The high burden of hospitalizations for primary EBV infection: a 6-year prospective survey in a French hospital.

Primary Epstein-Barr virus infection (PEI) is acquired increasingly later in life in developed countries, involving a growing number of adults. No studies have examined the effect of age on PEI. We conducted a prospective, single-centre, noninterventional survey to assess the clinical and economic effects of PEI care according to age. We included all serology-confirmed cases observed in all departments of a large regional hospital. Clinical and biologic data, therapeutics and costs of care were examined. Over a 6-year period, we included 292 subjects (148 children and 144 adults) with a median age of 15.4 years (range 9 months to 79 years). Adults were hospitalized more often (83% vs. 60%) and for longer periods of time (median 4 days vs. 2 days) than children (p ≤ 0.0001 for both). Two adults required a secondary transfer into the intensive care unit, although no children did. Typically, adults showed higher levels of activated lymphocytes and liver abnormalities. They also required the use of systemic corticosteroids more often (45% vs. 23%, p < 0.0001) and for longer periods of time (median 7 days vs. 3 days, p 0.02) than children. Overall, the costs were significantly higher for adults than for children (median, €1940 vs. €1130, p < 0.0001), mainly because of the frequency and duration of hospitalizations. Age increases the immune response and clinical severity of PEI, resulting in substantial additional costs for the community. Better recognition of the disease in adults could shorten the average length of hospital stay.

[Difficulties in the management of localised pulmonary Goodpasture's syndrome]. / Difficultés de la prise en charge d'une forme pulmonaire isolée du syndrome de Goodpasture.

INTRODUCTION: The diagnosis of the pulmonary forms of Goodpasture's syndrome is not easy and requires a renal biopsy when no anti-glomerular basement membrane antibodies are detected, since the disease can lead to spontaneous massive intra-alveolar haemorrhage that can be fatal. Treatment for the pulmonary-renal form combining corticosteroids, cyclophosphamide and plasmapheresis should be applied to the pulmonary form to control haemorrhage and prevent relapse. CASE REPORT: We report the case of a patient suffering from the localised pulmonary form of Goodpasture's syndrome in whom the diagnosis was delayed due to a negative indirect immunofluorescent antibody bioassay. After a serious early relapse remission was achieved with comprehensive treatment and a tobacco withdrawal programme. CONCLUSION: If there is no delay in diagnosis and comprehensive treatment is given, the prognosis for these patients is good with a recovery rate of 80 to 90%.

Postoperative changes in lipid profile: their relations with inflammatory markers and endocrine mediators.

Postoperative changes in plasma lipid profile have been studied in six patients undergoing aortobifemoral bypass. The second day after surgery, significant changes were: decreased levels of high density lipoprotein (HDL) cholesterol (by 55%), non HDL cholesterol (by 60%) phospholipid (by 50%), pre-beta-lipoprotein (by 70%), beta-lipoprotein (by 50%), apolipoprotein A1 (by 60%) and apolipoprotein B (by 55%). The magnitude of these changes correlated positively with serum levels of transferrin and negatively with serum levels of C-reactive protein. Triglyceride levels also showed a significant decrease (by 60%) while free fatty acids increased by 70%. Changes in triglyceride levels were not correlated with serum transferrin and C-reactive protein but showed a significant negative correlation with insulin levels. Our results suggest that both inflammatory and endocrine mediators are likely implicated in the postoperative changes in lipid profile.

In-vivo studies on Haemaccel-fibronectin interaction in man.

An enzyme-linked immunoassay has been recently set up for direct measurement of the binding capacity of plasma fibronectin to gelatin. This binding capacity could be completely inhibited in vitro by an eight-fold excess of gelatin, of Haemaccel, but not of Geloplasma. On the contrary, the levels of immunoreactive fibronectin measured by laser nephelometry did not change, in presence of 10 to 1000 micrograms ml-1 of gelatin, of Haemaccel or of Geloplasma. When infused into normal volunteers, Haemaccel provoked a strong and immediate inhibition of the plasma fibronectin binding capacity to gelatin. This inhibition was dose-dependent and maximal after infusion of 500 ml of Haemaccel. Twenty-four hours after this infusion, there was a progressive recovery of the gelatin-binding capacity, which was almost completely achieved 96 h later. The formation of complexes between Haemaccel and fibronectin was demonstrated by gel filtration chromatography and by affinity chromatography. Immunoreactive plasma fibronectin levels remained unchanged up to 24 h after infusion of 500 ml of Haemaccel. A transient decline to 50% of its initial value then occurred the second day after the infusion. Therefore, a delay existed between the formation of fibronectin-Haemaccel complexes and their elimination from the bloodstream. This delay decreased when smaller volumes of Haemaccel were infused, which strongly suggests that plasma fibronectin is cleared by means of Haemaccel and does not seem to play a role of opsonin in these conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

[Significance of lactate dehydrogenases in pleural effusions]. / Signification des lacticodéshydrogénases des épanchements pleuraux.

In order to determine the exact significance and origin of lactate dehydrogenases (LDH) present in pleural effusions, LDH and their enzymes were assayed in the serum and pleural fluid of 60 patients with wet pleurisy and in the main blood cells (haematocytes, polymorphonuclears mononuclears) found in pleural fluids. Our results showed that: a pleural fluid/serum LDH ratio above 0.7 indicates that the fluid is an exudate; however, in about 10% of inflammatory pleural effusions due to infection or cancer this ratio is comprised between 0.5 and 0.7; the enzyme profile of transudates only differs from that of normal serum by a slight increase in isoLDH 4 and 5; in exudates this profile is the reverse of the normal serum profile, with a decrease in isoLDH 1 and 2 and an increase in isoLDH 4 and 5; the enzyme profile provides little information on the origin of exudates, although a more than 30% rise in isoLDH 2 is in favour of a malignancy (mesothelioma excluded); polymorphonuclears contain more isoLDH 4 and 5 than mononuclears; activation of mononucleate cells is attended by a significant increase in intracellular isoLDH 4 and 5; the presence of red blood cells and/or haemolysis in an exudate cannot account for its high isoLDH 4 and isoLDH 5 content; the high content seems to be due, at least partly, to release of these enzymes by the polymorphonuclears and/or mononucleate cells involved in pleural inflammation.

Serum lipid and lipoprotein changes induced by new oral contraceptives containing ethinylestradiol plus levonorgestrel or desogestrel.

Changes in serum lipid and lipoprotein levels were evaluated in a randomized prospective study conducted in matched healthy young women before and after 6 months' use of three oral contraceptives (OCs): Trigynon (preparation A, n = 13), a triphasic OC containing low doses of ethinylestradiol (EE) and levonorgestrel (LNG); Marvelon (preparation B, n = 14), a monophasic OC containing low doses of EE + Desogestrel (DOG, a new progestogen derived from LNG); and Ovidol (preparation C, n = 11), a sequential OC containing higher doses (50 micrograms) of EE + DOG. After 6 months of use, total triglyceride levels were non-significantly increased by preparations A (+ 29% from basal values) and B (+21%), and very significantly increased by preparation C (+90%). Total cholesterol and phospholipids were unchanged by preparations A and B, whereas phospholipids were significantly increased by preparation C. However, HDL-cholesterol, LDL-cholesterol and their epidemiologically important ratios (HDL-chol:total-chol; LDL-chol:HDL-chol) were kept unchanged by all preparations tested. Apolipoprotein A-1 (Apo A-1) was slightly but significantly increased by all three preparations whereas apolipoprotein B (Apo B) was significantly decreased by preparation B. All ratios Apo A-1:Apo B were accordingly ("favorably") increased, especially during treatment with preparation B. In conclusion, the triphasic OC containing low doses of LNG does not induce obvious, clinically significant, alterations of lipid metabolism, and it is also the case for the low-dose monophasic combination of EE + DOG. The higher-dose sequential preparation of EE + DOG behaves as a more estrogenic compound, increasing total triglyceride concentrations above the normal range.

PIP: Changes in serum lipid and lipoprotein levels were evaluated in a randomized prospective study conducted in matched healthy young women before and after 6 months' use of 3 oral contraceptives (OCs): Trigynon (preparation A, n=13), a triphasic OC containing low doses of ethinylestradiol (EE) and levonorgestrel (LNG); Marvelon (preparation B, n=14), a monophasic OC containing low doses of EE + Desogestrel (DOG, a new progestogen derived from LNG); and Ovidol (preparation C, n=11), a sequential OC containing higher doses (50 mcg) of EE + DOG. After 6 months of use, total triglyceride levels were non-significantly increased by preparations A (+29% from basal values) and B (+21%), and very significantly increased by preparation C (+90%). Total cholesterol and phospholipids were unchanged by preparations A and B, whereas phospholipids were significantly increased by preparation C. However, HDL-cholesterol, LDL-cholesterol and their epidemiologically important ratios (HDL-chol:total-chol; LDL-chol:HDL-chol) were kept unchanged by all preparations tested. Apolipoprotein Apo A-1) was slightly but significantly increased by all 3 preparations whereas apolipoprotein B (Apo B) was significantly decreased by preparation B. All ratios Apo A-1:Apo B were accordingly ("favorably") increased, especially during treatment with preparation B. In conclusion, the triphasic OC containing low doses of LNG does not induce obvious, clinically significant, alterations of lipid metabolism, and it is also the case for the low-dose monophasic combination of EE + DOG. The higher-dose sequential preparation of EE + DOG behaves as a more estrogenic compound, increasing total triglyceride concentrations above the normal range.

A one-step determination of serum 5'-nucleotidase using a centrifugal analyzer.

We describe a one-step kinetic method for the determination of 5'-nucleotidase (EC 3.1.3.5). Inosine is formed by the hydrolysis of inosine 5'-monophosphate which is catalyzed by seric 5'-nucleotidase, and then is converted to hypoxanthine by nucleoside phosphorylase. Two moles of hydrogen peroxide are formed for each mole of hypoxanthine oxidized to urate by xanthine oxidase. The rate formation of hydrogen peroxide is monitored at 510 nm using the oxidation of the chromogenic system 3,5-dichloro-2-hydroxybenzenesulfonic acid/4-aminophenazone in the presence of peroxidase. beta-Glycerophosphate inhibits the unspecific cleavage of the substrate by alkaline phosphatases. Inorganic phosphate is added to improve the reagent stability, and ferrocyanide to reduce bilirubin interference. Automation of the technique requiring 20 microliter of serum on a centrifugal analyzer is also described.

Concentrating capacity of the kidney and nitrogen partition in the urine in Perodicticus potto (Prosimii, Lorisidae, Lorisinae).

The concentrating ability of the kidney in Perodicticus potto was investigated. As the relation between this capacity and the thickness of the medulla has been stressed by Schmidt-Nielsen & O'Dell, the size of the various layers in the kidney was measured. Based on our observation that the potto may excrete uric acid in fairly high concentrations, the partition of nitrogen in the urine was also explored.