[Kikuchi-Fujimoto's disease or histiocytic necrotizing lymphadenitis: A report of two familial cases]. / Maladie de Kikuchi-Fujimoto ou lymphadénite histiocytaire nécrosante : à propos de deux cas familiaux.

INTRODUCTION: The histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto's disease is characterized by a lymph node inflammation whose similarity with systemic lupus is generally admitted. CASE REPORT: Our description of two familial cases aims at raising the hypothesis of the existence of a genetic background in this disease following the example of what is observed in the autoimmune diseases. CONCLUSION: Pathophysiology of Kikuchi-Fujimoto's disease is probably multifactorial and may include predisposing genetic background and a possible infectious triggering event.

[Epileptic seizures and hematemesis in a young patient with sickle cell disease]. / Épilepsie puis hématémèse chez une jeune patiente drépanocytaire.

INTRODUCTION: Sickle cell disease is a multi-faceted disease, which can affect all organs. Here, we report the case of a young woman whose clinical presentation was confusing. CASE REPORT: An 18-year-old patient from Martinique in Caribbean area presented to the emergency room with widespread pain, as part of a vaso-occlusive crisis. She reported being followed for SS sickle cell anemia, with a history of vaso-occlusive crises and exchange transfusions in the past. Her hemoglobin rate was 83g/L. She was treated with opioid analgesics. Then, she presented several generalized tonic-clonic seizures and major episodes of hematemesis, which proved to be simulated by the patient, whose hemoglobin electrophoresis result was finally AS. CONCLUSION: This patient had therefore the Münchausen syndrome, mimicking sickle cell anemia, like eight other cases reported in the literature.

Impact of a multidisciplinary staff meeting on the quality of antibiotherapy prescription for bone and joint infections in orthopedic surgery.

INTRODUCTION: We studied the impact of a weekly multidisciplinary staff meeting (MSM) on the quality of antibiotherapy for bone and joint infections in orthopedic surgery, as part of professional practice assessment. MATERIALS AND METHODS: We retrospectively studied the file of patients hospitalized for bone and joint infection. We compared antibiotherapy compliance to good use (bacteriology, dose, length of treatment, length of adaptation to microbiology), and outcome at six months for patients with bone and joint infections, before (March 2007 to March 2009) and after (March 2009 to March 2011) implementation of the multidisciplinary staff meeting. We identified 28 patient files (32 infections) before MSM and 26 patient files (28 infections) after MSM. RESULTS: Antibiotherapy was adapted in 47% of cases before MSM, versus 96% after (P<0.0001). The dose was optimum in 72% of infections before MSM, versus 89% after (P=0.11) and the length of antibiotherapy complied with recommendations in 41% of infections before MSM, versus 86% after (P=0.0005). The average time of antibiotic adaptation to the antibiogram changed from 2 days before MSM to 1.7 days after (P=0.43). Forty seven per cent of patients were cured at six months before MSM, versus 57% after (P=0.45); the rate of treatment failure at six months decreased from 25% before MSM to 18% after (P=0.75). CONCLUSION: The effectiveness of antibiotherapy significantly improved concerning the spectrum and treatment duration (P ≤ 0.0005) after implementing MSMs in orthopedic surgery. But the clinical impact at six months was not significant due to the small population sample.

Positive blood culture in hospital: notification methods and impact of recommendations by an infectious disease specialist.

OBJECTIVE: The study's objective was to describe the notification methods of positive blood cultures and analyse the impact of recommendations made by an infectious disease specialist on the appropriateness of antibiotherapy. METHOD: We included all patients with positive blood cultures, from 12 different hospitals (including six with mobile infectious disease teams: MIDT) during a seven-day period. Medical records were retrospectively analysed to determine the delivered antibiotic treatment and the notification method of positive blood culture. We considered that the antibiotic treatment was appropriate if the antibiotic was effective on the isolated bacterium, whatever its spectrum. We assessed the impact of recommendations on appropriateness of antibiotherapy. RESULTS: One hundred and eighty-six patients were included. 44% (n=86) were considered as contamination cases. In true infections (n=104), Staphylococcus aureus and enterobacteria accounted for 51% of isolated bacteria. The Medical Unit was notified of blood culture positivity the day of positivity in 98% of cases (n=182). Antibiotic recommendations were given on the same day in 71% of cases. The antibiotic treatment was appropriate if recommendations were given in 92% of bacteremia, and only in 79% in without any recommendations (P=0.1). CONCLUSION: Antibiotic treatment seems to be more appropriate when antibiotic recommendations are given. This suggests that the MIDT has a key role in improving antibiotic prescriptions, whether for effectiveness, cost, or bacterial ecology.

Good recovery from aphasia is also supported by right basal ganglia: a longitudinal controlled PET study. EJPRM-ESPRM 2008 award winner.

AIM: It has long been a matter of debate whether recovery from aphasia after left perisylvian lesion is mediated by perilesional left hemispheric regions or by right homologous areas. To investigate the neural substrates of aphasia recovery, a longitudinal study in patients after a left single perisylvian stroke was performed. METHODS: Thirteen aphasic patients were H2(15)O PET-scanned twice at a one year interval during a word generation task. Patients are divided into two groups according to language performance for the word generation task at PET2. For the Good Recovery (GR) group, patients' performances are indistinguishable from those of normal subjects, while patients from the Poor Recovery (PR) group keep language disorders. Using SPM2, Language-Rest contrast is computed for both groups at both PET stages. Then, Session Effect contrast (TEP2-TEP1>0) is calculated for both groups. RESULTS: For the GR group, the Session Effect contrast shows an increase of activations in the left Postero-Superior Temporal Gyrus PSTG but also in the right thalamus and lenticular nuclei; for PR patients, the right lenticular nucleus activation is more important at PET1 than PET2. CONCLUSIONS: The crucial role of the left temporal activation is confirmed and its increase is linked to behavioural recovery. The role of the right basal ganglia to support good recovery from aphasia is a new finding. Their activation may be more task-dependant and related to inhibition of the right frontal cortex.

Automatic grapheme processing in the left occipitotemporal cortex.

In a previous event-related fMRI study, we showed that the left occipitotemporal cortex was specifically involved in the abstract categorization of visually presented alphabetic symbols. Here, we duplicate the fMRI study by measuring visual event-related potentials to verify whether the left posterior cortex supports the processing of graphemic representations at a perceptual, prelexical level. N170 amplitudes elicited by the categorically ambiguous stimulus 'O' were about twice as small in the left as in the right occipitotemporal region, and comparable to that of other letters on the left, and to that of other geometric figures on the right. The side asymmetry suggests that a graphemic module is unilaterally implemented in the left hemisphere, where it automatically processes heteromorphic representations that do not depend on the physical characteristics of the signal, whereas the difference in amplitude suggests that this left graphemic module is in series with, precedes and does not transmit information to, or inhibits a general shape-analysis module.

Epidemiological surveillance at Electricité de France-Gaz de France: health assessment of nuclear power plant employees between 1993 and 1998.

Because the 17,500 employees working in nuclear power plants at Electricité de France, the national power company, may be exposed to a wide variety of industrial hazards, the health insurance department of the company has set up an epidemiological surveillance programme for them. This report describes its first stage, an analysis of their health problems. This descriptive, cross-sectional and exhaustive study examined sick-leave, mortality and cancer incidence to assess the health of the employees working from 1993 through 1998. The analysis compared the employees in nuclear power plants, considered 'exposed', with the rest of the personnel of Electricité de France-Gaz de France, the 'non-exposed' (125,000 persons). Relative risks for these variables were estimated, after stratification for age, sex and work grade. Globally, the employees in the nuclear sector appeared to have fewer health problems than the other company employees. This was true regardless of age and especially for men, operating employees and supervisory employees. Nonetheless, three points must be noted: non-work accidents generated a non-significant excess of absenteeism and mortality among these employees, especially among management and supervisory personnel; suicides affected supervisors in particular; and an excess of primary malignant brain tumours affected both mortality [relative risk (RR) = 1.96, n.s.] and incidence, especially among operating employees (RR = 2.87, 95% confidence interval = 1.00-8.43). No excess of malignant blood disease was observed. This study, performed for surveillance purposes, points to brain tumours as a problem that raises important aetiological questions. Research is now necessary to provide answers. Surveillance of nuclear plant employees at Electricité de France should be continued and expanded to include the study of specific occupational exposures.

Event-related functional magnetic resonance imaging study of the extrastriate cortex response to a categorically ambiguous stimulus primed by letters and familiar geometric figures.

Functional neuroimaging studies have suggested a specific role of the extrastriate cortex in letter string and visual word form processing. However, this region has been shown to be involved in object recognition and its specificity for the processing of linguistic stimuli may be questioned. The authors used an event-related functional magnetic resonance imaging design with category priming to record the response elicited by the passive viewing of single letters, geometric figures, and of the categorically ambiguous stimulus "O" that pertains to both sets of familiar symbols. Bilateral activations in the extrastriate cortex were found, with a left predominance particularly pronounced for the ambiguous stimulus. Individual analysis of spatial extent and signal intensity showed a priming x stimulus x hemisphere interaction. When primed by the congruous categoric set, a bilateral decrease in activation was observed for letters and geometric figures. The ambiguous stimulus behaved as a letter for the left hemisphere, with decreased activation when primed by letters, whereas in the right hemisphere, an adaptation effect occurred when primed by geometric figures. These priming effects suggest that, for the ambiguous stimulus, letter processing was systematically involved in the left extrastriate cortex. The current results support the existence of a neural substrate for the abstract category of letters.

[Emergency cesarean section]. / Césarienne urgente.

Emergency cesarean section is a frequent high risk procedure. Systematic third trimester anesthesia consulation is of great value. The main problem is difficult intubation. It may be prevented by scoring patients according to Mallampati and Wilson, and by more frequent use of fiberoptic techniques. Perfect knowledge of a failed intubation drill is mandatory. Monitoring of ETCO2, SpO2 and curarisation comes in addition to basic monitoring. Special conditions as toxemia, major bleeding, allergies, maternal circulatory arrest are reviewed. Suggested protocols for general and locoregional techniques are presented.

[Our experience of spinal anesthesia for transurethral resection of the bladder and prostate. Retrospective study of 334 patients operated in 1986]. / Notre expérience de la rachianesthésie pour résection transurétrale de vessie et de prostate. Etude rétrospective de 334 patients opérés en 1986.

Retrospective study of one years is performed on 334 patients who undergo transurethral surgery. Spinal anesthesia is used in 263 cases, general anesthesia in 71. Spinal administration of local anesthetics (lidocaine hyperbaric 5% or bupivacaine 0.5%) or opioid (Pethidine 1 mg/kg) have been used in old patients without any complication. The advantages are less blood uses, early stand up, no discontinuity in oral nutrition. For our team there are only few contra-indications for spinal anesthesia: blood coagulation abnormalities or some very rare heart diseases.

[Use of erythrocytapheresis in a pregnant woman with sickle cell anemia]. / Utilisation de l'échange érythrocytaire chez une femme enceinte atteinte de drépanocytose.

A case is reported of a 23 yr old pregnant woman from Zaire in whom homozygous sickle-cell disease was discovered at her first obstetrical visit at 25 week amenorrhea. She had had two previous pregnancies: the first one had been voluntarily interrupted; the second one went to term, but the child, born in a state of apparent death, died on the third day. Despite severe normocytic anaemia (5 mmol.l-1 haemoglobin, 2.9 T.l-1 erythrocytes, 0.25 haematocrit, 93 fl mean globular volume), she was symptomless. The diagnosis was confirmed by haemoglobin electrophoresis: 0 haemoglobin A (HbA) and 0.854 haemoglobin S (HbS). Because foetal growth and maturation appeared satisfactory, no procedure to increase the HbA/HbS ratio was used before the 37th week of amenorrhea. At that time, erythrocytapheresis was carried out using a discontinuous flow cell separator. Eight phenotyped red cell packs without leukocytes (removed by filtration) were transfused; at the end of the procedure, there was 0.67 HbA and 0.25 HbS. At 39 week amenorrhea, haemoglobin electrophoresis gave 0.43 HbA and 0.47 HbS. No further treatment was therefore given. At the 40th week, she gave birth to a healthy girl, Apgar score 10 at 1 min. She was given two further red cell packs at start of labour, because her haemoglobin level had fallen to 6.4 mmol.l-1. In the immediate postpartum, her HbS level was 0.38. The aims, advantages and disadvantages of the different techniques available for the treatment of homozygous sickle-cell anaemia in pregnancy are discussed.

Evidence for rotational contribution to protein-facilitated proton transport.

Two modes of molecular motion of carrier molecules can, in principle, lead to a facilitated transport of a substrate: translational and rotational diffusion. In the present study, which deals with the mechanism of the facilitated diffusion of H+ and O2 in solutions of earthworm hemoglobin, examples for both types of facilitation are presented. Only translational, not rotational, diffusion of earthworm hemoglobin appears to lead to a facilitated O2 flux. In contrast, substantial facilitated H+ fluxes of comparable size arise from rotational diffusion as well as from translational diffusion of this large protein. This is derived from measurements of facilitated H+ and O2 fluxes in earthworm hemoglobin solutions and determinations of the rotational and translational diffusion coefficients of earthworm hemoglobin with the help of a theoretical treatment of facilitated diffusion by rotational carrier diffusion. H+ transport by rotational protein diffusion appears to be a case where the often-postulated mechanism of facilitated transport by rotation of a carrier lends itself to experimental verification.

Endoscopic haemostasis by injection-therapy in high-risk patients.

The diagnosis of an upper gastrointestinal bleeding can be clarified quickly and reliably by emergency endoscopy. It would seem reasonable to make this efficient diagnostic approach available for therapy in order to stop the bleeding. Over a period of 2 1/2 years, we discovered an active bleeding or several recurrences during emergency endoscopy in 36 patients with a high operative risk. In these cases we attempted local haemostasis by sclerosing injections. Most patients had signs of shock at the time of admission. The average haemoglobin level was 7:42 g/100 ml, the average blood requirement was 4,4 units in the first 24 hours. 12 patients had stress lesions, 19 patients important factors militating against an operation, namely age and serious primary diseases, 5 patients had other risk factors. In 33 out of 36 patients (91.9%) haemostasis was accomplished during endoscopy. In 7 patients recurrences occurred, 3 bleeds were arrested by a repeated sclerosing. Thus definitive haemostasis was achieved in 29 patients (80.6%). We believe that it is justified to attempt endoscopic sclerotherapy in high-risk patients before undertaking an emergency operation.

[Conservative management and sclerosing injections in the treatment of esophageal variceal bleeding - a comparative study (author's transl)]. / Konservative Therapie und Wandsklerosierung bei der Osophagusvarizenblutung. Eine vergleichende Untersuchung.

In a 3-year-period (1977-1979) we have treated 76 esophageal variceal bleedings from 60 patients. We compared the results of the usual conservative therapy in the first 18 months with the results of the second in which we additionally tried to sclerose the varices. Both groups of patients were comparable as well to age and sex as to aetiology and functions of the liver.

Net charge and oxygen affinity of human hemoglobin are independent of hemoglobin concentration.

The dependence of net charge and oxygen affinity of human hemoglobin upon hemoglobin concentration was reinvestigated. In contrast to earlier reports from various laboratories, both functional properties of hemoglobin were found to be independent of hemoglobin concentration. Two findings indicate a concentration-independent net charge of carbonmonoxy hemoglobin at pH 6.6: (A) The pH value of a given carbonmonoty hemoglobin solution remains constant at 6.6 when the hemoglobin concentration is raised from 10 to 40 g/dl, indicating that there is no change in protonation of titratable groups of hemoglobin: (b) the net charge of carbonmonoxy hemoglobin as estimated from the Donnan distribution of 22Na+ shows no dependence on hemoglobin concentration in this concentration range. The oxygen affinity of human hemoglobin was determined from measurements of oxygen concentrations in equilibrated samples using a Lex-O2-Con apparatus (Lexington Instruments, Waltham, Mass.). P50 averaged 11.4 mm Hg at 37 degrees C, pH = 7.2, and ionic strength approximately 0.15. Neither P50 nor Hill's n showed any variation with hemoglobin concentrations increasing from 10 to 40 g/dl.

Proton transport by phosphate diffusion--a mechanism of facilitated CO2 transfer.

We have measured CO2 fluxes across phosphate solutions at different carbonic anhydrase concentrations, bicarbonate concentration gradients, phosphate concentrations, and mobilities. Temperature was 22-25 degrees C, the pH of the phosphate solutions was 7.0-7.3. We found that under physiological conditions of pH and pCO2 a facilitated diffusion of CO2 occurs in addition to free diffusion when (a) sufficient carbonic anhydrase is present, and (b) a concentration gradient of HCO3- is established along with a pCO2 gradient, and (c) the phosphate buffer has a mobility comparable to that of bicarbonate. When the phosphate was immobilized by attaching 0.25-mm-long cellulose particles, no facilitation of CO2 diffusion was detectable. A mechanism of facilitated CO2 diffusion in phosphate solutions analogous to that in albumin solutions was proposed on the basis of these findings: bicarbonate diffusion together with a facilitated proton transport by phosphate diffusion. A mathematical model of this mechanism was formulated. The CO2 fluxed predicted by the model agree quantitatively with the experimentally determined fluxes. It is concluded that a highly effective proton transport mechanism acts in solutions of mobile phosphate buffers. By this mechanism; CO2 transfer may be increased up to fivefold and proton transfer may be increased to 10,000-fold.