Changing epidemiological and clinical aspects of imported malaria in Belgium.

BACKGROUND: In the early nineties the increase of imported malaria in some European countries was temporarily halted, but it resumed in 1994. More Africans, more European travelers, and fewer long-term residents were counted amongst patients. A shift towards more subacute disease has been noted. This study intends to assess whether the same trends were observed in Belgium. METHODS: Clinical and epidemiological data of 128 patients treated for malaria in 1997 at the Institute of Tropical Medicine and the University Hospital of Antwerp were compared with 209 malaria patients treated in 1988/1989. Risk factors for clinical presentation and parasitemia were analysed. RESULTS: In Belgium the number of reported imported malaria cases remained almost stable between 1988 and 1997. In 1997, there were more African patients, less infections from Central Africa, and 50% less residents. Less patients reported prophylaxis use. The causative agent shifted from Plasmodium falciparum to other species. Subacute and atypical malaria became less frequent. In both years, there were no deaths, and severe malaria did not increase significantly. Mefloquine disappeared almost as a curative treatment, and was replaced by quinine, with or without a long acting agent, or by halofantrine. The ethnic origin, nor the use of chemoprophylaxis, influenced disease characteristics. In 1988, malaria attacks in the previous months predisposed to subacute disease; longer residence, and attacks in the previous months, protected against high parasitemia; longer symptom duration correlated with absence of fever, and with splenomegaly. None of these risk factors was correlated with severe malaria. CONCLUSION: The incidence of subacute malaria dropped significantly in the last decade. Although this presentation is almost limited to residents, the decline in malaria can not be explained by an overall shorter duration of stay, since the decline in this particular clinical presentation of malaria was also spectacular in residents. Apparently, insufficient treatment of malaria attacks in the previous months is the only independent risk factor.

Early results of a modified Brunelli procedure for scapholunate instability.

Twenty-two patients with a diagnosis of scapholunate instability underwent a modified Brunelli procedure. The overall results of this short follow-up study showed that a majority of patients (17 out of 22) had relief of pain. Grip strength recovered well. Postoperative range of motion was reduced in extension and flexion, remained unchanged for radial deviation and improved for ulnar deviation. The radiological appearance of dynamic or static scapholunate instability did not change after the procedure. Most patients (17 out of 22) felt subjective improvement and would have the operation again. A significantly poorer result was seen in those patients with an unresolved medicolegal claim. Although short-term results are encouraging for some patients, the authors feel that more long-term follow-up is needed before recommending the procedure.

The results of ulnar shortening for ulnar impaction syndrome.

From the Centre tfr Hand Twenty-three wrists in 22 patients (mean age, 37 years) with ulnar impaction syndrome were treated by ulnar shortening. The mean ulnar shortening was 2 mm (range, 1-4 mm). At a mean follow-up time of 33 months, 17 patients had obtained good subjective pain relief and 16 were shown to have a good overall outcome using the Wrightington Hospital Wrist Function Evaluation.

Bassini's hernial repair and adductor longus tenotomy in the treatment of chronic groin pain in athletes.

A prospective study was initiated to evaluate the surgical treatment of chronic groin pain resistant to conservative treatment. Forty-one patients were treated using Bassini's hernial repair and percutaneous adductor longus tenotomy between 1984 and 1998. All patients were males aged 17 to 34 years and were mainly soccer players. Twenty-seven patients underwent a unilateral and 14 a bilateral procedure. All patients had resumed their sporting activities on average 6.9 months after surgery (range 6 to 15 months). Thirty-seven performed at the same level and 4 at a reduced level. Only one patient performed at a lower level due to persistent groin pain. We conclude that, when conservative treatment for pubic pain in athletes fails, a combination of hernial surgery and adductor longus tenotomy can provide successful results.

[Temporal evolution of blood pressure and heart rate reaction to various stressors in coronary and non-coronary subjects (author's transl)]. / Evolution temporelle des variables hémodynamiques en résponse au stress.

The temporal evolution of systolic and diastolic blood pressure and heart rate in reaction to several stresses is measured in a group of 21 post myocardial infarction and 21 non coronary subjects. Heart rate modifications depend essentially upon the nature of stress: catheterization induces tachycardia while a stressing film induces bradycardia. These observations can be connected to environmental intake or rejection. During catheterization stress, the systolic blood pressure is high in both groups but returns to its normal values as soon as the intervention ends. In response to anxiety films, it persists higher in coronary patients than in normal subjects, who do not seem to react to this kind of stress. These results arise the question of either a longer recuperation, or a different reactivity to symbolic stressors (films).

[Temporal evolution of fibrinogen and platelets in reaction to various stressors in coronary and non-coronary subjects (author's transl)]. / Evolution temporelle du fibrinogéne et du nombre de plaquettes en réponse au stress.

Twenty-one postmyocardial infarction patients are compared with twenty-one matching non-coronary subjects. Fibrinogen level as well as whole blood platelet count were measured six times for each subject in a timespan of 2 hours, during which two stress situations are induced. Throughout the experiment, non-coronary subjects show significantly lower levels of fibrinogen and higher blood platelet count. These two variables follow a specific temporal evolution. Stressfull situations are directly related with a significant decrease in the whole blood platelet count. Films inducing a directional anxiety match a lower blood platelet count, as compared to films inducing a diffuse anxiety. A link may be hypothesized between the stress-induced decrease in blood platelet count and the relative thrombopenia of coronary patients.

[Temporal evolution of lipids in reaction to various stressors in coronary and non-coronary subjects (author's transl)]. / Evolution temporelle des lipides en résponse au stress.

In order to assess the impact of coronary disease on sequential physiological reactions to stress, this study compares 21 post myocardial infarction patients with 21 matching non-coronary subjects. In each group, levels of phospholipids, triglycerides, cholesterol, FFA, alpha-, beta, pre-beta-lipoproteins and the ratio cholesterol/triglycerides are assessed, six times consecutively in a timespan of 2 hours. Concomitantly, two stressful situations are induced: the first stress is catheterization, the second is a film implementing either a focused-or diffused anxiety. Phospholipids react essentially to catheterization stress. While the ratio cholesterol/triglycerides turns out to be sensitive to psychological stress, neither cholesterol nor triglycerides alter individually when psychological stress is present. Throughout the experiment, levels of beta-lipoproteins very significantly in time and with respect to the theme of the film attended; coronary patients do not show the same sequential variations as normal subjects do. Variations in alpha-lipoproteins differentiate coronary from normal subjects. Levels of FFA vary according to the nature of the film attended and differ in normal and coronary subjects: extreme values are observed in normal subjects rather than coronary patients. Hyperlipidemia, as a reaction to stress, is a process interlinked with many factors, each increasing the liability of coronary disease.

[Temporal evolution of neuro-endocrine secretions in reaction to various stressors in coronary and non-coronary subjects (author's transl)]. / Evolution temporelle des variables neuro-endocrines en résponse au stress.

The purpose of this study is a comparison of sequential physiolocical reactions to different stressors in 21 post-myocardial infarction and 21 non-coronary subjects. Two stressful situations are induced in a timespan of 2 hours; the first stress is catheterization, the second is a film implementing either a focused or a diffuse anxiety. Throughout the experiment, the following physiological parameters are assessed six times consecutively: levels of catecholamines, cortisol, TSH, insulin and the ratios: adrenalin/fnor-adrenalin and adrenalin/cortisol. Results indicate that levels of adrenalin and cortisol show specific variations with time and are most sensitive to catheterization. Levels of nor-adrenalin very differently with time among coronary patients, as well as they do in normal subjects. Individuals submitted to focused anxiety show increased levels of catecholamines and cotisol, as well as a lower level of insulin than subjects submitted to diffuse anxiety. The sequential evolution of cortisol differs in coronary patients and normal subjects and in function of the type of film attended. Physiological reactions to stress and far more specific and interdependent than prior studies stated in the past. They vary with the degree and the nature of stress. It is our belief that there is no standardised response to stress.

Application of gas-liquid chromatography to the routine identification of nonfermenting gram-negative bacteria in clinical specimens.

A total of 430 strains of glucose-nonfermenting gram-negative bacteria representing 35 species were analyzed for their cellular fatty acid composition by gas-liquid chromatography (GLC). On the basis of qualitative differences in their cellular fatty acid composition, these bacteria could be divided into 19 distinct chromatographic groups. Eight Pseudomonas species, Achromobacter xylosoxidans, group Vd, and Agrobacterium radiobacter were identified from their fatty acid compositions alone. The other glucose-nonfermenting gram-negative bacterial species studied here, classified within nine distinct GLC groups, were easily recognized by using the GLC fatty acid analysis supplemented with a limited number of conventional biochemical tests. The results support the hypothesis that bacterial fatty acid composition is rather specific and that qualitative GLC fatty acid analysis can be adapted in the clinical laboratory either to provide additional criteria for differentiation of closely related groups or to serve as a rapid and highly reproducible method for their routine identification.

Two AIDS patients with life-threatening pancreatitis successfully treated, one with ganciclovir the other with foscarnet.

Two AIDS patients, clinically suspected to have cytomegalovirus (CMV) pancreatitis are described. The first patient was successfully treated with ganciclovir 10 mg/kg/day. This patient refused ganciclovir maintenance treatment and developed 3 other episodes of pancreatitis which responded each time to ganciclovir. The second patient was successfully treated with foscarnet 200 mg/kg/day followed by maintenance foscarnet treatment 100 mg/kg/day. No pancreatitis relapse was observed.

Atypical varicella zoster infection in persons with HIV infection.

Four patients with HIV infection and severe immunodeficiency are described who developed atypical varicella zoster lesions. Three of the patients presented with chronic varicella zoster lesions. In two of them such lesions were hyperkeratotic. All three patients had been treated initially with subtherapeutic doses of acyclovir. In one of the patients the lesions were clinically resistant to high dose acyclovir treatment and disappeared only when renal insufficiency developed during foscarnet-famcyclovir treatment. One patient developed a disseminated varicella zoster infection.

Choledochocele: diagnosis by magnetic resonance imaging.

The value of magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) is demonstrated in a case of a 22-year-old female with a small choledochocele clinically presenting with acute cholecystitis and pancreatitis. Previous abdominal sonography and computed tomography were not diagnostic. MRI and MRCP showed a cystic dilatation of the distal common bile duct, intramurally located in the second portion of the duodenum and protruding into the duodenal lumen. These findings allowed a confident diagnosis of a choledochocele.

Severe myoclonus in a patient recovering from falciparum malaria.

Isolated myoclonus has rarely been reported as a complication of Plasmodium falciparum malaria. We describe the development of chaotic myoclonic jerks in an afebrile and conscious patient, the fourth day of treatment with quinine for P. falciparum infection. The myoclonus finally resulted in a generalized tonic-clonic seizure and coma, which resolved without further antimalarial treatment.

Nosocomial septicaemias in a cardiologic ward. A case-control study.

Nosocomial septicaemias were studied in a cardiologic ward at the University Hospital of Antwerp, Belgium. The incidence of nosocomial infections was found to be 2.7 per 1,000 admissions per year. A case-control study suggested that in contrast with coronarography and pacemaker implantation, percutaneous transluminal coronary angioplasty may be a risk factor for nosocomial septicaemia (OR 4.5, 95% confidence interval 0.7-33.4).