Lipoxin A(4) and interleukin-8 levels in cystic fibrosis sputum after antibiotherapy.

UNLABELLED: Antibiotics are largely prescribed for cystic fibrosis (CF) respiratory exacerbations. Effects of antibiotics on the inflammatory profile of the patients have been shown but remain controversial. Lipoxin A(4) (LXA(4)) is a lipid mediator, reported to play a central role in resolving airway inflammation. The aim of the study was to investigate the consequences of antibiotherapy on LXA(4) and IL-8 levels in CF patients' airways. METHODS: Eighteen CF patients (7 females, median age 20, range 8 to 47 years) consecutively admitted at the CF center of Montpellier for antibiotics during pulmonary exacerbation, were enrolled. Before and after antibiotics, all patients underwent spirometry (FEV(1) and FVC), bacterial cultures and cell counts in sputa. IL-8 and LXA(4) concentrations were determined in sputum samples by the median of immunometric assays. RESULTS: As previously reported, after antibiotics therapy, FEV(1) and FVC significantly improved. While neutrophil cell counts and IL-8 levels decreased, the LXA(4) levels significantly increased after antibiotics therapy and were inversely correlated with IL-8 levels. In conclusion, we reported a correlation between antibiotics treatments and inflammatory markers in CF sputum. Our data provide evidences for a novel effect of antibiotics increasing the concentration of the anti-inflammatory lipid mediator LXA(4).

Rapid anti-secretory effects of glucocorticoids in human airway epithelium.

Glucocorticoids are anti-inflammatory molecules classically described as acting through a genomic pathway. Similar to many steroid hormones, glucocorticoids also induce rapid non-genomic responses. The present paper provides a general overview of the rapid non-genomic effects of glucocorticoids in airway and will be mainly focused on a retrospective of the authors work on rapid effects of glucocorticoids in airway epithelial cell transport. Using fluorescence microscopy, short circuit current measurements in human bronchial epithelial (16HBE14o(-)) cells, we reported rapid non-genomic effects of dexamethasone on cell signalling and ion transport. Dexamethasone (1 nM) rapidly stimulated Na(+)/H(+) exchanger activity and pH(i) regulation in 16HBE14o(-) cells. Dexamethasone also produced a rapid decrease of intracellular [Ca(2+)](i) to a new steady state concentration and inhibited the large and transient [Ca(2+)](i) increase induced by apical adenosine tri-phosphate (ATP). Dexamethasone also reduced by 1/3 the Ca(2+)-dependent Cl(-) secretion induced by apical ATP. The rapid effects of dexamethasone on intracellular pH and Ca(2+) were not affected by inhibitors of transcription, cycloheximide or by the classical glucocorticoid and mineralocorticoid receptors antagonists, RU486 and spironolactone, respectively. The rapid responses to glucocorticoid were reduced by the inhibitors of adenylated cyclase, cAMP-dependent protein kinase (PKA) and mitogen-activated protein kinase (ERK1/2). Our results demonstrate, that dexamethasone at low concentrations, rapidly regulates intracellular pH, Ca(2+) and PKA activity and inhibits Cl(-) secretion in human bronchial epithelial cells via a non-genomic mechanism which neither involve the classical glucocorticoid nor mineralocorticoid receptor.

[Screening and imaging guided biopsies of the breast]. / Dépistage et ponctions guidées du sein.

In cases of subclinical mammographic abnormalities, being able to determine after screening, the indications regarding the type of imaging guidance and the type of biopsy equipment. In presence of microcalcifications, stereotactic mammography, either screen-film or digital, is the modality of choice. As fine needle aspiration cytology is insufficient, it is necessary to obtain tissue specimens with at least 14 Gauge Tru-cut needle, triggered by automatic guns, or coaxial needles of 11 G or 8 G, adaptable on a vacuum aspiration system. In case of mammographic opacities or masses, the same type of sampling can be used under US guidance as long as there is a good sonographic contrast of the lesion. Fine needle puncture, well accepted, keeps all its interest for cystic lesions and for solid ones, because of the value of its multidirectionnal sampling that well trained cytopathologists can make very informative. However, in case of insufficient or discordant results, US guided microbiopsies or macrobiopsies, using newer guns, allow to obtain a histologic diagnosis equivalent to surgical biopsy. If fine needle US guided puncture can be performed in first intention, straight after ultrasonographic examination, percutaneous micro- or macrobiopsies (using US or stereotactic guidance) must be undertaken in second intention after having explained to the patient this ambulatory procedure, the eventual risks, and by insisting on the results that can be expected for a precise diagnosis.

[Comparison between scintigraphy, B-mode, and power Doppler sonography in acute pyelonephritis in children]. / Imagerie comparative entre techniques scintigraphique et echographiques en mode B et Doppler energie dans la pyelonéphrite aigüe de l'enfant.

PURPOSE: Comparing Power Doppler imaging versus technetium-dimercapto-succinic-acid (Tc-DMSA) scintigraphy in acute pyelonephritis of childhood. INCLUSION CRITERIA: First episode of urinary tract infection, clinical and biological findings suggesting an upper lesion, absence of urological malformation or obstruction, absence of reflux (or vesico-ureteral reflux inferior to grade 3). Number of patients: 49, length of the study: 26 months (from November 95 to January 98). METHODS: Tc99m-DMSA scintigraphy (after five days), B mode and Power Doppler imaging (on the day of admission or the following day). Systematic cystography (day 5 to day 30). RESULTS: In terms of positive diagnosis, scintigraphy was superior to Power Doppler, and the latter was superior to B mode ultrasonography. Sensitivity (scintigraphy being the gold standard) was equal for both B mode and Power DopplerUS imaging, but combined Power Doppler and B mode US provided improved results. CONCLUSION: Currently, the results with Power Doppler imaging are insufficient to replace DMSA scintigraphy. However, Power Doppler is a good complement to B mode US.

Indicaciones de las punciones controladas con ecografía y calidad de las muestras / Indications for ultrasonographically guided punction and quality of the specimens obtained

Las punciones mamarias bajo control ecoguiado prolongan el examen senológico. Los autores recuerdan las diferentes técnicas que permiten efectuar estos gestos con el máximo de eficacia al mismo tiempo que se limitan los riesgos. Las indicaciones actuales de las punciones con aguja fina, de las microbiopsias y de las macrobiopsias son precisadas (AU)

[A novel approach to the biomechanical study of the talocrural joint in man using MRI. Contribution of dynamic images]. / Nouvelle approche de l'étude biomécanique de l'articulation talocrurale chez l'homme par I.R.M. Apport des images dynamiques.

A cineradiographic study of the talocrural joint allows a new biomechanical approach of the ankle: MRI with axial and coronal slides were realized: for volume reconstruction in passive movement; scanner was used for axial slides in active movement. There is evidently neither distosis of the bimalleolar grip in dorso- and plantar flexion, nor movement of the lateral malleolus of the fibula, in opposition to the classical description. An anatomical rotation is discussed.

Metaphyseal anadysplasia in two sisters.

Metaphyseal anadysplasia is a rare form of metaphyseal chondrodysplasia with well-defined radiological abnormalities. The prognosis is good as the natural course results in regression of the lesions with normal stature in adulthood. The few reported cases, exclusively in male children, indicated possible X-linked recessive transmission. The documentation of two affected sisters suggests genetic heterogeneity or another mode of inheritance.

[Fine-needle cytology and core biopsy of nonpalpable breast lesions. When appropriate?]. / Cytoponctions et ponctions biopsiques des lésions mammaires non palpables. Quand prélever?

The respective roles of fine-needle cytology and core biopsy for the investigation of breast densities and microcalcifications are discussed. For microcalcifications, the type, number, and conditions of development should be taken into account, and the reliability of investigations are directly related to stereotactic visibility, i.e., to advances in digitization. Fine-needle biopsy has been almost completely discarded as a means for investigating microcalcifications but remains useful when performed under ultrasound or stereotactic guidance to investigate densities presumed to be nonmalignant. Doubtful densities are best investigated by core biopsy.

[Aponeurotomy and degenerative lesions of the plantar aponeurosis. Contribution of magnetic imaging]. / Aponévrotomie et lésions dégénératives de l'aponévrose plantaire. Apport de l'imagerie par résonance magnétique.

PURPOSE OF THE STUDY: Talalgia are frequent. Their etiologies are various and diagnosis is sometimes difficult. MATERIAL: From 1980 to 1993, 12 cases of degenerative lesions of plantar aponeurosis were treated surgically. M.R.I. revealed 6 chronic aponeurositis and 6 old tears. The treatment was an aponeurectomy with resection of calcaneal spine after a conservative treatment for several months. The histological examination found inflammation in all cases (aponeurositis or rupture), a calcification of aponeurosis, a cartilaginous metaplasia and fibromatosis. METHODS: Patients were evaluated at a minimum of 2 years follow-up and a maximum of 6 years. The post-operative results were estimated using 3 criteria: pain disappearance, results on the foot static, patients functional activity. RESULTS: Global score was : 9 very good and good results, one fair result and 2 bad results. The M.R.I. realized at the time of revision revealed a good healing of plantar aponeurosis in 5 cases, defect in 1 case, inflammation in 3 cases and defect associated with inflammation in 3 cases. DISCUSSION: Surgical treatment can be suggested in failures of talalgia conservative treatment. Degenerative injuries of plantar aponeurosis, as rupture or aponeurositis may take advantage of an aponeurectomy. Short term results show pain disappearance in 75 per cent of cases without modification of the plantar arch. CONCLUSION: M.R.I. allows to explain exactly the origin of talalgia. After a failure of conservative treatment, some talalgia may take advantage of an aponeurectomy.

[Tenography in tenosynoviopathies of the posterior tibial tendon]. / La ténographie dans les ténosynoviopathies du tendon tibial postérieur.

PURPOSE OF THE STUDY: The authors wanted to study diagnosis contribution and therapeutic importance of tenography in posterior tibial tendon tenosynoviopathies. MATERIAL: The series included 42 patients (26 females and 16 males) from 23 to 69 years old. The affection had a course for about two years. A trigger or promoter factor was founded in 32 cases. Clinical examination found only 12 standard feet. Biological exams were normal. METHODS: All patients had a tenography. When tenosynoviopathy was diagnosed, the surgeon injected cortivazol in the sheath by the catheter, within the extra-tendinous space. In case of treatment failure, a synovectomy was realized with possible tendinous suture, under the protection of a weight bearing plaster cast for 21 days. RESULTS: Pathological features: we have founded 26 major irregularities of the sheath, extensive with scalloped outlines of which 8 were supra-malleolar and 18 sub-malleolar, 15 irregularities located at the level of the sheath outline of which 4 were supra-malleolar and 11 sub-malleolar and with a tear of 1 cm length. Long term results: among 36 reviewed patients, pain disappeared in 29 cases, after only one injection (21 cases), or after a surgical treatment (8 cases). DISCUSSION: Tenography has for us great interest for the diagnosis of a tenosynoviopathy, allowing in the same time an extra-tendinous injection of corticoid in the sheath itself. But it doesn't always allow to make a diagnosis of a tendinous tear. A part of our failures can be secondary to these tears. According to our results it could be recommended to practice in a first time a tenotomodensitometry (teno TDM). In case of a tear, a surgical treatment by synovectomy with suture may be proposed first, for a tenosynoviopathy an injection must be realizes. CONCLUSION: Tenography allows a precise diagnosis and in the same time, a treatment by injection. The tendinous tears require a surgical suture but are better diagnosed on a teno TDM.

Mammography in younger women.

Breast imaging is not frequently performed in women aged 35 years or younger for several reasons. Approximately half of the radiographic examinations of a breast symptom give normal results because the expected density of the breast in younger women may obscure abnormalities. Results from biopsies performed subsequent to positive mammogram findings confirm the predominance of benign lesions; cancers are rarely observed. After reviewing the main breast diseases that occur in the 20- to 35-year-old age group, we evaluated the accuracy of mammography in diagnosing malignancy, and attempted to summarize guidelines for breast imaging in young women, whose breasts are quite sensitive to radiation.

[Thrombosis of the aorta in newborn infants]. / Thrombose de l'aorte du nouveau-né.

The authors report a case of a neonate presenting with thrombosis of the abdominal aorta following catheterisation of the umbilical artery. The diagnosis was established by ultrasonography in a context of isolated anuria. Immediate disobstruction by Fogarty's method results in cure.

[Pleuro-pericardial cyst in children]. / Kyste pleuro-péricardique de l'enfant.

We report the case of 3 1/2 year old child presenting a left pleuropericarditic cyst causing febrile cough and an opacity of the left lower lobe of the lung. We underline the importance of computed tomography of the thorax allows differential diagnosis with encysted effusion. Surgical treatment rarely indicated in pleuropericarditic cysts has stopped respiratory symptoms.

[Place of mammary ultrasonography in breast diseases]. / Place de l'échographie mammaire en sénologie.

Ultrasonography is the only morphological exploratory breast examination which is truly valid and inexpensive and may usefully complement clinical examination and mammography which remain the basic and absolutely necessary investigative tools in this pathology. Constant improvement of the spatial resolution of the "barrettes" permits us to characterize anomalies of 3 millimeters. These linear probes are easily manageable, permitting a better ultrasound guiding of breast punctures. The main indications for ultrasonography remain, in addition to the evaluation of any "nodule", the evaluation of disseminated or localized densities, where mammography is less beneficial. If exploratory ultrasonography proves very useful in malignant pathology, it has certainly been most useful in benign diseases, permitting us to determine a precise etiology and a better adjustment of the treatment.

[Role of ultrasound in studying the first urinary infection in children]. / Place de l'échographie dans l'investigation d'une première infection urinaire chez l'enfant.

A retrospective study comparing the findings of ultrasonography (5 MHz transducer) versus intravenous pyelography and voiding cystourethrography was conducted in 92 patients during the course of an initial urinary tract infection (greater than or equal to 10(5) bacteriae/ml, WBC greater than 25/mm3) gathered over a period of 5 years. The average interval of time between ultrasonography and intravenous pyelography was 8 days (range 1-70). False positive results for ultrasonography were noted in 11% (5 of 45 cases), while false negatives were observed in 36% (17 of 47). Of the 47 cases of obstructive uropathy diagnosed by conventional means, ultrasonography missed the diagnosis in 1 case of ureteral duplication as well as in 16 children with vesicoureteral reflux. In comparison, intravenous pyelography missed 8 of these 21 cases of vesicoureteral reflux. Overall sensitivity of ultrasonography was mediocre at 64% but excellent at 96% after excluding cases with vesicoureteral reflux. Specificity was poor for the group of patients with vesicoureteral reflux (33%) and did not improve when they were excluded (40%). Sensitivity and specificity were comparable whatever the age group. In conclusion, we would recommend that when both ultrasonography and voiding cystourethrography are normal in children with a urinary tract infection, intravenous pyelography could safely be deferred.

[Role of arteriography and x-ray computed tomography in the current evaluation of pigmented villonodular synovitis]. / Place de l'artériographie et de la tomodensitométrie dans le bilan actuel des synovites villo-nodulaires pigmentées.

The angiographic characteristics of five surgically proven cases of pigmented villonodular synovitis are reported. A CT scan was performed in one case. CT scan arthrography is very useful when it demonstrates regions of high attenuation. The angiography never demonstrated in the five cases capillary blush nor arteriovenous shunting, but a regular hypervascular mass. These findings are helpful for the surgeon suggesting the best surgical approach and the best site of biopsy.