[Progressive paralysis of the diaphragm following intra-abdominal chemotherapy]. / Paralysie diaphragmatique progressive consécutive à une chimiothérapie intra-abdominale.

INTRODUCTION: In patients presenting with intra-abdominal tumor and peritoneal carcinomatosis, cytoreductive surgery associated with hyperthermic chemotherapy may offer improved survival. We describe a case of diaphragmatic paralysis following that kind of procedure. CASE REPORT: A 60-year-old woman presented with respiratory insufficiency following cytoreductive surgery and intra-abdominal hyperthermic chemotherapy performed for pseudomyxoma intraperitonei. Pulmonary function assessment demonstrated a restrictive pattern. Three successive chest CT-scans demonstrated a thinning diaphragm muscle. Respiratory insufficiency eventually led to the death of our patient. CONCLUSION: We conclude in favor of a muscular degeneration of the diaphragm consecutive to the combined effect of cytoreductive surgery and intraperitoneal chemotherapy. Owing to the unusual nature of this complication, we did not consider it as a hypothesis at an early point in this patient's management. We think physicians should be aware of such a complication in order to consider it in a timely way. We recommend performing a biopsy of the diaphragm for pathology examination to assess muscular degeneration.

[A bilateral diaphragmatic paralysis due to Parsonage and Turner syndrome--its evolution over eight years]. / Paralysie diaphragmatique bilatérale imputable à un syndrome de Parsonage-Turner. Evolution à huit ans.

The diaphragmatic paralysis is a rare disease whose causes and evolving forms are numerous. We report the development to eight years of paralysis diaphragmatic bilateral attributed to a Parsonage-Turner syndrome: the lack of recovery is proved by respiratory functional follow-up. The therapeutic possibilities, limited, are discussed.

[Evaluation of adherence to the regulations for declaration of notification of transfusion reactions with fever and chills. A study of the Association Inter-Régionale du Sud-Est d'Hémovigilance (AIRSEH)]. / Evaluation de la conformité à la réglementation des déclarations d'incidents transfusionnels pour frissons-hyperthermie dans des établissements de santé du sud-est de la France (groupe AIRSEH).

Febrile non-hemolytic transfusion reactions (FNHTR) are the most frequently reported acute adverse effects of blood products, and should be notified within 48 h according to the hemovigilance regulation. In order to study the conformity of these notifications and to search for factors associated with non-conformity, we retrospectively studied all FNHTR notified by voluntary centers of the AIRSEH group from 1st September 1994 to 31st December 1999. Seven hundred and sixty-one FNHTR were registered by 10 centers, most of them were benign (grade 1); 67.8% were non-conform. The non-conformity was associated with the number of biological investigations performed (median number, respectively, 4.24 and 2.94--P = 0.038--in non-conform and conform notifications--P = 0.038) in univariate analysis. Using a logistic regression model, center and severity were the only two factors significantly associated with non-conformity. Different center practices, and in particular the interface between the hospital and the blood bank, may be responsible for the effect center. Moreover, the non-conformity concerns first of all benign FNHTR. A stronger separation between alert and epidemiological surveillance is proposed in order to improve the notifications' conformity.

Detection of picobirnavirus in HIV-infected patients with diarrhea in Argentina.

Diarrhea due to enteric pathogens is an important complication of advanced HIV infection. Picobirnaviruses are agents recently linked with human enteritis. In total, 197 fecal samples collected from HIV-infected and noninfected patients with and without diarrhea were investigated for the presence of rotavirus and picobirnavirus by polyacrylamide gel electrophoresis. Picobirnavirus was detected in 8.8% of 57 HIV-infected patients with diarrhea, but it was detected in neither those without diarrhea (p<.018) nor in the group of subjects uninfected with HIV (p<.022). All genomic electropherotypes of picobirnavirus strains had a wide pattern. Picobirnavirus genome segments varied in size between 2.4 and 2.7 and 1.6 and 1.9 kbp for the slow and fast migrating bands, respectively. Rotaviruses were not detected in any of the clinical groups studied. Two methods for the extraction of nucleic acid-phenol/chloroform and guanidinium thiocynate (GTC)/silica-were compared. Detection of picobirnavirus by polyacrylamide gel electrophoresis was 2.5 times more sensitive following guanidinium thiocynate RNA extraction. This investigation offers preliminary results about the circulation of picobirnavirus in HIV-infected patients in Córdoba, Argentina.

PIP: In 1988, a new group of viruses containing a bisegmented double-stranded RNA genome was described and named "picobirnavirus" (PBV). Viruses with similar properties have subsequently been found in fecal specimens collected from HIV-infected and noninfected patients with gastrointestinal symptoms in several countries. The present study used polyacrylamide gel electrophoresis (PAGE) to examine fecal specimens from 197 HIV infected and noninfected adults, with and without diarrhea, from Cordoba, Argentina, for rotavirus and PBV. PBVs were detected in the stools of 5 HIV-infected patients with diarrhea (8.8%), but in none of the other subgroups (HIV-positive patients without diarrhea, HIV-negative patients with diarrhea, HIV-negative patients without diarrhea). 3 of the 5 stool samples positive for PBV were also positive for intestinal parasites (mixed infection), but these parasites were found with equal frequency in HIV-infected patients without diarrhea. Rotaviruses were not detected in any of the subgroups. PBV genome segments varied in size between 2.4-2.7 and 1.6-1.9 kbp for the slow and fast migrating bands, respectively. PBV detection by the PAGE technique was 2.5 times more sensitive after guanidinium thiocyanate RNA extraction. Further research is required to determine the duration of excretion of PBVs in HIV-infected patients with diarrhea and understand the immune response to infection.