[Pneumococcal pneumonia in a patient with HIV infection. Development to excavation. Apropos of a case]. / Pneumopathie à pneumocoque chez une patiente infectée par le VIH. Evolution vers l'excavation. A propos d'un cas.

An HIV-infected patient presented with pneumococcal pneumonia with abscess formation. The causal effect of the pneumococcal infection on abscess formation was discussed. Since the advent of antibiotics, necrotizing pneumococcal pneumonia is rarely observed but clinicians should nevertheless be aware of this possibility, particularly because of the HIV epidemic.

[Myocardial infarction by spontaneous dissection of coronary arteries in a subject with type IV Ehlers-Danlos syndrome]. / Infarctus du myocarde par dissection spontanée des artères coronaires chez un sujet atteint d'un syndrome d'Ehlers-Danlos de type IV.

Acute myocardial infarction with spontaneous coronary dissection was fatal in a 33-years-old man. Autopsy and family history revealed type IV Ehlers-Danlos syndrome. In this disease, conjunctive tissue is fragilized due to a deficit in type III collagen which leads to spontaneous ruptures in large and medium sized arteries. The present case is the first with a proven rupture of the coronary arteries. This disease should be entertained in young people with no atherogenous risk factor and an acute coronary disorder since peripheral skin and joint syndromes may be discreet or missing. Treatment is difficult in case of spontaneous coronary dissection. Thrombolysis is not possible and diagnosis may require angiography which is in itself dangerous due to the fragility of the coronary vessels.

Effect of a protein-sparing diet on responses to exercise in obese subjects.

We have studied muscular work efficiency and VO2 peak in seven obese individuals (body mass index: 38.9 +/- 5.8 kg.m-2) before and after twelve days of a low-caloric diet (protein-sparing modified fast) providing about 2460 kJ/day. Respiratory gas exchanges were measured at rest and during an exercise protocol through a rubber mask connected to a pneumotachograph and a mass spectrometer. A significant reduction in body mass was observed with the diet therapy (109 +/- 12 vs 105 +/- 14 kg; p < 0.02). No significant differences were observed in VO2 peak (1.78 +/- 0.32 vs 1.88 +/- 0.43 l/min, p > 0.05) and work efficiency (26 +/- 5 vs 24 +/- 4%, p > 0.05), after the diet protocol. It is concluded that the low-caloric diet used had no effect on muscular work efficiency.

Postprandial thermogenesis and hormonal release in lean and obese subjects.

One group of 10 obese people (1.72 times normal weight) was compared to a control group of 9 normal-weight subjects. Oxygen consumption (VO2), immuno reactive growth hormone (IRGH), and rectal temperature (Tre) were measured every 15 min on an average, during the 5 h following a protein meal composed of 6 egg-whites and 50 g of casein totaling 1 340 kJ. The results show that postprandial thermogenesis (PPT) is the same in both groups: maximum increase in VO2 averages 15% in the obese and 16% in the control groups respectively. Energy expenditure integrated over the 5 h was 129 kJ for the obese and 114 kJ for the control subjects, i.e. 9.6% and 8.5% of the energy meal content. The rise in Tre was identical for both groups (0.4 degrees C over 3 h). For IRGH, the preprandial reference figures were much lower in the obese: 52 pmole.dm-3, as compared to 145 pmole.dm-3. In all control subjects, the protein meal resulted in a IRGH peak of, on average, 455 pmole.dm-3 about 2 h after. This was not observed in 4 of the obese subjects, while in the remaining 6, the mean peak value was 165 pmole.dm-3, occurring after 1 h. The other hormonal or chemical compound simultaneously analysed (glucagon, cortisol, PRL, T3, glucose, lactate, NEFA) do not show any significant variations but insulin blood level for which a postprandial increase was measured in both groups. It is concluded that after a protein test meal: PPT in overweight people is no different from that in people of normal weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Determinants of increased energy cost of submaximal exercise in obese subjects.

The energy cost of submaximal cycling exercises is studied in 23 obese (OS) and 13 lean control (LS) subjects at 1) a constant pedaling frequency (60 rpm) and at various work loads [external work loads (Wmec) up to 100 W] for one group of OS and LS, and at 2) constant Wmec (brake free and 60 or 70 W) and various frequencies (38-70 rpm) for a second group of OS and LS. The total energy expenditure (WO2) is calculated from O2 consumption (VO2) measured in both conditions and is compared with anthropometric data. The results show that at rest or at the same Wmec, WO2 is always greater in OS than in LS. At rest the quotients of WO2 over body surface area are not significantly different. At work the difference in WO2 cannot be explained by the muscular mechanical efficiency, which is not statistically different in OS (26 +/- 7.8%) and LS (25 +/- 4.6%). The calculated increase in the work of breathing of OS can account only for 5-15% of the energy overexpenditure. The energy cost of leg movement is estimated in brake-free cycling trials; it is significantly greater in OS than in LS (118 J compared with 68 J/pedal stroke), but when divided by leg volume the figures are not different (9.2 compared with 8.5 J X dm-3 X pedal stroke-1). Leg moving may account for approximately 60-70% of the energy cost of moderate exercise in cycling OS. The remaining difference in WO2 between OS and LS (20-30%) may be explained by an increase in muscular postural activity related to the lack of physical training of OS.

Mechanics and energetics of stilt walking.

Three subjects were studied walking on a sports track with and without 1-m-long stilts. They were asked to walk in different ways. Pace length, step rate, heart rate, and oxygen consumption were measured under both conditions at different speeds. The results show that walking speed is generally faster for stilt walking than for normal walking. The higher speed is achieved due to increased pace length in spite of a decrease in step rate. The relationship between energy expenditure and walking speed is approximately the same in both cases. This result may be explained by two opposing factors: increase of pace length and decrease of step rate decrease the energy requirements of stilt walking, but the foot loading presented by the stilt walking exaggerates these conditions and increases energy expenditure.