Ano-rectal lymphogranuloma venereum: 22 cases reported in a sexually transmited infections center in Paris.

In January 2004 the European Surveillance of Sexually Transmitted Infections Network (ESSTI) issued an international alert regarding an outbreak of Lymphogranuloma venereum (LGV) in Rotterdam in a sexual network of men who have sex with men (MSM). Further to this alert, a retrospective survey was set up by the Institut de Veille Sanitaire and the reference laboratories for N.gonorrhoeae and Chlamydia in France. Our STI clinic in Paris carried out a clinico-biological retrospective study involving 154 MSM screened for anorectal sexually transmitted infections (STIs) between January 2002 and May 2004 and a prospective study between May 2004 and August 2004. Out of 216 swabs of rectal discharge from homosexual or bisexual males, a total of 32 were positive for C. trachomatis (14.8%) (3 patients in 2002, 11 in 2003 and 18 in 2004). C. trachomatis-positive rectal strains were genotyped to detect the specific C. trachomatis serovars and revealed serovars L(2) for 22 patients (respectively 1 in 2002, 9 in 2003 and 12 in 2004). Serum antibody titers for Chlamydia trachomatis were determined among 14 subjects and revealed strongly positive in 13 cases (1/512 to 1/16384) titers of IgG. These 22 patients with clinico-biologically confirmed anorectal lymphogranuloma venereum (ARLGV) were all homosexual men. They ranged from 28 to 52 years (mean age 39.2 years). 12 of 21 (57.1%) subjects with an ARLGV diagnosis were seropositive for human immunodeficiency virus (HIV) (one not done). Although rare, anorectal lymphogranuloma venereum (ARLGV) still exists in France and should not be forgotten in the differential diagnosis of rectal problems in male homosexuals.

Intravenous methotrexate for primary central nervous system non-Hodgkin's lymphoma in AIDS.

OBJECTIVE: To evaluate high-dose intravenous methotrexate in primary central nervous system (CNS) lymphoma in HIV-infected patients. DESIGN: An uncontrolled pilot trial. SETTING: An infectious diseases department in Paris, France. PATIENTS: All consecutive AIDS patients with primary CNS lymphoma attending the same unit from August 1994 to March 1996. INTERVENTIONS: Methotrexate was intravenously administered at a dose of 3 g/m2 every 14 days with leucovorin rescue. A maximum of six cycles was planned. Steroids were given to all patients and haematological growth factors were administered as required. MAIN OUTCOME MEASURES: Rate of response, time to response and survival. RESULTS: Fifteen patients (10 with histological documentation) were recruited. The median time since clinical onset was 27 days (range, 7-69 days), median Karnofsky score was 51 (range, 30-70), and mean CD4+ cell count was 30 +/- 19 x 10(6)/l (range, 7-69 x 10(6)/l). Complete responses, defined as clinical improvement and disappearance of contrast-enhancing brain abnormalities on computed tomography or magnetic resonance imaging, were obtained in seven out of 15 patients (three out of 10 patients with histological diagnosis and four out of five patients without histological confirmation). The Karnofsky score of these seven patients improved to 80 +/- 10 (range, 70-100). The mean time taken to respond was 62 +/- 20 days (range, 45-90 days). One patient relapsed at 6 months. Six patients failed to respond, and two died of severe sepsis on days 15 and 45. The median survival time was 290 days (range, 11-570 days): 73 days (range, 11-570 days) in the 10 patients with histological diagnosis, and 347 days (range, 286-409 days) in the five patients without histological confirmation. Side-effects occurred in 10 patients, with gastrointestinal disorders in five, mucositis and skin rash in two, and fever in three patients; however, these events were mild and did not require cycle postponement or dose changes. No cognitive dysfunction occurred. CONCLUSION: Methotrexate appears to be an attractive alternative to radiation therapy for primary CNS lymphoma and is associated with a far greater improvement in quality of life relative to historical series of radiation therapy.

[Lesions of the conus medullaris and the cauda equina caused by cytomegalovirus in HIV infection. 7 cases]. / Atteintes du cône terminal et de la queue de cheval dues au cytomégalovirus au cours de l'infection à VIH. 7 observations.

OBJECTIVES: Neurologic infections caused by cytomegalovirus are common in patients with acquired immunodeficiency syndrome (AIDS). The prognosis is particularly severe when the infection is localized in the conus medullaris and/or the cauda equina. METHODS: Among the 861 patients with AIDS treated in our unit from 1991 to 1993, 7 cases involving cytomegalovirus infection of the conus medullaris and/or the cauda equina were studied retrospectively. RESULTS OF THE CASE REPORTS: Clinical manifestations were nearly always the same: low back pain, motor deficiency in the lower limbs progressing to flaccid paraplegia and sphincter failure. The cerebrospinal fluid contained a high cell count with unaltered polynuclears and increased protein levels. In 6/7 patients virus cultures and search for the viral genome in the cerebrospinal fluid were positive. The clinical course was favourable in 6 patients after 3 weeks treatment with ganciclovir and/or foscarnet. Virology tests became negative in three-fourths of the patients. Nevertheless, relapse occurred after 4.2 weeks despite long-term therapy. CONCLUSION: The severe clinical course of this disease and the gravity of constantly fatal relapse requires highly adapted treatment and overall health care.

[Angiosarcoma after total knee prosthesis. Apropos of a case]. / Angiosarcome après prothès totale de genou. A propos d'un cas.

The authors describe the case of an angiosarcoma associated with a knee prosthesis. The appearance of a malignant tumour in the area of the implantation of a metallic prosthesis is rare. The pathogenesis of this association is still unknown. The authors make an analysis of the problem on the basis of a review of the literature.

[Trans-ethmoid meningocele diagnosed in adults. Description of one case]. / Meningocele transetmoidal. Diagnóstico en edad adulta: presentación de un caso.

The meningocele and encephalocele are extracranial herniation of single meninges or meninges with brain tissue, through cranial defect. This pathology can be classificated according to contain or localization. The trans-etmoidal encephalocele is the 5% of meningoencephaloceles, and they are the 8-19% of all neural tube dysraphism. We report a 54 year-old woman with a spontaneous rhinorrhea due to an trans-ethmoidal meningocele associate with a recurrent meningitis. The computed tomographic (CT) revealed a trans-ethmoidal meningocele and she was treated with surgery. In presence of a patient with recurrent meningitis is necessary value the possibility of rhinorrhea, and an exhausted radiology study will be fulfill for identify the opening in the skull through leak CSF, and offer the best treatment. The transetmoidal can be a cause of rhinorrhea. The CT scan study of anterior fosa is a good method for diagnostic of this pathology, however, the IRM is the election method.

Efeito do BAP no cultivo in vitro de Ocimum selloi Benth / Effect of BAP on in vitro culture of Ocimum selloi Benth

Visando promover a proliferação de brotações em segmentos apicais e nodais de Ocimum selloi em diferentes concentrações de BAP, plantas jovens de 60 dias serviram de doadoras de segmentos apicais e nodais. Os segmentos foram inoculados em meio MS preparado com a metade da concentração dos sais, e acrescido de 1,5% de sacarose e diferentes concentrações de BAP. O experimento foi conduzido no delineamento fatorial, 3 x 4, sendo 3 as posições dos segmentos de O. selloi (segmento apical, primeiro e segundo segmentos nodais) e 4 concentrações de BAP (0 - controle; 2; 4 e 6 mg L-1). Aos 30 dias, foram avaliados o número, comprimento e biomassa fresca e seca de brotos e raízes. Os primeiros e segundos segmentos apresentaram melhores resultados na indução de brotos de O. selloi, 7 e 8 brotos/explante, nas diferentes concentrações de BAP; porém, não houve formação de raízes na presença da citocinina. Nas condições testadas, recomenda-se o uso do primeiro e segundo segmento nodal suplementando o meio de cultivo com BAP para a proliferação in vitro de brotações de O. selloi.

The present study was undertaken to develop the proliferation of sprouts in apical and nodal segments of Ocimum selloi with different BAP levels. Young plants aged 60 days were used as donors of nodal and apical segments. The segments were inoculated in MS medium at half the concentration of salts supplemented with 1.5% of sucrose and different BAP levels. The experiment was in 3 x 4 factorial arrangement, 3 positions of O. selloi segments (apical segment; first and second nodal segment) and 3 BAP levels (0 - control; 2; 4 and 6 mg L-1). After 30 days, the number, the length, and the fresh and dry biomass of sprouts and roots were evaluated. The first and the second segments showed better results in inducing O. selloi sprouts, 7 and 8 sprouts/explant, at the different BAP levels, but there was not root formation in the presence of the cytokinin. Under the tested conditions, use of the first and the second nodal segments is recommended in addition to supplementing the culture medium with BAP for in vitro proliferation of O. selloi sprouts.

Definition and diagnosis of cytomegalovirus colitis in patients infected by human immunodeficiency virus.

The definition and routine diagnosis of cytomegalovirus (CMV) colitis in patients infected by human immunodeficiency virus (HIV) are controversial. In 100 consecutive HIV-infected patients who underwent colonoscopy for the investigation of diarrhea, we compared the yields of routine diagnostic tools for CMV infection and assessed the risk of further CMV organ disease in subgroups of patients with the following features: full evidence of CMV colitis (group 1), colonic CMV infection but no endoscopic lesions (group 2), and no evidence of colonic CMV infection (group 3). All biopsies taken during colonoscopy were examined immediately by routine hematoxylin and eosin (H&E) staining and viral culture and then pooled for second-line H&E staining and immunohistology. Among the 15 diagnoses of CMV colitis (group 1), two were missed during initial H&E examination, and both patients developed further CMV organ disease during follow-up. Of the 12 group 2 patients 11 were not receiving anti-CMV drugs at the time of initial colonoscopy. CMV organ disease was not significantly more common in these patients than in group 3 during follow-up. We conclude that routine H&E staining of colonic biopsy specimens for CMV inclusions is not 100% sensitive for CMV colitis. The favorable outcome of colonic CMV infection without endoscopic lesions suggests that only patients with full evidence of CMV colitis warrant specific antiviral therapy.