[Management of biliary fistulas in surgery for hepatic hydatid cyst]

One of the most important problems of the surgical treatment of the hydatid disease of the liver is the remaining cavity of the cyst. Its evolution is mainly decided by the existence and the debit of a biliary fistula. During 10 years (1997-2006), 138 patients with 166 hydatid cysts of the liver were admitted and operated in our clinic. Among them, 57 cysts had a biliary fistula, found during the operation, while in 11 other patients the fistula became obvious 1 or 2 days after the procedure. The incidence of biliary fistulas (68 of 166 cases, which means 41%) is higher, due to the location of the cysts, mainly in the central parts of the liver. There were 44 (65%) low debit fistulas and 24 (35%) high debit fistulas. Our surgical attitude regarding the cavities with biliary fistulas has considerably changed; while between 1997-2000 an anastomosis with a Y or Omega jejunal loop was the most frequent technique, nowadays we use the external drainage of the cavity, associated to endoscopic sphincterotomy, for fistulas with large volumes (more than 300 ml/day) and/or persistent. Whenever it is possible, we practice the direct suture of the biliary fistula.

Predictive value of clinical and microbiological parameters for the treatment outcome of scaling and root planing

OBJECTIVES

To compare the clinical and microbiological outcome of non-surgical periodontal therapy after 6 months with data obtained after hygienic phase or 6 weeks after completion of non-surgical therapy, in order to evaluate the value of clinical and microbiological parameters to predict treatment success.

MATERIAL AND METHODS

Clinical and microbiological data were available from 271 sites in 10 systemically healthy non-smokers with moderate-to-advanced chronic periodontal disease (24-32 sites per individual). Subgingival plaque samples were tested for the presence of Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Tannerella forsythensis and Treponema denticola using RNA probes.

RESULTS

Stepwise multiple linear regression analysis revealed a significant impact of the number of sites with visible plaque index >1 after hygienic phase on the bleeding tendency of a subject at month 6 (p<0.01). Furthermore, an association could be demonstrated between the number of residual pockets (PD>3 mm) 6 months after therapy and the number of bleeding sites and suppurating sites after hygienic phase (p=0.016). Six weeks after therapy, the mean total bacterial loads had a significant impact on the bleeding tendency of a subject at month 6 (p<0.01). Although the average numbers of sites with persisting P. gingivalis, A. actinomycetemcomitans, T. forsythensis and T. denticola seemed to be very similar 6 weeks and 6 months after therapy, large variations were noted between subjects, and therefore the microbiological status of a subject at week 6 could not predict the status at month 6.

CONCLUSIONS

The present study showed a limited potential of microbiological tests, performed after hygienic phase or shortly after non-surgical periodontal therapy, to predict the clinical outcome 6 months later, but confirmed the importance of an establishment of perfect oral hygiene before non-surgical therapy.

[Small bowel tumors -- peculiarities of diagnosis and evolution]

The authors analyze 13 cases of small bowel tumors. There are emphasized the difficulties of diagnosis, which is rarely established before the laparotomy. In the same time, clinical features are few and operations are often performed too late, in emergency, due to tumors complications (perforation, bleeding, occlusion). There are also presented new etiopathogenic hypothesis, recently mentioned in literature. Surgical treatment is followed by many post-operative complications. Five-years survival is low, under 40% of patients.

Non-covalent binding of benzaldehyde to beta-lactoglobulin: characterisation by spectrofluorimetry and electrospray ionisation mass-spectrometry

β-Lactoglobulin (β-lg), which is found in the milk of several mammal species, is the most abundant protein in bovine whey (McKenzie, 1971). The interaction properties of β-lg with a large variety of small hydrophobic ligands have been extensively studied (Sawyer et al. 1998). β-Lg belongs to the super-family of hydrophobic molecule transporters called the lipocalins, which characteristically bind hydrophobic ligands inside a central calyx (Godovac-Zimmermann, 1988; Perez et al. 1989; Brownlow et al. 1997; Wu et al. 1997; Qin et al. 1998).

At present, whey protein concentrates containing a high percentage of β-lg are commercially available in a very large quantity, but most of the processes used in milk technology involve heat-treatments that are known to affect the initial conformational state of β-lg. Such conformational changes have consequences for both the physicochemical and functional properties in food systems, including a decrease in the availability of lysine, due to Maillard reactions (Léonil et al. 1997) and a decrease in the affinity constant for binding to retinol (Laligant et al. 1991) and to flavour compounds (O'Neil & Kinsella, 1988). In the field of protein-volatile compound interactions, we have recently reported a significant enhancement of foaming properties of β-lg solutions (50 mM-NaCl, pH 6) in the presence of aroma compounds such as isoamyl acetate (Marin & Relkin, 1999), benzaldehyde (BZA; Marin & Relkin, 2000) and vanillin (Relkin & Vermersh, 2000). The observed increase in foaming properties of β-lg was postulated to be due to formation of surface active complexes between β-lg and aroma compounds.

In the present work we have investigated the interaction between a β-lg concentrate (prepared by ultra-diafiltration on an industrial scale) and BZA; particularly, evidence was sought for the presence of covalently bound monomers, dimers and lactolated monomers.

[Acute abdomen and diabetic patients--difficulties of diagnosis and therapeutical decision]

We present a retrospective study based on 50 diabetic patients with acute abdominal diseases. Usually, clinical features were not typical, without defining signs of acute abdomen, despite frequent severe anatomo-pathological forms (6 of 12 acute appendicitis were gangrenous, with generalised or localised peritonitis; 15 of 22 acute colecystitis were gangrenous). In diabetic patients, with metabolic disorders and cetoacidosis, positive diagnosis and the decision of laparotomy are difficult problems, often delated, with a negative influence on the evolutions and prognosis of these patients.

Microbial Community Composition and Ecology of an Acidic Aquatic Environment: The Tinto River, Spain

We studied the correlation between physicochemical and biological characteristics of an acidic river, the Tinto River, in Southwestern Spain. The Tinto River is an extreme environment characterized by its low pH (mean of 2.2) and high concentrations of heavy metals (Fe 2.3 g/L, Zn 0.22 g/L, Cu 0.11 g/L). These extreme conditions are the product of the metabolic activity of chemolithotrophic microorganisms, including iron- and sulfur-oxidizing bacteria, that can be found in high concentrations in its waters. The food chain in the river is very constrained and exclusively microbial. Primary productivity in the Tinto River is the sum of photosynthetic and chemolithotrophic activity. Heterotrophic bacteria and fungi are the major decomposers and protists are the major predators. A correlation analysis including the physicochemical and biological variables suggested a close relationship between the acidic pH values and abundance of both chemolithotrophic bacteria and filamentous fungi. Chemolithotrophic bacteria correlated with the heavy metals found in the river. A principal component analysis of the biotic and abiotic variables suggested that the Tinto River ecosystem can be described as a function of three main groups of variables: pH values, metal concentrations, and biological productivity.

[Evaluation of the adherence to nursing care protocols in a district]

An experience of construction and implementation of nursing care protocols and procedures for district nurses is described. A course was offered to all the district nurses, where the indications for the nursing care of some common patients' problems (pressure sores management, mobilization of the stroke patient, the management of patients in pain; the nursing care to stoma patients etc.) were presented. After having compared their work habits with the indications derived from the literature, the nurses were asked to produce protocols and procedures for the problems addressed during the course. The protocols were revised by experts and formally adopted by the responsible of the District, printed in a booklet and mailed with an official letter, to all the district nurses. After two years from the mailing, the knowledge of the nurses (44) on the areas covered by the guidelines was assessed with a multiple choice questionnaire. The level of knowledge varied from 100% of correct answers for the meatal care before catheterization, to the 23% of correct answers on how to remove the needle from a port-a-cath system. The level of knowledge was dishomogenous not only across nurses but also across subjects. In fact low level of correct answers were obtained also for frequently encountered problems, such as patients with pressure sores. The possible causes of the failure of the implementation of the guidelines are discussed.

[Communication in the patient care team about palliative situations' results of a survey at the Laennec Hospital, Paris]

The authors report results from a sample survey in a university hospital in connection with the aspects of communication in medical team about paliative situations. The questionnaire, made from a paliative care group, consults the usual practices and during crisis just as patient is dying, in a curative medical care. Hospital is not a place to die. Difficulty in survey are probably in keeping with individual and collective defences opposite to dying patient.

[Tuberculous adenopathies of the mediastinum: surgical experience in adults]

Fifty eight patients were treated for mediastinal tuberculous adenopathies in the thoracic surgery department from 1986 to 1992. Surgery was diagnostic in 49: mediastinoscopy n = 42, left anterior mediastinotomy n = 3, thoracotomy n = 3 and video assisted surgery n = 1. Surgery was in view of cure in 9: bronchial fistula despite medical treatment n = 6, recurrence under medical treatment n = 3. Mediastinal tuberculous adenopathies rarely complicate in adults. Surgical treatment is quickly effective in prolonging and complicating cases under medical treatment and also probably diminishes the risk of bronchial and pulmonary sequellaes.

Environmental airborne tremolite asbestos pollution and pleural plaques in Afghanistan

A 51-year-old man underwent pleuroscopy for radiologic pleural abnormalities. Pathologic examination of pleural and lung biopsy specimens concluded on hyalinized pleural plaques associated with mild asbestosis. Transmission electron microscopy analysis showed significant retention of tremolite asbestos fibers. The absence of any occupational exposure to asbestos and the existence of geologic deposits of tremolite in the Kabul area of Afghanistan suggest an environmental exposure during the patient's childhood spent in this region.

The evolutionary history of Drosophila buzzatii. XXIII. High content of nonsatellite repetitive DNA in D. buzzatii and in its sibling D. koepferae

The frequency and types of repetitive nonsatellite DNA of two sibling species of the repleta group of Drosophila, D. buzzatii, and D. koepferae have been determined. For each species, the analysis is based on a sample of more than 100 clones (400 kb) obtained from genomic DNA. A theoretical model has been developed to correct for the presence of a mixture of repetitive and unique DNA in these clones. After correction, a high content of repetitive DNA has been demonstrated for both species (D. buzzatii, 19-26%; D. koepferae, 27-32%). The repetitive sequences have been classified according to their hybridization pattern when used as probes against genomic DNA and by their in situ hybridization signals on polytene chromosomes. Data suggest that the main nonsatellite component of these species is simpler and more repetitive than that of D. melanogaster, pointing to a wide variability in content and class size distribution of repetitive DNA among Drosophila species.

Osteoarticular tuberculosis of the symphysis pubis presenting as a hypogastric cystic mass in a woman with primary Sjögren's syndrome

A 79-year-old woman with primary Sjögren's syndrome and immune thrombocytopenia presented with a hypogastric cystic mass. Twenty-three months previously she received a 7-month course of prednisone at moderate doses to control the thrombocytopenia. A computed tomography showed a cystic mass, destruction of the left pubis with involvement of the symphysis and erosion of the right pubis. The cystic mass was surgically removed. Epithelioid granulomata were found on pathological examination and Mycobacterium tuberculosis was grown in Löwenstein medium. This is the first reported case of osteoarticular tuberculosis with such a presentation and only the second localized to the pubis.

Sexual isolation in Drosophila. I. Theoretical models for multiple-choice experiments

Several simple models are developed to calculate expected mating frequencies in ethological isolation experiments. They take into account the effect that the peculiar sexual behavior of Drosophila species can have in multiple-choice experiments. These models depend on only three basic parameters: male competitive ability (C), female receptivity (R) and the coefficient of females acceptance (A). Two types of model can be distinguished: (1) models with discrete preferences, in which A is a measure of the percentage of females accepting a particular kind of male and (2) models with continuous preferences, in which A represents the probability of acceptance for each courtship. It is demonstrated that the information rendered by just one experiment, although effective for determining whether sexual isolation exists, it is insufficient to estimate its degree or to demonstrate that it is asymmetrical. Further developments of the models under more complex conditions as well as their implications for reinforcement and founder effect theories are discussed.

Chromosome location of a family of genes encoding different acidic ribosomal proteins in Saccharomyces cerevisiae

DNA probes from the genes encoding the acidic ribosomal proteins L44, L44' and L45, as well as from reporter genes for chromosomes IV, VII, XII and XV, have been hybridised to Southern blots of Saccharomyces cerevisiae DNA resolved by pulsed field gel electrophoresis. The protein L44' and protein L45 genes have been found to hybridise to chromosome IV, identified by the CAT1 gene probe, while the protein L44 probe hybridises with a band containing chromosomes VII and XV, identified by the ATPase 1 and HIS3 genes respectively.

[Cat-scratch disease. Comments on a clinical case]

The authors present a clinical case of cat's scratch disease, with lymphadenitis and inoculation pustule. A series of observations are made on the importance of anamnesis, histopathologic examination, elimination of other clinical entities with lymphadenopathic manifestations, for determining the diagnosis. The recent investigations are aimed at identifying the etiologic agent. The treatment of the disease is symptomatic.