[Value of procalcitonin for infants with bronchiolitis in an emergency department]. / Dosage de la procalcitonine et bronchiolites vues dans un service d'accueil des urgences pédiatriques.

CONTEXT: Very few studies have evaluated the role of procalcitonin (PCT) in infants with bronchiolitis. AIMS: To describe infants who had both a diagnosis of bronchiolitis at the emergency department and a blood test including PCT, and to compare the characteristics of children according to the PCT value. METHODS: Infants admitted to the Pediatric Emergency Department between 1 January 2014 and 31 December 2014 who had a diagnosis of bronchiolitis and a blood test including PCT were included. The clinical, biological, and radiological characteristics of the infants with PCT <1 or ≥1g/L were compared. RESULTS: One hundred thirty six infants were included. Patients with high PCT (n=20) had a higher temperature (38.5°C, IQR=37.8-38.6 vs. 37.5°C, IQR=37.1-38.2; P<0.01), C-reactive protein (50mg/L, IQR=25-83 vs. 5mg/L, IQR=0-19; P<0.01), and neutrophils (7.8×109/L, IQR=6.0-8.5 vs 4.5×109/L, IQR=2.9-6.6; P<0.01) higher than patients with low PCT (n=116). Presence on the chest x-ray of alveolar condensation did not differ between the two PCT groups. Infants coming from the low-PCT group received fewer antibiotics (14.7% vs 65%; P<0.01). CONCLUSION: In a Pediatric Emergency Department, PCT with a value of 1 or more cannot predict the presence of alveolar condensation on the chest x-ray. It seems to be associated with the antibiotics prescription, even if this could not be proved because of the design of the study.

Conformational changes in membrane proteins of multidrug-resistant K562 and primary rat hepatocyte cultures as studied by Fourier transform infrared spectroscopy.

The multidrug resistance (MDR) phenotype has been investigated by means of Fourier transform infrared spectroscopy (FT-IR/S) on cell smears. We investigated K562 cell lines (sensitive and doxorubicin-resistant, the latter being MDR too) and primary cultures of rat hepatocytes (HEP). HEP displayed elevated levels of P-glycoprotein (P-gp) with time in 2-4 day-old culture, thus developing in the same time a MDR phenotype. No functional P-gp activity could be detected in HEP at day 1 after cell seeding. Given the sensitivity of FT-IR/S and using computational treatment of FT-IR data, we found that spectra of MDR-K562 and HEP from day 2 to day 4 displayed close protein conformational changes involving beta-sheets. These changes might be in close relationship with the MDR-phenotype and P-gp overexpression.

Ultrastructural appraisal of the multidrug resistance in K562 and LR73 cell lines from Fourier transform infrared spectroscopy.

Two different cell lines sharing the multidrug resistance (MDR) phenotype were investigated for 8 months by means of Fourier transform IR spectroscopy on cell smears. We studied (a) a human leukemic doxorubicin-sensitive K562 cell line, from which a doxorubicin-resistant K562 cell subline was subsequently derived; (b) a Chinese hamster LR73 drug-sensitive line, subsequently transfected with the expression plasmid pDREX4 containing the mdr1 gene, to produce a multidrug-resistant LR73 subline (MDR-LR73). The sensitivity of Fourier transform IR spectroscopy has allowed differentiation between sensitive and MDR phenotypes among the above lines, even in double blind studies. The MDR phenotype is characterized by three combined features in spectra: (a) a decrease in the intensities of the amide I and II bands; (b) a shoulder on the high wave numbers slope of the amide I bands; (c) a shift toward the high wave numbers of the amide II bands. Furthermore, computational treatment of Fourier transform IR spectra (deconvolution and Gaussian curve-fitting techniques), has evidenced, in MDR-K562 and MDR-LR73 cell sublines, a conformational change involving the same protein in both sublines. It is hypothesized that the protein implicated in the conformational change may be related to the MDR phenotype.

Conformational changes of human serum albumin in vivo induced by free fatty acids as studied by Fourier transform infrared spectroscopy.

Binding of free fatty acids (FFA) to human serum albumin (HSA) was studied by Fourier transform infrared (FT-IR) spectroscopy. Six volunteers ran a marathon race in order to induce changes in their basal plasma FFA levels. Three volunteers were well-trained and three untrained. The non-deconvolved HSA spectra show two types of spectra: the first one includes the untrained runners, who, after the run, display noticeable changes in the absorbance intensity of the amide I band, which also shifts to higher frequencies. The second one includes the well-trained subjects who exhibit few changes after the race. Examination of the deconvolved spectra of HSA shows two types of spectra, as well: the first class displays important decreases in the absorbance of the component assigned to alpha-helix after the race, together with a gradual growth of the two components that can be assigned to turns. The second class, which includes the well-trained subjects, exhibits few changes after the run. These data are interpreted in terms of conformational changes due to a less ordered alpha-helix state of HSA after FFA binding, while the emergence of components assigned to turns may reflect the exposure of several histidine residues to the solvent (which are buried in HSA when FFA/HSA less than 4). Our data are consistent with the Karush model of FFA to HSA binding.

Aneurysmal portahepatic venous fistula: report of two cases.

Two cases are reported of congenital intrahepatic portacaval shunts in middle-aged women who had encephalopathy or hypoglycemia. Real-time ultrasound (US) investigations revealed vascular communication between the left portal and hepatic veins in one patient and communication between the right portal and hepatic veins in the other. These findings were confirmed using angiography with pressure measurement. One patient underwent surgery; the other received dietetic treatment. The findings in these two cases are compared with those of three previously reported cases.

[Glucose intolerance and post-stimulatory hypoglycemia secondary to a probably congenital intrahepatic portacaval anastomosis]. / Intolérance au glucose et hypoglycémie post-stimulative secondaires à une anastomose porto-cave intrahépatique vraisemblablement congénitale.

Recurrent malaise in a 63 year old woman were found to be due to hypoglycaemic episodes. During a 5 hour oral glucose tolerance test, the "impaired glucose tolerance" type initial hyperglycaemic wave was followed by a post-stimulative hypoglycaemia. Serum C-peptide levels were normal during the test, but the insulin response which was initially normal became excessive, with a consequent decrease of the C-peptide/insulin ratio, similar to that usually observed in hepatic malfunction. An hepatic ultrasonography, a cavography and a selective superior mesenteric arteriography showed an intra-hepatic porto-caval anastomosis, probably congenital in origin. This vascular abnormality accounts for the blood glucose problems: the porto-caval shunt explains the early hyperglycaemia by defective liver uptake of glucose and secondary hyperinsulinism occurs because of the reduced hepatic degradation of the insulin secreted in normal quantity. The late hyperinsulinism then leads to secondary hypoglycaemia.

[Congenital intrahepatic portacaval anastomosis: analysis of manifested glucose abnormalities]. / Anastomose congénitale porto-cave intra-hépatique; analyse des anomalies glucidiques révélatrices.

The authors report a case of a high-flow intrahepatic portacaval shunt due to a congenital venous abnormality. Suspected by digestive echography, the abnormality was confirmed by angiography. A precise analysis of glycoregulation showed an "impaired glucose tolerance", followed by post-stimulative hypoglycemia with persistant hyperinsulinemia and lowering of the C peptide/insulin ratio. These abnormalities seem to be related to the shunt only. This observation appears as an experimental model permitting the appreciation of the disturbances in glucose metabolism related to an intrahepatic shunt without any hepatic cell disorder.

[The ductus bump. Transient dilatation of the ductus arteriosus (author's transl)]. / Le ductus bump. Dilatation transitoire du canal artériel.

Transient, physiologic and rare, dilatation of the ductus arteriosus in asymptomatic neonates, shown by left superior mediastinal mass. It appears only on the PA chest roentgenogram, with vascular characteristics. It disappears after three or four days of regular checking and the diagnosis is thus confirmed, cutting out any other mediastinal pathology. There is no need to use more stressing or ruder technics.

[Radiological aspects of Mallory-Weiss syndrome (author's transl)]. / Aspect radiologique du syndrome de Mallory-Weiss.

A case of Mallory-Weiss syndrome was diagnosed by joint baryum study and endoscopy. A survey of publications (15 references) shows that this affection is frequent and could be responsable of 5 to 10% of upper digestive hemorrhage of which some are grave. But conventional radiology only exceptionnally reveals these superficial lesions. Without endoscopy and according the ulceration be deep, the radiologist should be able to reveal the lesion a sa niche.