[Gamma heavy chain disease associated with aggressive B lymphoma in the context of myelodysplastic syndrome]. / Maladie des chaînes lourdes de type gamma associée à un lymphome B diffus à grandes cellules dans un contexte de myélodysplasie.

INTRODUCTION: Heavy chain disease is a rare entity characterized by the production of incomplete immunoglobulin heavy chain without associated light chain. It is a B-cell lymphoproliferation, categorized according to the immunoglobulin involved. It is often associated with lymphomas but also with autoimmune diseases. OBSERVATION: We report the case of a 70-year-old patient who presented a gamma-type heavy chain disease, associated with a diffuse large B-cell lymphoma in the context of myelodysplastic syndrome. CONCLUSION: This is the first case of diffuse large B-cell lymphoma associated gamma heavy chain disease described in the context of myelodysplastic syndrome.

Drivers of soil and tree carbon dynamics in urban residential lawns: a modeling approach.

Soils constitute the largest sink of terrestrial carbon (C), and urban soils have the potential to provide significant soil C storage. Soils in urbanized landscapes experience a multitude of human alterations, such as compaction and management subsidies, that impact soil C dynamics. While field studies may provide data on urban soil C storage, modeling soil C dynamics under various human impact scenarios will provide a basis for identifying drivers of urban soil C dynamics and for predicting the potential for these highly altered soils to store C over time intervals not typically amenable to empirical validation. The goal of this study was to model soil C dynamics in residential lawns using CENTURY, a dynamic mechanistic model, to determine whether drivers of soil C dynamics in natural systems (e.g., soil texture) were equally useful for estimating soil C content of highly modified soils in urban residential areas. Without incorporating human impacts, we found no relationship between initial CENTURY model simulations and observed soil C (P > 0.05). Factors that best explained soil C accumulation for the observed soil C (bulk density, r2  = 0.30; home age, r2  = 0.37; P < 0.01) differed from those found important for the CENTURY model simulations (percent sand, r2  = 0.72, P < 0.001). Therefore, we conducted a modeling exercise to test whether simulating potential construction disturbance and lawn management practices would improve modeled soil and tree C. We found that incorporating these factors did improve CENTURY's ability to model soil and tree C (P < 0.001). The results from this analysis suggest that incorporating various human disturbances and management practices that occur in urban landscapes into CENTURY model runs will improve its ability to predict urban soil C dynamics, at least within a 100-yr time frame. Thus, enhancing our ability to provide recommendations for management and development practices that result in increasing urban soil C storage.

[Pelvic hydatid cyst: differential diagnosis with a bacterial abscess with cutaneous fistula]. / Kyste hydatique pelvien : diagnostic différentiel d'un abcès bactérien fistulisé

The genus Echinococcus is a worldwide tapeworm with a two host mammalian cycle. Among the six described species, Echinococcus granulosus (EG) and Echinococcus multilocularis are the most important in respect to their public health importance. Infected human, as an intermediate accidental host, presents single to several cysts, mainly located in the liver. We are describing the clinical, radiological and histological findings of a woman born in Morocco, recently arrived in France and presenting a pelvic hydatid cyst. The misknowledge of such a diagnosis conducted to initial surgery and thus a risk of further metastasised lesions. We are suggesting that any hypoechogenic pelvic lesion in a patient originated from a Mediterranean country should be considered as a pelvic localization of EG.

Use of palivizumab to control an outbreak of syncytial respiratory virus in a neonatal intensive care unit.

To evaluate the safety and effectiveness of a humanized respiratory syncytial virus (RSV) monoclonal antibody (palivizumab) to control an outbreak of RSV in a neonatal intensive care unit (NICU), we retrospectively analysed two RSV outbreaks. Between 11 November 1998 and 18 March 1999, two separate RSV outbreaks occurred in a large (26 beds) NICU. All procedures for preventing nosocomial spread of RSV (including the use of palivizumab in the second outbreak) were retrospectively analysed. The cumulative incidence (CI), secondary attack rate (SAR) and risk ratio of infection were determined before and after the use of palivizumab for all patients and for those with gestational age below and above 32 weeks in the NICU during the second outbreak. Standard infection control measures were effective in the first outbreak (three cases). In the second outbreak, after three index cases, five additional infants were newly RSV-infected within one month. Three infants had RSV pneumonia and required mechanical ventilation; one infant died. Standard infection control procedures were initiated from the beginning of this outbreak. Palivizumab was given to all infants in the NICU after the fifth case was identified. CI was 2.4% in the first 15 days and 10.5% in the second, and SAR was 2.9 per thousand in the first 15 days and 14.1 per thousand in the second, both dropping to zero after the administration of palivizumab. The risk ratio of infection was 4.65 times higher in infants under 32 weeks gestational age. After the use of palivizumab, there were no additional identified cases. In addition to careful infection control procedures, the use of palivizumab might have contributed to arresting the outbreak of RSV infection in the NICU, suggesting that it could be an additional resource in the control of severe nosocomial RSV outbreaks.

Tratamiento con metformin en pacientes con enfermedad hepática grasa no alcoholica portadores de resistencia a la insulina / Treatment with metformin in patient with nonalcoholic steatohepatitis disease carrier of insuline resistance

Determinar si el tratamiento con metformin modifica los valores de aminotransferasas séricas y la histología hepática en pacientes con enfermedad hepática grasa no alcoholica (EHGNA) y Resistencia a la insulina (RI). 22 pacientes con diagnóstico histológico de EHGNA, RI y transaminasas elevadas recibieron tratamiento con metformin 1000 mg/día. Fueron seguidos por tres meses (n: 4), seis meses (n:4, nueve meses (n:7) y 12 (n:7), con controles trimestrales de aminotransferasas y control histológico al año. Utilizamos t de student pareada y análisis de varianza, p<0.05. La TGo disminuyó en 9 pacientes, y se normalizó en 11; la TGP disminuyó en 9 pacientes y se normalizó también en 9 pacientes, siendo estadísticamente significante en el grupo seguido por seis (p=0,007) y doce meses (p=0.02). Al tercer mes de seguimiento en todos los pacientes disminuyeron la TGO (84,5 a 37,04; p=0,000037) y la TGP (137,27 a 72,95; p=0,0019067). Se repitió la biopsia herpática post-tratamiento en 3 pacientes. En uno disminuyó el grado de 2 a 1 sin cambios en el estadio y en los otros dos no cambió ni el grado ni estadío. El metformin disminuyó las aminotransferasas séricas significatntemente llegando a normalizarse los valores en la mitad de los pacientes tratados. No podemos establecer conclusdiones sobre los efectos del metformin en la histología hepática por el pequeño número de pacientes con biopsia hepática post-tratamiento

[Malaise with sweating induced by eye-drop. A case of iatrogenic pathology caused by diagnostic error]. / Malaises avec sueurs dus à un collyre. Un cas d'errance diagnostique due à une pathologie iatrogène.

INTRODUCTION: Eye-drops can provoke various systemic side effects and diagnosis of an iatrogenic pathology can made difficult. Observation For 4 months, and 80 year-old man had experienced severe recurrent episodes of sweating concomitant with shaking of the legs. Alpha stimulating eye-drops, prescribed for his glaucoma, were at the origin of these problems. On withdrawal of the latter, the symptoms regressed. DISCUSSION: Diagnosis of an iatrogenic pathology was made after 3 months of medical explorations. The delay in diagnosis was prolonged because the patient had not mentioned the use of an active ingredient, since it was in the form of eye-drops. CONCLUSION: The search for drug-induced causes must be systematic when faced with any unexplained symptom and must include all the active ingredients, whatever their form of administration.

[Oral histoplasmosis 34 years after return of Africa]. / Une histoplasmose du plancher buccal 34 ans après un retour d'Afrique.

INTRODUCTION: Histoplasmosis is a tropical fungal infection sharing many similarities with tuberculosis: the transmission by air dropplets, the usually asymptomatic primary-infection, the disseminated infection encountered among immunosuppressed patients and the granulomatous pathological lesions. In France, histoplasmosis is uncommon and may be misdiagnosed as tuberculosis. OBSERVATION: A 78 years old male patient presents with a raspberry-like lesion of the mouth causing difficulties to eat and weight loss of 14 kg. The diagnosis of tuberculosis is evoked because of the presence of a giant-cell granuloma in one of the biopsies. The histoplasmosis serology, requested because the patient stayed in Africa, is positive. Revisions of the pathology put into evidence the presence of spores in histiocytes confirming diagnosis of histoplasmosis. The treatment with itraconazole is effective. CONCLUSION: Histoplasmosis is a differential diagnosis of tuberculosis, especially in endemic regions. The histoplasmosis serology can be useful. The reference in diagnosis examinations keeps being the microscopic observation of spores and their mycological growth.

Symptomatic macroglossia and tongue myositis in polymyositis: treatment with corticosteroids and intravenous immunoglobulin.

Symptomatic macroglossia occurs in some rare congenital muscle diseases, such as Becker's and Duchenne's dystrophies or Pompe's disease. Herein we describe a case of symptomatic macroglossia with myositis of the tongue occurring in a patient with polymyositis. Tongue myositis was evidenced by dysarthria, frequent biting during mastication, swallowing difficulties without aspiration, and noisy breathing. Magnetic resonance imaging showed homogeneous hypertrophy of the tongue, especially the mouth's floor muscles. The diagnosis of tongue myositis was established by electromyography and biopsy. No other cause for the macroglossia was found. Symptoms resolved quickly with corticosteroid and intravenous immunoglobulin treatment. To our knowledge, this is the first reported case of symptomatic tongue myositis occurring in the course of polymyositis.

Hypercapnic coma due to diaphragmatic involvement in a patient with dermatomyositis.

We report an acute respiratory distress by diaphragmatic involvement due to dermatomyositis. A fifty year-old patient with typical dermatomyositis presented an acute respiratory insufficiency with hypercapnic coma due to diaphragmatic muscle involvement. Respiratory state required mechanical ventilation initially and improved secondarily gradually upon corticosteroids and intravenous immunoglobulins. Only few cases of acute respiratory distress in dermatomyositis due to respiratory muscle involvement are reported in literature.

Spatial and temporal evolution of the levels of tritium in the Tagus River in its passage through Caceres (Spain) and the Alentejo (Portugal).

This work is the result of a collaboration between Spanish and Portuguese laboratories. The specific objective was to quantify the time evolution during 1994, 1995 and 1996 of the radioecological impact of the liquid releases of 3H from the Almaraz Nuclear Power Plant (ANPP) in the section of the Tagus River corresponding to Cáceres province in Spain and the Alentejo region in Portugal. We found that the temporal evolution of the levels of tritium depends on the management of the water held in the cooling reservoir of the ANPP and the presence of the dams that exist along the river. This management regime has a 12-month period. Also the movement of the mass of tritiated water (HTO) downriver was much faster during 1996 than 1995 or 1994 due to the hydrological differences between those years and consequently to the different amounts of water transferred between the reservoirs of the dams. From the hypothesis that hydrodynamically it is impossible to differentiate tritiated water from non-tritiated water, a model was constructed that satisfactorily reproduces the temporal evolution of the 3H in the zone of the Tagus River in which the exchange of water takes place, with the cooling reservoir of the Almaraz Nuclear Power Plant.

Nitrogen deposition to and cycling in a deciduous forest.

The project described here seeks to answer questions regarding the role increased nitrogen (N) deposition is playing in enhanced carbon (C) sequestration in temperate mid-latitude forests, using detailed measurements from an AmeriFlux tower in southern Indiana (Morgan-Monroe State Forest, or MMSF). The measurements indicate an average atmosphere-surface N flux of approximately 6 mg-N m(-2) day(-1) during the 2000 growing season, with approximately 40% coming from dry deposition of ammonia (NH3), nitric acid (HNO3), and particle-bound N. Wet deposition and throughfall measurements indicate significant canopy uptake of N (particularly NH4+) at the site, leading to a net canopy exchange (NCE) of -6 kg-N ha(-1) for the growing season. These data are used in combination with data on the aboveground C:N ratio, litterfall flux, and soil net N mineralization rates to indicate the level of potential perturbation of C sequestration at this site.

[Non-complicated Horton's disease: initial treatment with methylprednisolone 500 mg/day bolus for three days followed by 20 mg/day prednisone-equivalent. Evaluation of 15 patients]. / Maladie de Horton non compliquée: traitement initial par trois bolus de 500 mg de méthylprednisolone suivis de 20 mg/j d'équivalent-prednisone. Evaluation chez 15 patients.

PURPOSE: To assess the efficacy and tolerance of three methylprednisolone boluses (500 mg/d) followed by a standard dose of prednisolone, 20 mg/d, as the initial treatment of non-complicated giant-cell arteritis. METHOD: A retrospective study of 15 cases. RESULTS: Six men and nine women with a mean age of 70.9 years were treated and followed for 41.5 months. Initial mean ESR was 83 mm; mean C-reactive protein level was 94.6 mg/L. The boluses were well tolerated, excepted in one patient who developed acute psychosis. After initiating the oral treatment, two patients presented signs of clinical relapse during the first month, and were given higher doses of corticosteroids. At 1 month, 12 patients were asymptomatic, nine of whom had normalized ESR and CRP. Mean ESR was 23; mean CRP was 13 mg/L. At 3 months, the mean prednisone dose delivered was 18.2 mg/d. Mean ESR was 12 mm. The cumulative prednisone dose given during the first year was 5,349 (+/- 2,512) mg. In the 13 patients who necessitated no more than 20 mg/d prednisone, no sequelae of giant-cell arteritis, no fractures nor major treatment intolerance occurred-during the first 2 years of treatment. Treatment was stopped in eight patients after a mean duration of 48.6 months. CONCLUSION: Treatment with pulse methylprednisolone 500 mg/d for 3 days followed by 20 mg/d oral prednisone could be a valuable corticosteroid-sparing strategy in many patients with uncomplicated temporal arteritis.

C-CAM1 expression: differential effects on morphology, differentiation state and suppression of human PC-3 prostate carcinoma cells.

Studies in rat prostate and liver have suggested that C-CAM1 is involved in the formation and maintenance of histotypic associations in tissues and possibly tumors. Most recently, C-CAM1 has been shown to suppress tumorigenicity of prostate and colon carcinoma cells. However, the mechanisms whereby C-CAM1 suppresses growth and the relationship of this activity to its proposed role in histotypic interactions remain largely unknown. In the present study, we have analysed the growth, phenotypic, morphological and ultrastructural characteristics of four human PC-3 prostate carcinoma cell lines transduced with C-CAM1 retrovirus. We report that three of four lines regained their tumorigenic phenotype in vivo while maintaining high levels of C-CAM1 expression and a growth retarded phenotype in vitro. These findings suggested that high levels of C-CAM1 expression were negatively influencing recovery during reconstitution after freezing or during the latency period after subcutaneous injection and that loss of suppression resulted from changes in expression of other molecules required for full disclosure of C-CAM1 mediated growth inhibition. Results from Northern blot and immunofluorescence analyses of tumor nodules demonstrated that C-CAM1 decreased rather than enhanced phenotypic differentiation and induced ultrastructural and morphological changes that occurred independently of tumor suppression.

Application of immunomagnetic beads in combination with RT-PCR for the detection of circulating prostate cancer cells.

Recently published protocols using Reverse Transcriptase Polymerase Chain reaction (RT-PCR) for prostate specific antigen (PSA) provide a sensitive means for detecting circulating prostate cancer cells. Attempts to use these assays for staging of prostate cancer have produced conflicting results. As a first step towards rectifying these discrepancies, a modified immunobead-RT-PCR assay capable of detecting as few as 10 prostate cancer cells in 8cc of blood was developed. This 10 fold increase in sensitivity was achieved in part by introducing two target cell enrichment steps. As a model system to assess sensitivity of the modified assay, template RNA was extracted from PSA positive human carcinoma cells suspended in human blood and isolated with immunomagnetic beads following incubation with an epithelium specific antibody. After 45 cycles of PCR, product from as few as 10 target cells could be readily detected when displayed on a 2% agarose gel stained with SYBR Green fluorescent dye. The identity of amplified DNA fragments was confirmed by Southern blot hybridization. When applied to blood samples from patients with proven metastatic disease, the immuno-bead RT-PCR assay was successful in detecting circulating PSA positive epithelial cells, suggesting this assay may be useful for assessment of disease progression or recurrence.

[Neonatal screening of hemoglobinopathies in a population residing in Portugal]. / Rastreio neonatal de hemoglobinopatias numa população residente em Portugal.

The primary objective of newborn screening of hemoglobinopathies is the early identification of infants with sickle cell disease, as they are at increased clinical risk. Other goals include the identification of other types of clinically significant hemoglobinopathies and the detection of heterozygous carriers followed by the screening and counselling of family members. We performed a pilot study for the neonatal screening of hemoglobinopathies in 400 samples of cord blood taken from a maternity in Lisbon. We did not find any newborn with sickle cell disease. Six samples were from sickle cell heterozygotes, the respective families were studied and informed. We looked for the presence of alpha-thalassemia at birth in 100 consecutive samples of cord blood, by the presence of Hb Bart's, abnormal red blood cell indices and alpha-globin genotype. The results show an incidence of 10% of alpha-thalassemia (-alpha) carriers and 4% of triple alpha-globin gene carriers. The authors discuss the feasibility of neonatal screening of hemoglobinopathies in a Portuguese-speaking population consisting of a low prevalence of Hb S trait autoclonous group and a high prevalence immigrant minority.