[Quinquina and man]. / Du quinquina et des hommes.

Many great discoveries have been made by chance but some have been the result of human perseverance and ingenuity. A sterling example of the second case is quinquina that was discovered in Peru and is now produced in Java. Quinquina has gone through centuries without losing its medical efficacy that efficacy allowed the exploration and colonization of Africa and played a key role in the ability to conduct overseas military campaigns. Because of its strategic importance, it was a coveted resource. It led to the discovery of homeopathy and dyes, allowed the development of organic chemistry, and has been used to make alcoholic bitters and soft drinks.

Antibodies directed against a variable and neutralizable region of the HTLV-I envelope surface glycoprotein.

The majority of neutralizing antibodies of HTLV-I are directed against linear epitopes of the envelope surface glycoprotein (gp46) in the immunodominant region 175-199. Although gp46 presents a remarkable degree of conservation, the substitution of the proline at position 192 by a serine is described for 10 isolates among the 54 sequenced ones. This amino acid substitution is known to induce an important change in the orientation of the exposed residues of this region and has drastic consequences on the immunogenicity of the neutralizable epitopes located in this region. We developed monoclonal antibodies directed against epitopes located in this region containing a proline or a serine at position 192. The six monoclonal antibodies obtained recognize the gp46 at the surface of living HTLV-I producing cells, two of them are specific of a 190-197 epitope with a serine at position 192. This demonstrates that the antigenicity of this epitope differs depending on the presence of a proline or a serine at position 192. Altogether, these results demonstrate that the immunodominant neutralizable region 175-199 is antigenically variable.

Past and current roles for cephalosporin antibiotics in treatment of meningitis. Emphasis on use in gram-negative bacillary meningitis.

The therapy of gram-negative bacillary meningitis is less than adequate to date; the agents recommended do not achieve bactericidal levels in purulent cerebrospinal fluid. Because optimal antibiotic therapy of meningitis occurs when the cerebrospinal fluid level of an antibiotic is above the concentration needed to kill the offending pathogen, another group of agents needs to be considered. The newer cephalosporins or cehalosporin-type antibiotics (cefotaxime, moxalactam), by virtue of their marked activity against gram-negative bacilli and their ability to achieve significant CSF levels, merit serious consideration as therapy for gram-negative bacillary meningitis. Investigators in Europe and the United States have developed preliminary data demonstrating the efficacy of these agents in a growing number of cases. In the group presented herein, of the 35 cases in which gram-negative bacillary meningitis was treated with the newer cephalosporins, there were only four failures.

[Evaluation of the pharmacovigilance follow-up of zidovudine]. / Bilan d'un suivi de pharmacovigilance de la zidovudine.

A therapeutic committee was established in Toulouse Regional University Hospital in order to prescribe zidovudine in patients suffering from AIDS. Using an informatic card, the side effects were evaluated in the 125 patients treated by Zidovudine since the creation of the Committee (from July 1987 to January 1989). Zidovudine was prescribed from May 1987 to June 1988 at the total dose of 1,200 mg daily from June 1988 at 900 mg daily. The most frequent side effects were hematologic: zidovudine used alone (or associated with non hematotoxic drugs) elicited in 21.2% of patients a neutropenia (defined as a number of neutrophils less than 1,000/mm3), in 2.4% anaemia (haemoglobin less than or equal to 9 g/100 ml) and in 4.8% neutropenia associated with anaemia. When zidovudine was administered with hematotoxic drugs, neutropenia, anaemia or the association of both were observed in 12.0%, 3.2% and 2.4% of patients respectively. These hematologic side effects were always regressive after drug cessation. However, it is important to underline the low incidence of hematological side effects on red cells of zidovudine in the present study. This result is unexpected. The other side effects of Zidovudine (used alone) did not led to modification in drug treatment: gastrointestinal disturbances (30.4%), headaches (16.8%), insomnia (13.6%), somnolence (6.4%).... These side effects appeared during the four first months and decreased with the continuation of drug treatment. Their imputation was difficult to define and differentiate to evolution of the disease.

[Travel medicine]. / La médecine des voyages.

Travel Medicine was inherited from Tropical Medicine and was organised around the development of intercontinental travels. It concerns all types of travellers, especially tourists, migrants and expatriates. It must be universal, scientific, but first of all preventive. Its aims to the information of all professionals concerned by health and tourism. Its goal is also the training of physicians and the education of travellers regarding their own responsibilities.

[Development and trends from 1986 to 1993 of the attitude of intercontinental travellers on departure from France, with respect to malaria prophylaxis]. / Evolution et tendances de 1986 a 1993 de l'attitude des voyageurs intercontinentaux au départ de France, vis-a-vis de la prophylaxie du paludisme.

Simultaneously to information campaigns on malaria prevention in France, 5 successive surveys were performed from 1986 to 1993 on the knowledge and attitudes of travellers regarding malaria prevention. French travellers (principally towards Sub Saharan Africa) know the risk of malaria and the measures of prevention (96%). Chimioprophylaxis using chloroquine has been progressively replaced by mefloquine and then by the association mefloquine-proguanil; 25% of travellers know mosquito prevention measures (repellents and impregnated bed nets) and 27% know the stand-by treatment. Passive attitude of travellers has been modified (in part due to their education) and tend to emphasize today their own responsibility.

[Information communication to travelers, the French and Belgian experiences]. / Communication de l'information aux voyageurs, les expériences française et belge.

Providing relevant and up-to-date information to professionals and the general public is possible through many existing as well as developing means of communication including telephone and faxing, databases, answering machines and internet. Professionals may use information networks in order to harmonize advice given to their patients or clients. An exchange may also be established among all types of travel medicine professionals for keeping up with the latest relevant news and information or for sharing new ideas. Because travellers are now more proactive on their health than ever before, basic information designed for the general public is also becoming necessary. Examples of the various uses of communications in France and in Belgium are considered below.

[Infectious disease observed upon travel return. Retrospective and prospective investigation conducted in 1992 with 15 hospitals]. / Pathologie infectieuse observée au retour des voyages. Enquête rétrospective et prospective menée en 1992 auprès de 15 hôpitaux.

We report 1,302 cases of patients observed in the Department of Infectious Diseases in 15 French hospitals: 1,036 in a retrospective study in 1991; 266 in a prospective study in 1992. 48% of patients suffered from malaria, diarrhoea or hepatitis; 50% were admitted in the hospital. We have numbered 191 cases of non tropical diseases, 14 cases of HIV seropositivity and 14 cases of adverse events due to antimalarial chemoprophylaxis.

[Real information needs of the traveller before his departure. Results of a survey by questionnaire]. / Les besoins réels en information du voyageur avant son départ. Résultats d'une enquête par questionnaire. Société française de la Médecine des Voyages.

This study is based upon 727 questionnaires completed by French travellers 10 days after intercontinental travel. The response rate was 40%. Two out of 5 travellers had generally mild health problems: fever (12%), diarrhoea (36%). Forty-six of them took drugs, which they had brought with them during their travel. Ten per cent had a satisfactory visit to a local physician. Medical informations given before departure appears to be sufficient, useful and relevant in more than 90% of cases. The traveller would like to receive them from his own physician or from vaccination centers. Other informations as insurance, assistance, administration, finances, appeared to have been incorrectly perceived by 20% of the travellers. The travel agent is the one who should provide adequate information. The traveller, in general, plans to do more travelling for his own well being if not for his work. Would not the bigger risk for him be "not to travel at all".

[Use of leukocytes labelled with 99m Technetium sulfide colloids for the detection of experimental aseptic inflammatory foci]. / Utilisation de leucocytes marqués par des colloïdes de sulfure de Technétium 99m pour la détection des foyers inflammatoires aseptiques expérimentaux

The authors propose a technique of labelling of leukocytes based on the phagocytic power of these cells with regard to sulphide particles in the colloidal state labelled with 90mmTc. These labelled leukocytes maintain their normal function and can be detected in the inflammatory foci created in experimental animals in the form of an abscess. Satisfactory results were thus obtained by scintiscanning after auto and allo-transfusion of labelled leukocytes. The role of hyperemia in the results obtained is eliminated by comparative study using non-diffusible vascular tracers. The type of vector, tracer and marker, the innocuity of the method suggest that it may be used in human clinical medicine for the early diagnosis of certain inflammatory foci.

[Evaluation and perspectives of a new cephalosporin: ceftriaxone]. / Bilan et perspectives d'une nouvelle céphalosporine: la ceftriaxone.

Following a brief review of the main bacteriological and pharmacokinetic properties of ceftriaxone, the authors present a therapeutic evaluation of this new cephalosporin antibiotic. The effects of ceftriaxone in severe infections, such as septicaemia, bacterial meningitis, urinary tract infections, typhoid, bone infections and sexually transmitted diseases, are described on the basis of recent publications. Mention is also made of the adverse reactions to, and benign side-effects of the drug. Finally, the advantages of ceftriaxone in the treatment of some infections are envisaged: the single daily dose and short therapeutic courses may modify therapeutic habits and exert a beneficial effect on costs in some cases.

[Imipenem-cilastatin in infections]. / L'imipénème-cilastatine en infectiologie.

A multicentre open trial was conducted in 31 centres to evaluate the therapeutic and ecological impact of imipenem-cilastatin on patients admitted to infectious pathology departments. Two-hundred patients (mean age: 58 +/- 19.4 years) were included in the study. The predominant infections were septicaemia, severe urinary tract infections and lower respiratory tract infections. Most of the patients treated (188/200) had associated severity factors. The acute infectious episode had been present for 9.3 +/- 12.2 days before the drug was prescribed. In the majority of patients the infection was hospital-acquired. Two-hundred and fifteen out of the 298 initial bacterial isolates were Gram-negative bacilli. Imipenem-cilastatin was administered alone in 74.5 per cent of the patients during 14.1 days on average in doses of 30 mg/kg/day. The drug was given as first-choice treatment in 60 per cent of the cases and after failure of another antibiotic therapy in 40 per cent. Clinical cure was obtained in 180 of the 198 assessable patients. Among therapeutic failures, 4 were due to the emergence during treatment of an imipenem-resistant Pseudomonas aeruginosa, but 30 of the 42 strains of Pseudomonas isolated before treatment were eradicated. The therapeutic success rates were 100 per cent in intra-abdominal infections, 94 per cent in septicaemias, 97 per cent in urinary tract infections and 82 per cent in lower respiratory tract infections, this last figure being one of the highest recorded in clinical trials. Frequent colonization or superinfection were not encountered in this study. The incidence of phlebitis at the site of injection was 14 per cent.

[Diaphragmatic paralysis after puncture of the internal jugular vein]. / Paralysies diaphragmatiques après ponction jugulaire interne.

Two cases of paralysis of the diaphragm occurring after puncture of the internal jugular vein are reported. Both were old cancer patients, requiring an internal jugular venous catheter for intravenous feeding. Although the catheter was easily placed in both cases, the diagnosis of diaphragmatic paralysis was made postoperatively. The first patient remained asymptomatic, despite paradoxical breathing when lying supine; there was no change in her condition up to her death 4 months later. The second patient became increasingly breathless, with hypoxia and hypercapnia, during recovery from a gastrostomy under general anaesthesia. She required artificial ventilation, from which she could not be weaned and died 25 days later. A lesion of the phrenic nerve is possible when placing an internal jugular venous catheter, because they are closely related behind the sternocleidomastoid muscle. In the opposite to compression by a haematoma, or transient blockade following local anaesthetic infiltration, such a direct injury may be irreversible.

[Treatment with a cefotaxime-fosfomycin combination of staphylococcal or enterobacterial meningitis in adults]. / Traitement par l'association céfotaxime-fosfomycine des méningites de l'adulte à staphylocoques ou à entérobactéries.

Thirty-two patients were included in this trial: 22 with staphylococcal meningitis (including 5 methicillin-resistant) and 10 with enterobacterial meningitis. Mean duration of treatment was 14.5 and 15.9 days respectively. The combination was synergistic in vitro against 10 of the 12 strains of Staphylococcus and 5 of the 6 strains of Enterobacteriaceae studied. Bacteriological sterilization occurred in all cases which could be evaluated, and clinical recovery was obtained in 95.2% of patients with staphylococcal meningitis (4 unrelated deaths) and 100% of patients with enterobacterial meningitis (2 deaths). Bactericidal power of the cerebro-spinal fluid, often less than 1/8, was not correlated with effectiveness against Staphylococci. Mean CSF concentrations of cefotaxime, desacetylcefotaxime and fosfomycin on the 2nd and 15th days of treatment were 4, 3.5 and 39.8 mg/l and 2.2, 2.1 and 28.0 mg/l, respectively. Clinical and biological acceptability was satisfactory. There were three cases of superinfection or colonization, by Pseudomonas and Enterobacter.

[Treatment of septicemia with latamoxef. Multicentric study of 60 cases]. / Traitement des septicémies par le latamoxef. Etude multicentrique de soixante cas.

Sixty patients including forty two males and eighteen females, age range: 18-87 years, received antibacterial single drug treatment with latamoxef for septicemia. Forty nine patients had underlying conditions including multiple trauma, neoplasm, cardiovascular, metabolic and respiratory tract diseases. Causative pathogens were isolated in all cases. The predominant isolates were E. coli (thirty), Klebsiella pneumoniae (tent) and Enterobacter (seven). A single organism was isolated in fifty seven cases; in the other three cases two organisms were isolated from blood cultures. Mean daily dosage was 46.6 +/- 6.1 mg . kg-1 (range: 14-113 mg . kg-1). In the majority of cases (fifty two) dosage was 3 g . d-1 or less; in thirty cases it was no higher than 2 g . d-1. Duration of therapy ranged from six to thirty eight days. Serum titer was measured in many cases and latamoxef blood levels were assayed in nine patients. A satisfactory clinical response was achieved in fifty eight cases and fifty eight bacteriological cures were also obtained. There was no statistically significant difference in therapeutic response between the 2 g and 3 g daily dosage groups. Tolerance was very good; untoward effects were few and required drug discontinuation in one case only.

[Urinary tract infection in an urban population: etiology and antibiotic sensitivity as a function of patient history]. / Infections urinaires en pratique de ville: étiologies et sensibilité aux antibiotiques en fonction des antécédents. l'AFORCOPI-BIO. Association pour la Formation Continue en Pathologie Infectieuse des Biologistes.

OBJECTIVE: The aim of this study was to explore the relationship between etiological factors, bacterial isolates and Escherichia coli susceptibility to antibiotics in ambulatory patients with urinary tract infection. PATIENTS AND METHODS: A prospective study was conducted in 13 private medical laboratories in France in March 1998. Data were collected on 658 cases involving 679 strains in ambulatory patients with urinary tract infections. Data on age, gender, catheter insertion within the 7 preceding days, and history of hospitalization, urinary infection and antibiotic treatment during the 6 preceding months were recorded. The distribution of the bacterial isolates and Eschericha coli sensitivity to ciprofloxacin, cotrimoxazole, and gentamycin were studied. RESULTS: E. coli was most frequently isolated in women, in patients with no catheter or without a history of antibiotic treatment, hospitalization or urinary infection. There was no difference in E. coli sensitivity according to sex and age in women. In patients with prior antibiotic treatment, all the tested antibiotics except gentamycin were significantly less active. In case of prior hospitalization, the E. coli isolates were more resistant to amoxicillin, quinolones, cotrimoxazole and gentamycin. The level of E. coli suceptibility rose as the delay since hospitalization or urinary infection increased. CONCLUSION: Ambulatory patients comprise a heterogeneous population requiring particular attention to correctly adapt therapeutic strategies.

[Recent evolution of travel medicine in France and in the world]. / Evolution récente de la médecine des voyages en France et dans le monde.

The purpose of this study is to show the different steps which have to led to the individualization of this discipline. The necessity of Travel Medicine is a result of the rapid expansion in international and intercontinental travel, in the development of means of prevention of risks linked to this increased travel, in modification made in the doctor-traveler relationship, and in the updating of everchanging epidemiological data. A strategy was developed in France, taking into account all components involved, leading to the creation of the French Travel Medicine Society in 1993. This society can be as an example abroad. The International Society of Travel Medicine was founded in 1992, Atlanta. Travel Medicine has always existed, but the organisation of its structures and especially the training of specialists has to be reconsidered. The main goal of Travel Medicine is the prevention, through information, of medical risks while travelling. This discipline is first and foremost a matter of Public Health. Investigation of this domain is far from complete.

[Importance of the "Personal Serologic Immunization Card" among travelers]. / Intérêt d'une carte personnelle sérologique d'immunisation chez le voyageur.

The "Personal Immunization Card" is entering more and more in practice, even though its existence is not yet acknowledged. One of his advantages is to consider the travel medicine counsellor on one hand and the travelling adult on the other hand, being able to take a licit decision in account to informative data. That means to give the two actors-guarantors of the compliance--the responsibility in Public Health, in a domain considered until now in the same way as that of vaccinations in Infancy. The obligations and recommendations may not be sufficient, it is necessary to be convincing at the adult age. Without a doubt, we should get ride of the a priori with the progress in biology. We shall update our behaviour.