Crystal structure of bis-(propane-1,3-di-ammonium) hexa-fluorido-aluminate fluoride trihydrate.

The title compound, (C3H10N2)2[AlF6]F·3H2O, was obtained using the solvothermal method with aluminium hydroxide, HF and propane-1,3-di-amine as precursors in ethanol as solvent. The structure consists of isolated [AlF6](3-) octa-hedra, diprotonated propane-1,3-di-amine cations [(H2dap)(2+)], free fluoride ions and water mol-ecules of solvation. The Al-F bond lengths in the octa-hedral [AlF6](3-) anions range from 1.7690 (19) to 1.8130 (19) Å, with an average value of 1.794 Å. Each [AlF6](3-) anion is surrounded by three water mol-ecules and by six diprotonated amine cations. The 'free' fluoride ion is hydrogen bonded to four H atoms belonging to four dications and has a distorted tetra-hedral geometry. The three water mol-ecules are connected by hydrogen bonds, forming trimers that connect the AlF6 octa-hedra and dications into a three-dimensional framework.

[Perineal recurrence of an aggressive angiomyxoma: Is an incomplete resection useful?]. / Récidive d'un angiomyxome périnéal agressif : une chirurgie d'exérèse incomplète est-elle utile?

Angiomyxoma is a rare but aggressive mesenchymal tumor. It commonly develops in the pelvis, perineum and groin and is more common in females. Angiomyxoma characteristically has a high incidence of local recurrence. The only treatment of recurrence is surgical re-excision. We report a case of recurrent aggressive angiomyxoma, which was only incompletely resected.

[Shoulder arthritis due to Haemophilus aphrophilus]. / Arthrite d'épaule à Haemophilus aphrophilus.

We report a case of shoulder arthritis due to Haemophilus aphrophilus. The patient, a 56 year-old woman, was immunocompetent. She presented with a septic arthritis of the left shoulder without portal of entry. A synovial fluid sample was cultured and positive for a gram-negative bacillus after 8 days. It was identified as Haemophilus aphrophilus, in the HACCEK group, by PCR ARN 16S. We did not find any associated endocarditis. The patient recovered. As far as we know, this is only the 5th reported case of arthritis due to this microorganism.

Microsporidia: accumulating molecular evidence that a group of amitochondriate and suspectedly primitive eukaryotes are just curious fungi.

Microsporidia are obligate intracellular parasites that have long been considered to be primitive eukaryotes, both on the basis of morphological features and on the basis of molecular, mainly ribosomal RNA-based, phylogenies. However, accumulating sequence data and the use of more sophisticated tree construction methods now seem to suggest that microsporidia share a common origin with fungi and are therefore most probably just curious fungi. In this paper, we describe the current views on the phylogenetic position of the microsporidia and present additional evidence for a close relationship between fungi and microsporidia on the basis of reanalyzed ribosomal RNA data. In this respect, the importance of incorporating detailed knowledge of the substitution pattern of sequences into phylogenetic methods is discussed.

Colonization with methicillin-resistant Staphylococcus aureus in ICU patients: morbidity, mortality, and glycopeptide use.

OBJECTIVE: To determine the impact of methicillin-resistant Staphylococcus aureus (MRSA) colonization on the occurrence of S. aureus infections (methicillin-resistant and methicillin-susceptible), the use of glycopeptides, and outcome among intensive care unit (CU) patients. DESIGN: Prospective observational cohort survey. SETTING: A medical-surgical ICU with 10 single-bed rooms in a 460-bed, tertiary-care, university-affiliated hospital. PATIENTS: A total of 1,044 ICU patients were followed for the detection of MRSA colonization from July 1, 1995, to July, 1 1998. METHODS: MRSA colonization was detected using nasal samples in all patients plus wound samples in surgical patients within 48 hours of admission or within the first 48 hours of ICU stay and weekly thereafter. MRSA infections were defined using Centers for Disease Control and Prevention standard definitions, except for ventilator-associated pneumonia and catheter-related infections, which were defined by quantitative distal culture samples. RESULTS: One thousand forty-four patients (70% medical patients) were included in the analysis. Mean age was 61+/-18 years; mean Simplified Acute Physiologic Score (SAPS) II was 36.4+/-20; and median ICU stay was 4 (range, 1-193) days. Two hundred thirty-one patients (22%) died in the ICU. Fifty-four patients (5.1%) were colonized with MRSA on admission, and 52 (4.9%) of 1,044 acquired MRSA colonization in the ICU. Thirty-five patients developed a total of 42 S. aureus infections (32 MRSA, 10 methicillin-susceptible). After factors associated with the development of an S. aureus infection were adjusted for in a multivariate Cox model (SAPS II >36: hazard ratio [HR], 1.64; P=.09; male gender: HR, 2.2; P=.05), MRSA colonization increased the risk of S. aureus infection (HR, 3.84; P=.0003). MRSA colonization did not influence ICU mortality (HR, 1.01; P=.94). Glycopeptides were used in 11.4% of the patients (119/1,044) for a median duration of 5 days. For patients with no colonization, MRSA colonization on admission, and ICU-acquired MRSA colonization, respectively, glycopeptide use per 1,000 hospital days was 37.7, 235.2, and 118.3 days. MRSA colonization per se increased by 3.3-fold the use of glycopeptides in MRSA-colonized patients, even when an MRSA infection was not demonstrated, compared to non-colonized patients. CONCLUSIONS: In our unit, MRSA colonization greatly increased the risk of S. aureus infection and of glycopeptide use in colonized and non-colonized patients, without influencing ICU mortality. MRSA colonization influenced glycopeptide use even if an MRSA infection was not demonstrated; thus, an MRSA control program is warranted to decrease vancomycin use and to limit glycopeptide resistance in gram-positive cocci.

False synergy between vancomycin and beta-lactams against glycopeptide-intermediate Staphylococcus aureus (GISA) caused by inappropriate testing methods.

The combination of vancomycin and beta-lactams is often considered synergistic and has been recommended for the treatment of glycopeptide-intermediate Staphylococcus aureus (GISA) infections. In this study, the combination of vancomycin or teicoplanin with different beta-lactams was tested. When using NaCl 4% w/v, for better expression of heterogeneous resistance to beta-lactams, with a longer (48-h) incubation period and a higher (10(7) CFU/mL) inoculum, the association of vancomycin with beta-lactams was antagonistic. However, a synergistic effect was observed for teicoplanin under the same conditions.

[Conservative treatment of the spleen. Report of 50 cases]. / Le traitement conservateur de la rate. A propos de cinquante cas.

From 1983 to 1989, 50 patients have been treated by spleen conservation. Traumatism was iatrogenic in 9 cases, caused by public highway accidents in 31 cases, domestic accident in 9 cases and penetrating trauma in one case. Spleen conservation includes: 26 partial splenectomies, 11 cauterisations, 10 sutures, 5 auto-transplantations, and 3 abstensions after laparotomy and little spleen trauma. Three deaths were observed secondary to cerebral trauma, and two complications have been seen: one during the operative solved by total splenectomy, and one rebleeding after splenorraphy, reoperated and splenectomy was performed with good evolution. The follow-up of partial splenectomy showed that splenic remnant keeps an epuration activity.

[Anal metastasis of colonic adenocarcinoma?]. / Métastase anale d'un adénocarcinome du côlon?

Two cases of sigmoid and anal adenocarcinoma are reported. The two patients were treated by abdominoperineal resection of the rectum and resection of the sigmoid colon. The relationship between colonic adenocarcinoma and anal adenocarcinoma is not obvious but possible. The various mechanisms of tumoral spread are discussed and the most frequent mechanism seems to be cellular exfoliation.

[Tuberculous mesenteric lymphadenitis: a case report]. / La lymphadénite mésentérique d'origine tuberculeuse: à propos d'un cas.

The authors report a case of mesenteric tuberculous lymphadenitis which mimic a pancreatic cystadenoma. They emphasize ultrasound and CT scan features which lead to the recognition of tuberculosis and permit a percutaneous fine needle biopsy. Laparotomy seems the most reliable method for a positive diagnosis. The place of different imaging methods is discussed.

[Neutropenia with fever]. / Neutropénie fébrile.

CAUSAL GERMS: Over the last 10 years, hemotology units have seen many changes in the epidemiological pattern of infections in neutropenic patients, with a growing number of infections caused by Gram-positive germs. The number of septicemias due to multiresistant Gram-negative germs (Pseudomonas aeruginosa, Strenotrophomonas maltophilia) has however remained high. IMPACT OF THERAPEUTIC REGIMENS: Improved prognosis in neutropenic patients depends for a large part on careful management of septic episodes. As the risk of septicemia is strongly correlated with the degree of efficacy of antibiotic regimens, susceptibility data must always be examined when developing antibiotic protocols in units caring for neutropenic patients.

[Rhino-orbito-cerebral zygomycosis (mucormycosis) in diabetes insipidus]. / Zygomycose (mucormycose) rhino-orbito-cérébrale avec diabète insipide.

A case of rhino-orbito-cerebral zygomycosis in a diabetic patient treated with insulin is reported. Diagnosis was suspected because of extensive necrotic lesions of the face and was confirmed by mycologic tests. During hospital stay the patient developed a diabetes insipidus and the outcome was lethal because of the extension of lesions in spite of convenient antimycotic therapy.

[Treatment of severe botulism with 3,4-diaminopyridine]]. / Traitement d'un botulisme grave par la 3,4-diaminopyridine.

INTRODUCTION: The specific treatments of botulism with serotherapy and with guanidine are of debatable efficacy. We report a case of nutritional toxin B botulism successfully treated with 3,4-diaminopyridine. OBSERVATION: Following a meal, a 69 year-old woman consulted for digestive disorders followed by damage to several cranial pairs, autonomous nervous system and ventilation command, motivating mechanical ventilation on tracheal intubation. Administration of symptomatic treatment with 3,4-diaminopyridine led to progressive improvement, although the diagnosis of toxin B botulism was confirmed. COMMENTS: Administration of 3,4-diaminopyridine, the efficacy of which had been suggested by the review of experimental literature, led to rapid and clear improvement, probably due to its potentiating effect on acetylcholine release in the neuromuscular junction.

[The Munchausen syndrome: a diagnosis not to be forgotten in urology]. / Le syndrome de Münchausen, un diagnostic à ne pas oublier en urologie.

INTRODUCTION: Among the manifestations of Münchausen's syndrome, "neurological" forms may exist. OBSERVATION: We present the case of a patient presenting with urinary retention following treatment for urinary incontinence. The patient had injected himself with infected urine collected from his catheter, in order to create septicemia. COMMENTS: Nephritic colitis, false gall stones, addition of fecal matter or of food and saliva in the urine or the bladder, neurogenic bladder and urinary infections have all been reported as possible manifestations of Münchausen's syndrome. Diagnosis of this syndrome is often delayed and laborious, after repeated hospitalisations, examinations and often aggressive treatment. Its therapeutic management is difficult. Patients, despite proof, deny their deceit and refuse psychiatric care.

[Suboccipital tuberculosis: a case report]. / Tuberculose sous-occipitale. A propos d'un cas.

Suboccipital tuberculosis is an uncommon localization of Pott's disease. The gravity results from the neurological and life threatening risk. We report a case of suboccipital tuberculosis in a 22-year woman who survived. She was given an anti-tuberculosis antibiotic regimen due to pulmonary and pericardal involvement. The patient interrupted her treatment after four months and was admitted six months later for torticolis and spastic tetraplegia without sphincter disorders. Standard x-rays and MRI of the head confirmed suboccipital Pott's disease. Transcranial evacuation was performed and the patient was again given anti-tuberculosis antibiotics. The clinical course was favorable with definitive recovery 45 days later. The patient continued the antibiotic regimen for nine months. An orthopedic supporting device was worn for nine months. The diagnosis of suboccipital tuberculosis can be confirmed on MRI. Appropriate treatment is a subject of debate between exclusive orthopedic or combined orthopedic and surgical treatment. Prognosis depends on the neurological deficit, early diagnosis and prompt treatment.

[Postero-lateral surgical approach to soft cervical herniated discs. Technical note]. / Abord postéro-latéral des hernies discales cervicales molles. Note technique.

Most ruptured cervical discs are operated on by an anterolateral approach. The posterior approach is an older procedure, nowadays underused because it was associated with a high morbidity, especially in terms of medullary complications. However, posterior approach has evolved in posterolateral route, which is not so devastating and has a very low morbidity rate. It gives excellent functional results when surgery is dedicated to monoradiculopathy from soft posterolateral cervical hernias. It seems appropriate to consider this surgical route as an alternative to anterolateral surgery in these very selected cases. The authors describe and comment the technique.

[Hydatid cyst of the liver]. / Le kyste hydatique du foie.

Hydatid cyst of the liver is a parasitic disease caused by Echinococcus granulosus. The principal complications are infection, biliary duct fistula, and rupture into the peritoneum or chest. Diagnosis has become easier with advances in ultrasonic imaging and CT scanning. Surgery remains the most effective treatment but postoperative complications arise in 30% of cases, particularly when the surgical approach is conservative. Radical surgical approaches give better results and should be used in most cases. Biliocutaneous fistula and infection of the residual cavity are the most common postoperative complications and result in prolonged hospitalization and excess costs. New therapeutic strategies incorporate endoscopic, percutaneous, and medical therapies with surgery and have allowed an improvement in morbidity and mortality due to hydatid cysts of the liver. Until immunization becomes a possibility, preventive measures are necessary to avoid disease recurrence.

[Hydatic cysts of the liver ruptured into the thorax. Diagnostic and therapeutic aspects]. / Les kystes hydatiques du foie rompus dans le thorax. Aspects diagnostiques et thérapeutiques.

Hydatic cysts of the liver can rupture into the thorax. The aim of this work was to demonstrate how abdominal access can be used in most cases. We report 44 cases of hydatic cysts which ruptured into the thorax among a series of 1411 hydatic cysts of the liver operated between 1974 and 1995. Abdominal ultrasound and chest x-ray provided the diagnosis preoperatively in 35/42 operated cases (one case of spontaneous elimination of a hydatic membrane via a cutaneous orifice and one case of preoperative death). Thoracophrenolaparotomy was used in 12 cases, thoracotomy with laparotomy in 6, thoracotomy alone in 5 and laparotomy alone in 19. Pulmonary resections were performed in 18 cases. No procedure could be performed in one patient who died at the beginning of surgery. A breach in the diaphragm was repaired in 41 cases. The dome of the cyst was resected in 29 cases and complete pericystectomy was performed in 12. There were 7 post-operative deaths. There were no deaths in the abdominal access patients. All emergency problems were controlled with abdominal access. Thoracic access was reserved for specific cases.

[Isolated abdominal pain revealing a paraprosthetic fistula in a patient with Takayasu arteritis]. / Douleur abdominale isolée révélant une fistule paraprothétique au cours d'une maladie de Takayasu.

Aortic aneurysms and stenosis occurring in Takayasu arteritis may require aortic prosthesis that can be complicated by aorto-digestive fistula. We report a 41-year-old female who presented with an isolated abdominal pain revealing a para-prosthetic aorto-duodenal fistula complicating a Takayasu arteritis. The diagnosis of aorto-digestive fistula may be difficult if abdominal pain is isolated and imaging inconclusive. Surgical procedure may be necessary to obtain the diagnosis and constitutes the main part of the treatment before fatal outcome.

[Tumoral form of abdominal actinomycosis: a retrospective case series of seven patients]. / Actinomycoses abdominales à forme tumorale : une série rétrospective de sept observations.

PURPOSE: Abdominal actinomycosis is an uncommon chronic infectious disease due to Actinomyces, a Gram-positive bacteria. This saprophytic bacteria of digestive tract and genital mucosa can occasionally become pathogenic mimicking a digestive neoplasia. The aim of this study was to underline diagnostic features of abdominal actinomycosis and to summarize data about clinical, diagnostic and therapeutic approach of this type of infection. PATIENTS: From January 1995 to December 2007, retrospective data concerning patients with abdominal actinomycosis who were followed-up in the University Hospital Sahloul (Sousse, Tunisia) were analysed. RESULTS: Seven patients with abdominal actinomycosis were identified during the study period. All presented with an abdominal mass. The diagnosis of actinomycosis was obtained after surgical resection in all cases. The histological study permitted the diagnosis in six cases, and the surgical samples grew up Actinomyces in two patients. For the five patients who received prolonged and adapted antibiotic therapy, a favourable outcome was observed. CONCLUSION: Actinomycosis must be included in the differential diagnosis of invasive abdominal lesions with "malignant appearance".