[Ophthalmology and urban underprivileged. Experience of 150 patients]. / Ophtalmologie et situation de précarité en milieu urbain. À propos d'une expérience de 150 patients.

INTRODUCTION: An ophthalmology consultation was carried out at the Hôtel-Dieu to facilitate eye care in underprivileged patients referred by the general medicine PASS (socialized health care) of the same hospital. MATERIALS AND METHODS: The files of 150 consecutive patients examined by a single ophthalmologist between January 2012 and June 2013 were reviewed. A standard examination was performed in these patients, sent with a consult sheet, to which a response was sent to PASS. As necessary, prescriptions were also written for the patients. RESULTS: Most patients (89/150) were immigrants from sub-Saharan Africa. Additionally, there were 25 Europeans with only 5 French, and 17 Asians. The mean age was 41 years with 90 men (mean age 43) and 60 women (mean age 36). The most common systemic diseases observed were hypertension, (13), diabetes (6), and hepatitis (6). The mean best-corrected visual acuity (129 patients) was a slightly more than 8/10 (16/20) (measurable in 143 patients). Refractive state (measured in 129 patients) was myopia (46), hyperopia (41), presbyopia (isolated in 12 cases), astigmatism (26), and emmetropia (28). Optical correction was prescribed in 87 patients. The main pathological conditions included pingueculae (19), cataracts (19), trauma (13) of which 4 patients were monocular, and pterygia (9). DISCUSSION AND CONCLUSION: Refractive errors were the main abnormality observed in these underprivileged patients. Apart from cataract as a pathologic condition observed in the general population, more characteristic of this sub-Saharan population were pinguecula, pterygium and trauma. This study highlights the more general question of access to eye care for all underprivileged patients.

[Socio-demographic characteristics and health status of patients at a free-of-charge outpatient clinic in Paris]. / Analyse du profil socio-démographique et médical des patients de 5 permanences d'accès aux soins de santé (PASS) parisiennes.

PURPOSE: In the context of the French National Health Service, a free access to healthcare facilities (the PASS: "permanence d'accès aux soins de santé") has been implanted in 2000 for patients without health insurance or those dealing with financial hardship. There is few data about socio-demographic characteristics of the patients using these services. The objective of this study was to provide descriptive data about socio-demographic characteristics and motivation of those patients who use these clinics. METHODS: This descriptive cross-sectional study was conducted between April an May 2008, in 5 PASS clinics from academic tertiary hospitals in Paris. Descriptive data on patient were collected by general practitioners at the end of their consultations. RESULTS: This study included 581 patients. The mean age was 42 years, and 65% of patients were males. Only 50.9% declared a salary income and 38.5% had a health insurance. Half of the patients were homeless, and 80% were migrants. The main reasons to visit these health facilities were direct access (no appointment needed), being in financial difficulty and having a medical record in the same hospital. Half of the patients had one chronic disease at least, while only a third of them saw regularly a physician. A total of 834 diseases were found among the 581 patients, including 411 chronic diseases, and 17% of the patients had a psychologic or a psychiatric disorder. Prognosis was divided in three grades: good, low and poor. Almost a half of the patients were considered by the doctor as having a low or a poor prognosis if they would not receive a therapy. CONCLUSIONS: The findings of this study suggest that the PASS carry out their mission: most of the patients frequenting these facilities live under poor conditions and are in poor health status compared to the patients having access to conventional outpatient services.

[Assessment of preventive practices in primary care occurring in hospital]. / Évaluation des pratiques préventives d'une consultation de médecine générale hospitalière.

BACKGROUND: Preventive measures are available for most of the pathological conditions causing premature mortality in France. Moreover, there is a seven-year discrepancy in life expectancy figures between persons in the least favorable socio-occupational categories and the rest of the general population. The overall target of our study was to analyze preventive practices applied as part of routine primary care in the outpatient clinics of a general medicine hospital in Paris (Hotel-Dieu) where the majority of patients belong to unfavorable social categories. METHODS: We collected and analyzed the content of all outpatient visits conducted during a three-week period using a questionnaire designed to gather information about areas of preventive care requiring particular attention. RESULTS: Analysis of 211 outpatients visits shows that the population concerned was young (44±17-year-old) and that the visits lasted longer than commonly observed (21±8 min). Cancer screening was performed in 25 to 50% of the theoretical targeted population. Addictions were discussed during half of the visits, yet follow-up and advice on how to stop addictive behavior were insufficient. Blood pressure was measured during half of the visits. Vaccinations were checked for 60% of patients and STD status for 30%. Seventy percent of the patients stated they wanted to attend a preventive care consultation; the physician considered this type of consultation would be useful for 30% of patients; the opinions were in disagreement for half of the patients. Lack of time, heavy workload in terms of number of visits, and the current setup of charts prevented updating various precautionary measures, which would have been appropriate for each patient as a function of age, gender, past history and lifestyle. CONCLUSION: This inquiry highlights many weaknesses in our preventive practices. Delegating some medical acts, a more adapted medical file and the implementation of dedicated consultations could help improve prevention in this particularly vulnerable population. The key to success of such measures lies in physician and patient awareness.

[Disseminated tuberculosis and profound thrombopenia]. / Tuberculose disséminée et thrombopénie profonde.

Thrombocytopenia within the context of disseminated tuberculosis can lead to complications requiring rapid treatment. Although the origin is generally central, thrombocytopenia can arise from an immune disorder. We hereby report a case of disseminated tuberculosis associated with thrombocytopenia, which required, in addition to antituberculosis therapy initiated before bacteriological proof, corticosteroid treatment and multiple platelet transfusions. The discovery of anti-platelet antibodies along with the success of immunomodulator therapy confirmed the auto-immune origin of this thrombocytopenia.

Expression of Krox proteins during differentiation of the O-2A progenitor cell line CG-4.

Krox proteins are important regulators of development and terminal differentiation. Using the rat glial progenitor cell line CG-4 as a model system for oligodendrocyte differentiation, we show that on the RNA level Krox-24 is the predominant member of the Krox family in these cells. Similar results were also obtained on the protein level as the major Krox protein from CG-4 cell extracts reacted specifically with an antibody against Krox-24. Whereas Krox-24 RNA and protein were abundant in undifferentiated CG-4 cells, a dramatic decrease in expression was detected after a 3-5-day period of differentiation during which we observed a reciprocal increase in the levels of myelin basic protein expression. Importantly, regulation of Krox-24 expression was very similar in CG-4 cells and primary oligodendrocyte cultures. When expression of Krox-24 in differentiating CG-4 cells was followed on a closer time scale, we observed a sharp and transient increase in Krox-24 RNA, protein, and DNA binding activity immediately after the onset of differentiation followed by an equally rapid decrease. This expression pattern implicates Krox-24 both in maintenance of the undifferentiated state and in the immediate early phase of differentiation of CG-4 cells and possibly oligodendrocytes.

Functional comparison of PML-type and archetype strains of JC virus.

Isolates of the human polyomavirus JC can be grouped as either PML-type or archetype strains primarily on the basis of divergence in their regulatory regions. Only PML-type viruses have so far been found to be associated with the human demyelinating disease progressive multifocal leukoencephalopathy. Here we have compared the functional properties of archetype and PML-type regulatory regions with regard to DNA replication and viral gene expression. No significant differences could be detected between archetype and PML-type regions in their ability to direct episomal DNA replication in the presence of JC virus T antigen. When viral gene expression was examined, early- and late-gene promoters from all PML-type strains exhibited a significantly higher activity in glial than in nonglial cells. Surprisingly, archetype strain promoters were also preferentially active in glial cells, although this effect was less pronounced than in PML-type strains. Furthermore, all promoters from archetype strains reacted to the presence of viral T antigen or the glial transcription factor Tst-1/Oct6 in a manner similar to the promoters of the PML-type viral strain Mad-1. Interestingly, T antigen and Tst-1/Oct6 were found to function in a species-specific and cell-type-specific manner, respectively. We concluded from our experiments that the differences in the regulatory regions cannot account for the different biology of archetype and PML-type viral strains.

Functional interaction between the POU domain protein Tst-1/Oct-6 and the high-mobility-group protein HMG-I/Y.

The POU domain protein Tst-1/Oct-6 is a transcriptional activator of human papovavirus JC virus in transient transfections. Because of its endogenous expression in myelinating glia, Tst-1/Oct-6 might also be an important determinant for the glia specificity of JC virus in vivo. Activation of viral early and late genes depends on the ability of Tst-1/Oct-6 to interact with an AT-rich element within the viral regulatory region. Here, we show that this element not only is bound by Tst-1/Oct-6 but, in addition, serves as a binding site for the high-mobility-group protein HMG-I/Y. In the presence of HMG-I/Y, Tst-1/Oct-6 exhibited an increased affinity for this AT-rich element. The specificity of this effect was evident from the fact that no stimulation of Tst-1/Oct-6 binding was observed on a site that did not allow binding of HMG-I/Y. In addition, both proteins interacted with each other in solution. Direct contacts were identified between the POU domain of Tst-1/Oct-6 and a short stretch of 10 amino acids in the central portion of HMG-I/Y. These results point to an accessory role for HMG-I/Y in the activation of JC viral gene expression by the POU domain protein Tst-1/Oct-6. In agreement with such a role, HMG-Y synergistically supported the function of Tst-1/Oct-6 in transient transfections, measured on the early promoter of JC virus or on an artificial promoter consisting of only a TATA box and the common binding element for Tst-1 and HMG-I/Y.

The POU domain protein Tst-1 and papovaviral large tumor antigen function synergistically to stimulate glia-specific gene expression of JC virus.

Synergism between transcriptional activators is a powerful way of potentiating their function. Here we show that the glial POU domain protein Tst-1 (also known as Oct-6 and SCIP) and large tumor antigen (T antigen) synergistically increased transcription from both the early and the late promoters of papovavirus JC in glial cells. Synergism between both proteins did not require T-antigen-mediated DNA replication or direct binding of T antigen to the promoter. The ability of T antigen to functionally cooperate with Tst-1 was contained within its N-terminal region, shown by the fact that small tumor antigen (t antigen) could substitute for T antigen in transfection experiments. In addition to this functional synergism, a direct interaction between Tst-1 and T antigen was observed in vitro. Using deletion mutants of Tst-1 and T antigen, the POU domain of Tst-1 and the N-terminal region of T antigen were found to participate in this interaction. Because of the low levels of Tst-1 present in oligodendrocytes, synergism between Tst-1 and T antigen could be an important factor in establishing the lytic infection of oligodendrocytes by JC virus during the course of the fatal demyelinating disease progressive multifocal leukoencephalopathy.

[Results of the Insall operation (plasty of the anterior cruciate ligament by transfer of the fascia lata with bone block) in the treatment of chronic anterior instability of the knee. Analysis of 30 cases with at least 1 year of follow-up]. / Résultat de i'intervention d'Insall (plastie du ligament croisé antérieur par transfert du fascia lata avec bloc osseux) dans le traitement des laxités chroniques antérieures du genou. Analyse de 30 cas avec recul minimum d'un an.

The authors have performed the Insall procedure on 30 knees since 1981. The results are analysed with a minimum of one year follow-up. The procedure, which is an active transfer of the iliotibial tract to the tibial plateau is based on the action of the proprioceptive structure of the muscles of the thigh. It produced a decrease of 50 p. 100 in the anterior drawer sign, the Lackman test disappeared in two thirds of the cases and the pivot-shift test disappeared in four knees out of five. Twenty-two patients engaged in some kind of sport before their accident; 17 were able to practice their sport at the same level after the operation. The results as evaluated by the CLAS system were good in 23, fair in five and poor in two. The indications are discussed and the results compared with those obtained after other procedures. This procedure should be performed on patients suffering disabling instability in daily life with a marked anterior drawer sign, but who are not high level athletes. The technical details are given. The transfer should be sufficiently massive, solid and well vascularised. The lateral stability of the knee should not be impaired by the procedure.

[Veno-occlusive disease of the liver. Treatment by portocaval shunt]. / Maladie veino-occlusive du foie. Traitement par anastomose porto-cave.

A case of hepatic veno-occlusive disease revealed by abdominal pains and the rapid constitution of ascites in a 33-year old French female is reported. She had taken medicinal plants in order to loose weight. Liver biopsy showed typical histological changes consisting of centrizonal hemorrhagic necrosis and centrolobular vein obstruction with endophlebitis. Owing to an increase of ascites, a side-to-side portacaval shunt was performed. Eight months postoperatively, ascites had completely disappeared and the liver biopsy showed only a moderate centrolobular vein fibrosis. Five years later, the clinical state is normal.

[Adrenal cysts in the newborn. Apropos of 2 cases]. / Les kystes de la surrénale chez le nouveau-né. A propos de deux observations

Cysts of the adrenal gland are very rare in the neonatal period and are always diagnosed either at surgery or at autopsy. Two patients are reported. One is an infant born at term in whom a mass in the left loin was discovered on the 3rd day of life. At surgery a suprarenal tumour was discovered and a polycystic adrenal was removed: recovery was uneventful. Histology showed a cystic haemangioma in the adrenocortical tissue. The diagnosis made was that of a cystic haemangioma. The other patient is an infant born at 38 weeks gestation who became jaundiced and developed a haemolytic streptococcal septicaemia. A mass was found in the right lumbar region on the 3rd day. The calcified egg-shell appearance, renal arteriography and an intravenous pyelogram demonstrated the cystic appearance of the adrenal. The cystic mass and the adrenal gland were removed and the patient recovered. Histological examination suggested that a pseudocyst had arisen secondary to a haemorrhagic infarct caused by a septic embolus. Adrenal cysts are classified as true cysts and pseudocysts (which must be distinguished from unilateral haematomas). The histological appearances are reviewed. These patients may be added to the 11 neonatal case reports in the literature (9 haemorrhagic pseudocysts, only 2 true cysts). To our knowledge cystic haemangioma has not previously been reported.