[Experience feed back committee in radiotherapy (CREx): a compulsory tool for security management evaluation at two years]. / La cellule de retour d'expérience (CREx) en radiothérapie: un outil indispensable au management de la sécurité. Une évaluation après deux ans d'activité au centre Oscar-Lambret.

After working on treatment organisation in radiotherapy (bonne pratiques organisationnelles en radiothérapie - action pilote MEAH 2003), the development of a security policy has become crucial. With the help of Air France Consulting and the MEAH, three cancer centers in Angers, Lille and Villejuif worked together on the implantation of experience feed back committees (CREx) dedicated to the registration, analysis and correction of precursor events. After two years, we report the centre Oscar-Lambret experience in Lille and try to get the recommendations for generalisation of the process. This seems now to be compulsory for security management in oncology.

[Two cases of FSH secreting adenomas (author's transl)]. / Deux cas d'adénome hypophysaire à FSH.

The authors report two cases of FSH secreting adenomas in men and attempt to draw out some features of these very uncommon pituitary tumors. Absence of gynecomastia is emphasized. Diagnosis proceeds from systematic radio-immunoassay of pituitary hormones. Evidence of FSH secretion results from paradoxical gonadotropin stimulation by TRH and secretory granules seen by electronic microscope. Immunofluorescence studies are still to perform. Dynamic testicular secretion and, in one case, histologic examination were performed.

Doxycycline in the treatment of respiratory tract infections. Results of a pan-European multi-centre trial.

In the winter of 1973-4, general practitioners from seven European countries took part in a multi-centre trial of doxycycline in the treatment of infections of the respiratory tract. The carefully designed protocol was observed by all participants. A total of 1,747 patients were admitted to the trial; their ages ranged from 6 years to over 80. The commonest diagnoses (50%) were acute bronchitis and acute exacerbations of chronic bronchitis. On the recommended dosage of 200 mg doxycycline on the first day, followed by 100 mg daily thereafter (though 200 mg could be continued daily in severe cases), 87% of patients achieved good or very good results. Both subjective (pain) and objective (sputum volume and viscosity, temperature, cough) measures showed rapid improvement, usually by the third to fifth days. Side-effects were minimal and mainly gastrointestinal and caused only 4 patients to discontinue treatment. Overall, doxycycline proved its effectiveness and rapidity of action.

[Cholestatic icterus due to oral contraceptives]. / Ictère cholestatique des contraceptifs oraux.

PIP: A case report of cholestatic jaundice in a 25 year old woman, who had had jaundice at age 4 years, and had taken Stediril (a combined oral contraceptive) for 1 month, implicates either the pill or a possibly hereditary hyperlipidemia. The jaundice developed in 2 weeks with vomiting, epigastric pain, anorexia, then discolored urine and feces, and intense pruritus. On hospitalization the patient had moderate bilirubinemia (56 mg/1), low alkaline phosphatase (13 U.K.) and slightly high serum glutamate pyruvate transaminase (270 U.W.). There were elevated serum cholesterol (3 gm/1), triglycerides (2.05 gm/1), total lipids (10.6 gm/1), and a definitely increased pre-beta lipoprotein, suggesting hyperlipidemia type IV (Frederickson classification). Liver biopsy showed fibrosis of the portal spaces lymphocytic infiltration, canalicular and intrahepatocytic thrombi. On laparoscopy the liver had a regular lower border, normal volume color and surface. Albumin, prothrombin and flocculation tests were normal. The patient's jaundice lasted about 1 month, then liver function slowly improved, although pruritus remained intense. Probably this jaundice was due to oral contraceptives, in a patient predisposed either by jaundice in childhood or endogenous hyperlipidemia.^ieng

Evaluation of the Epsilometer test (E test) for testing the susceptibility of coagulase-negative staphylococci to teicoplanin.

The antimicrobial susceptibilities of 118 clinical isolates of coagulase-negative staphylococci to teicoplanin were determined by disc diffusion and the Epsilometer test (E test) and the results were compared with the MICs determined by the agar dilution method of the National Committee for Clinical Laboratory Standards (NCCLS). There was a poor correlation of r = 0.5 between the zone diameters of inhibition and agar dilution MICs and 10 and four of the 11 isolates for which the MICs were > or = 32 mg/L were misclassified as susceptible by the disc test after applying the interpretative criteria of the NCCLS and the Comité de l'Antibiogramme de la Société Française de Microbiologie (CASFM), respectively. The E test tended to result in MICs that were lower than those determined by agar dilution and only 66% of MIC were within +/- 1 log2 dilution of each other. Only one of 11 resistant strains was detected by the E test and, although there was no false resistance, six resistant strains were misclassified as susceptible after applying the criteria of the NCCLS as were four such isolates when the criteria of the CASFM were employed, probably as a result of using too light an inoculum. Disc diffusion is not a reliable means of determining the susceptibility of coagulase-negative staphylococci but might be replaced by the E-test provided that discrepant results can be resolved by using a denser inoculum.

Comparison of different beta-lactam-glycopeptide-gentamicin combinations for an experimental endocarditis caused by a highly beta-lactam-resistant and highly glycopeptide-resistant isolate of Enterococcus faecium.

A synergistic bactericidal effect between penicillin, vancomycin, and gentamicin has been described against enterococci highly resistant to beta-lactams and glycopeptides. Since such a synergy was also observed in vitro between ceftriaxone, teicoplanin, and gentamicin against Enterococcus faecium 70/90, the efficacy of different combinations including penicillin or ceftriaxone, vancomycin or teicoplanin, and gentamicin was compared in vivo in experimental endocarditis. In vitro, all four triple combinations provided a bactericidal effect. In rabbits, after a 5-day treatment, the ceftriaxone-vancomycin-gentamicin combination was the most effective, both in reducing the total bacterial titers and in eradicating the subpopulation resistant to the synergy. Compared with the 5-day regimen, 10- and 20-day regimens of ceftriaxone-vancomycin-gentamicin, each followed by a 3-day antibiotic-free period, increased the number of sterilized animals but failed to avoid the emergence of resistant bacteria, which occurred in 10%-20% of animals.

Activation of G-proteins by receptor-stimulated nucleoside diphosphate kinase in Dictyostelium.

Recently, interest in the enzyme nucleoside diphosphate kinase (EC2.7.4.6) has increased as a result of its possible involvement in cell proliferation and development. Since NDP kinase is one of the major sources of GTP in cells, it has been suggested that the effects of an altered NDP kinase activity on cellular processes might be the result of altered transmembrane signal transduction via guanine nucleotide-binding proteins (G-proteins). In the cellular slime mould Dictyostelium discoideum, extracellular cAMP induces an increase of phospholipase C activity via a surface cAMP receptor and G-proteins. In this paper it is demonstrated that part of the cellular NDP kinase is associated with the membrane and stimulated by cell surface cAMP receptors. The GTP produced by the action of NDP kinase is capable of activating G-proteins as monitored by altered G-protein-receptor interaction and the activation of the effector enzyme phospholipase C. Furthermore, specific monoclonal antibodies inhibit the effect of NDP kinase on G-protein activation. These results suggest that receptor-stimulated NDP kinase contributes to the mediation of hormone action by producing GTP for the activation of GTP-binding proteins.

In vitro interactions between different beta-lactam antibiotics and fosfomycin against bloodstream isolates of enterococci.

The effects of 16 different beta-lactam-fosfomycin combinations against 50 bloodstream enterococci were compared by a disk diffusion technique. Cefotaxime exhibited the best interaction. By checkerboard studies, the cefotaxime-fosfomycin combination provided a synergistic bacteriostatic effect against 45 of the 50 isolates (MIC of cefotaxime at which 90% of the isolates were inhibited, >2,048 micrograms/ml; MIC of fosfomycin at which 90% of the isolates were inhibited, 128 micrograms/ml; mean of fractional inhibitory concentration indexes, 0.195). By killing curves, cefotaxime (at 64 micrograms/ml) combined with fosfomycin (at > or = 64 micrograms/ml) was bactericidal against 6 of 10 strains tested.

Bordetella bronchoseptica pneumonia with shock in an immunocompetent patient.

Bordetella bronchoseptica is a rarely reported cause of human infection, but is a common respiratory tract commensal of mammals. Human infection with B. bronchoseptica is almost always associated with severe underlying disease and contact with an appropriate animal reservoir. We report a case of pneumonia with shock caused by B. bronchoseptica in an immunocompetent patient.

[Type IIb primary hyperlipoproteinemia. An homogenous series of 412 cases]. / Hyperlipoprotéinémie primaire de type IIb. Une série homogène de 412 observations

On the basis of a homogeneous series of 412 cases of type IIb primary hyperlipoproteinaemia, the authors compare their experience with findings in the literature. The prevalence of this type of hyperlipoproteinaemia in the general population has been underestimated at 3%. Biological diagnosis remains simple (identification of a double and distinct excess in beta and pre beta lipoproteins). Extravascular lipid deposits (gerontoxon, xanthelasma, tendon xanthomata) are not type specific. Hyperlipidaemic syndrome is rare. Above all, the importance of type IIb in atheromatous disease in the young subject now seems obvious. The mode of hereditary transmission of the familial anomaly is not certain but would appear to be often associated with a double heterozygote condition.

[Ludo Van Bogaert's cerebro-tendinous xanthomatosis. Apropos of 2 cases]. / Xanthomatose cérébro-tendineuse de Ludo Van Bogaert. A propos de deux observations.

The authors report of two familial cases of Ludo Van Boggert cerebro-tendinous xanthomatosis. Biochemical studies carried out in one of the patients confirmed the work of Salen indicating that the disorder is due to an enzyme problem in the hepatic synthesis of primary bile acids from cholesterol (fault in the production and cholic and chenodesoxycholic acid an an increase in the synthesis of cholestanol).