Clostridium ramosum rapidly identified by MALDI-TOF MS. A rare gram-variable agent of bacteraemia.

Clostridium ramosum is an enteric anaerobic, endospore-forming, gram-positive rod with a low GC content that is rarely associated with disease in humans. We present a case of C. ramosum bacteraemia. To the best of our knowledge, this is the second case of C. ramosum bacteraemia in an elderly patient presenting with fever, abdominal pain and bilious emesis. We highlight the Gram stain variability, the lack of visualization of spores and the atypical morphology of the colonies that showed C. ramosum in a polymicrobial presentation that initially appeared to show monomicrobial bacteraemia. The microorganism was rapidly identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). We present a comprehensive literature review of 32 cases of clinical infections by C. ramosum in which we describe, if available, sex, age, clinical symptoms, predisposing conditions, other organisms present in the blood culture, other samples with C. ramosum , identification methodology, treatment and outcome.

Associations of sympathetic and parasympathetic activity in job stress and burnout: A systematic review.

This systematic review examines the relationship between sympathetic and parasympathetic activity on the one hand and job stress and burnout on the other, and is registered at PROSPERO under CRD42016035918. BACKGROUND: Previous research has shown that prolonged job stress may lead to burnout, and that differences in heart rate variability are apparent in people who have heightened job stress. AIMS: In this systematic review, the associations between job stress or burnout and heart rate (variability) or skin conductance are studied. Besides, it was investigated which-if any-guidelines are available for ambulatory assessment and reporting of the results. METHODS: We extracted data from relevant databases following the PRESS checklist and contacted authors for additional resources. Participants included the employed adult population comparing validated job stress and burnout questionnaires examining heart rate and electrodermal activity. Synthesis followed the PRISMA guidelines of reporting systematic reviews. RESULTS: The results showed a positive association between job stress and heart rate, and a negative association between job stress and heart rate variability measures. No definite conclusion could be drawn with regard to burnout and psychophysiological measures. No studies on electrodermal activity could be included based on the inclusion criteria. CONCLUSIONS: High levels of job stress are associated with an increased heart rate, and decreased heart rate variability measures. Recommendations for ambulatory assessment and reporting (STROBE) are discussed in light of the findings.

PLANET TOPERS: Planets, Tracing the Transfer, Origin, Preservation, and Evolution of their ReservoirS.

The Interuniversity Attraction Pole (IAP) 'PLANET TOPERS' (Planets: Tracing the Transfer, Origin, Preservation, and Evolution of their Reservoirs) addresses the fundamental understanding of the thermal and compositional evolution of the different reservoirs of planetary bodies (core, mantle, crust, atmosphere, hydrosphere, cryosphere, and space) considering interactions and feedback mechanisms. Here we present the first results after 2 years of project work.

Water deprivation and circadian changes in plasma arginine vasotocin and mesotocin in the domestic hen (Gallus domesticus).

Possible circadian variations in plasma levels of arginine vasotocin (AVT) and mesotocin (MT) were assessed in domestic hens (Gallus domesticus) under a 12h:12h light-dark (LD) schedule. Blood samples were taken at 4h intervals, and neurohypophyseal hormone levels were determined by radioimmunoassay. Marked circadian changes in both AVT and MT were observed in hens provided free access to water. Minimal and maximal AVT levels occurred at 08:00 and 20:00, respectively. Minimal MT levels occurred at 20:00, whereas maximal MT levels occurred over a broad time period of 04:00 to 12:00. In water-deprived hens, plasma AVT levels were elevated at each time point, and the circadian variations in plasma AVT and MT levels were attenuated. These results demonstrate that rhythmicity in neurohypophyseal function in a lower vertebrate species, like that in mammals, is disrupted by osmotic stress.

Une nouvelle approche therapeutique dans le traitement des ulceres de buruli

l'ulcere de Buruli est une affection due au mycobacterium ulcerans qui entraine une importante destruction de la peau. Le traitement chirurgical consiste en de larges excisions suivies de greffes de peau mince. actuellement les pansements a l'acide acetique a 2 pour cent que les auteurs ont experimentes sur 17 malades permettraient d'eviter les excisions larges donc d'economiser de la peau pour ne se limiter qu'a la seule greffe cutanee lorsque l'ulcere ne cicatrise pas de lui-meme

[Caudal anesthesia: experience at the University Hospital Center of Treichville. 50 cases]. / Anesthésie caudale: expérience du Centre Hospitalier Universitaire de Treichville. A propos de 50 cas.

The above account concerns 50 cases of caudal anaesthesia with 2% plain lidocaine (i.e. without adrenaline), after a preliminary and a complementary general anaesthesia for surgical operations in the infra umbilical region not exceeding one hour in duration. The anaesthetic effect was as rapid as the recovery from it. The analgesic effect was excellent in 98% of cases. No per or post operative complications were observed with the employment of this technique. The authors recommend that this technique should be employed more frequently in day case pediatric surgery.

[Darrier-Ferrand's dermatofibroma on the forehead. Wide cranial-cutaneous exeresis followed by scalp plastic surgery]. / Dermatofibrome de Darier et Ferrand du front. Exérèse large cranio-cutanée suivie de plastie du cuir chevelu.

The authors report on a case of Darier-Ferrand's dermatofibroma on forehead. It was a very uncommon localization. They stress on the specific treatment applied: forehead cranioectomy and scalp plasty, made compulsory after several exercises and their reappearances.

[Cure of an enormous eventration by abdominoplasty. Technical note. A case report]. / Cure d'une monstrueuse èventration par abdominoplastie. Note technique. A propos d'un cas.

The secondary eventrations after delivery are the prime cause of women's eventrations. These eventrations are enormous in Africa because the post-partum women do not make active movements to develop again the abdominal strap. In Europa or North America the treatment would make use of prosthetic materials but in Africa the climatic and working conditions do not take the utilization of such method. The authors purpose a cure allied aponevroplasty according to JUDD technique with abdominoplasty. The result is satisfactory and durable.

[Ileo-sigmoid knot. 16 cases]. / Le noeud iléo-sigmoïdien (ileo-sigmoid knot). 16 cas.

A retrospective study of 16 cases of ileo sigmoid knot, treated at Treichville Hospital in Abidjan Côte-d'Ivoire, is reported by the authors between 1970 and 1989. This pathology is not so seldom and concerned 14 men and 2 women from 14 years old to 61 years old with an average of 42 years. The more precise description of the physiopathology of this occlusion allows to classify this pathology as an independent entity from the other types of volvulus. The physiopathologic knowledge described allow a more precise diagnostic approach and a better codified therapeutic attitude.

[Treatment of Buruli's ulcers by excision-graft]. / Le traitement des ulcères de Buruli par excision-greffe.

Buruli's ulcer is a real disease of public health. In Ivory Coast, 50 patients were treated from February 1987 to August 1991. It realizes a real destruction of skin and subcutaneous tissues. The germ is Mycobacterium ulcerans. The preferential localisation is the limbs in children of 14 years old. Large ulcer with polycyclic margin are treated by extended excision and thin skin grafts. But deformities persist after the surgical treatment. Hospitalisation is long and drugs are expensive.

[Dupuytren's contracture: review of the literature. Case report of a black African]. / La maladie de Dupuytren: revue de la litterature. A propos d'un cas chez l'Africain noir.

In one case of Dupuytren's contracture the authors make an important literature review. The affection is rare with the black man but frequent in caucasian population. Its origin is therefore european. They point out alcoholism and microtrauma due to the patient's antecedents and job.

[Skin expansion in plastic surgery. (University Hospital Center of Treichville-Abidjan)]. / L'expansion cutanée en chirurgie plastique. (Centre Hospitalier Universitaire de Treichville-Abidjan).

The skin expansion by inflatable prosthesis is a recent method to resolve insufficient tissue a short series of 7 cases. But the authors think that despite these inconveniences this technique needs to be largely diffused and used judiciously.

[Microsurgery in revascularizations and replantations of the upper extremity in emergency cases. Department of Plastic and Reconstructive Surgery. University Hospital Center of Treichville-Abidjan]. / La microchirurgie dans les revascularisations et les réplantations du membre supérieur en urgence. Département de chirurgie plastique et reconstructrice Centre Hospitalier Universitaire de Treichville - Abidjan.

The authors report their experience in vascular and nervous microsurgery. They remark that there is a long time between the emergency reception of the wounded person and the appeal to plastic surgery. They deplore also the bad collaboration between the different department of emergency surgery. Finally they emphasize that the scarcity of cases is due to insufficient information of different departments of emergency surgery in microsurgery era.

[Semilunar dislocations. A report of 8 cases. (Orthopedic service-University Hospital Center of Treichville-Abidjan)]. / Les luxations du semi-lunaire. A propos de 8 observations. (Service Orthopédie-Centre Hospitalier Universitaire de Treichville-Abidjan).

The authors have underlined in a study made on 8 observations that the lunate dislocation is scar. All their patients were men under 40 years old. Industrial injury was the most dominant cause. Using WITVOET and ALLIEU's classification, they noticed a predominance of perilunar and posterior dislocations (7/8 cases). Perilunar anterior dislocations and isolated scaphoid carpal dislocation have not been encountered. The treatment which has been orthopaedic or surgical has given moderate results: Good results = 4; Average result = 1; Bad results = 2; Non seen to again = 1 The authors think that a precocious diagnosis and an orthopaedic treatment in the forms detected early and surgical treatment in ancient forms are the only guarantee of a good functional result avoiding dread diseases such as carpal instability, radiocarpal arthrosis.

[Intra-keloid excision and deferred corticoid infiltration in the treatment of keloids. University Hospital Center of Treichville-Abidjan]. / Exérèse intra-chéloïdienne et infiltration différée de corticoïdes dans le traitement des chéloïdes. (Centre Hospitalier Universitaire de Treichville-Abidjan).

On a series of 38 keloid surgery patients the authors noted a strong female predominance and the frequency of ear lobule keloid. After some rather unsuccessful excision-suture of the keloid they recommend the intra- keloid excision to be followed by a late corticoid infiltration but deferred until the 15th day. The results obtained were encouraging but some researches have to be made with regard to the etiology of this affection which might probably resolve the therapeutic problem.

[Pheochromocytoma in black Africa. Report of 9 cases]. / Le phéochromocytome en Afrique noire. A propos d'une série de 9 observations.

Pheochromocytoma exists in black African countries with the same frequency observed in other places. The characteristics of our series of nine patients are the followings: an average age of 19, 6 years old, a sex-ratio of 1, 25, a paroxysmal high blood pressure for six patients, no MEN neither malignant tumors, the measures of V.M.A. done positively eight times, a retropneumoperitoneum scan, seven arteriographies, three echographies which were consistently positive, one death post surgery by collapsus consecutive to tumor excision, only one contralateral recurrence and positive followings in all other cases.

[Combined volvulus of the sigmoid and the small intestine (physiopathology)]. / Les volvulus doubles du sigmoïde et du grêle (physiopathologie).

The physiopathology of combined volvulus of sigmoid and small intestine is discussed. In many cases a half-knot is involved, that is to say a "key" between the two ileal and sigmoid loops, difficult to describe with words but easy to understand by the use of a diagram and radiologic and intraoperative images of lesions, of possible assistance when releasing the loops or determining site of section of foot of occluded loops. Of 116 cases of sigmoid volvulus treated in the Treihville hospital, Abidjan between 1972 and 1983, eleven were associated with small intestine volvulus. Of these 11 cases, 9 were treated by emergency ideal colectomy and small intestine resection, with 3 deaths, and 2 by emergency ideal colectomy and small intestine reintegration, with 2 deaths. Operative mortality was therefore high (45%), global mortality being 24%. This is inherent in underdeveloped surgical units and will certainly improve greatly as hospital standing improves.

[Approach to the axillo-subclavian trunk using a sterno-cleido-costal flap]. / Voie d'abord du tronc axillo-sous-clavier par un volet sterno-cléido-costal.

Difficulty in exposure of the axillary-subclavian arterial trunk has led to the use of a wide approach by means of a lower pedicle flap with section through the middle of the clavicle, a partial upper median sternotomy and an easy to perform section of the first two costal cartilages. Displacement of the flap downwards clearly exposes the origin of and path taken by the subclavian artery, and the axillary artery, allowing temporary proximal and distal hemostasis. Repair of clavicle and sternum by wiring is then a simple and solid procedure. Two cases of subclavian arteriovenous fistula are used to illustrate use of this approach.