[Evaluation of 6 years of group B streptococcus (GBS) screening in near-term pregnant women]. / Bilan bactériologique de six ans de dépistage du streptocoque de groupe B (SGB) au cours du dernier trimestre de la grossesse.

Streptococcus agalactiae (GBS) is a significant cause of morbidity and mortality among newborns. Colonization frequently occurs in pregnant women, nearly all international recommendations suggest that all pregnant women must be screened for vaginal colonization at 34 to 37 weeks of gestation. The microbiological diagnostic modalities used to combat GBS had to be accurate and in short time frame. We reported a 6 years experience of GBS screening, comparing results of culture swab of prenatal vaginal specimens and newborns colonization or infection. The carriage rate of 13 to 14% of GBS in newborn was unchanged during all the study period.

[Is there a change in ecology of Candida species incriminated in fungemia? A 7 years study at Foch Hospital]. / Y a-t-il un changement perceptible dans l'écologie des Candida species responsables de fungémie? Observation de 2000 à 2006 à l'hôpital Foch.

Some Candidemia studies have documented changes in epidemiology of Candida species and some species were reported as emerging species. We conducted a study over a 6 years period and until 2005 we do not noticed any change in epidemiology of Candida even if Candida albicans still the most common species followed by Candida glabrata. No increase of candidemia was observed from 2000 to 2005 and we observed a decrease during the year 2006, this fact have to be confirm and may be related to other data: reinforcement of hygienic measures in our hospital, changes in treatment or preemptive treatment of yeasts and fungi with new azoles or candines molecules. On another side, patients from intensive care units and patients suffering of cancer were, as expected, the most represented population in our study.

[Uncomplicated urinary tract infections, what about fosfomycin and nitrofurantoin in 2006?]. / Quelle sensibilité aux antibiotiques pour les bactéries responsables d'infections urinaires ? Que penser de fosfomycine et nitrofuranes ?

Since 2000 to 2005 we assessed the prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated urinary tract infections (UTI). A total of 19 618 bacteria were studied, fosfomycin, fluoroquinolones, nitrofurantoin were in vitro the most potent drugs with more than 80% of susceptibility. If we compare year 2000 to 2005 we observed a significant decrease of susceptibility for fluoroquinolones. For the same point of comparison, fosfomycin and nitrofurantoin showed a favourable evolution. Rationale and prudent use of antibiotics must now moved us to prescribe parsimoniously fluoroquinolones especially for some indications such as uncomplicated UTI though there are some others "old antibiotics" with a role may be underestimated for this specific indication.

[French training program for medical students in transfusion medicine. Transfusion Medicine Teachers' College]. / Programme en transfusion des étudiants en médecine. Collège des enseignants en transfusion sanguine.

In France, transfusion medicine training program has been updated. A national committee of professors in transfusion medicine propose a series of 13 items which represent the minimum knowledge that general practitioners should possess. This overview of transfusion medicine is far below the level that specialists should reach and they will need an additional specialized training. Several French universities have set up their own training program which is quite similar to the work of the committee of professors. The following recommendations are not strict guidelines but is a common basis which will be improved in 2005 according to new evidence based transfusion medicine.

Isolation, purification and partial amino acid sequence of a highly hydrophobic new microcin named microcin L produced by Escherichia coli.

We report here the production, by an Escherichia coli strain, of two microcins, microcin J25 and a new one that we designated microcin L. The active peptides were separated by solid phase extraction on C(18) cartridges. Microcin L was then purified to homogeneity by cationic-exchange high-performance liquid chromatography. Its molecular mass, determined by mass spectrometry, is 8899 Da. The amino acid composition and the sequence of the first 40 N-terminal residues indicate that microcin L is a hydrophobic peptide, which exhibits high homology to gassericin and lactacin F which both belong to the class II bacteriocins.

Screening for HBV, HCV and HIV genomes in blood donations: shortcomings of pooling revealed by a multicentre study simulating real-time testing.

This study was undertaken in order to determine whether screening of viremic blood donations by testing of pooled donor samples could constitute a technically feasible transfusional safety measure. A pilot study of real-time simulation, on a day-to-day basis, of screening of three viral genomes (hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV)) was conducted by five French Blood Centers on plasma samples collected from blood donors and studied within undiluted samples and within sample pools of various sizes. This study was carried out within time conditions compatible with the release of platelets. For the detection of HCV and HIV genomes, the five laboratories achieved a sensitivity that decreased with the size of the sample pool. Four were successful in detecting all undiluted samples. In the 1/10 diluted samples, four failed to detect one HIV or HCV sample. In the 1/100 diluted samples, all laboratories failed to detect one or more HIV or HCV samples. For HBV genome, no participating laboratories detected all of the samples of the panel, even undiluted samples, and the sample pooling considerably affected sensitivity. The improvement and standardization of assays needs to be attained, and training of laboratories appears to be a step crucial for routine screening of viral genomes in blood donations.

[Leukodepletion of labile blood products]. / Déleucocytation des produits sanguins labiles.

On the first of April 1998, French authorities decided on the systematic leukodepletion of two blood products: Red blood cell concentrates and platelet concentrates coming from homologous donors. This measure is based on the following principle arguments: Purification of the therapeutic product, as white cells are just passenger cells. White cells interfere with the red cells and the platelets during storage, deteriorating the overall quality of the blood product. There are multiple effects on the recipient of allogeneic leucocytes: CMH II structures stimulation of the host immune system; graft versus host reaction; cytokines secretion and mediators release; class I anti-HLA allo-immunisation; in general, immunomodulation (immunosuppression); intraleukocyte infectious agent transmission. Several techniques make leukodepletion in blood products possible: 1. For the red cells, just one technique is basically used today: filtration either when the red cell concentrate is being prepared (filtering the whole blood), or after having obtained the concentrate, filtering that. The filters used today are from a third generation and their efficiency is above 99.9%. The final product contains thus less than 1.10(6) per unit, whereas the initial product contained 1.10(9) per cent. 2. For the platelets, apheresis technology makes it possible to obtain platelet concentrates directly leucoreduced (1.10(5)). However, there are still two questions: is this process also useful for plasma? and what about for autologous blood products?

Lymphocytic alveolitis after primary HIV infection with CMV coinfection.

Herein is a report of an adult case of primary HIV infection with cytomegalovirus coinfection causing cough, fever, and lymphocytic alveolitis. Primary HIV infection has not been previously reported as a cause of lymphocytic alveolitis.

Plasma erythrocyte relationship of catecholamines in human blood.

The equilibrating process of catecholamines (CAs) between plasma and red blood cells (RBC) was studied by measuring their erythrocyte/plasma concentration gradient (E/P ratio); ratio of E/P > 1 for a given amine was considered the consequence of its accumulation in or on RBC. We studied in vitro human blood obtained from 9 polycythemic patients from whom blood was drawn in control condition and in response to loading with exogenous CAs. Preliminary study showed a lack of difference in results obtained in these patients from those in 9 healthy volunteers and confirmed that RBC accumulate dopamine (DA) and epinephrine (EPI) but not norepinephrine (NE). When a moderate amount of exogenous CAs was added, plasma and RBC concentrations were increased, with a delay between the two compartments indicated by a decrease in the E/P ratio of DA and EPI. When a large amount of exogenous CAs was added, their RBC concentrations were in direct proportion to their plasma concentrations. Thus, the kinetics of CA equilibration between plasma and RBC appears to be dependent on their chemical structure (DA is more easily accumulated than NE) and their plasma concentrations. Physiologically, the E/P ratio of DA was significantly greater than 1, suggesting that RBC maintained their capacity to accumulate DA even when DA plasma concentration was very high. Additional studies demonstrated that accumulation of CAs in or on RBC is a reversible process, inhibited by cold temperature and increased when blood pO2 is drastically reduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Umbilical Paget's disease and prostatic carcinoma.

We report a case of umbilical Paget's disease occurring in a patient with a prostatic carcinoma. No other malignancy was found, and the patient was treated by surgical excision of the lesion. To our knowledge, the occurrence of extramammary Paget's disease of the umbilicus has not been reported previously. The clinical presentation, its association with prostatic carcinoma, and the possible pathogenesis are discussed.

Multicentre quality control of polymerase chain reaction for detection of HIV DNA.

OBJECTIVE: Seven French laboratories tested the specificity and sensitivity of the polymerase chain reaction (PCR) for the detection of HIV-1 DNA. METHODS: Following its own PCR protocols, each laboratory independently tested blind two panels of 20 coded peripheral blood mononuclear cell samples collected from HIV-1-seropositive individuals and from HIV-1-seronegative individuals at high or low risk of HIV infection. For the first panel, laboratories were free to select type and number of primers; for the second, all were required to use the two primer pairs Pol 3/4 and MMy 9/10' (Nef 1). RESULTS: False-positive and false-negative results were observed in all laboratories (concordance with serology ranged from 40 to 100%). In addition, the number of positive PCR results did not differ significantly between high- and low-risk seronegatives. The use of crude cell lysates in DNA preparation produced the same PCR results as phenol-extracted DNA. Discrepancies between laboratories indicated that factors other than primer pairs contributed strongly to laboratory variability. CONCLUSIONS: Our results emphasize the importance of both positive and negative controls in PCR and demonstrate the value of multicentre PCR quality control.

Antithrombin III and heparin cofactor II in patients with chronic renal failure undergoing regular hemodialysis.

Heparin enhances the inhibition rate of thrombin by both antithrombin III (AT III) and heparin cofactor II (HC II). We studied the activity of these two plasma proteins in patients with chronic renal failure (CRF) undergoing regular hemodialysis as their heparin requirements varied widely. In 77 normal blood donors, normal ranges (mean +/- 2 SD) were 82-122% for AT III and 65-145% for HC II. When compared with these controls 82 dialyzed CRF patients had a subnormal AT III activity and a significantly (p less than 0.001) lower HC II activity. To evaluate the effect of hemodialysis we compared AT III, HC II and total proteins in plasma before and after dialysis in 24 patients (12 with normal and 12 with low basal HC II activity). AT III and HC II activities significantly (p less than 0.001) increased in absolute value. When related to total plasma proteins, in order to suppress the influence of hemoconcentration induced by dialysis, AT III decreased significantly (p less than 0.01) whereas HC II increased slightly but significantly (p less than 0.01) in the 12 patients with low initial HC II activity. The decrease of AT III induced by heparin administrated during dialysis is likely to account for this relative decrease of AT III activity. A modification of the distribution of both HC II and heparin between the vascular wall and the circulating blood is evoked to explain the relative increase in HC II activity and the need for higher heparin dosage in patients with low HC II levels.

[Frequency of hepatitis B antigens in the blood of pregnant women]. / Fréquence de l'antigénémie HBs chez les femmes enceintes.

In the antenatal clinics of the Hospital Foch at Suresnes we have instituted testing for hepatitis B antigens routinely of all mothers coming to the clinic so that we can look at the immune state of children born to mothers who have the hepatitis B virus and have hepatitis B antigens. The incidence of hepatitis B antigens altogether was 0.77%, which is twice as frequent as found in blood donors at the same hospital. This high incidence is found in women coming from the African and Asian continents where it is found at the same level in blood donors in the Hauts-de-Seine region. If however we examine women born in France who live in the towns the incidence is 0.32%. An enquiry in a standard medical form does not show a true risk factor. When, however, a more precise questionnaire is filled in, we found that risk factors were present in eight out of ten positive cases. We only made this enquiry on sero-positive women. When the baby was born we gave a 1 ml dose of anti-hepatitis B immunoglobulin (100 IU) followed by three injections of 1 ml of vaccine (HEVAC B Institut Pasteur) on the 1st, 30th and 60th day of life. A repeat injection was carried out when the infant was one year old. Altogether 32 newborns were treated: they tolerated the products well and it was effective because all infants developed anti-hepatitis B antibodies in every case that was followed up.(ABSTRACT TRUNCATED AT 250 WORDS)