A community outbreak of Legionnaires' disease caused by outdoor hot tubs for private use in a hotel

During the period October-November 2017, an outbreak of Legionnaires' disease involving 27 cases occurred in the tourist area of Palmanova (Mallorca, Spain). The majority of cases were reported by the European Centre of Disease Prevention and Control (ECDC) as travel associated cases of Legionnaires' disease (TALD). Most cases belonged to different hotel cluster alerts. No cases were reported among the local population residing in the area. All tourist establishments associated with one or more TALD cases were inspected and sampled by public health inspectors. All relevant sources of aerosol emission detected were investigated and sampled. The absence of active cooling towers in the affected area was verified, by documents and on-site. Samples from hot tubs for private use located on the terraces of the penthouse rooms of a hotel in the area were included in the study. Extremely high concentrations (> 106 CFU/l) of Legionella pneumophila, including the outbreak strain, were found in the hot tubs of vacant rooms of this hotel thus identifying the probable source of infection. Meteorological situation may have contributed to the geographical distribution pattern of this outbreak. In conclusion, hot tubs for private use located outdoors should be considered when investigating community outbreaks of Legionnaires' disease of unclear origin.

Epidemiology and pathology of parotid tumors five-year retrospective study

AIM

To retrospectively analyze the epidemiological, clinical and pathological data of parotid tumors.

MATERIAL AND METHODS

Reassessment of the histologic diagnosis of parotid tumor in the patients admitted to the Oral and Maxillofacial Surgery Unit of the Iasi "Sf. Spiridon" University Emergency Hospital during 2009-2013. Data on gender, age, place of residence, location, size, surgical procedure type and histopatological type were recorded.

RESULTS

The risk of developing pleomorphic adenonma is 7.40 times higher in women and 4.08 times higher before the age of 50 years. The risk of Warthin tumor is 16.47 times higher in male patients and 3.58 times higher in urban patients. People older than 50 years have a 7.14 times higher risk of developing malignancy and rural people have a 2.41 times higher risk of developing cancer. Diabetes, obesity and systemic hypertension were not important risk factors in our study.

CONCLUSIONS

According to this study age and the place of residence could be important predictors for parotid gland tumors. Since in Romania there are few epidemiological data regarding the parotid gland pathology, further cohort studies are needed for a better understanding of their clinical and pathological behavior.

Solar radiation and water vapor pressure to forecast chickenpox epidemics

The clear seasonality of varicella infections in temperate regions suggests the influence of meteorologic conditions. However, there are very few data on this association. The aim of this study was to determine the seasonal pattern of varicella infections on the Mediterranean island of Mallorca (Spain), and its association with meteorologic conditions and schooling. Data on the number of cases of varicella were obtained from the Network of Epidemiologic Surveillance, which is composed of primary care physicians who notify varicella cases on a compulsory basis. From 1995 to 2012, varicella cases were correlated to temperature, humidity, rainfall, water vapor pressure, atmospheric pressure, wind speed, and solar radiation using regression and time-series models. The influence of schooling was also analyzed. A total of 68,379 cases of varicella were notified during the study period. Cases occurred all year round, with a peak incidence in June. Varicella cases increased with the decrease in water vapor pressure and/or the increase of solar radiation, 3 and 4 weeks prior to reporting, respectively. An inverse association was also observed between varicella cases and school holidays. Using these variables, the best fitting autoregressive moving average with exogenous variables (ARMAX) model could predict 95 % of varicella cases. In conclusion, varicella in our region had a clear seasonality, which was mainly determined by solar radiation and water vapor pressure.

Predictors of advanced disease and late presentation in new HIV diagnoses reported to the surveillance system in Spain

OBJECTIVE

To present surveillance data on advanced disease (AD) and late presentation (LP) of HIV in Spain and their determinants.

METHODS

We included all new HIV diagnoses notified by the autonomous regions that consistently reported such cases throughout the period 2007-2011. Coverage was 54% of the total Spanish population. Data sources consisted of clinicians, laboratories and medical records. AD was defined as the presence of a CD4 cell count <200cells/μL in the first test after HIV diagnosis, while LP was defined as the presence of a CD4 cell count <350cells/μL after HIV diagnosis. Odds ratios and their 95% confidence intervals (OR, 95% CI) were used as the measure of association. Logistic regressions were fit to identify predictors of AD and LP.

RESULTS

A total of 13,021 new HIV diagnoses were included. Among these, data on the outcome variable were available in 87.7%. The median CD4 count at presentation was 363 (interquartile range, 161-565). Overall, 3356 (29.4%) patients met the definition of AD and 5494 (48.1%) were classified as LP. Both AD and LP increased with age and were associated with male sex and infection through drug use or heterosexual contact. All immigrants except western Europeans were more prone to AD and LP. Multivariate models disaggregated by sex showed that the effect of age and region of origin was weaker in women than in men.

CONCLUSIONS

Despite universal health care coverage in Spain, men, immigrants and people infected through drug use or heterosexual contact seem to be experiencing difficulties in gaining timely access to HIV care.

The effect of bovine milk lactoferrin on human breast cancer cell lines

The evidence that biologically active food components are key environmental factors affecting the incidence of many chronic diseases is overwhelming. However, the full extent of such components in our diet is unknown, as is our understanding of their mechanisms of action. Beyond the interaction of these food components with the gut and intestinal immune functions, whey proteins such as lactoferrin are being tested as anticancer agents. Lactoferrin is an iron-binding protein that has been reported to inhibit several types of cancer. In the present work, the effects of bovine milk lactoferrin on human breast cancer HS578T and T47D cells were studied. The cells were either untreated or treated with lactoferrin concentrations ranging from 0.125 to 125 μM. Lactoferrin decreased the cell viability of HS578T and T47D by 47 and 54%, respectively, and increased apoptosis about 2-fold for both cell lines. Proliferation rates decreased by 40.3 and 63.9% for HS578T and T47D, respectively. For the T47D line, cell migration decreased in the presence of the protein. Although the mechanisms of action are not fully known, the results gathered in this work suggest that lactoferrin interferes with some of the most important steps involved in cancer development.

[Delayed diagnosis of HIV infection in Spain]

OBJECTIVES

To analyse the prevalence of delayed diagnosis (DD) of human immunodeficiency virus (HIV) infection, the trends over time and its determining factors from the Newly Diagnosed HIV-infected individuals Information System (SINIVIH) data, in process of being implemented in Spain.

METHODS

Cross-sectional study of newly diagnosed HIV-infected individuals between 2003 and 2007 in the 8 currently participating Spanish autonomous regions (AR). DD was defined as a CD4 count <200cells/μL at diagnosis. Adjusted odds ratios with 95% confidence interval were calculated using logistic regression (OR; 95%CI).

RESULTS

Among the 5785 newly diagnosed HIV cases reported, 4798 had a CD4 cell count at diagnosis. Of these, 37.3% met the DD definition. An additional 19% had between 200 and 350cells/μL. The proportion of DD was lower for women than for men (32.9% versus 38.6%). According to exposure category, it was higher in heterosexuals (42.4%) and injecting drug users (IDUs) (40.1%) than in men who have sex with men (MSM) (26.7%). In the Spanish patient group, in multivariate logistic regression analyses, adjusting for AR and year of diagnosis, men were more likely to have a DD (OR=1.49; 95%CI:1.21-1.85). Compared to younger patients (20-29 years), LD was more frequent in older: 30-39 years (OR=2.08; 95% CI:1.63-2.67), 40-49 years (OR=3.98; 95% CI:3.07-5.16) and >49 years (OR=6.77; 95% CI:5.10-9.00); and compared to MSM, was more frequent in heterosexuals (OR=1.75; 95% CI:1.43-2.15) and IDUs (OR=1.75; 95% CI:1.38-2.22). DD decreased from 2003 to 2007 (OR=1.38; 95% CI:1.08-1.76). The same associated factors were found in immigrants, but with different magnitude: stronger association with men, heterosexuals and IDUs, and weaker association with older age.

CONCLUSIONS

DD affects almost four in every ten newly diagnosed HIV-infected individuals, and is significantly more common among men, age group over 30 years, IDUs and heterosexuals. These are associated factors both in Spanish and immigrants, but in the last group the association is stronger. Strategies to increase the perception of risk among these groups are needed, as well as the implementation of the SINIVIH in the whole country to improve and to extend the information on DD.

Method for bacteriophage isolation against target Campylobacter strains

AIMS

Poultry meat is considered a major source of Campylobacter. This micro-aerobic bacterium is commonly responsible for foodborne illness. This work focuses on the isolation of Campylobacter coli lytic bacteriophages (phages) against target C. coli strains.

METHODS AND RESULTS

A method involving the enrichment of free-range chicken samples in a broth containing the target C. coli strains and salts (CaCl(2) and MgSO(4)) was used for phage isolation. This method allowed the isolation of 43 phages that were active against 83% of the C. coli strains used in the isolation procedure. Approximately 65% of the phages were also effective against Campylobacter jejuni strains.

CONCLUSIONS

The use of target pathogens in the phage isolation step improves the likelihood of detecting and isolating phages for the control of these specific strains.

SIGNIFICANCE AND IMPACT OF THE STUDY

This technique will be valuable in the context of phage therapy for enriching for phages that are active against specifically identified strains of bacteria, for example from a food poisoning outbreak or epidemic strains resistant to multiple antibiotics. In these situations, using the conventional methods for searching for bacteriophages active for these particular strains can be a time-consuming, if not an unsuccessful process. Using the isolation method described in this manuscript, the particular strains can be added to the enrichment broth increasing the probability of finding phages against them. Therefore, it will shorten the time needed for seeking phages able to lyse target strains, which in most of the cases, because of the rapid increase in antimicrobial-resistant bacteria, is of crucial importance.

[Comparison study of a real-time reverse transcription polymerase chain reaction assay with an enzyme immunoassay and shell vial culture for influenza A and B virus detection in adult patients]

INTRODUCTION

The age of the patients and the type of sample are major problems in the diagnosis of influenza. Most available diagnostic techniques are highly effective in pediatric patients and in nasopharyngeal aspirates. However, in the adult population and using throat swabs, these techniques are much less reliable.

AIM

We performed a prospective study comparing the efficacy of a commercial real-time reverse transcription PCR assay (RT-PCR) with that of an enzyme immunoassay (EIA) or shell vial culture (SV) in the detection of influenza A and B viruses in 125 throat swabs from adults with clinically suspected influenza during the 2007-2008 flu season.

MATERIAL AND METHODS

Throat swabs were subjected to rapid antigen detection for influenza viruses by means of a commercial dot-blot EIA. For the RT-PCR technique, RNA was extracted from 200 microL of each sample by the automated extraction system, EZ1 virus minikit (version 2.0). Genomic amplification of the extracted viral RNA was carried out using the OneStep RT-PCR FluA+FluB automated system with the SmartCycler amplification system. Each sample was inoculated into 2 SV of the MDCK cell line. Turnaround times were calculated from the time specimens were received in the laboratory to the time the result was reported to clinicians.

RESULTS

The EIA system detected 27 (21.6%) positive samples, RT-PCR 62 (49.6%) positive samples, and SV 56 (44.8%) positive samples. Among the 62 positive samples, EIA detected 27 (43.5%), RT-PCR 62 (100%) and SV 56 (90.3%). With the use of RT-PCR, 38.4% of the adults studied were diagnosed on the same day samples were received. Among the total, 67.2% of diagnostic results were obtained within the first 24 hours; turnaround time was 1.1 days.

CONCLUSION

The real-time RT-PCR method studied displayed high sensitivity and specificity in the detection of influenza virus in adult patients, when compared with the conventional techniques. With real-time RT-PCR, large numbers of samples can be rapidly tested and results provided the same day samples are received.

[Diagnostic yield of paediatric respiratory samples in the Balearic Islands Sentinel Influenza Surveillance Network]

INTRODUCTION

Influenza disease is subjected to surveillance by national networks (RC) that predict the epidemic behaviour by reporting clinical and virological data.

OBJECTIVES

To evaluate the effectiveness of the paediatric respiratory samples in the Balearic Islands RC in the last five epidemic seasons.

MATERIAL AND PATIENTS

A breath sample was taken from paediatric patients in the RC who had flu symptoms. The samples were inoculated in the MDCK cell line. We reviewed the epidemiological data of patients with a culture positive to influenza A and B.

RESULTS

A total of 338 pharyngeal swabs from the RC were analysed during the study period. Of these, 65 (19.3%) belonged to <14 years old patients, and 44.6% of the samples were positive as opposed to 39.1% of adult respiratory samples. The influenza A virus was isolated in 24 paediatric samples (82.7%) and the influenza B virus in 5 (17.3%). The mean age of the paediatric patients of the RC who were positive was 8.5 years. Only 3 patients in the 0-4 year old group were positive (10.3%) and 26 patients (89.7%) in the 5-14 years old group.

CONCLUSIONS

In spite that paediatricians represented only 22% of the RC doctors and obtain the 19.3% of all respiratory samples, the percentage and effectiveness of these is higher that that obtained in the adult population.

Antibiotherapy and pathogenesis of uncomplicated UTI: difficult relationships

In a time when conventional antibiotics are becoming increasingly less effective for treatment of infections, the relationship between bacteria and antimicrobial resistance is becoming more and more complicated. This paper provides a current review of studies reported in the literature pertaining to the antibiotherapy of human urinary tract infections (UTI), in a way that helps the reader direct a bibliographic search and develop an integrated perspective of the subject. Highlights are given to (bio)pathogenesis of uncomplicated cystitis. Features associated with the antibiotherapy of UTI such as development of resistance are presented in the text systematically. This review discusses recent advances in the understanding of how the predominant uropathogen Escherichia coli interacts with its host and leads to infection; so one can understand some of the reasons behind antibiotherapy failures.

Recognition of protozoa and metazoa using image analysis tools, discriminant analysis, neural networks and decision trees

Protozoa and metazoa are considered good indicators of the treatment quality in activated sludge systems due to the fact that these organisms are fairly sensitive to physical, chemical and operational processes. Therefore, it is possible to establish close relationships between the predominance of certain species or groups of species and several operational parameters of the plant, such as the biotic indices, namely the Sludge Biotic Index (SBI). This procedure requires the identification, classification and enumeration of the different species, which is usually achieved manually implying both time and expertise availability. Digital image analysis combined with multivariate statistical techniques has proved to be a useful tool to classify and quantify organisms in an automatic and not subjective way. This work presents a semi-automatic image analysis procedure for protozoa and metazoa recognition developed in Matlab language. The obtained morphological descriptors were analyzed using discriminant analysis, neural network and decision trees multivariable statistical techniques to identify and classify each protozoan or metazoan. The obtained procedure was quite adequate for distinguishing between the non-sessile protozoa classes and also for the metazoa classes, with high values for the overall species recognition with the exception of sessile protozoa. In terms of the wastewater conditions assessment the obtained results were found to be suitable for the prediction of these conditions. Finally, the discriminant analysis and neural networks results were found to be quite similar whereas the decision trees technique was less appropriate.

Development of an image analysis procedure for identifying protozoa and metazoa typical of activated sludge system

A procedure for the semi-automatic identification of the main protozoa and metazoa species present in the activated sludge of wastewater treatment plants was developed. This procedure was based on both image processing and multivariable statistical methodologies, leading to the use of the image analysis morphological descriptors by discriminant analysis and neural network techniques. The image analysis program written in Matlab has proved to be adequate in terms of protozoa and metazoa recognition, as well as for the operating conditions assessment.

Diminution de la mortalité et stabilité du taux de guérison dans le suivi de l’anorexie mentale

OBJECTIVES

Anorexia nervosa is an eating disorder that combines malnutrition, amenorrhea, and distorted body image. To learn more about the course of this disease we undertook a retrospective study of girls diagnosed with anorexia nervosa in the Saint Etienne Endocrinology Department between 1979 and 2004.

METHODS

Patients were diagnosed according to DSMIV criteria. Data collected to complete the Morgan-Russell outcome assessment schedule included chronology of illness, patients' morphological features, anorexia type, treatment choice, patient's gynecological history, and social status.

RESULTS

The study included 206 cases. The average follow-up period was 8.3 +/- 5.3 years. Defining recovery as stable BMI>17.5 kg/m2 for at least one year and recovery of normal menstruation, full recovery was observed in 55.8% and partial recovery in 25.7%, while 18.5% remained chronically ill. Early onset (i.e., during adolescence) was associated with good prognosis, and advanced emaciation and delayed or insufficient medical care with poor prognosis.

CONCLUSIONS

The seriousness of this disease is due more to the incidence of cases that become chronic than to the mortality rate. Prediction of severity would be improved by taking into account underlying personality traits, such as addictive tendencies and depression.

Cryptosporidiosis outbreak in British tourists who stayed at a hotel in Majorca, Spain

On 22 July 2003, the Scottish Centre for Infection and Environmental Health

Trends in the use of protozoa in the assessment of wastewater treatment

Increasing environmental pollution and the continuous development of new chemicals and drugs has led to ever growing concern about the potential effects of these compounds directly or indirectly on human health. As concerns water pollution, protozoa seem to be an excellent tool to assess both toxicity and pollution: they are regarded as biological indicators of pollution when their presence or absence can be related to particular environmental conditions, and they are considered test organisms when a species or population is used to evaluate the toxicity of relevant toxic compounds. Thus, an integrated approach is being developed to assess how toxic compounds affect the different biological levels of organisation--from the community level to the species level--of ciliated protozoa. The present paper reports and discusses the current state of the art of this approach.

Miniaturization and application of the MTT assay to evaluate metabolic activity of protozoa in the presence of toxicants

This paper describes a critical evaluation of a miniaturised colorimetric assay, using MTT (3-[4,5-dimethyl-thiazol-2-yl]-2,5-diphenyl-tetrazolium bromide) reduction, applied to protozoan viability testing. The toxic substances used were copper, zinc, Triton X-100 (a membrane surfactant) and cycloheximide (an inhibitor of the protein synthesis). The viability assay of the ciliate protozoan Tetrahymena pyriformis was optimised in terms of MTT concentration and incubation time. Since protozoa are non adherent cells the MTT assay was modified in order to maintain the medium in the well. MTT proved to be effective in the measurement of Tetrahymena pyriformis viability. Four hours of MTT incubation followed by 30 minutes of incubation with DMSO were found to be the best incubation times for optical density reading. Furthermore, 10 mg/ml of MTT solution was the concentration that gave higher values of optical densities with minor medium interference.

Physiological responses of Tetrahymena pyriformis to copper, zinc, cycloheximide and Triton X-100

Protozoa, and particularly ciliates, are essential in aerobic purification processes of wastewaters and have proved to be very sensitive to environmental changes. The physiological response of the ciliate Tetrahymena pyriformis was assessed in terms of mortality, growth and grazing capacity after exposure to four toxicants: copper, zinc, cycloheximide and Triton X-100. In the ranges of concentrations used, mortality, inhibition of growth and inhibition of grazing were observed with all toxicants employed, but in different ways. Copper and zinc showed lower toxicity than observed in other studies with protozoa, though some of the present results are in accordance with those reported by other authors. This supports the importance of the organism tested and the experimental conditions of the bioassays.

Effects of monensin feeding during development on female rats and their offspring

Monensin, a growth-promoting agent and coccidiostat used in veterinary medicine, was studied in terms of its effects on the development of female rats and their offspring when added to the diet. Young female rats received 100 or 300 ppm monensin mixed with powdered chow diet until adulthood, when they were mated and their offspring were evaluated for physical and neurobehavioural development. The data showed that 1) exposure to the higher monensin concentration reduced female body weight; no deaths occurred after exposure to the two monensin concentrations; 2) the offspring of the experimental group receiving 300 ppm monensin presented a weight reduction from 10 to 21 days of lactation; 3) incisor eruption was delayed only in females after exposure to the 100 ppm concentration. We conclude that exposure to monensin during development induces toxicity in female rats and has a notable adverse effect on growth with some limited effects on selective milestones of physical and functional development of the offspring during the postnatal period.

Safety and efficacy of insulin lispro in patients with diabetes mellitus

Lispro is a human insulin analogue with a very rapid onset of action, and a shorter duration of activity than soluble insulin. In order to assess the therapeutical value of lispro, we have had an open-label, non-comparative study, for 12 weeks, involving 19 IDDM patients. The treatment regimen with lispro and Humulin N has been adapted depending on each patient characteristics. Patients attended three visits, and the main metabolic control parameters included values of hemoglobin Alc, fasting and postprandial blood glucose monitoring. The patients themselves monitored their blood glucose using a glucometer. The mean age value of 19 patients (8 females and 11 males) was 22.32 (+/- 13.59) years. In patients previously receiving insulin treatment, therapy with lispro insulin significantly reduced postprandial glucose values. Lispro has been administered t.i.d. in 14 patients, and b.i.d. in 5 patients. At visit 1, mean value of HbAlc was 10.32% (+/- 1.63%); at visit 3, mean HbAlc was 9.90% (+/- 1.59%). Total insulin daily dose and the rate of short and long acting insulin did not change from visit 1 to visit 3. There has been reported only one serious adverse event during the study: a ketoacidosis due to a technical dosing error. Ten patients have reported mild hypoglycemic episodes. The outcomes of clinical study and of Quality of Life Questionnaire suggests that lispro--the first human insulin analogue used in humans--is effective, safe, and it is broadening beneficially the spectrum of insulins.

Comparative study of insulin antibodies in diabetic patients with primary insulin-dependence (type I) and secondary insulin-dependence (type II)

Insulin antibodies (% binding) were determined by RIA method in 404 insulin-treated diabetic patients divided into two groups: (A) primary insulin-dependent patients (Type I diabetes): 300 cases, 170 M, 130 F, mean age +/- SD 29.2 +/- 7.5 yrs, disease and insulin treatment duration 7.7 +/- 6 yrs: (B) Type II diabetic patients needing insulin (secondary insulin-dependence): 104 cases, 47 M, 57 F, aged 53.4 +/- 9.2 yrs, duration of diabetes 13.1 +/- 8.3 yrs, and of insulin treatment 3.1 +/- 2.1 yrs. Both groups of patients were with the same types of insulin preparations. In 297 cases, all belonging to group (A), fasting C-peptide was also determined. The titre of insulin antibodies was significantly (p less than 0.001) higher in patients with secondary insulin dependence than in those with primary insulin dependence (22.96 +/- 15.1% vs 10.25 +/- 9.89) in spite of the longer duration of insulin treatment in the later group; the mean C-peptide value found in 58 Type I diabetic patients with a binding capacity less than 10% was significantly lower (p less than 0.001) than that found in 11 Type I diabetic cases with a binding capacity greater than 20% (0.091 +/- 0.57 vs 0.273 +/- 0.37 pmol/ml); no correlation was found between insulin antibodies and metabolic control, insulin requirements or chronic complications.

[The potentials for immunization against influenza using liposome-incorporated viral surface antigens]

Studies were conducted using uni- and multilamellar liposomes to establish optimum conditions for influenza antigen incorporation in view of their transport to the target cells for experimental influenza prophylaxis in hybrid white mice. Radiometric determinations showed a good level of preparation purification, a good efficiency of incorporation in liposomes of the active biological material, the liposome linked radioactivity distribution among different organs. Charged liposomes induced solid and long lasting resistance against influenza control infection.

[Acute chondrolysis on primary protrusio acetabuli in children]

Two cases of acute chondrolysis of the upper femoral epiphysis associated with protrusio acetabuli are reported in two girls respectively 13 and 12 Y.O. The disease was unilateral in one patient and bilateral in other. Acute chondrolysis is characterized by onset of pain, restricted movements of the hip and evolution to an hip ankylosis within a few months. As usual no evidence of inflammatory disease could be shown at biology or at pathology of synovial membrane or of femoral head. CT and MR studies proved to be contributive in the first case. It's the author's opinion that in these 2 cases, chondrolysis appears as a complication of preexistent Protrusio Acetabuli.

[The multicystic kidney. Anatomo-radiological study of 19 operative specimens. Practical and pathogenic consequences]

19 specimen of pathologically proved multicystic kidneys were opacified; first through the ureter and second, if the ureter was not patent, through a puncture of one of the cysts (or several if the first cyst did not communicate with the ureter or with other cysts). The results are as follows. The ureter was hypoplastic but patent in 12 and communicated with some of the cysts in 9 or with all the cysts in 3. These communications consisted of large (12 cases) or small (15 cases) canals, or both large and small canals (11 cases). When patent, the ureter was connected to these canals. Moreover in most of the cases, there was a communication between cysts through such canals. Finally, only 3 cases fitted with the classical description having an atretic ureter and non communicating cysts. Our conclusion is that the same basal defect is present in congenital obstructions of pelvis and calyces; there is a continuous spectrum of malformations between congenital hydronephrosis, hydrocalyces and multicystic kidneys.

[Pseudo-ureteroceles resulting from the impression of a loop of a megaureter with an ectopic subvesical orifice]

The authors report 3 rare cases of pseudo-ureteroceles corresponding to a vesical imprint of an ectopic extra-vesical megaureter. When an ectopic extra-vesical ureter follows a sharp juxta-vesical buckle, it can give a deep imprint on the bladder and look similar to an ureterocele. I.V.P. and U.S. can be as misleading since the appearance of this type of megaureter and ureterocele can be similar, and differential diagnosis can be difficult. Such situations are rare. In a ten years of pediatric urologic practice, the authors who have investigated 51 ureteroceles and 26 extravesical ectopic ureters, have only observed 3 children with this lesion. These 3 cases corresponded to two simple ureters, in a 3 year old boy and in a 2.5 year old girl, and one upper ureter of a complete duplex system in a neonate baby girl with antenatal discovery. The clinical, radiological, sonographical and endoscopic clues to the diagnosis are discussed and illustrated.

Intra-renal reflux: a new cause of medullary hyperechogenicity?

A 5-month-old infant with untreated severe urinary tract infection and bilateral vesico-ureteral reflux, had diffuse intrarenal reflux and hyperechogenicity of the medulla of two normal sized kidneys. We discuss the hyperechogenicity of the medulla in relationship to the intrarenal reflux.

[Giant Meckel's diverticulum presenting as tumor]

The authors report a case of giant Meckel's diverticulum, presenting as a subumbilical abdominal mass, associated with an infectious picture and anemia in a 16 month-old boy. Epidemiologic, pathologic and clinical features of this rare disorder are reviewed as are the diagnostic means. The differential diagnosis with other cystic masses of the umbilical area (omphalo-mesenteric duct cyst, urachal cyst, mesenteric cyst, duplication) is discussed.

[Osteoid osteoma of the femur neck with synovitis simulating chronic monoarthritis of the hip]

The authors report a case of subperiosteal osteoid osteoma of the femoral neck in a 14 year-old girl presenting as chronic hip monoarthritis with narrowed coxofemoral joint space and non specific histological synovitis. They analyse the synovitis which is associated with some osteoid osteomas (hip, elbow, knee, ankle bones) emphasizing the "pseudo-arthritis of the hip" picture and insist that all cases of unexplained chronic monoarthritis of the hip should suggest subperiosteal osteoid osteoma of the neck.

Ultrasonography of hepatic cavernous haemangiomas

Cavernous haemangiomas, the most frequent benign tumours of the liver, are discussed by the authors in connection with 50 personal cases and surveillance of 35 solitary hyperechoic nodules less than 3 cm diam. without clinical or biological abnormalities. All the diagnostic images are reviewed but attention is focussed on ultrasound. All US patterns may be observed, but if the lesion is less than 3 cm, the echostructure is often hyperechoic and homogeneous. In view of their asymptomatic nature and the absence of risk of evolution for these small hyperechoic lesions, it appears legitimate to propose surveillance merely by US if there are no clinical symptoms and if liver function tests are normal.

[Radiologic study of aberrant pancreas of gastroduodenal topography. Apropos of 11 cases]

In connection with 11 observations of aberrant pancreas in the gastro-duodenal area, the authors review the general and radiological features of this pathology. In ten of the personal cases reported on, radiological examination allowed diagnosis following discovery of an intramural image centered around an umbilication. While not uncommon, pancreatic heterotopias are generally fortuitous findings due to the usual absence of clinical symptoms. They are small, and tend to occur in the digestive tract, especially in the antro-duodenal region. Possible complications include adenomatous transformation which may or may not be insulinogenic, cystic degeneration, cystenadenoma and carcinoma. Such complications are rare, however, and are generally not discovered before surgery. Radiological examinations were negative in 23,7% of the cases reviewed; while the typical image of a rounded filling defect centered around an umbilication is easy to diagnose, the value of radiology is considerably less when dealing with peduncular, subserous or complex forms. Although certain authors recommend only surveillance following radiological and endoscopic detection of a small aberrant pancreas, the majority of authors advise exeresis.

Indications for ultrasonography in parotid pathologies

In connection with 141 cases of parotid tumours, 21 adenopathies of the parotid region and 22 cases of parotitis, the authors define the role of ultrasonography in the exploration of the salivary glands. Use of simple criteria permits differentiation of benign from malignant tumours with a good degree of sensitivity (79.8% in our series). This score allows ultrasonography to be offered as the first complementary examination when dealing with a tumefaction of the parotid region. When ultrasonographic findings evoke a malignant lesion, a CT scan seems necessary to evaluate any extension in depth. In contrast, ultrasonography does not appear justified in cases of parotitis or lithiasic pathologies.

Stimulation by inlfuenza virus RNA of 3H-phenylalanine incorporation in a cell-free system

Purified and unpurified cell-free systems prepared from the chorioallantoic membrane of embryonated eggs were tested for polypeptide synthesis in the presence and absence of influenza virus RNA. Both systems exhibited an endogenous messenger activity determining 3H-phenylalanine incorporation into polypeptides in the absence of virus RNA. However, addition of influenza virus RNA to the systems clearly stimulated amino acid incorporation into polypeptides, offering the possibility of studying some aspects of the viral protein biosynthesis mechanism.