Case report of arthritis caused by Legionella anisa and review of the literature.

BACKGROUND: Legionella spp. is recognized as a common cause of community acquired pneumonia, with Legionella pneumophila serogroup 1 being the most prevalent. At least 70 species are described so far but few are identified in pathogenic conditions. Data on extrapulmonary infections are scarce. CASE PRESENTATION: A 73-yar-old male with chronic lymphoid leukemia was hospitalized for an insidious wrist arthritis. Ultrasound of the wrist showed a carpal and radiocarpal fluid effusion with positive Doppler signal. While routine bacterial cultures remained sterile, 16S rRNA PCR identified Legionella anisa. Ciprofloxacin 500 mg twice a day for a period of six weeks improved arthritis with full recovery at the end of the treatment. CONCLUSION: Legionella non pneumophila are a rare cause of septic arthritis especially found in immunosuppressed patients and identification of species could help clinician to adapt antibiotherapy.

Serum total periostin is an independent marker of overall survival in bone metastases of lung adenocarcinoma.

More than 35% of lung adenocarcinoma patients have bone metastases at diagnosis and have a poor survival. Periostin, a carboxylated matrix protein, mediates lung cancer cell dissemination by promoting epithelial-mesenchymal transition, and is involved in bone response to mechanical stress and bone formation regulation. This suggests that periostin may be used as a biomarker to predict survival in lung cancer patients. Serum periostin was assessed at diagnosis in a prospective cohort of 133 patients with lung adenocarcinoma of all stages. Patients were divided into localized and bone metastatic groups. Both groups were matched to healthy controls. Survival analysis and Cox proportional hazards models were conducted in the total population and in bone metastatic group. The median serum periostin level was higher in bone metastatic (n = 67; median: 1752 pmol/L) than in the localized group (n = 66; 861 pmol/L; p < 0.0001). Patients with high periostin (>median) had a poorer overall survival in the whole population (33.3 weeks vs. NR; p < 0.0001) and the bone metastatic group (24.4 vs. 66.1 weeks; p < 0.001). In multivariate analysis, patients with high periostin had increased risk of death (HR = 2.09, 95%CI [1.06-4.13]; p = 0.03). This was also found in the bone metastatic group (HR = 3.62, 95%CI [1.74-7.52]; p = 0.0005). Immunohistochemistry on bone metastasis biopsies showed periostin expression in the bone matrix and nuclear and cytoplasmic staining in cancer cells. Serum periostin was an independent survival biomarker in all-stage and in bone metastatic lung adenocarcinoma patients. IHC data suggest that periostin might be induced in cancer cells in bone metastatic niche in addition to bone microenvironment expression.

[Can one treat cases of multiple trauma in several stages? (author's transl)]. / Peut-on traiter les polytraumatisés en plusieurs temps?

Treat a case of multiple trauma in a single operative session is an ideal which in practice meets with several obstacles. A study of 125 cases of multiple trauma of which 66 were treated in one stage and 55 in several stages permits in spite of the difficulty of such a comparison, several conclusions. The mortality is not increased in cases of multiple operations, on the contrary, as we noted 27 p. cent of deaths in cases operated on in one stage, and only 15 p. cent in cases submitted to repeated surgery. The complications observed in lesions of the limbs were less numerous (8.8 p. cent) when operation was deferred. In fact, lesions treated as an emergency gave rise to 14 p. cent complications. In spite of the difficulty of interpretation of these figures due to the large number of factors influencing the results, it seems possible to affirm that it is not only possible but even advisable to operate on cases of multiple trauma in several stages, visceral lesions which endanger life and open fractures are the only lesions requiring emergency treatment. The other lesions should be operated on during one or several later stages drawing up a careful plan in relation to the lesions and their localisation.

[Should one choose the nail or the plate in treating a leg fracture?]. / Faut-il choisir le clou ou la plaque pour traiter une fracture de jambe

The authors have analysed the results of 126 tibial fractures treated by blind nailing with reaming and 112 tibial fractures treated by plating. They noted 5 septic complications after nailing, after plating, one non-union after nailing and 12 after plating, 3 malunions after nailing and 2 after plating. The cases treated by nailing united earlier. The Authors conclude that nailing is a more fiable technique than plating, and that the only fractures which should be plated are those which are not fit for nailing.