Heterogeneity of sensitization profiles and clinical phenotypes among patients with seasonal allergic rhinitis in Southern European countries-The @IT.2020 multicenter study

BACKGROUND

Pollen allergy poses a significant health and economic burden in Europe. Disease patterns are relatively homogeneous within Central and Northern European countries. However, no study broadly assessed the features of seasonal allergic rhinitis (SAR) across different Southern European countries with a standardized approach.

OBJECTIVE

To describe sensitization profiles and clinical phenotypes of pollen allergic patients in nine Southern European cities with a uniform methodological approach.

METHODS

Within the @IT.2020 multicenter observational study, pediatric and adult patients suffering from SAR were recruited in nine urban study centers located in seven countries. Clinical questionnaires, skin prick tests (SPT) and specific IgE (sIgE) tests with a customized multiplex assay (Euroimmun Labordiagnostika, Lübeck, Germany) were performed.

RESULTS

Three hundred forty-eight children (mean age 13.1 years, SD: 2.4 years) and 467 adults (mean age 35.7 years SD: 10.0 years) with a predominantly moderate to severe, persistent phenotype of SAR were recruited. Grass pollen major allergenic molecules (Phl p 1 and/or Phl p 5) ranged among the top three sensitizers in all study centers. Sensitization profiles were very heterogeneous, considering that patients in Rome were highly poly-sensitized (sIgE to 3.8 major allergenic molecules per patient), while mono-sensitization was prominent and heterogeneous in other cities, such as Marseille (sIgE to Cup a 1: n = 55/80, 68.8%) and Messina (sIgE to Par j 2: n = 47/82, 57.3%). Co-sensitization to perennial allergens, as well as allergic comorbidities also broadly varied between study centers.

CONCLUSIONS

In Southern European countries, pollen allergy is heterogeneous in terms of sensitization profiles and clinical manifestations. Despite the complexity, a unique molecular, multiplex, and customized in-vitro IgE test detected relevant sensitization in all study centers. Nevertheless, this geographical diversity in pollen allergic patients imposes localized clinical guidelines and study protocols for clinical trials of SAR in this climatically complex region.

Clearsight™ use for haemodynamic monitoring during the third trimester of pregnancy - a validation study

BACKGROUND

We assessed the validity of Clearsight™ as a non-invasive cardiac output and stroke volume monitoring device, comparing it with transthoracic echocardiography measurements during the third trimester of pregnancy.

METHODS

Measurements obtained from Clearsight™ were compared with those from echocardiography as the gold standard. The precision and accuracy of the Clearsight™ was measured using the Bland and Altman method. Clinical agreement with echocardiography was assessed using the agreement tolerability index.

RESULTS

Measurements were recorded from 44 pregnant women with a median [IQR range] gestational age of 33 [30-37] weeks. We found that Clearsight™ measurements presented a systematic overestimation of cardiac output, with mean bias [CI 95%] of 2.7 [2.3-3.0] L/min, with limits of agreement of  -0.1 to 5.4 L/min. It overestimated stroke volume, with a bias of 29.5 [25.0-33.4] mL and a limit of agreement of -1.6 to 60.1 mL. In addition, the analysis of cardiac output showed a percentage of error of 41% and intra-class correlation [CI 95%] of 0.37 [0.17 to 0.53, P <0.001]. For stroke volume, the percentage of error was 40% and intra-class correlation 0.16 [-0.1 to 0.34; P=0.27]. We found that agreement tolerability index scores were unacceptable. We evaluated the ability of the device to track changes in cardiac output by inducing a left lateral decubitus position, but the analysis was inconclusive.

CONCLUSION

The agreement between Clearsight™ and the echocardiography measurements of cardiac output and stroke volume were not within an acceptable range in the third trimester of pregnancy.

Lorentz Symmetry Violations from Matter-Gravity Couplings with Lunar Laser Ranging

The standard-model extension (SME) is an effective field theory framework aiming at parametrizing any violation to the Lorentz symmetry (LS) in all sectors of physics. In this Letter, we report the first direct experimental measurement of SME coefficients performed simultaneously within two sectors of the SME framework using lunar laser ranging observations. We consider the pure gravitational sector and the classical point-mass limit in the matter sector of the minimal SME. We report no deviation from general relativity and put new realistic stringent constraints on LS violations improving up to 3 orders of magnitude previous estimations.

Can point-of-care ultrasound predict spinal hypotension during caesarean section? A prospective observational study

Spinal anaesthesia for elective caesarean section is associated with maternal hypotension, secondary to alteration of sympathetic tone and hypovolemia, in up to 70% of cases. Measurement of the subaortic variation in the velocity time integral (VTI) after passive leg raising allows prediction of fluid responsiveness. Our objective, in this prospective single-centre observational study, was to assess the ability of change in VTI after 45° passive leg raising to predict hypotension after spinal anaesthesia. Ultrasound measurements were performed just before elective caesarean section. Anaesthesia, intravenous coloading and prophylactic vasopressor treatment were standardised according to current guidelines. We studied 40 women. Hypotension occurred in 17 (45%) women. The area (95%CI) under the receiver operating characteristics (ROC) curve for the prediction of spinal hypotension was 0.8 (0.6-0.9; p = 0.0001). Seventeen women had a change in VTI with leg elevation ≤ 8%, which was predictive for not developing hypotension, and 11 had a change ≥ 21%, predictive for hypotension. The grey zone between 8% and 21%, with inconclusive values, included 12 women. We suggest that cardiac ultrasound provides characterisation of the risk of hypotension following spinal anaesthesia at elective caesarean section, and therefore may allow individualised strategies for prevention and management.

Testing Lorentz Symmetry with Lunar Laser Ranging

Lorentz symmetry violations can be parametrized by an effective field theory framework that contains both general relativity and the standard model of particle physics called the standard-model extension (SME). We present new constraints on pure gravity SME coefficients obtained by analyzing lunar laser ranging (LLR) observations. We use a new numerical lunar ephemeris computed in the SME framework and we perform a LLR data analysis using a set of 20 721 normal points covering the period of August, 1969 to December, 2013. We emphasize that linear combination of SME coefficients to which LLR data are sensitive and not the same as those fitted in previous postfit residuals analysis using LLR observations and based on theoretical grounds. We found no evidence for Lorentz violation at the level of 10^{-8} for s[over ¯]^{TX}, 10^{-12} for s[over ¯]^{XY} and s[over ¯]^{XZ}, 10^{-11} for s[over ¯]^{XX}-s[over ¯]^{YY} and s[over ¯]^{XX}+s[over ¯]^{YY}-2s[over ¯]^{ZZ}-4.5s[over ¯]^{YZ}, and 10^{-9} for s[over ¯]^{TY}+0.43s[over ¯]^{TZ}. We improve previous constraints on SME coefficient by a factor up to 5 and 800 compared to postfit residuals analysis of respectively binary pulsars and LLR observations.

Lung ultrasound-guided management of acute breathlessness during pregnancy

Lung ultrasonography is a standard tool in the intensive care unit and in emergency medicine, but has not been described in the particular setting of the labour ward. During pregnancy, acute respiratory failure and pulmonary oedema are not uncommon life-threatening events. We present two case reports outlining the potential of lung ultrasonography in parturients. In case 1, lung ultrasonography allowed early diagnosis and treatment of acute dyspnoea in a parturient admitted for suspected asthma exacerbation. Lung ultrasonography revealed a 'B-pattern' of vertical lines radiating into the lung tissue, indicating severe pulmonary oedema complicating previously undiagnosed pre-eclampsia. In case 2, a pre-eclamptic patient was managed with combined transthoracic echocardiography and lung ultrasonography. The accuracy of lung ultrasonography in detecting interstitial oedema at a pre-clinical stage allowed adequate fluid resuscitation in this patient who had a high risk of alveolar pulmonary oedema. We believe that these cases strongly support the prospective validation of lung ultrasound for management of lung disorders in pregnant women.

[Therapeutic management of peritonitis]

Antibiotherapy is a fundamental for the treatment of peritonitis. It may be used before surgery or as a complementary treatment after. Experimental models have demonstrated that infections are both aerobic and anaerobic. During the first stage, septicemic with a high death rate, the infection is due to enterobacteria, mostly Escherichia coli. Between D5 and D7 in surviving animals, there is a second stage with abscesses due to anaerobic bacteria, mostly Bacteroides fragilis. The antibiotic treatment must include these two types of bacteria in its spectrum. The role of Enterococcus faecalis is not clearly defined, but this bacterium must be taken into account in case of organ failure or associated septic shock. Treatment options for secondary peritonitis may be, according to severity, cefoxitin, an Augmentin + gentamycin combination, Tazocillin, or ertapenem. The reference treatment for nosocomial or tertiary peritonitis is the imipenem + amikacin combination. An antifungal treatment (fluconazole) is usually necessary, at least until the results of peritoneal fluid culture are available. The duration of treatment is quite variable, ranging from 48 h in less severe forms to 14 days.

Human papillomavirus infection of the cervix uteri in women attending a Health Examination Center of the French social security

Since human papillomavirus (HPV) is the central causal factor in cervical cancer, understanding the epidemiology of this infection constitutes an important step towards development of strategies for prevention. Six hundred and fifty seven cervical samples were tested for HPV using PCR with consensus primers (MY09/MY11), by genotyping (restriction and sequencing analyses) and by cervical cytology, from women who attended a Health Examination Center of the French social security. Women with no cervical smear as well as women with cytological abnormalities within the last 3 years were recruited. HPV DNA was detected in 7.3% of the women (5.3% for high-risk, 2.4% for low-risk, and 0.5% for unknown risk types) including 6 (0.9%) mixed infections. Fifteen different genotypes were detected, of which genotypes 16 (22.2%), 58 (13.0%), 18 (11.1%), 30 (9.2%), and 33 (9.2%) were the most prevalent. In age group 17-25 years, we found the highest frequencies for both any (22.1%) and high-risk (14.7%) HPV, and prevalences gradually decreased with age. 5.2% of low-grade squamous intraepithelial lesion, 0.3% of high-grade squamous intraepithelial lesion, and 1.2% of atypical squamous cells of undetermined significance were found. The frequencies of high risk and all HPV types were significantly higher in squamous intraepithelial lesions than in those with normal and reactive/reparative changes (P < 0.0001). The prevalence of high-risk HPV in the atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion group (28.6%) was significantly higher than in the normal and reactive/reparative changes groups (3.4%) (P < 0.0001). HPV detection was associated with younger age, single marital and non-pregnant status (P < 0.0001), premenopausal status (P = 0.0004), and contraception (P = 0.0008). Marital status (OR 4.5; 95% CI = 2.3-9.0) and tobacco consumption (OR 3.0; 95% CI = 1.6-5.7) were predictive independent factors of HPV infection. The French system of Health Examination Centers might be of interest for following women regularly, especially those with a low socioeconomic status.

Les agents utilisés pour la sédation en neuro-réanimation

Sedation and analgesia can be routinely prescribed in head injury patients. The goals of such sedation are three: brain protection, prevention and treatment of intracranial hypertension and therapeutic facilitation. In such situation, the use of sedative and analgesic therapy should respect the rate of cerebral blood flow/cerebral oxygen consumption coupling while preserving cerebral perfusion pressure and decreasing the intracranial pressure. This treatment should have an analgesic and myorelaxing action with short and predictable time of action. The ideal sedation agent with all these properties does not exist. Only the combination of several different pharmacological classes of compounds may reach this goal. Benzodiazepines are the most frequently used agents. In most of the cases they are associated with analgesic agents such as opioid or ketamine. Opioids may be the basic analgesic agents because they do not produce brain haemodynamic modifications if arterial pressure is maintained. Among them, sufentanil, thanks to its pharmacokinetics properties, remains the most prescribed opioid. However, in the future, remifentanil that presents a fast elimination may be more frequently used for neurological follow up of patients. Ketamine whose use is subject of debate, has the main advantage of maintaining haemodynamic status. Ketamine has no side effects on brain haemodynamic when used with propofol or midazolam. Taking into account their deleting effect on haemodynamic status and immune system, barbituric are no longer used as long term sedative agents. However, their use is still recommended in the cases of refractory intracranial hypertension. Propofol remains the ideal sedative agent because of its short duration action but its use is limited by its cost. Its use may be recommended for short time sedations with or without an opioid drug. The curare use should be restrain to refractory intracranial hypertension to usual treatments and happening during stimulation.

Quelles perspectives thérapeutiques dans le syndrome septique ?

OBJECTIVE

To evaluate recent data provided on new treatments of patients with septic shock.

DATA EXTRACTION

A Medline search was performed to identify pertinent literature on the pathophysiology of septic shock and treatment strategies from 1990 to 2003. Keywords were "septic shock", "sepsis", "inflammation" and "management".

DATA SYNTHESIS

Advances were performed in our current understanding of pathophysiology of sepsis. The loss of homeostatic balance among the systemic inflammatory response and the disturbance of coagulation with generalized coagulopathy lead to organ failures and death. The administration of activated protein C (drotrecogin alfa) reducing this coagulopathy can decrease the mortality of septic shock patients. The modulation of inflammation did not make it possible to improve survival of septic shock patients until now. The efficacy of low doses of steroid has been recently shown in septic shock patients. In addition, new data highlighted the interest of an early goal therapy in patients with sepsis who are admitted to emergency.

CONCLUSION

The improvement of survival in septic syndrome patients is a difficult challenge. The uses of different new therapeutic options like protein C reactive, steroids, or early goal therapy in association should make it possible to reduce the mortality in septic patients.

Role of glycopeptides in the treatment of septic complications after cardiac surgery

Agents like Staphylococcus epidermidis and Staphylococcus aureus are common agents in both early and late prosthetic valve endocarditis (PVE). Streptococci, especially vividans and enterococci are more apt to occur late. Diphtheroids and gram-negative bacteria are also frequent in early and late PVE. Fungi are found at a frequency of 5 to 8% and a variety of unusual organisms are found in individual case reports. Treatment is based on parenteral therapy with a bactericidal agent that can achieve trough serum levels in excess of 8-10 X MICs of the infecting organisms. Initially the antibiotic selection should be active against the most common isolates. Because most S. epidermidis are beta-lactam-resistant, vancomcyin must be part of the initial empiric regimen. Vancomycin should be combined with rifampin or an aminoglycoside (usually gentamicin) or both. When there is a high level of resistance to aminoglycoside, vancomycin may be used alone until susceptibility data are available and then rifampin can be given together with an aminoglycoside or a quinolone to which the organism is susceptible. The aminoglycoside should be given for a maximum of 2 weeks, to avoid nephrotoxicity, and vancomycin for 6 weeks. Surgery is required in case of major emboli, hemodynamic decompensation, and uncontrolled infection. The presence of bacteremia for more than 1 week may warrant surgical intervention but, if the patient appears to be well and without emboli or hemodynamic problems, serum levels of antibiotic, particularly vancomycin, should be evaluated. Dosage regimen should be modified to achieve trough levels of vancomycin between 15 to 20 microg/ml. Use of vancomycin by continuous infusion may be considered with a targeted blood concentration of 15 to 20 microg/ml.

[Nosocomial infections due to rotavirus and respiratory syncytial virus in pediatric wards: a 2-year study]

Rotavirus and respiratory syncytial virus (RSV) infections represent up to 30% of the totality of nosocomial infections in paediatric wards. We studied the importance of these infections in the paediatric wards of the University Hospital Center of Poitiers, France, from October 1996 to September 1998. We defined as nosocomial an infection acquired after 3 days of hospitalization for rotavirus and after 7 days for RSV. The 274 cases of children presenting rotavirus gastroenteritis or RSV infection within this period were studied. Rotavirus was detected in stools by using an agglutination test and RSV was diagnosed in nasopharyngeal aspirations by direct examination with an immunofluorescence assay (IFA), cell culture and serotyping with IFA. We noted 50 rotavirus and 224 RSV infections, with a first epidemic of RSV subgroup B (49.5%) and a second epidemic of subgroup A (44.9%). 19 (38%) were rotavirus nosocomial infections and 5 (2.2%) were RSV nosocomial infections. The majority of the nosocomial infections occurred before the age of one year and particularly before the age of 6 months (42.2% for rotavirus, 60% for RSV). In comparison to community-acquired infections, children with rotavirus nosocomial infections were younger (9 months versus 12.5 months) which was the opposite for RSV nosocomial infections (10.8 months versus 6.5 months). The sex-ratio of children with community-acquired infections was 2.1 that was not reported in nosocomial infections. The length of stay in hospital was always longer in nosocomial infections (11.7 days versus 3.6 days for rotavirus; 38.8 days versus 4.8 days for RSV). Diarrhea (p = 0.007) and vomiting (p = 0.013) for enteric infections and wheezing (p = 0.02) for respiratory infections were more often observed in community-acquired infections. This study emphasizes the frequency and the consequences of rotavirus and RSV nosocomial infections in paediatric wards and the importance of the hygienic rules to prevent these infections.

Nucleotide sequence analysis of human T-cell lymphotropic virus type I pX and LTR regions from patients with sicca syndrome

Human T-cell lymphotropic virus type I (HTLV-I) is associated with adult T-cell leukemia (ATL) and tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM). Other inflammatory disorders may occur in HTLV-I-infected patients, such as sicca syndrome resembling Sjögren's syndrome. The sicca syndrome may be the unique clinical manifestation of HTLV-I infection, but is associated frequently with TSP/HAM, which could suggest that sicca syndrome might be an early event in disease progression to TSP/HAM in some cases. We investigated whether peculiar pX and LTR mutations could be related to sicca syndrome, or might argue the existence of clinical progression to TSP/HAM. pX, especially pX(I), pX(II), and pX(IV) ORFs corresponding to Tax cytotoxic T-lymphocyte epitopes, and LTR regions from Caribbean patients who have sicca syndrome with or without TSP/HAM, ATL patients, and healthy carriers were sequenced. The sequences were aligned and compared with ATK-1 prototype and published sequences. LTR sequences exhibited 1.5-2.4% of divergence with ATK-1. pX-sequenced regions showed a lower homology within p12(I) encoding sequences. Only few mutations were found within functionally important regions, but were not associated specifically with the clinical status. Finally, no mutations that could be related to sicca syndrome or argue the existence of clinical progression to TSP/HAM were found. It would be of interest to study the clinical evolution of HTLV-I-sicca syndrome in patients and to determine HTLV-I sequences from peripheral blood and salivary glands at different stages.

[Distinctive features of tuberculosis in the aged]

INTRODUCTION

Current recrudescence of human tuberculosis is ascribed to HIV. Nevertheless, other at-risk individuals, particularly the elderly, have been reported.

METHODS

A retrospective study aimed at defining distinctive features of tuberculosis in the elderly was conducted. Eighty-two records of patients aged 18 to 64 years were compared to those of 58 patients of 65 years of age and over.

RESULTS

In the French area considered in this study, the elderly represent the most at-risk group. Institutionalization is a significant risk factor for tuberculosis (RR = 4). Despite a past history of tuberculosis and public awareness campaigns, first-intent diagnosis was evoked in only 22% of the older patients. The mean number of infectious localizations was higher in the elderly (1.3/patient) than in younger patients (1.1/patient). Results of tuberculin skin tests are unreliable. Prognosis is poor in the elderly. In the present study, 14 of the 18 encountered deaths occurred in the elderly, of which eight were due to tuberculosis.

CONCLUSION

To decrease the current incidence of tuberculosis, evaluations of preventive measures in the elderly should be validated and implemented, especially in institutionalized patients.

Acute Q fever pneumonia: a review of 80 hospitalized patients

STUDY OBJECTIVES

To emphasize epidemiologic, clinical, or radiologic characteristics whose detection could lead to an early diagnosis and to enhance therapeutic efficacy.

PATIENTS

Eighty hospitalized patients from 1982 to 1996.

DESIGN

The diagnosis of Q fever infection was serologically confirmed in all the patients (phase II Coxiella burnetii antibody) using the complement fixation test and/or the indirect immunofluorescence antibody test.

RESULTS

Patients from rural and urban areas were noted in the same proportion; however, the usual epidemiologic factors such as contact with cats or farm animals were found in 40% of the patients. Mean age+/-SD was 49+/-20 years, and there was a higher sex ratio of male to female patients (1:3.44). We found a specific seasonal distribution since 80% of the cases occurred between February and May. Delay before referring to hospital was 8.2+/-7.8 days, while 69.3% of the patients received an antibiotic treatment that was mainly penicillin or cephalosporin. The dominant clinical features were dry cough and high fever, as the maximal temperature reached more then 40 degrees C in 58% of the patients. Digestive symptoms were rare. WBC count remained within normal range in 80% of the cases with a low proportion of lymphocytes in half of the patients, and the sedimentation rate was usually elevated (55+/-34 mm). Altered liver function consisted more frequently in an elevated level of alkaline phosphatase (70% of the cases) than transaminases, while hyponatremia was frequently mentioned (28.2% of the patients). We found radiologic evidence of unique lobar or segmental alveolar opacity involving more likely the lower lobes in 55 patients, and multiple or interstitial opacities in the others. Chest radiographs were considered normal in eight patients. The clinical response was favorable in all the patients with a reduction in fever 4.8+/-3.9 days after the start of treatment with the second antibiotic that included mainly erythromycin or quinolones, and chest radiographs returned to normal in 81% of the patients within the first month.

Genital recurrent infection occurring 6 months after meningitis due to the same herpes simplex virus type 2 (HSV-2) strain evidence by restriction endonuclease analysis

Herpes simplex virus type 2 (HSV-2) is more often sexually transmitted and associated with genital recurrent infection. However, HSV-2 neurological manifestations such as meningitis were already reported. We describe a case of meningitis due to HSV-2, preceded by signs suggesting a common cystitis, in a woman with no history of primary or recurrent genital infection. Six months later genital herpetic lesions occurred. One HSV-2 strain was obtained from cerebrospinal fluid (CSF) and another from genital lesions. The molecular comparative analysis using restriction endonuclease digestion patterns showed the similarity of the two strains. Our report illustrates that HSV-2 infections are underdiagnosed and that molecular techniques can be of value in clarifying the physiopathology of HSV diseases.

[Rhinovirus infections in hospitalized children: a 3-year study]

BACKGROUND

Rhinoviruses (RH) are responsible for acute respiratory illnesses, mainly in the upper respiratory tract.

POPULATION AND METHODS

3,152 children aged under 16 years, admitted to the Paediatrics department of the University Hospital Centre of Poitiers from January 1, 1993 to December 31, 1995 with ear, nose and throat (ENT) and/or respiratory symptoms were systematically investigated. One hundred and forty-five RH strains were isolated from nasopharyngeal secretions of 87 boys and 58 girls (mean age: 20.3 months). Among these, 92 (63.4%) were less than 1 year of age. Bacteriological investigations were done for 29 patients when a concomitant bacterial infection was suspected.

RESULTS

RH infection rate was maximum before 1 year of age (median age: 6.5 months) and decreased with age. RH were isolated throughout the 3 years, with a first peak from February to April, and a second one in autumn. The main symptoms were sibilants (27.6%) and cough (24.1%). Sibilants were more frequently associated in children under 12 months of age (P = 0.01). Sometimes, ophthalmologic or digestive symptoms were present. Three children with respiratory distress were transferred to the reanimation ward. In addition, a RH strain was isolated from a child who died of sudden infant death. Thirty-four children (23.4%) were co-infected by one or several viruses; the most frequently detected were the respiratory syncytial virus (41.2%) and the adenoviruses (35.3%). Twenty-nine children were infected by two viruses and five by three. Associated bacterial infections were diagnosed in 23 children, especially conjunctivitis due to Haemophilus influenzae (21.7%). Among these children, eight had a multiple viral infection.

CONCLUSION

RH have a limited pathogenicity but can be associated with serious illnesses among infants and children.

A blind study of the polymerase chain reaction for the detection of Mycobacterium tuberculosis DNA. Azay Mycobacteria Study Group

SETTING

Nine French laboratories routinely involved in mycobacterial work.

OBJECTIVE

To assess the detection of Mycobacterium tuberculosis in experimental samples by polymerase chain reaction (PCR) using the insertion sequence IS6110 as a target for deoxyribonucleic acid (DNA) amplification.

DESIGN

Nine laboratories participated in a blind study of the detection of M. tuberculosis by PCR in 20 coded samples containing either a definite number of M. tuberculosis complex (positive samples) or environmental mycobacteria (four samples) or no mycobacteria (five samples).

RESULTS

Five laboratories reported false-positive PCR results, with an average rate of 7%. All laboratories except one reported positive PCR results for samples containing 10(5) cfu/ml or more. M. tuberculosis DNA was detected in two thirds of samples containing 10(4) and 10(3) cfu/ml, and in one third of the samples containing 10(2) cfu/ml.

CONCLUSION

The results of the study suggest that PCR using IS6110 as a target for DNA amplication is neither very sensitive nor really specific for the detection of M. tuberculosis.

Seroprevalences of Toxoplasma, malaria, rubella, cytomegalovirus, HIV and treponemal infections among pregnant women in Cotonou, Republic of Benin

Seroprevalences for toxoplasmosis, malaria, rubella, cytomegalovirus, HIV and treponemal infections were evaluated among 211 pregnant women residing in the Cotonou area, Republic of Benin. One hundred and thirteen women (53.6%) had toxoplasma antibodies, 185 (87.7%) malaria antibodies and 181 (85.8%) rubella antibodies. Among the 205 (97.2%) women with cytomegalovirus antibodies, 6 presented recent or current infection. No HIV seropositivity was detected. Five (2.4%) of these women had a positive treponematosis serology corresponding to previous infection or reinfection. These results were compared with previous studies conducted in Africa. Routine serological screening should be recommended in young age and in pregnancy for rubella, only in pregnant women for HIV and toxoplasma infections, in order to control their possible consequences on women and newborns.

French multicenter study involving eight test sites for radiometric determination of activities of 10 antimicrobial agents against Mycobacterium avium complex

The radiometric BACTEC 460-TB methodology has filled an increased need in the screening of a wide range of antimicrobial agents against Mycobacterium avium (MAC) isolates on a patient-to-patient basis. In this context, a multicenter study involving eight test sites across France was performed to determine the MICs of 10 antimicrobial agents for MAC organisms. The aim of the investigation was to compare the in vitro activities of D-cycloserine, ethambutol, ethionamide, rifampin, amikacin, streptomycin, ciprofloxacin, sparfloxacin, clofazimine, and clarithromycin against MAC isolates. All of the test sites received the same clinical isolates of MAC, and the MICs were determined by a common protocol. The overall interlaboratory reproducibility of the MICs within +/- 1 dilution of the modal MICs varied from 79.70 to 100% (mean, 95.2% +/- 2.1%), whereas overall agreement of the MICs among the test sites varied from a mean of 91% +/- 4.1% to a mean of 98 +/- 1.3%. We confirmed that the proposed methodology is easy, accurate, and sufficiently reproducible to be used routinely in a clinical laboratory. Despite variations in the MICs of the same drug among strains, no link between the origin of MAC isolates (from human immunodeficiency virus-positive or -negative patients) and their drug susceptibilities was established. On the basis of the MICs that inhibited 50 and 90% of isolates tested for the drugs used, clarithromycin, clofazimine, ethambutol, and streptomycin were the most uniformly active against MAC; this was followed by amikacin, rifampin, and sparfloxacin. On the other hand, ciprofloxacin, D-cycloserine, and ethionamide showed only marginal in vitro activities.

[Epidemic of viral gastroenteritis in an elderly community]

Rotaviruses and adenoviruses are the main aetiologic pathogens of gastroenteritis in infants. Adults may also be concerned with usually mild clinical symptoms. An epidemic of viral gastroenteritis occurred in a long-term hospitalization ward from July 25 to August 21, 1991: 101 patients. This study involved 26 females and 6 males with a mean age of 86 years (range 70-101 years), presenting clinical symptoms of gastroenteritis. The clinical attack rate was 27.7%. Outcome was favourable for the majority of patients who recovered in 4-5 days. The main clinical signs were diarrhoea (90.6%), hyperthermia (18.8%) and vomiting (18.8%). Virology investigations gave the diagnosis of 8 rotavirus infections, 6 adenovirus infections and 2 rotavirus and adenovirus mixed infections. Among staff members, 3 rotavirus and one adenovirus infections were diagnosed. The precise origin of the epidemic could not be determined from rotavirus electropherotypes obtained from stools of elderly and paediatric patients hospitalized during the same period. This outbreak recalls the viral involvement in diarrhoeal episodes of elderly people. These episodes of viral gastroenteritis are responsible for high morbidity in the elderly and may upset a precarious physiological state.

Influenza epidemic among a community of elderly people in spite of vaccination

An outbreak of influenza occurred in a nursing home of 81 vaccinated elderly people. The clinical attack rate was 73%. The responsibility of an A/H3N2 strain was proved in 12 patients and 2 staff members of the 15 investigated persons. The vaccine was effective in reducing mortality but not morbidity. An antigenic drift between the wild and the vaccine strains was involved in the inefficiency of the vaccination.

[Success rate of ultrasonic exploration of the pancreas. Results of 266 followed-up cases]

In two series amounting to 266 cases, the overall success rate of ultrasonic diagnosis, in pancreatic lesions was 94%. Since most of pancreatic lesions, when clinical symptoms are present, are already rather large, imaging improvements did not enhance accurary, except for small lesions. The tenative analysis of small abnormalities can be responsible, with last generation machines, for an increase of false positive diagnoses.

Ultrasonography of the normal pancreas. Success rate and criteria for normality

Study of 135 ultrasonograms shows that it is possible to display the normal pancreas with 82% success. The pancreatic head ranges between 11 and 30/mm/in thickness, the isthmus 4-21 mm in thickness, and the corporeo-caudate area 24-32 mm in thickness. The pancreas may have a sausage, dumb-bell, or tadpole shape. Variance from these outlines and thicknesses should be considered pathological.

[Ultrasonic aspects of abdominal abscesses and hematomas]

Abdominal ultrasonography often enables to display the fluid collection of an abcess or haematoma. This type of diagnostic procedure is most useful in a post-operative period. The intestinal gases which stop the ultrasonic beam may be responsible for diagnostic failures. Positive results, which are the most frequent, are never the less precious to assess and decide a treatment policy.

[Contribution of xerography in the discovery of radiolucent billiary calculi (author's transl)]

Used in 100 patients, in whom the gall bladder was badly opacified, and apparently contained no stones, xeroradiography led to the appearance of images of radiolucent calculi on 8 occasions. Furthermore, it enabled a differential diagnosis between lacunae due to lithiasis and gaseous pseudo-lacunae. The weak system transfer density however prevented it being considered other than as a complementary method. Undoubtedly, however it announces the wider possibilities for electronic radiography, of which the images are comparable with a greatly reduced irradiation.

[Ultrasonic diagnosis of pancreatic conditions: a new tentative at a rational approach based on the analysis of 300 cases which were checked (with real time and degraded intensity scale). (author's transl)]

For a long time, echotomography of the pancreas was limited to the identification of pseudocysts. Little by little, those using ultrasound learnt how to construct images of the pancreatic gland itself, and faced with the changes in size and shape of the latter to recognize lesional processes. Analysis of the pancreatic echostructure represents an important step in the progress of the diagnosis of lesions. Echotomography, the results of which must be compared with those of roentgenological methods of exploration, as well as the clinical and laboratory data, enables the attainment of very fiable diagnoses of chronic pancreatitis with or without pseudo-cysts, of acute pancreatitis or of rare cystic tumors. The precision of the results however depends fundamentally on technical data: it is necessary to combine with the classical apparatus, with manual displacement of the wave, a tomo-echoscopic apparatus, with real time; above all, it is necessary to use the degraded intensity scale. This scale is innate in real time apparatuses. At present it takes the form of a complementary module, on the classical apparatuses. Without these technical conditions, real time and degraded intensity scale, it seems impossible to attack the problem of ultrasonic diagnosis of pancreatic conditions, except by exposing oneself to disappointments which would unmeritedly cast discredit on the method. Six years of experience, several thousands of pancreatic examinations, three hundred pancreatic lesions which were anatomically checked has however convinced us of the importance of echotomography in this field.