[Evaluation of the Beckman Coulter HmX hematology analyser at a general hospital]

The Beckman Coulter HmX is an hematological analyzer designed to provide a complete hematological profile including CBC, WBC differential (diff) and reticulocyte parameters. It has been evaluated in our laboratory over a two weeks period with three purposes: (1) a technical evaluation of the HmX performance, in regard to repeatability, linearity, carry over; (2) a comparison of numerical results (CBC, WBC diff) and analytical performance (flag sensitivity and specificity) with those obtained with the Coulter MaxM in use in our laboratory; (3) an analysis of the flagging algorithms using the blood smear as the reference method. The first part of the evaluation showed that the Beckman Coulter HmX is reproducible, and linear. The comparison between MaxM and HmX showed that the results given by the two instruments are similar and suggested that the Beckman Coulter HmX could replace the current hematology analyzer in use in our laboratory. The comparison of the flag system performance, between the Beckman Coulter HmX and the Coulter MaxM, has been performed with samples from three subgroups of patients (general departments, surgery and intensive care, hematological unit), and showed that the HmX is significantly more sensitive than the MaxM, with an higher global efficiency. The comparison of predictive values also showed a better performance of the HmX. In conclusion, the Beckman Coulter HmX is suited for an use in medium sized hospital laboratories (80 to 150 CBC diff/day), with good technical and analytical performance, a throughput of 75 samples/hr and a workstation allowing data management in accord with quality assurance guidelines in France.

Bone mineral acquisition during adolescence and early adulthood: a study in 574 healthy females 10-24 years of age

Low bone mass is known to be associated with an increased risk of fractures. Osteoporosis prevention by maximizing bone mass will be crucial and requires a better knowledge of bone mass acquisition during adolescence. Bone mass was assessed in 574 healthy volunteer females aged 10-24 years. Spine bone mineral density (BMD) in anteroposterior (AP L2-4) and lateral (LAT L3) views was measured using dual-energy X-ray absorptiometry (DXA) and AP bone mineral content (BMC) was calculated. At the same time, spine AP-BMD (L2-4) was evaluated in 333 normal menstruating women, aged 27-47 years. Bone values, osteocalcin and IGF-1 serum concentrations were correlated with chronological age, skeletal age, pubertal stages and time after menarche. In this cross-sectional study, AP- and LAT-BMD and BMC increased dramatically between skeletal ages 10 and 14 or until the first year after menarche. Between 14 and 17 skeletal years of age, AP-BMD and BMC increased moderately, whereas LAT-BMD remained unchanged. After skeletal age 17, or the fourth year after menarche, there was no significant increase in BMD or BMC, and their values did not differ from those of menstruating women. A serum osteocalcin peak was observed at skeletal ages 11-12 or at stage P3, whereas IGF-1 peaked at 13-14 skeletal years of age or at P4 and the first year after menarche. Eighty-six per cent of the adult bone mass of the spine is acquired before skeletal age 14 or the second year after menarche; therefore osteoporosis prevention programs will be particularly effective before that age.

[Concentration of lipids in ascitic fluid and the concentration gradient of albumin in blood and ascites: diagnostic significance]

The aim of this study was to test the diagnostic value of ascitic fluid cholesterol and triglycerides concentrations and of serum-ascites albumin concentration gradient in the differentiation between cirrhotic and malignant ascites. These biological parameters were determined, on the one hand in 34 cirrhotic patients, 6 of them having an hepatocellular carcinoma and 6 others having a spontaneous bacterial peritonitis and, on the other hand, in 16 patients with malignant ascites, 13 of them having an abdominal extra-hepatic or pelvic cancer, and 3 others having an extra-abdominal cancer with multiple liver metastases. Ascitic carcinoembryonic antigen assay and ascitic fluid cytology were also done in the 50 patients. In differentiating the cirrhotic patients from those with malignancy, ascitic fluid cholesterol concentration (discriminating value less than 1.1 mmol/l) ascitic fluid triglycerides concentration (discriminating value 0.5 mmol/l) and serum-ascites albumin concentration gradient (discriminating value greater than 11 g/l) allowed a diagnostic efficiency of 0.92, 0.80 and 0.77, respectively. Ascitic fluid cytology showed presence of malignant cells in 3/6 patients with hepatocellular carcinoma associated with cirrhosis, in 9/16 patients having a malignant ascites, and was negative in other patients. Ascitic carcinoembryonic antigen assay was abnormal only in 3/16 patients with malignant ascites. These results suggest that measurement of ascitic fluid cholesterol concentration must be included in the initial evaluation of patients with ascites of unknown origin.

'Pure' partial trisomy 2q in a male owing to malsegregation of a maternal translocation t(X;2)(p22.3;q32.1)

This report describes a male infant with partial trisomy 2q: 46,Y,der(X),t(X;2) (p22.3;q32.1)mat. The phenotype was compatible with partial trisomy 2q syndrome. Replication studies showed a random X inactivation in the mother. Soluble isocitrate dehydrogenase (IDH-1) dosage was within the expected range for a trisomic patient and favours the assignment of this locus to the region 2q32----qter.

[Outbreak of hand, foot and mouth disease in a day-nursery. A new clinical form? (author's transl)]

Ten cases of vesicular eruption affecting primarily the hands (4/10) and feet (6/10) occurred in a day-nursery for infants. An enterovirus related to coxsackie A 16 virus was isolated from two vesicular fluids and nine stools. The fact that the outbreak took place in the winter, the rarity of pharyngeal lesions (2/10), the high incidence of foot lesions and the presence of listlessness as only associated symptom lead to a discussion of the relationship between this small epidemic and true hand, foot and mouth disease.

[Kawasaki disease (mucocutaneous lymph node syndrome). Description of a case (author's transl)]

The authors relate a case of mucocutaneous lymph node syndrome, first described by Kawasaki in 1967, including a fever, lasting more than five days, an erythematous rash, cervical lymphadenitis, with a usually good prognosis. One to two percent of patients die suddenly of cardiac failure with coronary aneurysm and thrombosis. Microscopically coronary arteries such as other arteries show inflammation with dilaceration of the vascular wall without necrosis. These pathologic features suggest a relationship to infantile periarteritis nodosa.