and presumably acquired in Guadeloupe, a French Caribbean island where malaria has been considered to be eradicated since 1970.

Encrusted cystitis and pyelitis.

PURPOSE: Encrusted cystitis and pyelitis are chronic inflammations of the bladder and collecting system associated with mucosal encrustations induced by urea splitting bacteria. We review these infectious diseases. MATERIALS AND METHODS: A literature search was performed of the MEDLINE database from 1985 to 1997. Additional articles published before 1985 were also selectively included. RESULTS: Most of the articles were case reports or short series. During the last 10 years increasing numbers of cases have been diagnosed, especially in immunodepressed patients, and particularly in renal transplant recipients. Many bacteria have been demonstrated in this infection but Corynebacterium group D2 is currently the most frequent. The development of encrusted cystitis or pyelitis requires the presence of specific bacteria with an alkaline urine, a preexisting urological procedure and a clinical context predisposing to infection. Clinical diagnosis can be difficult but the presence of alkaline urine containing abundant calcified mucopurulent debris is highly suggestive. Demonstration of the bacteria requires prolonged cultures in enriched media. Treatment is based on adapted antibiotic therapy, acidification of urine and excision of plaques of calcified encrustation. The consequences of treatment failure are serious and can result in graft nephrectomy in kidney transplant recipients. CONCLUSIONS: Early clinical and bacterial diagnosis of encrusted cystitis and pyelitis could improve the prognosis of these infectious diseases.

[Two-stage excision of extensive cutaneous carcinoma of the face. A retrospective study of 80 patients]. / Exerese en deux temps des carcinomes cutanes etendus de la face. Etude retrospective de 80 malades.

INTRODUCTION: Delayed reconstruction (two-step surgery) comprised of tumor resection and repair three or four days later, after paraffin tissue fixation and histopathological examination, is one of the techniques used for complete excision of spreading cutaneous carcinomas. PATIENTS AND METHODS: In order to evaluate the efficacy and long term prognosis of delayed reconstruction surgery, we carried out a retrospective study of 80 patients treated by this method and (Kaplan- Meier) for correlation with the local recurrence rate: sex, age, anatomic site, histologic type and existence of previous therapy. Long term results have been estimated. Among the 80 patients studied, 76 patients have been followed. The sex-ratio was 0.48. Fifty-two percent of the population was more than seventy years old. Fifty-five percent of the tumors were situated on the nose. In 32,5 p. 100 of the cases, a prior therapy (surgery, electrodessication or radiation therapy) has been carried out. Histological analysis showed 87 p. 100 basal cell carcinomas (of which 26 p. 100 of morpheaform basal cell carcinomas) and 13 p. 100 squamous cell carcinomas. RESULTS: After the first operative step, there was total excision in 69 p. 100 of thecases. In the remaining cases, a second excision was performed with a margin of normal tissue. Recurrences were observed (some precocious recurrences and some late recurrences) in 18.4 p. 100 of the cases. No risk factor correlated significantly with the recurrence rate. However, analysis of the survival graph suggests that the squamous cell carcinomas recurred more often than the basal cell carcinomas. CONCLUSIONS: Although extemporaneous examinations (Mohs' technique) remains the gold standard technique in the management of spreading cutaneous carcinomas of the face, the delayed reconstruction (two-step surgery) is a credible alternative when compared to the recurrence rates reported in the literature with the other techniques (electrodessication, radiation therapy or cryosurgery).