Validity of resting myotonometric assessment of lower extremity muscles in chronic stroke patients with limited hypertonia: a preliminary study.

The aim of this preliminary study was to examine the validity of a recently-introduced tool (MyotonPRO) for the assessment of mechanical parameters of the main lower extremity muscles in patients with chronic stroke. Thigh and shank muscles of 20 stroke patients with limited hypertonia (11 men and 9 women; mean age: 52±11yrs) and 20 healthy controls (11 men and 9 women; mean age: 53±10yrs) were bilaterally evaluated with (i) MyotonPRO for muscle stiffness, tone and elasticity, (ii) ultrasonography for muscle and subcutaneous thickness, and (iii) dynamometry for isometric muscle strength. MyotonPRO parameters of stroke patients were reassessed a week later (inter-day test-retest design). For all the investigated muscles, MyotonPRO variables did not differ between the more affected and the less affected side of patients (P>0.05 for main side effect), and neither differed between patients and controls (P>0.05 for main group effect), except for gastrocnemius medialis stiffness that was higher in patients (300±51N/m) than in controls (281±29N/m; P<0.05). Thigh muscle stiffness was negatively correlated to subcutaneous thickness (r=-0.84 for the vastus lateralis; P<0.001), while only tibialis anterior stiffness and tone correlated positively with muscle thickness (both r=0.46; P<0.01). Test-retest reliability of MyotonPRO parameters was adequate, except for muscle elasticity. The validity of MyotonPRO for the evaluation of thigh muscles in chronic stroke patients is partially challenged by the poor discriminant ability and by the considerable impact of subcutaneous tissue thickness (sex-dependent) on mechanical parameters. The potential validity of MyotonPRO for the assessment of shank muscles requires further investigation.

Opioid antagonist detoxification under anaesthesia versus traditional clonidine detoxification combined with an additional week of psychosocial support: a randomised clinical trial.

BACKGROUND: While detoxification under anaesthesia accelerates the detoxification procedure, there is a lack of randomised clinical trials evaluating its effectiveness compared to traditional detoxification procedures, and a lack of data on long-term abstinence. METHODS: Prospective randomised clinical trial. Analysis by intention to treat and per protocol. SETTING: Specialised substance abuse unit in a psychiatric teaching hospital and an intensive care unit of a general hospital. PARTICIPANTS: Seventy patients with opiate mono-dependence requesting detoxification: 36 randomised to RODA (treatment as allocated received by 26) and 34 randomised to classical clonidine detoxification (treatment as allocated received by 21). MAIN OUTCOME MEASURES: Successful detoxification, safety and self-reported abstinence at 3, 6 and 12 months after detoxification. RESULTS: Socio-demographics were similar in both groups at baseline. No complications were reported during or after anaesthesia. According to the intention to treat analysis, 28/36 (78%) RODA patients and 21/34 (62%) of the clonidine group successfully completed the detoxification process (p=0.14). In the intention to treat analysis, 30% of RODA patients were abstinent after 3 months compared to 14% in the clonidine group (p=0.11). No difference was found at 6 and 12 months (both groups showed less than 5% abstinence after 12 months). The per-protocol analysis showed similar results with no statistical differences either for ASI mean scores or for the SF36 questionnaire. CONCLUSION: Although the detoxification success rate and abstinence after 3 months were slightly better for the RODA procedure compared to clonidine treatment, these differences were not statistically significant and disappeared completely after 6 and 12 months.

[Rapid induction of withdrawal with opiate antagonists under anesthesia: an alternative to treatment of opiate dependence?]. / L'induction rapide du sevrage par des antagonistes des opiacés sous anesthésie: une alternative dans le traitement de la dépendance aux opiacés?

Rapid induction of withdrawal by opiate antagonists under anesthesia is an opiate detoxification technique. This technique is useful to reduce intensity and duration of withdrawal. Therefore, this technique represents an alternative strategy in the treatment of opiate addicted patients. This paper attempts to present a brief history of this technique, and a critical review of related issues.

Clinical features and analysis of the duration of colonisation during an outbreak of Salmonella braenderup gastroenteritis.

During an outbreak of acute Salmonella braenderup gastroenteritis we performed a standardised interview encompassing questions on clinical symptoms in 156 (127 adults and 29 children) of 215 identified patients. Sequential stool cultures were obtained for up to five months in these 156 cases. We restricted the analysis to the 122 patients with at least 3 or more available cultures. They were treated with a fluoroquinolone, trimethoprim-sulfamethoxazole, or not treated with antibiotics, according to the decision of the practitioners. For this reason, a randomised double blind study was not possible. Minimum inhibitory concentrations (MIC) of the prescribed drugs were measured for representative isolates before and after treatment. The most frequent symptoms were diarrhoea (98%) and abdominal pain (96%). Vomiting occurred in 43% of cases. Children were more severely ill. Seven weeks after acute gastroenteritis, stool cultures were still positive for salmonella in 71% of the 22 children and 30% of the 100 adults examined (p < 0.002). This rate decreased progressively in both groups to 5 and 3% respectively at 20 weeks (n.s.). Among adults, no significant difference in enteric carriage over time could be demonstrated between untreated patients and those treated with either a fluoroquinolone or trimethoprim-sulfamethoxazole. MIC for salmonella isolates remained unchanged after treatment. In a cohort of patients infected with a single strain of salmonella, fluoroquinolone therapy of acute gastroenteritis failed to influence the duration of enteric carriage, despite continuing susceptibility of the strain. In children, the rate of clearance of Salmonella braenderup from stool was statistically lower until the tenth week after the acute disease, but there was no further difference after 5 months.

Outbreak of Salmonella braenderup gastroenteritis due to contaminated meat pies: clinical and molecular epidemiology.

OBJECTIVES: To determine the epidemiologic, clinical and molecular characteristics of an outbreak of severe gastroenteritis due to the ingestion of meat pies highly contaminated with Salmonella braenderup. METHODS: In October 1993, we observed an outbreak of Salmonella braenderup gastroenteritis that occurred in the Lausanne area, Canton de Vaud, Switzerland. Cultures of suspected food products, of samples at the incriminated food factory and from workers, as well as a case-control study, were used to determine the source of the epidemics. Ribotyping of representative Salmonella braenderup strains was performed to define the molecular epidemiology. The clinical characteristics of this infection were determined by using a standardized interview performed during and 6 months after the outbreak in 156 of 215 identified patients. RESULTS: The outbreak resulted from the ingestion of pies, heavily contaminated (> 106 CFU/g) with a strain of Salmonella braenderup. The contamination was due to mishandling and recycling of jelly poured on top of the products. According to its ribotype and plasmid characteristics, this strain had not been isolated previously in Switzerland. Ten of the 24 workers of the incriminated food factory were shedding the epidemic strain in their stools, and one of them reported gastroenteritis 3 weeks before the beginning of the outbreak. The estimated attack rate in the exposed population was 7.5%. The median incubation time was 18 h. Among 127 adult patients studied, 98% had diarrhea, 95% abdominal pain, 74% fever > or = 38.5 degrees C, 69% nausea and 35% vomiting. One patient developed prosthetic valve endocarditis, and one reactive arthritis. Long-term complications were not identified, although 12 patients complained of irritable bowel syndrome and 24 of unusual asthenia lasting for more than 6 weeks after infection. Children had more severe signs and symptoms compared to adults, and six of 29 needed hospitalization. CONCLUSIONS: This study showed that ingestion of food highly contaminated with Salmonella braenderup resulted in severe but typical gastroenteritis and indicated mishandling of food during manufacture as the cause of this outbreak.

[Rapidly progressive ascites]. / Ascite rapidement progressive.

A 50-year-old woman rapidly developed ascites with jaundice and worsening of general condition. On admission a nodule of the left breast was noted. Workup showed slight anomalies in liver tests and led to the diagnosis of portal hypertension, without visible lesion (CT scan, ultrasonography) of the liver. The patient suffered severe bleeding caused by esophageal varices necessitating urgent sclerotherapy. Several days later, her condition worsened rapidly due to acute respiratory distress syndrome followed by irreversible shock.

Use of norfloxacin for prevention of symptomatic urinary tract infection in chronically catheterized patients.

Thirty-four elderly inpatients with long-term urethral catheters were randomly assigned to receive either norfloxacin (200 mg/day) or placebo in a double-blind study with cross-over after three months. Twenty-three patients completed the entire study. Norfloxacin treatment was associated with a persistent decrease in gram-negative isolates (p < 0.005) and the acquisition of gram-positive norfloxacin-resistant flora. It also resulted in a highly statistically significant reduction of symptomatic urinary tract infections (1 vs. 12, p < 0.02), a decrease in catheter-associated local complications, obstructions and leakage (p < 0.05) and an improvement in the patients' general condition (p < 0.001). In conclusion, within the conditions of the present study, long-term suppression of gram-negative bacteriuria by norfloxacin reduced the incidence of catheter-related urinary tract infection and associated morbidity.

Complement-mediated serum activities against genetically defined capsular transformants of Haemophilus influenzae.

Although there are six different capsular serotypes of Haemophilus influenzae (a-f), only type b strains commonly cause systemic infections in man. The present study was performed to determine whether the propensity of the type b organism to cause invasive infections is due to a unique ability to evade complement-mediated host defenses. The ability of genetically defined capsular transformants (a-f) of an unencapsulated H. influenzae to resist the bactericidal and opsonic activities of serum was examined. The unencapsulated organism and the type f transformants were relatively susceptible to serum bactericidal activity in both adult and infant serum pools, the type a and e transformants were relatively resistant, and the types b, c and d transformants were intermediate. With respect to serum opsonic activity in both adult and infant serum pools, the unencapsulated organism and the type f transformant were relatively susceptible, the type a, b and e transformants were relatively resistant and the type c and d transformants were intermediate. Thus, although the type b capsule endows the organism with the ability to resist the bactericidal and opsonic effects of complement, this property is not unique to type b.

The molecular basis of pathogenicity in Haemophilus influenzae: comparative virulence of genetically-related capsular transformants and correlation with changes at the capsulation locus cap.

Serotype b strains of Haemophilus influenzae are strikingly more highly associated with episodes of invasive, life-threatening infection in young children than are strains of other serotypes, but the role that the capsule itself plays in determining this virulence has not been dissected away from that of possibly linked virulence determinants such as lipopolysaccharide (LPS). Using DNA from clinical isolates of all six serotypes (a-f) and a genetically-defined capsule-deficient recipient strain Rb-: 02, we constructed a series of capsular transformants otherwise identical with respect to outer-membrane protein and LPS subtype, biotype, and electrotype. Cloned DNA was also used to create type a and b transformants isogenic outside the capsulation locus to provide the most rigorous test to determine whether capsule alone modulates pathogenicity. Capsular transformants showed the same spectrum of virulence in an infant rat bacteremia/meningitis assay as wild-type strains, thus implicating the capsule polysaccharide as an independent determinant of virulence. Experiments in intact and splenectomised rats identified a critical role for type b capsule in enabling organisms to evade splenic clearance.

Oxygen affinity of haemoglobin modulates cerebral blood flow in premature infants. A study with the non-invasive xenon-133 method.

Low cerebral blood flow (CBF) is thought to cause ischaemic brain lesions in premature infants, but a normal outcome has also been observed. Low oxygen affinity of haemoglobin and high arterial oxygen content, independently, reduce CBF under normal, physiological conditions. Transfusions lower the amount of fetal haemoglobin [HbF] and therefore the oxygen affinity of premature babies. In 47 premature babies (range of gestational age 25-34 weeks, birthweight 740-1370 g), CBF was measured with the i.v. Xenon 133 method on days 1, 3 and 7. The relative amount of fetal haemoglobin [HbF] was used as a marker of oxygen affinity of haemoglobin and the haematocrit as representing the arterial oxygen content. A significant influence of [HbF] on CBF was found on days 1, 3 and 7 in ultrasonographically normal babies (n = 13). In babies with subependymal and/or intraventricular haemorrhage (n = 15), this correlation was significant only on day 3 and in those with abnormal intraparenchymal echodensities (n = 19) only on day 7. The correlation between haemoglobin concentration and CBF was not significant. Multiple regression analysis showed a significant influence of [HbF] on CBF independent of haematocrit, pCO2 and blood pressure. It appears that, after blood transfusion, normal babies, and to a lesser extent those with haemorrhages are able to lower their CBF according to the actual oxygen affinity of blood. However, low CBF (less than 10 ml/100 g/min) in non-transfused babies was often associated with later development of cystic periventricular leukomalacia.)