[Scrofuloderma: a misleading lesion]

We describe a case of scrofuloderma in an 8-year-old boy with a cutaneous tuberculosis lesion.

CASE REPORT

The child had spent holidays in Morocco. He presented a cutaneous lesion of the thigh which turned into an abscess with suppuration, in spite of surgical drainage. The lymph node analysis showed Koch bacilli and granuloma, leading to the diagnosis of scrofuloderma. Further exams found no other lesion. The course was favorable under treatment.

COMMENTS

With lupus vulgaris, scrofuloderma is the most common cutaneous tuberculosis lesion in children, particularly in developing countries. It is often associated with other organ lesions, such as bone or lung, and these must be sought. Scrofulodermas are unusual in Western countries, leading to misdiagnosis. Fortunately, adapted treatment most often results in recovery.

Prenatal diagnosis of lobar bronchial atresia

We report three cases of fetal lobar bronchial atresia referred to our Fetal Medicine Center during the mid-trimester of pregnancy over the last 15 years. Lobar bronchial atresia can mimic a main stem bronchial atresia on mid-trimester ultrasound examination as it induces extensive lobar enlargement, major mediastinal shift and eversion of the diaphragm. It was associated with severe pulmonary hypoplasia in all three cases, even though polyhydramnios and ascites were absent in two. Termination of pregnancy was performed at parental request after extensive counseling in each of the cases and necropsy confirmed one or two enlarged lung lobes leading to major compression of the remaining lobe(s) of the ipsilateral lung, the contralateral lung and the heart. No other anomalies were observed and the karyotype was normal in all cases.

Investigation of memory B cell responses to hepatitis B surface antigen in health care workers considered as non-responders to vaccination

Up to 20% of health care workers are considered as non-responders to hepatitis B vaccination (anti-HBs<10 m UI/ml in serum). We have explored memory B cells differentiated in vitro into anti-HBs antibody-secreting cells (anti-HBs-SCs) by ELISPOT assay. Anti-HBs-SCs were detected in vaccinated responders (n = 11) and non-responders (n = 10) but IgG anti-HBs-SCs were significantly lower in the non-responder group (p<0.001). Low amounts of HBs antibodies were also quantified by ELISA in non-responders' sera. These results indicate that a suboptimal B cell response exists in non-responders to HBV vaccination. This B cell response may mediate a protection against clinically significant breakthrough hepatitis B infection.

Isolation and characterization of bacterial strains with inulinase activity

Thirty-two bacterial strains growing on inulin as the sole carbon and energy source were isolated from soil samples by enrichment culture on a mineral medium. Twenty of the strains were identified as Flavobacterium multivorum. All the bacteria contained a beta-fructosidase that was active on both inulin and sucrose. The enzyme activity was cell bound and was produced at the end of the growth phase. These enzymes have potential uses in the preparation of fructose syrups from inulin and invert sugar from sucrose.

Mineralogy and pore water chemistry of a boiler ash from a MSW fluidized-bed incinerator

This paper presents an investigation of the mineralogy and pore water chemistry of a boiler ash sampled from a municipal solid waste fluidized-bed incinerator, subject to 18 months of dynamic leaching in a large percolation column experiment. A particular focus is on the redox behaviour of Cr(VI) in relation to metal aluminium Al(0), as chromium may represent an environmental or health hazard. The leaching behaviour and interaction between Cr(VI) and Al(0) are interpreted on the basis of mineralogical evolutions observed over the 18-month period and of saturation indices calculated with the geochemical code PhreeqC and reviewed thermodynamic data. Results of mineralogical analyses show in particular the alteration of mineral phases during leaching (e.g. quartz and metal aluminium grains), while geochemical calculations suggest equilibria of percolating fluids with respect to specific mineral phases (e.g. monohydrocalcite and aluminium hydroxide). The combination of leaching data on a large scale and mineralogical analyses document the coupled leaching behaviour of aluminium and chromium, with chromium appearing in the pore fluids in its hexavalent and mobile state once metal aluminium is no longer available for chromium reduction.

[The ventilatory response in chronic heart failure population]

Symptom-limited exercise test with peak oxygen consumption measurement possesses a strong prognostic value in chronic heart failure. This parameter allowing notably the selection of patients for heart transplant. Nevertheless, sub maximal effort and beta blocker therapy tend to limit its prognostic value. The ventilatory response evaluated by the minute ventilation - carbon dioxide production (VE/VCO2) linear regression slope during effort is generally considered to be a significant predictor of mortality and hospitalizations in HF population. An enhanced ventilatory response is correlated with a poorer prognostic. In addition, this parameter is not influenced by the intensity of the effort neither by the betablocker therapy. But, physiological determinants are not clear yet. Aim of our study is to confirm the important place of the (VE/VCO2) slope in HF patient's evaluation.

A rare form of midventricular Tako Tsubo cardiomyopathy

We report a case of a rare form of midventricular Tako Tsubo cardiomyopathy characterized by left ventricular angiography and cardiac MRI.

Determination of binary data for neptunium(V) nitrate

A stock solution consisting of a highly concentrated binary solution of neptunium(V) nitrate [NpVO2(NO3)] in water (about 4.5mol kg-1) was prepared and used to obtain a series of binary NpVO2(NO3)-H2O or ternary NpVO2(NO3)-HNO3-H2O solutions whose neptunium concentration ranged between about 0.22 and 4.5mol kg-1. Water activity and/or osmolality of these binary and ternary solutions were measured and used to calculate the variation of the osmotic coefficient of the real or fictive binary solutions versus NpVO2(NO3) concentration. The variation of the mean stoichiometric activity coefficient of this salt in water was then calculated. The densities of these solutions were also measured and used to express the activity coefficient values on both the molar and molal concentration scales.

Dimerization of Np(V) and media effects in concentrated solutions

Highly concentrated (up to 3.56mol L-1) binary solutions of NpO2NO3 were prepared to investigate the self-association of Np(V). By using visible/NIR absorption spectrophotometry and chemometric techniques, Np(V) was shown to be only monomeric below 0.2mol L-1, to exist under its monomeric and dimeric forms between 0.2 and 2mol L-1, to begin to form self-associates of higher degrees above 2mol L-1. In the range 0.2mol L-1 < C Np(V)<2mol L-1, the neptunium distribution between the free NpO2 + and dimeric (NpO2)2 2+ forms was determined by Raman spectroscopy. The simple solution concept was used to establish the activity function for the reaction of dimerization. Such a water activity function can be used to calculate the apparent dimer formation constant for any solution of known composition and water activity, provided that this solution is simple.

Determination of fictive binary data for uranium(IV) nitrate: preliminary results

The concept of simple solutions is applied to a quaternary system of U(NO3)4, HNO3, N2H5NO3 and H2O in order to determine fictive binary data for U(NO3)4. Hydrazinium nitrate solutions were used at low concentrations relative to the nitric acid and uranium(IV) nitrate concentrations, allowing this system to be considered as a ternary (U(NO3)4, HNO3, H2O) system. The simple behavior of the system allowed fictive binary data (osmotic coefficient and density) to be calculated from water activity and density measurements. The results were then used to calculate the coefficients related to Pitzer´s model and to specific interaction theory, used to model the deviation of the concentrated solution from ideality. The results were also used to calculate the activity coefficient of uranium(IV) nitrate in the presence of uranyl(VI) nitrate and nitric acid. The binary data obtained for uranium(IV) nitrate were found to differ significantly from the data for plutonium(IV) nitrate.

Plasma proteasome level is a reliable early marker of malignant transformation of liver cirrhosis

BACKGROUND

Proteasomes are the main non-lysosomal proteolytic structures which regulate crucial cellular processes. Circulating proteasome levels can be measured using an ELISA test and can be considered as a tumour marker in several types of malignancy. Given that there is no sensitive marker of hepatocellular carcinoma (HCC) in patients with cirrhosis, we measured plasma proteasome levels in 83 patients with cirrhosis (33 without HCC, 50 with HCC) and 40 controls.

METHODS AND RESULTS

Patients with HCC were sub-classified into three groups according to tumour mass. alpha-Fetoprotein (AFP) was also measured. Plasma proteasome levels were significantly higher in patients with HCC compared to controls (4841 (SEM 613) ng/ml vs 2534 (SEM 187) ng/ml; p<0.001) and compared to patients with cirrhosis without HCC (2077 (SEM 112) ng/ml; p<0.001). This difference remained significant when the subgroup of patients with low tumour mass (proteasome level 3970 (SEM 310) ng/ml, p<0.001) was compared to controls and patients with cirrhosis without HCC. Plasma proteasome levels were independent of the cause of cirrhosis and were weakly correlated with AFP levels. With a cut-off of 2900 ng/ml, diagnostic specificity for HCC was 97% with a sensitivity of 72%, better than results obtained with AFP. Diagnostic relevance of plasma proteasome measurement was also effective in low tumour mass patients (sensitivity 76.2% vs 57.1% for AFP).

CONCLUSION

The plasma proteasome level is a reliable marker of malignant transformation in patients with cirrhosis, even when there is a low tumour mass.

Cardiovascular rehabilitation increase arterial compliance in type 2 diabetic patients with coronary artery disease

AIMS

The effect of a cardiovascular rehabilitation program on arterial compliance in type 2 diabetes mellitus with coronary disease was studied.

METHODS

Hemodynamic data and arterial compliance were measured with a tonometer (HDI/Pulse wave CR-2000) in coronary artery disease patients with (n=32) and without (n=24) type 2 diabetes before and after a 6-week multidisciplinary cardiac rehabilitation program.

RESULTS

A decrease in heart rate and an increase in stroke volume without significant change in resting cardiac output were obtained in diabetic patients. Arterial compliance of both small and large arteries was significantly increased. In 10 diabetic patients, this increase could be related to an increase in the anti-hypertensive treatment and to the decreased blood pressure. In the 22 remainders, the small artery compliance was significantly increased independently of blood pressure change.

CONCLUSIONS

Exercise training as well as optimization of diabetes and dyslipidemia treatment could explain the improvement of arterial compliance. If these changes are long-lasting and if they improve prognosis remains to be evaluated.

Predicting early mortality among elderly patients hospitalised in medical wards via emergency department: the SAFES cohort study

OBJECTIVES

The aim of the study was, by early identification of deleterious prognostic factors that are open to remediation, to be in a position to assign elderly patients to different mortality risk groups to improve management.

DESIGN

Prospective multicentre cohort.

SETTING

Nine French teaching hospitals.

PARTICIPANTS

One thousand three hundred and six (1 306) patients aged 75 and over, hospitalised after having passed through Emergency Department (ED).

MEASUREMENTS

Patients were assessed using Comprehensive Geriatric Assessment (CGA) tools. A Cox survival analysis was performed to identify prognostic variables for six-week mortality. Receiver Operating Characteristics analysis was used to study the discriminant power of the model. A mortality risk score is proposed to define three risk groups for six-week mortality.

RESULTS

Crude mortality rate after a six week follow-up was 10.6% (n=135). Prognostic factors identified were: malnutrition risk (HR=2.1; 95% CI: 1.1-3.8; p=.02), delirium (HR=1.7; 95% CI: 1.2-2.5; p=.006), and dependency: moderate dependency (HR=4.9; 95% CI: 1.5-16.5; p=.01) or severe dependency (HR=10.3; 95% CI: 3.2-33.1; p < .001). The discriminant power of the model was good: the c-statistic representing the area under the curve was 0.71 (95% IC: 0.67 - 0.75; p < .001). The six-week mortality rate increased significantly (p < .001) across the three risk groups: 1.1% (n=269; 95% CI=0.5-1.7) in the lowest risk group, 11.1% (n=854; 95% CI=9.4-12.9) in the intermediate risk group, and 22.4% (n=125; 95% CI=20.1-24.7) in the highest risk group.

CONCLUSIONS

A simple score has been calculated (using only three variables from the CGA) and a practical schedule proposed to characterise patients according to the degree of mortality risk. Each of these three variables (malnutrition risk, delirium, and dependency) identified as independent prognostic factors can lead to a targeted therapeutic option to prevent early mortality.

[Ileocecal intussusception secondary to a cecal endometriosis]

We report the case of a 43-year-old woman, who presented a complete and non-reductible ileo-cecal intussusception with pre-occlusion. An ileocecal resection with ileocolic anastomosis was performed. The pathologic examination confirmed the diagnosis of colic endometriosis with transmural lesions, causing the intussusception. Altough the digestive endometriosis is quite classical and well-known, particulary with vermiform appendix and rectosigmoïd involvement, ileo-cecal intussusception secondary to endometriosis is rare.

[Comparative study of exercise-induced ischaemia in coronaropathy and aortic stenosis]

OBJECTIVE

To compare exercise and recovery data between a population of patients with proven CAD and patients with pure aortic stenosis (AS).

PATIENTS AND METHODS

Exercise testing results (bicycle ergometry) of 45 patients with AS (34 men, 66+/-12 years, 56+/-20 mmHg peak-to-peak gradient and valve area 0.78+/-0.48cm2) were compared to exercise testing results of 50 patients with CAD (41 men, 65+/-9 years, greater or equal to 70% stenosis on one vessel in 62%, two vessels in 30%, three vessels in 8%).

RESULTS

During exercise, 38% patients with AS and 82% patients with CAD had clinical symptoms. In the AS group, exercise duration was longer, heart rate (HR) was higher, maximal systolic and diastolic blood pressure were lower than in CAD group. The increase of systolic blood pressure was lower in the AS group (34+/-21 mmHg versus 47+/-27 mmHg, p<0.02). Maximal load achieved was not significantly different. Exercise ST depression appeared in 76% of AS group and 88% of CAD group (NS). No difference was found in ST depression, Detrano index and ST segment/HR slope. During recovery, no difference was found in HR variations. Clockwise rotation of the ST/HR recovery loop was more frequent in CAD group (35 patients versus 19 patients, p<0.001).

CONCLUSION

Most of the exercise and recovery data are similar in patients with AS and CAD. Significant discriminating criteria were the increase of systolic blood pressure during exercise and ST/HR recovery loop.

[Value of MRCP for diagnosis of biliary complications after liver transplantation]

PURPOSE

To assess the value of MRCP in the detection of biliary complications after orthotopic liver transplantation.

MATERIALS AND METHODS

27 transplanted patients with suspected biliary complication underwent a total of 34 MR and direct cholangiography procedures. MRCP were reviewed by 2 independent reviewers blinded to clinical and laboratory findings. The biliary tract was divided into 7 segments, and all lesions were evaluated using this segmental anatomy. Each segment was evaluated for the presence of dilatation, stenosis and intra-ductal debris. MRCP results were compared to results frpm direct cholangiography.

RESULTS

216 (98%) of 221 biliary segments could be evaluated on MRCP, with good to excellent visualization in 179 (80%) cases. Segmental analysis showed sensitivity, specificity and accuracy values of 85%, 81% and 83% for the detection of biliary stenosis, 82%, 81% and 81% for the detection of biliary dilatation, and 60%, 88% and 80% for the detection of inyraductal debris.

CONCLUSION

MRCP is accurate for the detection of biliary stenosis and dilatation in patients after liver transplantation and provides an alternative to direct cholangiography.