Clinical evaluation of a dressing with poly absorbent fibres and a silver matrix for managing chronic wounds at risk of infection: a non comparative trial.

OBJECTIVE: To assess the efficacy, safety and acceptability of a new silver poly absorbent dressing (UrgoCleanAg) in the local management of exudative chronic wounds at risk of infection, with inflammatory signs suggesting heavy bacterial load. METHOD: This prospective, multicentre, non-comparative clinical trial was conducted in French hospital wards (dermatology and vascular medicine) or specialised private-practice physicians. Patients were considered at high-risk of infection when presenting with at least three of five selected inflammatory clinical signs, suggesting a heavy bacterial load (pain between two dressing changes, erythema, oedema, malodorous wound and presence of a heavy exudate). They were treated for a maximum period of four weeks, and followed by the physician on a weekly basis, including a clinical examination, area tracings and photographs. The primary efficacy criterion of the trial was the relative wound surface area reduction at the end of the four weeks of treatment. Acceptability was documented by the nursing staff at each dressing change between the weekly evaluations. RESULTS: We recruited 37 patients with chronic wounds. Wound surface area, mostly covered by sloughy tissue, was reduced by 32.5% at the end of the treatment (median value), while the clinical score (maximum value of 5, based on inflammatory clinical signs) decreased from 4.0 to 2.0. Effective debridement properties were documented (62.5% relative reduction of sloughy tissue at week 4; 58.8% of debrided wounds at week 4) and improvement of the periwound skin status was noted (healthy for 28.6% of the patients at week 4 versus 2.7% at baseline). In addition, the tested wound dressing presented a good safety profile associated to a high level of acceptability, noted by both patients and nursing staff. CONCLUSION: These clinical data support that the tested dressing is a credible therapeutic alternative for the management of chronic wounds at risk of infection with inflammatory signs suggesting heavy bacterial load.

[Toxocariasis mimicking liver tumor]. / Toxocarose hépatique pseudotumorale.

INTRODUCTION: Toxocariasis is a common helminth infection that causes visceral larva migrans in humans. It has a wide and varied clinical spectrum. CASE: A 60-year-old woman consulted after 6 months of recurrent biliary pain with fever. Laboratory tests showed moderate disturbance of liver enzymes and hypereosinophilia (10 400/mm3). Imaging studies revealed a pseudotumor in hepatic segment IV, hyperechoic in abdominal ultrasound and low density in computed tomography. The diagnostic conclusion after ultrasound-guided liver biopsy was unspecific granulomatous hepatitis and eosinophilic infiltrate. The course of the antibody titer to Toxocara canis finally resulted in a diagnosis of Toxocara infection. Outcome was good following treatment with diethylcarbamazine. DISCUSSION: Some clinical features of liver toxocariasis can mimic tumors and may be interpreted histologically as granulomatous hepatitis, eosinophilic infiltrate of the hepatic portal vein, and/or necrotizing eosinophilic abscesses. Treatment is not yet well codified, but the symptomatic forms call for albendazole or diethylcarbamazine.

[Ulcerating haemorrhagic colitis induced by celecoxib]. / Colite aiguë ulcéro-hémorragique induite par le célécoxib.

INTRODUCTION: Selectivity of cyclooxygenase-2 inhibitors (Cox2 inhibitors) decreased gastroduodenal toxicity of nonsteroidal anti-inflammatory drugs. Effects on colic mucosa are little known. OBSERVATION: A case history is described of a 38-year-old women, without digestive past, who presented with hemorrhagic ulcerated acute colitis beginning 2 days after starting celecoxib (200 mg/d) prescribed for sciatica. DISCUSSION: Intrinsic imputability of celecoxib is very probable in this case report by combination of chronological and semiological criteria. Extrinsic imputability is discussed, starting from the available bibliographical data which relate primarily to rofecoxib. CONCLUSION: This observation, which constitutes, as far as we know, the first case report of hemorrhagic ulcerated colitis related to celecoxib, confirms the colic toxicity of anti-Cox2 and identify a new cause of acute colitis. Report of colic side effects with Cox2 inhibitors is required because of their new marketing.

[Recurrent acute idiopathic pancreatitis. Look for a chronic inflammatory disease of the intestine]. / Pancréatite aiguë récidivante idiopathique. Chercher une maladie intestinale chronique inflammatoire.

INTRODUCTION: Among the new identified causes of so-called idiopathic acute pancreatitis are chronic inflammatory diseases of the intestine. OBSERVATION: A 21 year-old man was hospitalised for the third episode of unexplained acute pancreatitis. Digestive endoscopies revealed an ulcerated terminal ileitis compatible with Crohn's disease. DISCUSSION: The frequency of idiopathic pancreatitis in patients exhibiting a chronic inflammatory disease of the intestine is of around 1%. Pancreatic involvement may precede the digestive manifestations of Crohn's disease and its clinical expression varies. An auto-immune mechanism appears to be responsible.

Biliopancreatic fistulas complicating pancreatic pseudocysts: a report of three cases demonstrated by endoscopic retrograde cholangiopancreatography.

Three patients were found to have fistulation of the pancreatic and common bile ducts, complicating chronic pancreatitis in one patient and acute pancreatitis in two patients. Closure of the fistula was achieved with biliary and pancreatic stenting in one patient; the other two patients were treated surgically because endoscopic treatment had failed. The clinical and radiological features of this exceptional complication are presented, with a brief review of the topic.

[Buerger's disease or thromboangiitis obliterans]. / La maladie de Buerger ou thromboangéite oblitérante.

The Buerger's disease or thromboangiitis obliterants (TAO) is a non atheromatous inflammatory disease which alters medium and small-sized arteries and veins. It can be found world-wide, but it is more frequent in Eastern Europe, Middle East, Asia and Southeast Asia. Young men and smokers are the most affected. The incidence of this disease is increasing among women. The cause of this disease is unknown yet. The most striking fact is the relationship between TAO and tobacco. The diagnostic is most often late in front of a digital leg ischemia. Complementary exams help to its diagnostic and management but none of them are specific out of the pathology. The affection is evolving towards distal gangrene with amputation in 5 to 10% of cases. Prostacyclin demonstrated its efficiency. Revascularization surgery is difficult but sometimes possible. Sympathectomy, medular stimulation must be suggested. The patient survival is not at stake and the prognosis is above all functional. The most important element in the treatment is stop smoking definitively.

[Marchiafava-Bignani disease of good prognosis. Two cases]. / Maladie de Marchiafava-Bignami d'évolution favorable. Deux observations.

BACKGROUND: Marchiafava-Bignami disease or corpus callosum necrosis, is an uncommon complication of chronic alcoholism. Prognosis is severe. CASE REPORTS: Two young adults with chronic alcoholism who developed Marchiafava-Bignami disease initially improved clinically. DISCUSSION: Diagnosis has been facilitated with MRI. An MRI exploration should be performed in chronic alcoholic patients presenting chronic encephalopathy with dementia, dysarthria, hypertonia, and ataxia, or acute encephalopathy with confusion, dumbness, seizures, and hypertonia. Necrosis of the corpus callosum gives the diagnosis of Marchiafava-Bignami disease.

Agenesia bilateral de la vía espermática: estudio molecular y sus posibilidades terapéuticas / Congenital bilateral absernce of the vas deferens: molecular approach and treatment

Objetivo: Examinar la incidencia de mutacionews del gen regulador transmembranosos de la fibrosis quística (CFTR) en pacientes argentinos con agenesia bilateral de la vía espermática (CBAVD). Material y métododos: Entr abril de 1995 y junio de 1997, 17 pacientes en quienes se efctuó el diagnóstico de CBAVD fueron evaluados clínicamente y para 22 mutaciones del gen CFTR usando reacción en cadena de la polimerasa (PCR). Nueve pacientes realizaron 14 ciclos de ICSI (inyección espermática intracitoplasmática) utilizando espermatozoiodes rcuperados del epidimio ( 12 ciclos) o del testículo ( 2 ciclos). Resultados: Todos los pacientes eran sanos, sin evidencias de fibrosis quísticas. En 10 pacientes ( 58,8 por ciento) se detectó una MUTACIÓN DERL cftr. eN LA icsi la tasa de fertilización fue de 67,3 por ciento y la tasa de embarazo y nacimiento por ciclo fue de 35,7 por ciento y 28,5 por ciento. Conclusiones: La CBAVD parecería ser una forma genital de la fiobrosis quística, encontrándose en los pacientes argentinos con esta patología una incidencia de mutaciones de CFTR similar a la de otros países. Estos pacientes pueden reproducirse por técnicas por lo que es importante efectuar estudios moleculares y brindarles consejo genético

Agenesia bilateral de la vía espermática: estudio molecular y sus posibilidades terapéuticas / Congenital bilateral absernce of the vas deferens: molecular approach and treatment

Objetivo: Examinar la incidencia de mutacionews del gen regulador transmembranosos de la fibrosis quística (CFTR) en pacientes argentinos con agenesia bilateral de la vía espermática (CBAVD). Material y métododos: Entr abril de 1995 y junio de 1997, 17 pacientes en quienes se efctuó el diagnóstico de CBAVD fueron evaluados clínicamente y para 22 mutaciones del gen CFTR usando reacción en cadena de la polimerasa (PCR). Nueve pacientes realizaron 14 ciclos de ICSI (inyección espermática intracitoplasmática) utilizando espermatozoiodes rcuperados del epidimio ( 12 ciclos) o del testículo ( 2 ciclos). Resultados: Todos los pacientes eran sanos, sin evidencias de fibrosis quísticas. En 10 pacientes ( 58,8 por ciento) se detectó una MUTACION DERL cftr. eN LA icsi la tasa de fertilización fue de 67,3 por ciento y la tasa de embarazo y nacimiento por ciclo fue de 35,7 por ciento y 28,5 por ciento. Conclusiones: La CBAVD parecería ser una forma genital de la fiobrosis quística, encontrándose en los pacientes argentinos con esta patología una incidencia de mutaciones de CFTR similar a la de otros países. Estos pacientes pueden reproducirse por técnicas por lo que es importante efectuar estudios moleculares y brindarles consejo genético(AU)

Altered luteinizing hormone pulsatility in infertile patients with idiopathic oligoasthenozoospermia.

In a previous study, we demonstrated that oligoasthenozoospermic (OAZ) patients had two types of testosterone response to human chorionic gonadotrophin (HCG) administration: group 1 (OAZ-1) had an altered, monophasic (no first peak) response, and group 2 (OAZ-2) had a normal biphasic response. The objective of the present work was to study the luteinizing hormone (LH) pulsatility in OAZ-1 compared with both OAZ-2 and men of proven fertility (PF), in order partly to determine the possible aetiology of the blunted acute testosterone response to HCG in these patients. LH pulsatility was measured in 10 PF, 10 OAZ-1 and 10 OAZ-2 patients, in blood samples taken every 5 min for 6 h in PF, and for 4 h in OAZ patients. LH values were determined by a time-resolved immunofluorometric assay. Frequency and amplitude of the LH pulses were determined by a computer program. LH pulse frequency, expressed as pulses/4 h, was significantly lower in OAZ-1 (1.5+/-0.97) than in PF (2.4+/-0.63) and OAZ-2 (2.4+/-0.84) patients. In six OAZ-1 and two OAZ-2 patients, LH pulsatility was diminished, as they showed less than two pulses/4 h. No statistically significant differences in LH pulse amplitude were found. These results, together with a higher number of OAZ-1 cases found with decreased LH pulsatility, suggest that, at least in a subset of these men, quantitative and/or qualitative alterations of LH secretion might have occurred.

Ultrastructural pathology of the sperm flagellum: association between flagellar pathology and fertility prognosis in severely asthenozoospermic men.

An ultrastructural study of spermatozoa in a series of 247 severely asthenozoospermic patients disclosed two kinds of anomalies. The first was dysplasia of the fibrous sheath, a primary defect of spermatozoa with hypertrophy and hyperplasia of the fibrous sheath, associated axonemal anomalies, familial incidence and chronic respiratory disease. The patients could be divided into two subgroups: the complete form (all spermatozoa affected) and the incomplete form (alterations in 70-80% spermatozoa). There were no spontaneous or in-vitro fertilization (IVF) pregnancies. Intracytoplasmic sperm injection (ICSI) in six patients resulted in successful fertilizations, but only two pregnancies were obtained. These features configure a phenotype that suggests a genetic origin. The second anomaly was non-specific flagellar anomaly (NSFA), random secondary flagellar alterations affecting variable numbers of spermatozoa, without respiratory disease or familial incidence. 54 men with NSFA were followed for 2-6 years. Of these, 18 achieved conception, either spontaneous or by means of assisted fertilization, followed by 14 pregnancies and 12 live births. Their sperm motility significantly increased during the follow-up period. In the remaining 36 men motility did not change during the follow-up period and there were no fertilizations or pregnancies. We conclude that in severe asthenozoospermia, ultrastructural examination of spermatozoa has an effective prognostic value, identifying two syndromes with very different flagellar alterations and fertility potentials.

[A case of nasal entomophtoral phycomycosis observed in an arid African region (Somalia)]. / A propos d'un cas de rhino-entomophtoro-phycomycose observé en zone sèche Africaine (Somalie).

On the African continent, rhinophycomycosis entomophtorae, a deep mycosis due to Conidiobolus coranatus, has been encountered mainly in wet forest areas. Only one case, which involved a Tchadian, has been reported in a dry zone. The present report describes a case observed in a 30-year-old Somalian, who lived all his life in the rural zone of Dinsoor where the climate is hot (temperature between 22 degrees C and 30 degrees C) and dry (annual rainfall less than 400 mm). In this patient, diagnosis was based on the presence of a characteristic bifocal deformation of the central region of the face and on histological findings typical of rhinophycomycosis entomophtorae. This case underlines the fact that this deep mycosis can occur outside of wet forest areas in Africa. Thus practitioners should not rule this diagnosis out simply on the basis of climatic conditions.

[Clinical and biological aspects of a collective alimentary toxi- infection by group A streptococcus in a military unit stationed in Djibouti]. / Aspects cliniques et biologiques d'une toxi-infection alimentaire collective à streptocoque du groupe A survenue dans une unité militaire stationnée à Djibouti.

An outbreak of streptococcal pharyngitis due to a group A beta-hemolytic streptococcus has occurred in a French Army unit based in Djibouti during the month of september 1991. Out of 304 sick soldiers, 73% were seen by a physician in the initial 48 hours of the outbreak. All the patients showed a sore throat, associated with myalgia and rachialgia (85%), headache (26%) and digestive signs (24%). They were given a systematic antibiotic therapy by a penicillin or a macrolide, so no post-streptococcal complication was observed. From 23 throat swabs, 10 Streptococcus pyogenes strains were recovered with identical chimiotype, antibiotype and serotype (T:11, M non typable). Five serological assays were performed on 33 paired (early and 15 days later) samples of serum: ASLO (latex agglutination and microtitration), ASH, ASD and ASK. ASLO microtitration with ASD appear to be the most profitable association. The cost of such an outbreak is very heavy. More, the operational capacity of this unit was seriously compromised as long as 6 days. Measures to be applied are those used for the prevention of foodborne diseases, including medical surveillance of the cooking staff and strict observance of cool conservation of cooked meals and foods.

Epidemiology of Haemophilus influenzae type b disease in France.

Results are reported of an epidemiological study which spanned ten years and was carried out in two French departments. A total of 277 cases of Hib disease occurring in children < 5 years old are reported and, in this age group, the incidence is evaluated at 21/100,000. Meningitis accounted for 64% of infections and epiglottitis for 7%. While the overall mortality rate was 3.3%, death was secondary to meningitis in 7/8 cases. Sequelae, which were all related to meningitis, were major in 1.2% of cases, severe in 9% of cases, and involved some hearing loss in 3.3% of cases. The monitoring networks set up in the two departments were characterized by sensitivities of 87 and 94%, respectively. They should prove useful in assessing the impact of vaccination, when large-scale implementation of vaccination has spread to both departments.

Altered testicular hormone production in infertile patients with idiopathic oligoasthenospermia.

We studied the kinetics of testicular response to human chorionic gonadotropin (hCG) in oligoasthenospermic and asthenospermic patients (OAZ-AZ). The responses of testosterone (T), androstenedione (A), 17 OH-progesterone (17OHP), and estradiol (E2) were evaluated in 60 OAZ-AZ patients and compared to those of 10 normal men. The responses of T, A, and 17OHP to hCG in the control group displayed a biphasic pattern with an initial peak at 4 hours and a second peak after 24 hours. The E2 response showed a single peak between 24 and 48 hours after hCG administration. OAZ-AZ patients had two types of T responses: group 1 (n = 40) had no first peak and group 2 (n = 20) had a normal response pattern. The response of A was similar to that of T, and the E2 response was normal in both groups. There were three types of 17OHP responses in group 1 (low, high, or normal); however, the 17OHP response was normal in group 2. Treatment of group 1 with aromatase inhibitors (aminoglutethimide or testolactone) induced an improvement of the acute T response only in patients with high or normal 17OHP response to hCG, whereas no effects were observed in patients with low 17OHP response. In group 2, the aromatase inhibitors induced no changes in the T response. These results demonstrate that in some OAZ-AZ patients (group 1, blunted T response) testicular hormone production is altered. They also suggest the presence of two enzyme blocks: one at the 17,20 desmolase level, mediated by E2, and another at early biosynthetic steps, not mediated by E2.

[Epidemiology of Haemophilus influenzae type b meningitis in 2 French departments]. / Epidémiologie des méningites à Haemophilus influenzae type b dans deux départements français.

Meningitis represents a frequent and severe expression of Haemophilus influenzae type b disease. The results of a 7 year-epidemiologic study (Jan 1980 to Dec 1986) undertaken in 2 French departments are reported herein. One hundred and twenty-three cases of meningitis were detected, representing a yearly rate of 15 cases for 100,000 children aged 0 to 4 years. The real incidence is probably higher and has been estimated as 17/100,000 which corresponds to 572 annual cases for the entire country. The death rate was 3.3% and severe sequelae were documented in 1.6%. To these should be added less severe neurologic (9%) and hearing (2.4%) deficits. These results show that the incidence of meningitis is comparable to the rate observed in Northern Europe but lower than the one reported in the United States. However, the rates of mortality and of neurologic deficit published in recent studies are comparable to those in the present report. Hearing sequelae are probably underestimated and would need systematic screening during the immediate follow-up period.

Dysplasia of the fibrous sheath: an ultrastructural defect of human spermatozoa associated with sperm immotility and primary sterility.

A study of a group of five patients presenting with primary sterility and showing severe sperm immotility is presented. Most spermatozoa in these patients showed rigid, short, thick, and/or irregular tails and 95 to 100% were immotile. Electron-microscopy disclosed a common pattern of flagellar abnormalities. There was a dysplastic development of the fibrous sheath, which appeared hyperplastic and disorganized. The axoneme was either missing or grossly distorted. In a few instances, a normal flagellum could be identified. Similar alterations also were detected in maturing spermatids, suggesting that the described defect develops during spermiogenesis. Two of the five patients had recurrent bronchial and sinusal infections and bronchiectasis, suggesting the possible existence of an associated abnormality in respiratory cilia. The existence of a common ultrastructural defect affecting most spermatozoa, its presence in two brothers, and the possibility of association with immotile respiratory cilia point to the existence of a syndrome (namely the "dysplasia of the fibrous sheath") of possible familial transmission.