[Diagnosis of a systolic murmur among young asymptomatic patient: An assessment of professional practices for the expertise in military medicine]. / Diagnostic d'un souffle systolique cardiaque chez un jeune patient asymptomatique : une évaluation des pratiques professionnelles en médecine militaire d'expertise.

UNLABELLED: The finding of a systolic heart murmur is common in medical military practice. Albeit often benign among young healthy adults, it can reveal a valvular or a cardiac disease, which could worsen during workout or expose to risk of a sudden death. This study aims to evaluate the diagnostic efficiency of the military general practitioner when discovering a systolic murmur among young asymptomatic patients. MATERIALS AND METHODS: During one year, this study involved all the general practitioners of the medical military centres of Brittany and the cardiologists of the military hospital in Brest. It prospectively enrolled a cohort of all military asymptomatic patients under 40, without any underlying known heart condition. Military general practitioners listed, thanks to an anonymous form, the main features of the systolic murmur and of the ECG and proposed an auscultatory diagnosis: innocent or organic murmur. Then cardiologists did the same and finally performed a transthoracic echocardiography giving the diagnosis. RESULTS: Fifty-eight patients were referred, 5 not meeting the inclusion criteria. Of the 53 patients included, military general practitioners found 46 innocent murmurs and 7 organic ones. Cardiologists found 51 innocent murmurs and 2 organic. Transthoracic echocardiography just took on one organic murmur (linked with a bicuspid aortic valve), spotted by the specialist, though judged innocent by the general practitioner. DISCUSSION: Most of innocent murmurs diagnosed by general practitioners (45/46) were confirmed. Regarding the seven organic murmurs, the main selected criteria (intensity over 3, orthostatic persistence, diffuse irradiation) are mostly in accordance with the literature, proving right medical instincts. Authors propose a practical management of systolic murmurs among asymptomatic young patients. CONCLUSION: Military general practitioners seem to master symptoms of organic murmur. This assessment argues for a promotion of a holistic clinical examination, which will help not only to rationalize the use of transthoracic echocardiography in economic terms but also to value the medical expertise.

[Echographic diagnosis of systolic murmur among 280 young French militaries. Implications for the expertise in military medicine]. / Diagnostic échographique d'un souffle cardiaque systolique au sein d'une population de 280 jeunes militaires français. Implications en médecine d'expertise militaire.

UNLABELLED: Clinically discovering a systolic murmur is frequent among the young military population. When this murmur does not sound benign, a transthoracic echocardiography (TTE) is made to detect any cardiopathy, which could cause sudden cardiac death. The aim of this study was to evaluate the interest of systematic TTE in the assessment of any cardiac systolic murmur (CSM) among militaries. METHODS: We ran a retrospective monocentric study in the "Clermont-Tonnerre" military hospital in Brest. We included all patients sent for TEE, aged 15 to 30 years old, from the 1st January 2010 until the 31st July 2013. RESULTS: Two hundred and eighty TTES assessing CSM were performed. We found 28/280 (10%) echocardiographic abnormalities: 13 were bicuspid aortic valves (4.6%), 6 were ventricular septal defects (2.15%), 3 were atrial septal defects (1.07%), 4 were mild mitral regurgitations (1.43%), one mild pulmonary stenosis (0.35%) and one aortic stenosis (0.35%). No hypertrophic cardiomyopathy was found. Concerning military expertise, 11 (3.92%) patients among these 28 with abnormal TEE were considered unfit for work or "fit for work with limitations". CONCLUSION: Assessing a cardiac systolic murmur with TEE lead to the diagnosis of a cardiomyopathy in 10% of the case. This study enhances the importance of systematic TEE when a CSM is detected in the young military, in order to determine if those soldiers can still fulfill their military duty.

[Practical conduct for patients with a lonely hypoxemia at rest or during exercise]. / Démarche diagnostique d'une hypoxémie « nue ¼ de l'adulte.

INTRODUCTION: Hypoxemia is a decrease in blood oxygen partial pressure. This work aims at presenting a practical conduct for patients with a lonely hypoxemia at rest or during exercise, defined by the absence of dyspnea at rest, obvious clinical or radiographic abnormality. STATE OF THE ART: Diagnostic tools available to the clinician are clinical examination, CT scan, echocardiography, hyperoxia test, trans cranial ultrasound and lung scintigraphy. This work proposes a practical diagnostic approach, with a main role of chest CT. PERSPECTIVES: Work is underway to determine more precisely the place of echocardiography for the diagnosis of intra or extra cardiac shunts. CONCLUSIONS: The finding of a lonely hypoxemia requires careful diagnostic approach to quickly rule out potentially serious causes and not to disregard the rare causes.

[Systematic implementation of transthoracic echocardiography, transesophageal echocardiography and 24-hour Holter ECG for the detection of cardiac sources of embolism in patients with stroke or transient ischemic attack. A retrospective study of 220 patients]. / Rentabilité diagnostique de l'échographie cardiaque transthoracique, transœsophagienne et du Holter ECG réalisés à titre systématique lors du bilan étiologique d'un premier accident vasculaire cérébral ischémique. Étude rétrospective de 220 patients.

INTRODUCTION: Embolism of cardiac origin accounts for around 20% of ischemic strokes. ECG and transthoracic echocardiography (TTE) are commonly obtained during the evaluation of patient of ischemic stroke but specific indications for the transesophageal (TEE) echocardiography and 24-hour Holter ECG (Holter) remain uncertain. OBJECTIVES: The aim of this study is to report the contribution of TTE, TEE and Holter performed as a routine during the evaluation of patients with ischemic stroke (IS) or transient ischemic attack (TIA). METHODS: This is a retrospective single-center study of 220 patients hospitalized between 1st January 2007 and 31st December 2010 for a first IS or TIA. RESULTS: One hundred and forty-three IS and 77 TIA are identified. The average age of patients was 66 years (18-88 years). TTE/TEE/24-hour Holter allowed the diagnosis of cardiac sources of embolism in 135 patents (61.3%). TTE/TEE identified potential source of cardiogenic embolism in 126 patients (52.2%). Twenty four-hour Holter ECG tracked supraventricular arrhythmia in 15 patients (6.7%), 9 (4%) which had non-contributory ultrasound assessment. CONCLUSION: The systematic implementation of TTE/TEE/Holter is useful for identifying potential sources of cardiogenic embolism. The performance of TEE remains above the TTE. Holter should be recommended because it is a cost effective and non-invasive tool.

Regulation of the early steps of 3-phenylpropionate catabolism in Escherichia coli.

Microbial catabolism of phenylpropanoid compounds plays a key role in the degradation of aromatic molecules originating from the degradation of proteins and plant constituents. In this study, the regulation of the early steps in the utilisation of 3-phenylpropionate, a phenylpropanoid compound, was investigated. Expression of the hcaA gene product, which is involved in 3-phenylpropionate catabolism in Escherichia coli, was positively regulated by HcaR, a regulatory protein similar to members of the LysR regulators family. Remarkably, the expression of hcaA in the presence of 3-phenylpropionate was sharply and transiently induced at the end of the exponential growth phase. This occurred in a rpoS-independent manner. This transient induction was also mediated by HcaR. The expression of this positive regulator is negatively autoregulated, as for other members of the LysR family. The expression of hcaR is strongly repressed in the presence of glucose. Glucose-dependent repression of hcaR expression could only be partially overcome by adding exogenous cAMP.

Pyrophosphate increases the efficiency of enterobactin-dependent iron uptake in Escherichia coli.

Exogenous inorganic pyrophosphate increases the biomass yield of Escherichia coli. In this report, we show that the effect of pyrophosphate is related to iron uptake. We have found that addition of pyrophosphate, ammonium iron (III) citrate or iron (III) chloride, in M63 minimal medium containing 1.7 microM of iron, causes an increase in growth yield. In contrast to iron chloride or ammonium iron (III) citrate, exogenous pyrophosphate is deleterious to strains unable to synthesize enterobactin. Thus the positive effect of pyrophosphate is related to the enterobactin uptake system expressed in a low iron content medium. Pyrophosphate in minimal medium has a repressing effect on the expression of Fur-regulated genes. In iron rich medium where enterobactin synthesis is strongly decreased, addition of pyrophosphate increases expression of Fur-regulated genes. Furthermore, this latter regulatory effect of pyrophosphate in iron-rich medium is enhanced in the absence of enterobactin synthesis. It has also been shown that addition of pyrophosphate protects the cell against the oxidative stress caused by the presence of hydrogen peroxide in an iron-rich containing medium. These results indicate that pyrophosphate acts as an iron-chelating agent, could trigger the enterobactin-dependent iron uptake system and could promote an increased binding of iron to enterobactin.

Spinal cord compression resulting from Burkitt's lymphoma in children.

We report seven cases of spinal cord compression resulting from Burkitt lymphoma in boys aged 15 years and below. This became manifest clinically as acute or rapidly progressive spinal cord compression. All the patients showed total paraplegia with a sensory loss at thoracic level and sphincter disturbances. Four patients were operated on, the operation permitting exeresis of an epidural tumor. In three cases surgery was followed by chemotherapy. One patient was treated exclusively with chemotherapy. Owing to the effectiveness of chemotherapy, surgery should be considered only in cases of rapid deterioration or for diagnostic purposes.

[EEG and treatment with Arsobal in human African trypanosomiasis]. / EEG et traitement par l'arsobal dans la trypanosomiase humaine africaine.

EEG in patients suffering form HAT at the meningoencephalitis stage displays the characteristic features of the disease. Now since most of the patients are treated at an early stage, the majority of the EEG are normal or with mild abnormalities. Where abnormalities occur, they present a diminished background activity interrupted by bursts of synchronous and generalised polymorphic delta waves at 1.2 c/s. A strict correlation frequently exists between severity of clinical symptoms and the degree of EEG abnormality. These EEG abnormalities disappears very often, after the first period of the treatment by melarsoprol. EEG seems useful to follow the course of the patients treated by melarsoprol.

[Tropical African neuromyelopathies: 61 studied cases in the Ivory Coast]. / Neuromyélopathies tropicales africaines: 61 cas étudiés en Cote d'Ivoire.

Sixty one cases of tropical myeloneuropathies (TNM) from Abidjan, Ivory Coast, are reported. The mean age of patients was 35 years. The socioeconomic level was often very low and puerperality was a common initiating factor. Several clinical forms are noted: pure pyramidal (16 cases), pure ataxic (11 cases), sensory motor polyneuritis (8 cases), combined sclerosis of the spinal cord (1 case), ataxic polyneuritis (25 cases). In fact the extent of the pathobiological process was more severe as shown by slowings of peripheral motor nerve conduction velocities, prolonged central conduction time determined after cortical and spinal stimulations, and a severe sensory axonal impairment on nerve biopsies. These changes were observed with varying degrees in all clinical forms. As long as the etiological factors of TMN are not known (preventing from the possibility to split this disease in several entities) it is preferable to speak about one global disorder and not isolated various clinical forms (e.g. particulary: tropical spastic paraplegia). HTLV-I retrovirus seems to play a limited role in the etiology of TMN in Ivory Coast (1 positive case).

Proteolytic activities and ribulose 1,5 bisphosphate carboxlyase degradation in leaves of soybean (Glycine max L. Merril) with different nitrogen status.

Changes in soluble proteins and Rubisco (E.C.4.1.1.39) contents were examined in leaves of nitrogen-deprived and nitrogen-sufficient soybeans. Rubisco content was very responsive to nitrogen stress, and this protein appeared to be the largest source of mobilizable nitrogen in the senescent leaf. Loss of soluble proteins and Rubisco was associated with a decrease in the activities of several proteolytic enzymes measured using artificial substrates: carboxypeptidase, aminopeptidase and haemoglobinase.The in vitro activity of enzyme(s) which can degrade Rubisco was investigated using endogenous Rubisco and in vitro radiolabelled Rubisco as substrates. Highest endopeptidic cleavage of endogenous Rubisco occured at pH 4; the enzyme responsible for this breakdown appeared to be a sulfhydryl-dependent proteinase. In contrast, [(14)C] Rubisco was attacked preferentially at pH 9, by a peptide hydrolase sensitive to EDTA. No increase in Rubisco-degrading activities was detected in nitrogen-deficient soybean leaves compared to control plant leaves.

Gamma-globulins patterns in CSF of inflammatory neurological diseases in tropical Africa.

400 CSF electrophoreses were performed on Black West Africans (Ivory Coast) with inflammatory infections of the nervous system. In the normal state, the CSF of the Black African contains a higher concentration of gamma-globulins than the European (15.8% compared to 8--10%). This study permits us to confirm indirectly the classical idea of the extreme rarity of MS in tropical areas: an increase in the gamma-globulins of the CSF has been shown in 22% of the cases and the two principal responsible infections are trypanosomiasis (57.3%) and SSPE (16.8%). The oligoclonal distribution by various authors in trypanosomiases was not found. On the contrary, a nonclonal aspect of gamma-zone was constantly found (49/50). It is possible that the differences are in accordance with the different evolutionary phases of the disease, and that the oligoclonal distribution is a marker of the autoimmune state of the disease.

[Cerebrospinal fluid gamma globulins in neurological disorders affecting black Africans (author's transl)]. / Les gamma-globulines du liquide céphalo-rachidien dans les affections neurologiques du Noir African.

Four hundred C.S.F. electrophoreses were carried out in black West Africans (Ivory Coast) suffering from inflammatory disorders of the nervous system. In the normal state, the C.S.F. of the black African contains more gamma globulins than that of the white (15.8% as opposed to 10%). The study provides indirect evidence of the classical notion of the extreme rarity of DS (Disseminated sclerosis) in the tropics. Hypergammaglobulinorachia was demonstrated in 22% of cases, the two principal disorders responsible being trypanosomiasis (57.3%) and sub-acute sclerosing panencephalitis (16.8%). The oligoclonal distribution described in trypanosomiasis was not found. On the contrary, a homogeneous appearance of the gamma zone was constantly demonstrated (49/50). It is possible that these differences are related to the various phases in the course of the disease, and that oligoclonal disturbation is a marker of the auto-immune phase.