Alternaria infection of the skin and joints. A report of two cases involving the hand.

Alternaria is a fungus that is usually saprophytic but occasionally causes skin infections. Involvement of other structures is exceedingly rare. We report two cases in which a joint was also affected. The possible precipitating role of intraarticular glucocorticoid therapy is discussed. Both patients achieved a full recovery after itraconazole therapy, given for 12 and seven months, respectively.

[Arthropathies of the limbs in dialyzed renal failure patients]. / Arthropathies des membres chez les insuffisants rénaux dialysés.

During the last few years, articular symptoms have been reported in chronic renal failure patients on maintenance haemodialysis. A prospective study of arthropathies of the limbs was conducted in 73 such patients: 20 had experienced periarthritis, 32 had tendinous calcifications (3 or more in 16 cases), 29 had destructive arthropathies (especially of the hands) and 10 had calcium pyrophosphate dihydrate deposition. The periarthritis attacks were associated with the presence of tendinous calcifications. The destructive arthropathies could be due to calcium apatite microcrystal deposition, but the study provided no direct evidence of this mechanism. However, the pattern of erosive lesions, their location and their possible association with tendinous calcifications in the same joint were suggestive of calcium apatite deposition. Calcium pyrophosphate deposition, which affected the oldest patients, did not seem to be due to chronic renal failure treated with dialysis. The most important arthropathies were found in patients who had been haemodialysed for a long time, although the correlation was not statistically significant. The dialysis pattern did not seem to influence the articular disorders. There were more cases of calcification and periarthritis among patients whose phosphocalcium product (in mg) exceeded 6000, but the difference with other patients was not statistically significant. Periarthritis and arthropathies are truly disabling for these patients.

[Value of the measurement of intra-articular lactates. Contribution to the diagnosis of septic arthritis. Interpretation of 370 evaluations]. / Intérêt de la mesure des lactates intra-articulaires. Apport au diagnostic des arthrites septiques. Interprétation de 370 évaluations.

This retrospective study interprets the results of 370 evaluations of the lactate level of joint fluid. 5 groups were established: joint fluid from cases of mechanical (114) and microcrystalline (67) joint diseases, from inflammatory arthritis (149) and from septic arthritis (40). There was a significant difference between the lactate level in fluid from septic joints and that in the other groups. However, there was no significant difference between the rheumatoid joint fluid and the septic joint fluid. The increased level of intra-articular lactate can therefore be considered to be an argument in favour of the diagnosis of septic arthritis, but there is a certain rate of false positives (particularly in the case of rheumatoid arthritis) and false negatives, which require a very careful interpretation of the test. In cases of inflammatory arthritis with a cell count of more than 10,000 per mm3, there is a correlation between the white cell count and the lactate level. This relation is not observed in the case of septic arthritis. The authors did not detect any difference in the levels of intra-articular lactate according to the nature of the infecting organism. They studied 4 specimens of joint fluid from gonococcal arthritis and the levels of lactate were similar to those of other types of septic arthritis.

[Peritonitis in renal failure patients treated by continuous ambulatory peritoneal dialysis. Treatment by intraperitoneal administration of a group M penicillin]. / Les péritonites des insuffisants rénaux traités par dialyse péritonéale continue ambulatoire. Traitement par administration intrapéritonéale d'une pénicilline du groupe M.

From February 1980 to February 1983, 55 patients with chronic renal failure were put on continuous ambulatory peritoneal dialysis. Eighty-four episodes of peritonitis occurred., i.e one episode every 9.9 months of treatment. Since staphylococci accounted for 58% of the germs identified, intraperitoneal therapy with a penicillin M was instituted while dialysis was continued through chambers. Cure was obtained in 85.7% of all episodes, either with the penicillin M alone (57% of the cases) or after adjustment of the antibiotic therapy to bacteriological results (28.6% of the cases). Dialysis was discontinued in 10 patients (18%) on account of the peritonitis. The duration of hospital stay for peritonitis was 3.6 days per patient per year. These results were compared with those obtained by other groups. The advantages of penicillin M are its ease of administration, its narrow spectrum and high activity against the pathogens most commonly encountered, and its very low toxicity.

[Study of erythrocyte bilirubin. Evaluation of the risk of kernicterus]. / Etude de la bilirubine érythrocytaire. Appréciation du risque d'ictère nucléaire.

351 analysis of bilirubin binding by erythrocytes (BE) and of non conjugated bilirubin (NCB) are realised. 15 analysis have an increasing of the value: 6 with NCB and BE high with EST; 3 with NCB high and BE normal with EST; 6 with NCB high and BE normal without EST and any complication.

[Analysis of bilirubin binding by erythrocytes. Study of kernicterus risk (author's transl)]. / Etude de la bilirubine érythrocytaire. Appréciation du risque d'ictère nucléaire.

351 analysis of bilirubin binding by erythrocytes (BE) and of non conjugated bilirubin (NCB) are realised. 331 analysis. 15 analysis have an increasing of the value : 6 with NCB and BE high with EST ; 3 with NCB high and BE normal with EST ; 6 with NCB high and BE normal without EST and any complication.

[Direct urinary antibiotic sensitivity studies. A rapid method of therapeutic orientation in a urology department (author's transl)]. / Antibiogramme urinaire direct. Méthode rapide d'orientation thérapeutique en service d'urologie.

Two hundred and thirty antibiotic sensitivity studies performed directly on urine in a urology department were compared with the results of cytological and bacteriological examinations of the same urine in the laboratory. The direct sensitivity study proved valid in 65% of cases. This method, which shortens the time in which results are obtained, is thus useful in a urology department.

[Dwarf colony mutants of "Escherichia coli" study of a strain isolated from an uroculture (author's transl)]. / Mutants déficients à colonies naines de Escherichia coli: étude d'une souche thiamine-déficiente isolée d'une uroculture.

A dwarf colony mutant of Escherichia coli was isolated from the urine of a patient with an asymptomatic urinary infection. This dwarf mutant growths poorly (minute transparent colonies) on Trypticase Soja and Mueller-Hinton agar, and requires thiamine concentration of 3 x 10-11 M.