[HIV infection in the child after materno-fetal transmission: early treatment with azidothymidine and prevention of secondary infectious complications]. / Infection par le VIH de l'enfant après contamination materno-foetale: prise en charge précoce par un traitement associant azidothymidine et prévention des complications infectieuses secondaires.

Twenty-four perinatally HIV infected children received early treatment as soon as the diagnosis of viral contamination was established. In 13 cases (group 1), this diagnosis was based on a viremia and/or antigenemia during the first 6 months of life. In 11 cases (group 2), children were more than 15 months-old and had a positive HIV antibody test. Therapy included azidothymidine (AZT, 400 mg/m2/d) and the prevention of secondary infectious complications with intravenous immunoglobulin and cotrimoxazole. With a median follow-up of 26 months, we reported no case of severe secondary infection and no case of encephalopathy. Hematological side effects of AZT were rarely observed. Only one patient developed anemia. In all other cases, the only hematological abnormality was macrocytosis of red blood cells. Before treatment, the mean value of T4 cells age-adjusted count was 96, 86 and 91%, respectively, for groups 1, 2 and the entire study group. At the time of analysis, these values were 64, 62 and 63% respectively. This decrease was statistically significant for group 1 and for the entire study group, but did not reach statistical significance for group 2. These data show that AZT is probably insufficient as a long-term therapy for HIV infected children. Other therapeutic approaches need to be developed in the future, notably the combination of anti-retroviral drugs.

[Phrenic stimulation in respiratory paralysis caused by spinal cord injuries]. / La stimulation phrénique dans les paralysies respiratoires des traumatismes médullaires.

Phrenic stimulation is reserved for the rare patients with central neurogenic apnea due to isolated upper spinal cord injuries. Presenting a series of ten cases the authors describe the indications for phrenic stimulation, the technique of implantation and the conditions for diaphragmatic training by the use of stimulation by low frequency trains allowing for an increase in the number of low muscular fibers. The continuation of accompanying neurological rehabilitation and nursing of these severely handicapped patients is not to be neglected because of the length of the training protocole as the aim is their return home. This technique, therefore, seems particularly suitable for application in a few specialized centers where research for material totally implantable and adapted to the physiological requirements of the patient can be conducted parallel to treatment.

[Patients treated for one year with tianeptine. Results at one of the centers of South-Eastern France]. / Patients traités un an par la tianeptine. Présentation des résultats obtenus par l'un des Centres du Sud-Est de la France.

Tianeptine is a new antidepressant with a tricyclic molecular structure. Its main neurochemical effect consists in an increase in serotonine re-uptake. Its efficacy as antidepressant and its good clinical safety have been confirmed in controlled trials against reference drugs. 1,231 patients with a DSM III diagnosis of major depression or dysthymic disorder were included in a long-term trial with tianeptine. 510 patients completed the one-year treatment period. The results of a subgroup of 100 patients treated in one of the centres of south-east France will be presented. 47 of these patients completed the trial. This study allowed to evaluate the therapeutic efficacy as well as the clinical safety of tianeptine during long-term prescription. Patients were treated in an open design after a 4-7 day placebo washout period. Therapeutic effects were assessed by the C.G.I. items (1 and 2), MADRS, HARS and HSCL. For the evaluation of clinical and paraclinical safety, spontaneous complaints of the patients and CGI-3 were documented; body weight, blood pressure and blood chemistry were also measured. Homogeneity between completers and non-completers was tested before statistical analysis of the clinical effects. Results of completers were analyzed using a two-way ANOVA (time x subjects); Newman-Keuls tests were performed in the case of a significant time effect. End-point analysis was used to test the results of the total sample. Patients completing the trial had a mean MADRS baseline score of 32.8. Given high this score, the patients have to be considered genuinely depressed at inclusion.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of bronchoalveolar lavage and findings of cytologic studies in the diagnosis of interstitial lung diseases]. / Der Stellenwert der bronchoalveolären Lavage und zytologischer Untersuchungsbefunde in der Diagnostik interstitieller Lungenerkrankungen.

In 27 patients with roentgenologically suspected interstitial pulmonary disease, bronchoscopy was carried out with the rigid bronchoscope. The examination material obtained (BAL fluid, transbronchial lung biopsy, perbronchial lymph node biopsy, mucosal biopsy) was submitted to a histological and cytological work-up. The established cell distribution in the BAL fluid confirmed the findings reported in the literature. In sarcoidosis, irrespective of the roentgenological stage, a 30 to 35% lymphocytosis was observed. The combination of BAL, perbronchial lymph node biopsy, transbronchial lung biopsy and bronchial mucosal biopsy permitted confirmation of the sarcoidosis in more than 90% of the cases. The -hit rate- of the perbronchial lymph node biopsy was 90.6% in stage 1, 85% in stage 2, and 77% in stage 3.

[Detection of bronchial cancer recurrence in fibrothorax using nuclear magnetic resonance tomography]. / Nachweis eines Bronchialkarzinomrezidivs in einem Fibrothorax mittels Kernspintomographie.

A case is reported in which magnetic resonance imaging successfully differentiated tumour nodules from the connective tissue of a fibrothorax. Computed tomography of the thorax had previously failed to distinguish the tumour tissue. This clearly makes magnetic resonance superior to computed tomography in the differentiation of different tissues within a fibrothorax.

[Phase II study with etoposide/vincristine in small cell bronchial cancer (extensive disease)]. / Phase-II-Studie mit Etoposide/Vincristin beim kleinzelligen Bronchialkarzinom (extensive disease).

The remission rates achieved with the combination of vincristine and etoposide are comparable with other frequently employed therapeutic regimens (ACO/EPICO, cisplatin/etoposide). The combination of etoposide with vincristine represents an alternative, in particular with respect to a merely palliative approach to treatment.

[Infection by the HIV virus and transfusions. Study of 38 pediatric cases]. / Contamination par le virus HIV et transfusions. Etude de 38 observations pédiatriques.

We report the cases of 38 children with transfusion-associated HIV infection: 18 hemophiliacs and 2 patients with Von Willebrand disease, 6 with hemoglobinopathies, 8 with malignant diseases or aplastic anemia, 2 transfused during neonatal period and 2 during a surgical operation. Two groups with a different prognosis were found: In group A [hemophilia and Von Willebrand disease (n = 20)] 17 patients were asymptomatic or only with lymphadenopathy; 3 reached stage IV and none died. In group B [Others (n = 14)] 2 patients were asymptomatic, 4 reached stage IV and 8 died, 4 of them directly from AIDS. The difference between both groups was statistically significant. Prognosis of HIV infection is particularly severe in patients with leukemia, malignant tumors and aplastic anemia.

[Adjuvant therapy of non-small cell bronchial cancer with mopidamol]. / Adjuvante Therapie des nicht-kleinzelligen Bronchialkarzinoms mit Mopidamol.

Between January 1982 and April 1986 a double-blind randomized placebo controlled study of mopidamol, employed as adjunct therapy to surgery in patients with non-small cell bronchial carcinoma, was performed at 7 hospitals. The main criteria were occurrence of metastases and survival. Mopidamol was given perioperatively at a dose of 2 x mg i.v. daily, and postoperatively orally at a dose of 3 x 500 mg daily. The treatment period was scheduled to at least 2 years and in some of the patients was prolonged to 3 years. The standard therapy of each individual center was given as basic therapy. A total of 270 patients were included in the study, 147 in the placebo and 123 in the mopidamol group. By the end of the study 52 deaths from metastases had occurred in the placebo group (35%) compared with only 32 (26%) in the mopidamol group. This difference is statistically significant at p less than 0.05 with the one-sided test. A comparison of life-tables according to Kaplan-Meier shows a statistically significant difference in favour of the group treated with mopidamol (savage p less than 0.05). Cox's multivariate analysis confirmed the statistically significant difference in favour of the group treated with mopidamol, the inclusion of the risk factors tumour stage and histology in the evaluation results in a p-value of 0.02. With respect to the incidence of metastases there were no appreciable differences between the treatment groups. The incidence of side effects or undesired events was equal in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Quantification of pulmonary alveolar microlithiasis in the CT]. / Quantifizierung der pulmonalen alveolären Mikrolithiasis im CT.

Pulmonary alveolar microlithiasis is a rare, familial disease with massive symmetrical intra-alveolar calcium deposition. Conventional CT findings and CT measurements with a dual energy technique were carried out in a 26-year-old patient suffering from this disease. The importance of the findings in the differential diagnosis and for estimating the progression and prognosis of the disease is discussed.

[Is there any justification to the scintigraphy and echotomography B association for the tracking down of hepatic metastases? (author's transl)]. / L'association scintigraphie et échotomographie B dans le dépistage des métastases hépatiques est-elle justifiée?

Regarding the tracking down of hepatic metastases, a study was made on 58 patients presenting either digestive or genital adenocarcinoma. The determining criterion of selection was the carrying out of the three following tests within the same month (Technetium 99 Scintigraphy, Echotomography B and surgery). The global breakdown of exact answers is in favour of echography (72% against 53%), echography being more reliable than scintigraphy. Therefore echotomography B seems to be the first morphological method that should be proposed; and for improving the tracking down, scintigraphy makes the interpretation of the results more difficult, and reduces the number of correct answers.

Clinical pharmacokinetics of local anaesthetics.

The present study has utilized a clinical model to compare the pharmacokinetics of four currently available amide local anaesthetic agents in theoretically equipotent concentrations. In addition to providing comparative data concerning the onset and duration of analgesia, anaesthesia, paresis, and paralysis, it has provided definitive confirmation of the clinical impression that under certain circumstances following the performance of a nerve block, motor blockade may actually precede sensory blockade, and an explanation for this seeming violation of established neurophysiological principles has been postulated. The study has also raised questions concerning the sequence of recovery from motor and sensory blockade which still await explanation.

Estimation of T- and K-cell activity in the peripheral blood of sarcoidosis patients.

Depressed ADCC activity was found in sarcoidosis patients in clinical Stage II when whole blood was used as the effector cell pool. Whole blood in Stage I patients as well as purified peripheral lymphocytes of sarcoidosis patients did not reveal a diminished cytotoxic activity. Stimulation experiments with PHA, Con A, and PPD in two different concentrations resulted in a normal PHA response, a significantly decreased Con A response (regardless of the clinical stage of the patients), and a significantly decreased PPD responsiveness of peripheral lymphocytes in Stage II patients, respectively. Regarding the distribution of peripheral B and T lymphocytes, only a significantly depressed T-cell number in Stage I sarcoidosis patients was observed. Peripheral cells forming EA and EAC rosettes and staining for membrane-bound immunoglobulins were within normal ranges. Serum antibody titers to different herpes viruses, including Epstein-Barr virus, were found not to be elevated. Twenty percent of sarcoidosis patients showed anti-immunoglobulins in their sera specific for the Fc and Fab fragment.