Spontaneous rupture of a nongravid uterus: a case report.

Rupture of a gravid uterus is a known complication of a cesarean hysterotomy. Uterine rupture of a nongravid uterus is usually caused by trauma, instrumentation, a pelvic mass, infection, or malignancy. Spontaneous rupture of a nongravid uterus is a rare event with only 4 cases reported in the English literature since 2011. This was the case of a healthy 52-year-old woman with a remote history of 2 cesarean deliveries and an endometrial ablation. The patient presented with severe right lower-quadrant pain. The hospital evaluation revealed a hemoperitoneum, a 5 cm endometrial complex or mass, and layering of blood product along the cesarean delivery scar. Exploration confirmed a spontaneous rupture of the previous hysterotomy. The patient was treated successfully with a total abdominal hysterectomy. Pathology report confirmed the uterine wall defect. Uterine rupture in the non-gravid uterus is a rare event. Presentation may be atypical but consistent with the diagnosis. Spontaneous uterine rupture should be considered in the nongravid patient with abdominal pain and a hemoperitoneum of unclear origin.

[Epidemiology and antimicrobial resistance of Streptococcus pneumoniae strains isolated in Ile de France area during 2001]. / Epidémiologie et résistance aux antibiotiques de Streptococcus pneumoniae en Ile de France en 2001.

OBJECTIVE: The authors wanted to assess the level of Streptococcus pneumoniae antibiotic resistance in Ile de France. METHOD: In 2001, 637 clinical strains of S. pneumoniae were prospectively collected from 32 microbiology laboratories. RESULTS: Fifty one percent of strains were isolated from children under 15 years of age and 49% from adults. In children, 76% of strains came from otitis media, 20% from blood culture, in adults most strains (92%) came from blood culture. The overall prevalence of non-susceptible penicillin pneumococci was 61% higher in children (73%) than in adults (50%). Among the non-susceptible penicillin pneumococci 21.8% were resistant (CMI > 1 mg/l). Strains with decreased susceptibility to amoxicillin and cefotaxime were 38% and 17% respectively. Resistant strains to these two drugs (CMI > 2 mg/l) were rare 2.6% and 0.4% respectively. Among other antimicrobial agents, rate of resistance was 63% to erythromycin, 47% to cotrimoxazole, 40% to tetracycline, and 23% to chloramphenicol. The most frequent serogroups were serogroups 19 and 14, respectively 23% and 18%. Serotypes included in heptavalent vaccine covered 90% of children strains under 2 years of age. CONCLUSIONS: The prevalence of resistance to penicillin was high in children particularly in otitis media pus (76%).

Shema, Vidui, Yivarechecha: what to say and how to pray with Jewish patients in chaplaincy.

A 90-minute focus group was conducted with five male and two female Jewish professional chaplains from Reform, Conservative, and Orthodox backgrounds. This study describes and discusses eight principal themes that emerged from the focus group: (a) the identity, (b) role, and (c) practices of a chaplain; (d) Jewish chaplaincy prayers; (e) practices for chronic versus acute care; (f) patients' reactions to the chaplain's gender; (g) general and spiritual interventions; and, finally, (h) challenges in chaplaincy.

[Case report: positive signals from automated blood-culture system with negative direct Gram examination]. / A propos d'hémocultures détectées positives en système automatisé mais dont l'examen direct est négatif.

Detection of positive haemoculture is usually managed by an automated system. When a bottle is detected positive but that the Gram coloration does not reveal germs by direct examination, transfer onto chocolate blood agar generally allows to confirm or infirm bacteraemia. In light of a case of Fusobacterium nucleatum bacteraemia, we discuss the opportunity of pairing it with an enrichment broth. M. N, hospitalized in the hepatogastroenterology department, runs a fever of undetermined origin. Three pairs of blood samples are collected on May 7th, 2004, another pair on May 9th, 2004 and a last pair on May 10th, 2004. They are incubated in a Bactec 9120 analyzer. A positive signal is detected in the two last anaerobic haemocultures pairs after four days of incubation, but in both cases, the Gram coloration does not bring germs to light. A systematic transfer of the broth onto chocolate blood agar with incubation under CO2 enriched atmosphere and anaerobiosis is carried out. After 24 hours, the solid media remain sterile. The samples found positive by the Bactec(TM) are then transferred onto Schaedler broth in order to favour a potential growth of fastidious germs. The culture will prove to be positive only in this enrichment medium, allowing the identification of F. nucleatum. An hepatic abscess will then be revealed in the patient. It thus appears judicious to associate an enrichment medium with transplanted solid medium when the context is evocative of a real infection (clinic, positivity delays...).

Establishment of a cell line expressing human parvovirus B19 non-structural protein from an inducible promoter.

Human parvovirus B19 non-structural (NS) protein is supposed to play a major role in B19 replication and transcription, and therefore in B19 pathogenicity. Constitutive expression of NS protein in stable cell lines has failed so far, presumably because of its cytotoxicity. To avoid this cytotoxic effect, we have cloned the NS gene in an Epstein-Barr virus episomal vector under the control of a steroid inducible promoter (5xGRE) and transfected this construction into HeLa cells. We obtained stable cell lines inducibly expressing high level of NS protein, with 50% of the cells demonstrating specific nucleo-cytoplasmic staining. In Western blot analysis, three B19 NS proteins (72, 68 and 60 kDa) were found but a unique NS transcript was detected by Northern blotting. The NS protein expressed in HeLa cell lines was demonstrated to be functional as it trans-activates the B19 P6 promoter. These cell lines might be major tools for further study and characterization of B19 NS protein.

[Retrospective study of the value of the RIBA-3 test in 68 patients with discordant serologies with regard to hepatitis C obtained with third generation ELISA tests. Is there still a value in RIBA-3?]. / Etude rétrospective de l'intérêt du test RIBA-3 pour 68 cas de sérologies discordantes vis-à-vis du virus de l'hépatite C obtenues avec des tests ELISA de 3e génération. Reste-t-il un intérêt au RIBA-3?

The aim of the present study is to evaluate the ability of RIBA-3 to resolve cases with controversial ELISA results, since modifications have been introduced by the manufacturer in July 1997 to analyse immunoblot patterns. Sera from 68 patients are studied: 49 controversial cases Ortho/Murex, 17 Ortho/Abbott and 2 cases tested by the three ELISA kits. Indeterminate patterns by ELISA assays remain unresolved in 65% of the samples. RIBA analysis performed in patients with controversial results Ortho/Murex seems to reveal a lack in sensitivity of the Murex kit, but does not show differences in the specificity between these two immunoassays. The RIBA patterns among the samples with Ortho/Abbott controversial results do not demonstrate any discrepancy in the sensitivity of these ELISA tests but it appears that Ortho could be less specific. Our data need to be further confirmed by the analysis of more samples. At last, when the ELISA result is included in the grayzone, the RIBA pattern is generally indeterminate and it is negative in other cases. Finally, the controversial ELISA results, that are mainly found in patients with severe immunosuppression, remain indeterminate depending on the RIBA test. Moreover, the immunoblot is less sensitive and more expensive than any other HCV ELISA test, so there is no convenience to use it for confirmation of a preliminary positive or indeterminate screening.

[A case report of post-rubella myelitis in an adult]. / A propos d'un cas de myélite post-rubéolique chez l'adulte.

Neurological complications following rubella are only rarely encountered. We report a case of isolated myelitis. A 44-year-old healthy female suffered from an erythematous macular rash which rapidly cleared. However, the following days, dysuria initiated hospitalization. On admission, she was febrile but alert and in normal mental status. General physical examination was quite unremarkable. Four days later, she suffered from acute urinary retention, fecal retention and vaginal hypoesthesia. Routine laboratory data, chest skull and spinal column X-rays were unremarkable. The sterile cerebrospinal fluid contained 30 lymphocytes/mm3, 0.48 g/ml of protein but normal amount of glucose. Rubella antibody titers showed a significant elevation and specific IgM were detected by immunocapture. Improvement was rapid and recovery was uneventful except a mild vaginal hypoesthesia that persisted 5 weeks later. Diffuse myelitis occurring shortly after rubella vaccination have also been described. The immunopathological mechanisms by which involvement of the nervous system occurs is far from clear. Little is known about the pathogenesis of post-vaccination myelitis and although the mecanism of sensitization and the specific neural antigens are not known, post-infectious and post-vaccinal myelitis are thought to share a common pathogenic basis.

[Prenatal diagnosis of viral infections. A two year study in Strasbourg]. / Diagnostic prénatal des infections virales. Bilan de deux années d'activité à Strasbourg.

We report here the results of a 2-year study on the prenatal diagnosis of viral infections in Strasbourg. This screening was carried out by virus isolation, by PCR assay, or by detection of IgM fetal antibody for 98 pregnant women at risk of transmitting one of the viruses that causes fetal disease such as parvovirus B19 (B19), Herpesviruses [cytomegalovirus (CMV), varicella-zoster virus, herpes simplex virus] and rubella virus. A viral etiology was proven in 7 out 98 cases: PCR applied to B19 DNA detection was positive in 5 amniotic fluids (AF), 2 fetal serums and one ascitic liquid. The diagnosis of 2 cases of CMV infection was obtained by both PCR and virus isolation in AF from twins fetuses. The detection of specific IgM in maternal serum or fetal serum is useful to achieve the diagnosis but serological tests on other samples have no efficiency. No virus was found in any other specimen, but the genome of Toxoplasma gondii was detected by PCR in 1 of 17 AF samples analyzed at the Institut de Parasitologie. These findings show that PCR assay is a sensitive method for the positive diagnosis of intrauterine infection and promises to careful follow-up of the pregnancy.

Line probe assay for detection of human immunodeficiency virus type 1 mutations conferring resistance to nucleoside inhibitors of reverse transcriptase: comparison with sequence analysis.

We compared the line probe assay (LiPA) to sequence analysis for the detection of mutations conferring resistance to nucleoside inhibitors of human immunodeficiency virus type 1 (HIV-1) reverse transcriptase (RT). Plasma samples from 40 patients who had received zidovudine, dideoxyinosine, and dideoxycytosine, alone or in combination, and who were enrolled in the ALTIS 2 clinical trial (lamivudine [3TC] plus stavudine) were tested at enrollment and at week 24. RT PCR products from plasma were used for LiPA, and DNA was used for sequence analysis. LiPA gave uninterpretable results for 8.5% of the analyzed codons corresponding to 63 samples, mainly for codons 41, 69, and 70. Several minor discrepancies between the two methods occurred, mainly due to the ability of LiPA to detect mixed populations while sequence analyses detect a single homogeneous population. LiPA is suitable for detecting mixed populations and easy to implement in clinical laboratories and might be useful for epidemiological surveys of primary HIV-1 resistance.

Identification of constitutional WT1 mutations, in patients with isolated diffuse mesangial sclerosis, and analysis of genotype/phenotype correlations by use of a computerized mutation database.

Constitutional mutations of the WT1 gene, encoding a zinc-finger transcription factor involved in renal and gonadal development, are found in most patients with Denys-Drash syndrome (DDS), or diffuse mesangial sclerosis (DMS) associated with pseudohermaphroditism and/or Wilms tumor (WT). Most mutations in DDS patients lie in exon 8 or exon 9, encoding zinc finger 2 or zinc finger 3, respectively, with a hot spot (R394W) in exon 9. We analyzed a series of 24 patients, 10 with isolated DMS (IDMS), 10 with DDS, and 4 with urogenital abnormalities and/or WT. We report WT1 heterozygous mutations in 16 patients, 4 of whom presented with IDMS. One male and two female IDMS patients with WT1 mutations underwent normal puberty. Two mutations associated with IDMS are different from those described in DDS patients. No WT1 mutations were detected in the six other IDMS patients, suggesting genetic heterogeneity of this disease. We analyzed genotype/phenotype correlations, on the basis of the constitution of a WT1 mutation database of 84 germ-line mutations, to compare the distribution and type of mutations, according to the different symptoms. This demonstrated (1) the association between mutations in exons 8 and 9 and DMS; (2) among patients with DMS, a higher frequency of exon 8 mutations among 46, XY patients with female phenotype than among 46,XY patients with sexual ambiguity or male phenotype; and (3) statistically significant evidence that mutations in exons 8 and 9 preferentially affect amino acids with different functions.