Molecular characterization of glycopeptide-resistant enterococci from hospitals of the picardy region (france).

We studied 138 glycopeptide-resistant enterococci (GRE) strains, consisting of 131 glycopeptide-resistant Enterococcus faecium (GREfm) and 7 glycopeptide-resistant Enterococcus faecalis (GREfs). The GREfm strains were resistant to penicillin, ampicillin, vancomycin, and teicoplanin, while the GREfs strains were only resistant to vancomycin and teicoplanin. The van A gene was the only glycopeptide determinant present in all GRE isolates investigated. Genes coding for Hyl and Hyl+ Esp were detected in 39 (29.8%) and 92 (70.2%) of the 131 GREfm isolates, respectively. Three of the 7 GREfs were positive for gelE+asa 1 genes, 3 for gel E gene, and 1 for asa 1 gene. The genetic relationship between the 138 GRE was analyzed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). GREfm isolates were clustered in a single genogroup (pulsotype A), and GREfs were clustered in six genogroups (pulsotypes B-G). Among the isolates investigated by MLST, only 18 PCR products were sequenced (12 E. faecium and 6 E. faecalis), and 9 sequence types (STs) were identified.

[Treatment in primary Streptococcus pneumoniae peritonitis in adult: a case report and review of the literature]. / Prise en charge thérapeutique de la péritonite primitive à Streptococcus pneumoniae de l'adulte: étude d'un cas et revue de la littérature.

INTRODUCTION: Streptococcus pneumoniae primary peritonitis is rare. The diagnosis is uneasy and the treatment is not standardised. CASE REPORT: We report a single case of S. pneumoniae primary peritonitis needing surgical treatment. DISCUSSION: S. pneumoniae primary peritonitis can be medically treated. Surgery is needed in case of sepsis, associated digestive injuries or failure of medical treatment.

[Uveitis and chronic intestinal inflammatory diseases: three case studies]. / Uvéites et maladies inflammatoires chroniques de l'intestin: à propos de 3 cas.

INTRODUCTION: The most frequent inflammatory chronic bowel diseases are Crohn disease and ulcerative colitis, which present extra intestinal manifestations, particularly, arthritis and ocular inflammation. Anterior uveitis is the main ocular manifestation and remains exclusively an inflammatory process. MATERIAL AND METHODS: [corrected] We report three cases of bilateral uveitis, with ulcerative colitis in two cases and Crohn disease in the last case. In the two first cases, uveitis occurred after 8 years of bowel disease which was stabilized by sulfasalazopyridine and 6 months after bowel surgery. In the third case, the patient was followed for Crohn disease for 3 years with anterior uveitis relapse concomitant to bowel relapse. RESULTS: In the two first cases, there was no recurrence after corticosteroids topical therapy. In the third case, topical and systemic corticosteroids provided adequate control of ocular inflammation, but the follow-up was marked by pupillary and inflammatory glaucoma, which required gonio-surgery. DISCUSSION: Anterior uveitis is the most frequent ocular manifestation in chronic inflammatory bowel disease: approximately 1.9-4.9% in Crohn disease and 1.6% in ulcerative colitis. The uveitis course is synchronous with bowel relapse and its treatment requires anti-inflammatory agents. Nevertheless, in severe relapse, recovery is obtained after the resection of the entire involved bowel segment.

[Macular serous detachment revealing acute lymphoblastic leukemia]. / Décollement séreux maculaire révélateur d'une leucémie aiguë lymphoblastique.

BACKGROUND: Leukemias are a group of malignant diseases caused by immature hematopoietic cells proliferating in the blood marrow. Some manifestations result from ocular-orbital involvement, which usually occurs through the central nervous system. Other manifestations stem from vasculopathy and/or hemorheologic disorders (anemia, thrombocytopenia, hyperviscosity). OBSERVATION: We report a case of a 42-year-old women presenting with loss of vision caused by serous macular detachment. The investigations showed the diagnosis of acute lymphoblastic leukemia. Steroids and chemotherapy led to complete remission with normal visual acuity during a follow-up of 29 months. DISCUSSION: Ocular involvement is seen in 28%-80% of leukemia cases. The most obvious findings are the presence of retinal hemorrhages, which are most commonly located in the posterior pole. The intraretinal hemorrhage may contain a white component that usually is a white dot in the center of the hemorrhage, but other clinical features are described. Serous detachment of the neuroepithelium is seldom reported, and can be the first symptom of the disease. Other ocular findings include infiltrative involvement of the chorioretina, anterior segment involvement, and orbital location. Ocular location is estimated to be an equivalent of central nervous system involvement, and subsequently requires adequate treatment (steroids, chemotherapy and radiotherapy of the central nervous system). CONCLUSION: Ocular manifestations of leukemia are frequent but rarely reveal the disease. Serous detachment is rarer. However, the diagnosis of leukemia should be considered in case of pigmentary epithelium involvement.

[Ophthalmic manifestations of acute leukemia]. / Manifestations ophtalmologiques des leucémies aiguës.

Orbital and ocular lesions are the third most frequent extramedullar locations of acute leukemia after the meninges and testicles. These lesions are treated as a central nervous system lesion; therefore diagnosis is essential to therapeutic adjustment. We present a retrospective study on charts of children treated for acute leukemia between 1996 and 1998. Ophthalmic examination was carried out when there were ocular symptoms. One hundred ninety-six children were treated for acute leukemia. Twelve children (6.1%) had an ocular and orbital lesion: 7 boys and 5 girls, with an average age of 6 years. Six had acute lymphoblastic leukemia, 6 had acute myeloid leukemia. Visual acuity was 1/10 in 9 children. Four children had an initial orbital lesion with a rapidly progressing exophthalmos. The hemogram and myelogram showed a granulocytic sarcoma. Two children who had been previously treated for acute leukemia presented a bilateral anterior uveitis with hypopyon; anterior chamber paracentesis showed blast cells and confirmed the ocular relapse. A corneal lesion was found in 2 children and in 2 cases, the optic nerve had edema; a decrease in visual acuity was the sign of the optic nerve lesion. Two patients had retinal infiltration with hemorrhages in the posterior pole. Prophylaxis consists of intrathecal injection of methotrexate and reinforcement of chemotherapy. Central nervous system irradiation is seldom used in children. Orbital and ocular lesions carry a poor prognosis according to the majority of authors. Two years after diagnosis of the ocular lesions, only 1 of the children studied remains alive.

[Epithelial cyst in the superior internal angle: a case report]. / Kyste épithélial de l'angle supéro-interne: à propos d'un cas.

Most orbital cysts in childhood are epidermoids or dermoids. We report one uncommon case of an 8-years old girl with a lacrimal orbital cyst revealed by discrete proptosis and pseudo-ptosis in which the cystic histopathological study revealed a lacrimal structure.

[Tuberculous uveitis]. / Uvéite tuberculeuse.

Ocular tuberculosis is relatively rare; however, the most common ocular lesion during ocular tuberculosis is uveitis. The recrudescence of this disease is probably caused by human immunodeficiency virus or long-term corticotherapy. The authors report a of chronic unilateral tuberculosis-related uveitis complicated by panophthalmia with subconjunctival abcesess and scleral fistula. A histopathological study revealed a granulomatous inflammation with caseous material. An extensive work-up revealed no extraocular lesion. A systemic bactericidal treatement associated with topical steroids decreased the local inflammation with phthisis bulbi, and with no spread of the infection. The authors discuss the etiopathogenic, clinical, and therapeutic aspects of tuberculosis-related uveitis.

Simultaneous subconjunctival and subscleral mitomycin-C application in trabeculectomy.

OBJECTIVE: To establish the efficacy and safety of simultaneous subconjunctival and subscleral application of mitomycin-C in trabeculectomy. DESIGN: A prospective, randomized study. PARTICIPANTS: Sixty-eight patients (68 eyes) with refractory glaucomas were included in the study. INTERVENTION: Eyes were randomly assigned to receive intraoperative mitomycin-C (0.3 mg/ml) applied under the conjunctival flap (group 1), scleral flap (group 2), or under both flaps (group 3). MAIN OUTCOME MEASURES: Mean intraocular pressure (IOP), postoperative medications, visual acuity, filtering bleb appearance, and complications. RESULTS: There was a significant difference in IOP at 6, 9, and 12 months after surgery among the three groups (P = 0.021, 0.026, and 0.033, respectively ANOVA). At 12 months, the mean IOP in group 3 was 9.8+/-3.7 mm Hg compared with 13.4+/-5.5 mm Hg in group 2. (P = 0.015) and 12.4+/-4.4 mm Hg in group 1 (P = 0.039). Success rate (21 mm Hg or less), number of antiglaucoma medications, and complications showed no statistical significant difference between the three groups at each postoperative visit. CONCLUSIONS: Mitomycin-C applied under the scleral flap may have an additional beneficial effect when combined with simultaneous subconjunctival exposure.

[Epidemiology of orbital processes in children. 54 cases]. / Epidémiologie des processus orbitaires chez l'enfant. A propos de 54 cas.

PURPOSE: The aim of this work was to study epidemiological aspect of orbital processes occurring in childhood. PATIENTS AND METHODS: Fifty-four cases of orbital processes treated between January 1990 and January 1997 were retrospectively reviewed. RESULTS: Mean patient age was 4.2 years (range 1 to 15), 36 were males and 18 were females. Proptosis was the first manifestation in 34 cases, other manifestations were low vision (8 cases), ocular pain (14 cases), inflammatory signs (11 cases), ocular palsy (14 cases). The first cause of these processes was secondary tumors, especially retinoblastoma (13 cases). Other causes were rhabdomyosarcoma (9 cases), orbital hydatic cyst (8 cases), inflammatory pseudotumors (7 cases), capillary hemanigoma (4 cases) chloroma (3 cases), glioma (1 case), lymphangioma (8 cases), and mucocele (1 case). DISCUSSION: We emphasize the particular epidemiological aspect of orbital processes in Moroccan children where retinoblastoma predominates and compare our findings with data in the literature.

[Tumor of the lacrimal sac. Dangers of simple excision biopsy]. / Tumeur du sac lacrymal. Dangers de la biopsie exérèse simple.

Lacrimal sac tumors are relatively uncommon tumors which recur readily and have poor prognosis if adequate care is not provided early. We report here a case of lacrimal sac tumor in a 56-year-old patient with bilateral pseudophakia and an atypical chronic dacryocystisis aspect of the left eye. After clinical and paraclinical investigations, the patient underwent surgical excision of the tumor followed by external radiotherapy. During follow-up, the patient developed a local recurrence which required surgical removal and radiotherapy. Despite early and adapted management, the prognosis of this tumor remains poor.

[Visual prognosis factors in congenital cataract]. / Les facteurs de pronostic visuel dans la cataracte congénitale.

PURPOSE: Study of different factors which can change the visual prognosis in congenital cataract. METHODS: One hundred seventy eyes of 100 children with congenital cataract are operated by extracapsular cataract extraction with limbic incision. Posterior rhexis and anterior vitrectomy were associated in children under 2 years. Implantation was used in 42%, contact lens in 8%. Other cases were corrected by glasses. The prognostic factors studied were: uni- or bilaterality, partial or complete aspect of cataract, age of apparition and management, and association with other malformations. RESULTS: Only 9 eyes out of 30 with unilateral congenital cataracts had visual acuity > or = 2/10; 44.4% of bilateral cataracts had visual acuity > or = 2/10; The best visual acuity was noted in progressive and partial cataract without associated malformations.

[Inflammatory proteins of the seminal fluid]. / Les protéines inflammatoires du plasma séminal.

If the clinical asymptomatic infection of the genital tract is a very frequent diagnosis of the hypofertility, it's quite important to know if the infection is evolutive or not. The assessment of inflammatory proteins of the seminal plasma as albumin IgA, gamma-globulins, lysozyme allows to do the differential diagnosis. So, an increase of such proteins is the expression of an evolutive infection.