Severe lupus with infectious thyroiditis and lethal cardiomyopathy.

Clinical cardiomyopathy is an uncommon complication of systemic lupus erythematosus (SLE) and intracavitary thrombosis is rare. We describe a patient with active SLE who developed rapidly progressive cardiomyopathy, the fatal course of which was complicated by an intracavitary thrombus. Repeat cardiac echography studies and the endomyocardial biopsy proved to be helpful in diagnosing the lupus myocarditis and aided the regulation of therapy. Furthermore, the patient presented an acute suppurative thyroiditis never before described, to our knowledge, in SLE.

Virus recovery from stools of patients undergoing bone marrow transplantation.

Diarrhea in marrow transplant recipients is a frequent complication attributable to non-infectious events such as acute GVHD or infectious events such as viral gastroenteritis. Rotavirus and enteric adenovirus are the most frequent viral pathogens. To determine the frequency of these infections, we prospectively examined the stool specimens of 94 patients who underwent autologous BMT (34 cases) or allogeneic BMT (60 cases). Stool specimens were examined from patients twice weekly. Nineteen of the 94 patients were infected with viral pathogens. This study showed: (1) an incidence of viral gastroenteritis identical in autologous and allogeneic BMT (20%), (2) a persistent risk despite treatment in laminar air flow rooms, (3) a significant association with severe acute GVHD, and (4) a significant risk of multiple viral infections in autologous BMT recipients. Rotavirus and adenovirus are a cause of enteritis involvement in patients undergoing BMT and they may be underdiagnosed and confused with GVHD. Screening of stool specimens after BMT should be directed to prevention and treatment of these viral infections to decrease the morbidity and mortality associated with BMT.

[Extrapulmonary and disseminated pneumocystosis in HIV infection]. / Pneumocystoses extrapulmonaires et disséminées au cours de l'infection par le VIH.

Three cases of extrapulmonary disseminated Pneumocystis carinii infection are reported. All 3 patients had HIV infection with less than 50 CD4 lymphocytes per cubic millimeter and were having aerosols of pentamidine as prophylactic treatment of pneumocystosis. P. carinii may invade numerous organs and in particular the liver, spleen and bone marrow. Extrapulmonary lesions, often pan-symptomatic, are to be feared in deeply immunodepressed patients receiving prophylactic aerosols of pentamidine. Infection of the choroid can be detected by systematic ophthalmoscopy. An early diagnosis raises hopes of a good, if temporary, response to treatment.

[Thrombotic thrombocytopenic purpura. A case diagnosed by MRI]. / Purpura thrombotique thrombocytopénique. 1 cas avec imagerie par résonance magnétique.

A 67-years old woman developed sudden headache and transient vertigo. One week later, left arm paresis appeared and the patient became comatose. Investigations showed thrombocytopenia with hemolytic anemia and the presence of numerous irregularly contracted red cells (schizocytes). This was consistent with the diagnosis of thrombotic thrombocytopenic purpura. As focal neurological manifestations and widespread mental changes were still present when she emerged from coma, magnetic resonance imaging was performed showing numerous small infarcts in the white and grey matters.

Primary malignant lymphoma of the liver. Report of two cases and review of the literature.

We present two cases of primary malignant lymphoma of the liver, a very unusual localization of primary malignant lymphoma since only 31 similar cases were reported in the literature. The main symptoms included: hepatomegaly, fever, slight cholestasis and non specific alteration of the liver appearance on ultrasonography or computed tomodensitometry examination. Diagnosis was established in both cases by histopathological demonstration of infiltration by large lymphoid cells. Immunophenotyping in one case confirmed a B cell phenotype. Primary malignant lymphomas of the liver are high-grade malignant large-cell tumours and the immunophenotype, when known, is of the B type. The prognosis of these tumours is not well known due to their extreme rarity. They appear to be highly chemosensitive and cure may be obtained in the long-term in some cases. These data justify careful histological assessment in all cases of hepatomegaly of a tumoral nature.

[The cost of hospital acquired infections]. / Le coût des infections acquises à l'hôpital.

Two complementary studies were carried out. a) A three months study on nosocomial infection frequency, with a simultaneous assessment of the nosocomial infection risk factors (infected or non infected body on entry in the department, the kind of pathology, simplified scores of seriousness) and of the length of the hospital stays to compare the average length of stay for overinfected patients and for nosocomial infection non contaminated patients, after checking those factors through adjustment, themselves responsible for a prolongation of the stays. b) An evaluation of the cost of the sole antibiotics used in the treatment of a Serratia nosocomial infection epidemic which developed in the department. The quantitative and qualitative analysis of each case was made by the prescribing doctor in order to attribute its proper costs to each case. Over a three months period, 112 patients were considered as presenting a risk of nosocomial infection, which means that they were hospitalized in the department for more than 48 hours. Twenty two nosocomial infection carriers were examined; they represented 38 cases of overinfection. The length of stay was of 10.3 days among the non carriers of nosocomial infection, and of 32.4 days among the overinfected patients, but more interesting is the figure of 13.2 days per case. Over a year, it thus amounts to 1,950 hospitalization days due to nosocomial infections, which corresponds, in a department of 24 beds, to an average of 5 beds occupied permanently. Besides, the antibiotic for the 12 Serratia nosocomial infection carriers was evaluated to a cost of F. 75,000.

[Detection of nosocomial infections: a proposal of a protocol for a prospective study]. / Le dépistage des infections nosocomiales: propositions de protocole pour une étude prospective.

If meant to be effective, the detection of nosocomial infections demands considering the means that should be used for a daily gathering of necessary complete information. An experiment led in a medical intensive care unit have suggested the elements of such a gathering work. This must be prospective and aimed to relate the frequency, more that the importance of nosocomial infections. It will be carried by a willing and specialized nurse, and will be limited to the necessary warning signs only. As a rule, the information linked to the infection causes will not be looked for. Finally, a special care will be given to ensure a good feedback to the clinician, which is the main purpose of that work. Yet, such an information gathering protocol has to be flexible, and it is even one of its survival conditions regarding the variety of means and requirements inherent of each department.