Cerebrospinal Aß11-x and 17-x levels as indicators of mild cognitive impairment and patients' stratification in Alzheimer's disease.

In the present work, the concentrations of Aß11-x and Aß17-x peptides (x=40 or 42), which result from the combined cleavages of ß-amyloid precursor protein (AßPP) by ß'/α or α/γ-secretases, respectively, were assessed in cerebrospinal fluid (CSF) samples from patients with Alzheimer's disease (AD) or mild cognitive impairment (MCI). Specific multiplexed assays were set up using new anti-40 and anti-42 monoclonal antibodies (mAbs) for the capture of these N-truncated Aß peptides and anti-11 or anti-17 mAbs for their detection. The specificity, sensitivity and reproducibility of such assays were assessed using synthetic peptides and human cell models. Aß11-x and Aß17-x were then measured in CSF samples from patients with AD (n=23), MCI (n=23) and controls with normal cognition (n=21). Aß11-x levels were significantly lower in patients with MCI than in controls. Compared with the combined quantification of Aß1-42, total Tau (T-Tau) and phosphorylated Tau (P-Tau; AlzBio3, Innogenetics), the association of Aß11-40, Aß17-40 and T-Tau improved the discrimination between MCI and controls. Furthermore, when patients with MCI were classified into two subgroups (MCI ≤1.5 or ≥2 based on their CDR-SB (Cognitive Dementia Rating-Sum of Boxes) score), the CSF Aß17-40/Aß11-40 ratio was significantly higher in patients with CDR-SB ≤1.5 than in controls, whereas neither Aß1-42, T-Tau nor P-Tau allowed the detection of this subpopulation. These results need to be confirmed in a larger clinical prospective cohort.

[Withdrawal in opiate addicts in an internal medicine hospital unit]. / Sevrage des toxicomanes dépendant des opiacés, dans une unité hospitalière de médecine interne.

Withdrawal of opiates drug addicts in Internal Medicine is unusual in France. Four main preliminary conditions are requested: 1--Drug addict preparation and self motivation, 2--Inter and intra institution team collaboration, 3--Opening the hospital towards community agencies, 4--Hospital staff recruited on volunteer basis. Within two years (1992-1993), 210 opiates drug addicts were hospitalized for withdrawal. Two third were males, median age was 27, median years of addiction was 7. Thirty percent were seropositive for HIV, 70% for HCV. Hospitalisation lasted 7 days for heroin addicts and 10 days for morphin, codein or buprenorphin addicts. Successful withdrawn was observed for 70% patients but six months after withdrawal, only 15% remained abstinent.

[Pregnant seropositive drug addicts]. / La toxicomane séropositive enceinte.

Understanding actual experiences of sexuality and pregnancy in HIV positive drug addicts is essential for the prevention of AIDS dissemination. A rigorous organization and a coherent therapeutic project are needed for pregnancy supervision (pregnancy being carried on in over 50 percent of cases), for psychological preparation to the recognition of foetus reality and birth, and for newborn follow up to prevent his abandonment. The specific problems of pregnancy, seropositivity and drug addiction should be taken into account at the same time. The intervention of a voluntary, motivated and polyvalent team and a hospital opening towards outreach workers are two essential conditions of success.

[Campylobacter fetus spondylodiscitis]. / Spondylodiscite à Campylobacter fetus.

The case of a sixty-two year old man with Campylobacter fetus spondylodiscitis is reported. Despite of adequate antibiotherapy, the outcome was bad and death occurred. Three other cases of Campylobacter fetus spondylodiscitis are reported in the literature. Tomodensitometry disclosed a paravertebral abscess with gas, that make our observation original.

Presence of villin, a tissue-specific cytoskeletal protein, in sera of patients and an initial clinical evaluation of its value for the diagnosis and follow-up of colorectal cancers.

Villin is an actin-binding protein found in a few normal adult epithelia, namely epithelial cells in the digestive and urogenital tracts. Moreover, villin production is maintained in malignant cells. We assumed that cell lysis and necrosis of solid tumors producing villin might result in villin release into blood. We analyzed the villin content of sera from 788 patients and controls using an enzyme-linked immunosorbent assay. Patients and controls were classified into healthy donors, patients with benign diseases of the gastrointestinal tract, patients with colorectal cancers, and patients with malignant nondigestive diseases. In the panel of sera analyzed, the sensitivity of the assay for colorectal cancers was 50.5%, and its overall specificity for malignant digestive tumors was 94.5%. Results were statistically analyzed comparing each group of sera with each other. We conclude that the presence of villin is indicative of a pathological state in the gastrointestinal tract (P less than 0.001). Finally, we followed villin levels after tumor resections (60 patients). We found that the villin level in sera remains low in remissions but is raised in recurrences. We suggest that the villin assay may have clinical utility as a diagnostic adjunct for adenocarcinoma of the gastrointestinal tract. It may also have some value in monitoring patients with advancing colorectal carcinomas after resection of these tumors.

[Treatment by external drainage of perirenal abscess in AIDS]. / Guérison par drainage externe d'un abcès périrénal au cours d'un SIDA.

Fever of undetermined origin in a young white heroin addict with a positive HIV (human immunodeficiency virus), serology was secondary to a staphylococcal perinephric abscess. Ultrasound examination and tomodensitometry allowed the diagnostic. Percutaneous drainage led to complete recovery. Interventional radiology associated with antibiotherapy appears to be an alternative to surgery in the treatment of perinephric abscesses.

Exercise- and allergen-induced asthma do not change the production of Paf-acether by neutrophils and platelets.

Paf-acether, whose role has been suggested in asthma, is a mediator released by stimulated neutrophils, platelets and other cells. Neutrophils and platelets are activated in vivo during exercise or allergen-induced asthma. Upon in vitro stimulation, macrophages from mice treated with an inflammatory stimulus, such as thioglycoccollate, release less paf-acether than macrophages from non-treated mice. We hypothesized that upon in vitro activation platelets and neutrophils should produce less paf-acether after exercise- or allergen-induced asthma. To test this hypothesis, we measured the production of paf-acether by neutrophils and platelets obtained before, 15 and 75 min after exercise in seven normal subjects and five asthmatic subjects with exercise-induced asthma, and in five other asthmatic subjects after specific challenge with Dermatophagoides Pteronyssinus. Purified neutrophils and washed platelets were incubated independently for 10 min at 37 degrees C with no specific activator, with a platelet activator (thrombin, 1 IU.ml-1), a neutrophil activator (opsonized zymosan, 1 mg.ml-1), and both together. We found no significant difference between asthmatic and normal subjects in the amount of paf-acether synthesized by platelets or neutrophils and no fall in the production of paf-acether after exercise- or allergen-induced asthma. However, our method may lack sensitivity in detecting partial activation of these cells and is based on the assumption that changes in peripheral blood cells are representative of changes of these cells in lungs.

[Septic arthritis caused by Campylobacter fetus]. / Les arthrites septiques à Campylobacter fetus.

The ten published cases of septic arthritis due to Campylobacter fetus and two more recent cases, one of which was a delayed septic complication of a total hip replacement, are discussed. In 83% of cases, febrile monoarthritis occurred which in 7 out of the 12 cases involved an already diseased joint in a subject over 70 years of age (half of the patients), who was frequently alcoholic and presented either cancer or hepatic cirrhosis and/or diabetes. Hyperleukocytosis of the blood was variable (55% of cases). The joint fluid, which contained a high level of deteriorated polynuclear cells, was routinely cultured on an enriched medium in an anaerobic or microerophilic atmosphere and in 10 out of 12 cases Campylobacter fetus was isolated within 15 days, even in the absence of previous antibiotic therapy. The arthritis, which showed little sign radiographically of destructiveness, was cured, leaving no sequellae in most cases. Treatment usually involved ampicillin or the tetracyclines, either alone or in association with the aminoglycosides.

[2 cases of AIDS in patients with hemophilia A]. / Deux cas de SIDA chez des hémophiles A.

The authors report the first two cases of lethal AIDS in haemophilia A in France. One French case of AIDS in haemophilia B has already been reported. The diagnosis was based on the observation of opportunist infections associated with severe depression of cell-mediated immunity in both cases. The possibility of active transmission of the LAV retrovirus by factor VII concentrate is discussed. This raises the problem of the signification of anti-LAV antibodies in haemophiliac patients and the control of products used for the treatment of haemophilia.