Role of bacteriological analysis of the joint fluid in the diagnosis of the septic arthritis in adults in low-income countries such as Madagascar.

Septic arthritis is a serious disease and its treatment remains a major challenge. Demonstration of the microorganism is the key to diagnosis according to all international guidelines. In developing countries such as Madagascar, where access to basic health services is still difficult, bacteriological analysis of the joint fluid is not yet available in most healthcare facilities. We propose effective solutions that are scientifically valid, adapted to the country's socioeconomic conditions and current health situation, while taking international recommendations into consideration. We propose that the few university hospitals with rheumatology departments and good reference laboratories should be supported to participate in a pilot program to compile data to establish the clinical and bacteriological profiles of septic arthritis here. In lower level health centers where bacteriological examinations of the joint fluid and other complementary tests are more or less impossible, a diagnosis of septic arthritis is mainly based on clinical findings. Accordingly, all diagnosis and management should be centralized in these reference centers, which will allow the adaptation and progressive update of guidelines for the management of septic arthritis.

[A case of anal Burkitt's lymphoma]. / Une observation de lymphome de Burkitt à localisation anale.

Burkitt non hodgkin lymphoma affects children and young adults. It is endemic in tropical Africa and it has especially facial and abdominal localisations. We report a case of anal localisation in a 22 years-old man, human immunodeficiency virus (HIV), negative aiming to show clinical, therapeutical and evolutive particularities of this exceptional localisation. Only two cases were reported but in HIV positive patients. Perianal abscess was first evoked, but per-operatory findings and histology rectify the diagnosis. Without chemotherapy, the "natural" evolution was rapidly fatal. Despite the efficacy of nowadays protocols, showing 80% of recovery, this observation illustrates the difficulty of malignant affection's management in developing countries caused by diagnostic delay and high cost of chemotherapy.

Perceived job stress but not individual cardiovascular reactivity to stress is related to higher blood pressure at work.

Psychological stress has been reported to be related to higher blood pressure (BP) and unfavorable cardiovascular profile. However, because of the complexity of personal stress management, a multilevel stress measurement strategy is needed. The aim of this cross-sectional study was to analyze the respective influences of the subjective perception of professional strain (high demand and low latitude) and cardiovascular reactivity to a stress test (Stroop stress test) on BP. Worksite BP was measured in 303 healthy normotensive subjects, 18 to 55 years of age, who worked in the same chemical company. In a subset of 70 randomly selected subjects, 24-hour ambulatory BP was performed to assess BP during working hours. The 20% of subjects who reported the highest job strain (high-strain group) or the highest BP stress reactivity (high-responder group) were compared with the remaining subjects (80%) (non-high-strain or low-responder groups). Subjects who submitted to the highest job strain had significantly higher ambulatory diastolic BP (4.5 mm Hg, P=0.015) during only working hours, whereas BP was similar during the remaining hours. Worksite BP and stress cardiovascular reactivity were similar between job strain groups. BP stress reactivity did not influence worksite and ambulatory BP. Spontaneous BP variability assessed by standard deviation and spectral analysis was equivalent between complementary groups. Prevalence of microalbuminuria was significantly higher in the high-responder group (8.2% versus 2.5% in low responders) and only slightly higher in the high-strain group (6.2% versus 3.2% in non-high strain). Potential confounding factors, such as age, gender, alcohol consumption, salt intake, body mass index, and occupation, which were equivalent between groups, did not interfere with our results. Our study quantifies high-professional strain effects on BP levels that appear to be higher only during the working period and to be independent from spontaneous BP variability and stress BP reactivity.

[Spindle cell breast sarcoma]. / Sarcome mammaire à cellules fusiformes.

A voluminous tumor of the right breast, weighing 3,950 g, is described in a 42-year-old malagasy woman. On microscopic examination eight of ten slides showed a monomorphic proliferation of spindle cells; on the two slides, they were associated with scarce ducts and rare epithelial cell clusters. This case raises the question of the association of a phyllodes tumor with a spindle cell sarcoma and their prognostic significance.

Interaction between pepsin and acid secretion during fundic perfusion in cat and rabbit.

1. The effect of perfusion at pH 5.5 of a Heidenhain pouch on acid and pepsin secretion was studied in cats and rabbits. 2. In basal conditions, acid secretion was not modified by the perfusion while pepsin secretion was increased in both species. 3. After a meal, the perfusion did not modify the stimulation of acid secretion in cats nor the absence of secretions in rabbit. Stimulation of pepsin secretion was the same with or without perfusion in both species. 4. In rabbit, in contrast to cat, pepsin and acid secretions were independent during the meal-induced phase of gastric secretion.

Variation of gastric lipase secretion in the Heidenhain pouch of the cat.

In the cat, gastric lipase secretion was equally but weakly stimulated by pentagastrin, a major stimulant of acid secretion, and by carbamylcholine, a major stimulant of pepsin secretion. Lipase was also stimulated by fresh liver, which induces a large blood gastrin release and not by canned food, which is a poor gastrin releaser. Lipase output always preceded that of acid an pepsin. Lipase was not correlated with acid and pepsin secretion while acid and pepsin were well correlated during all stimulations but not in basal state. Lipase is co-localized with pepsin in the chief cells but is also present in pepsin-free cells, the mucus surface cells of the fundus and the antrum. The distribution of lipase explains the lack of correlation between pepsin and lipase as already mentioned. However, our data show that lipase secretion is under the control of gastric stimulants and might play a role in the gastric initiation of pancreatic meal lipolysis.

Cholinergic and pentagastrin stimulation of the gastric secretions of acid, pepsin and lipase in the awake rabbit.

Acid, pepsin and lipase secretions were simultaneously studied in awake rabbits with a Heidenhain pouch during cholinergic (carbamylcholine 20 micrograms.kg-1 x h-1) or maximal pentagastrin stimulation (64 mu.kg-1 x h-1). To avoid lipase inactivation by low pH, the pouch was perfused at a constant pH, with a solution irrigating the pouch without inducing any pressure. Acid and pepsin outputs were equally activated by both stimulants. Lipase output was stimulated much more by pentagastrin (x26) than by carbamylcholine (x6). The maximal lipase output preceded that of acid output. Lipase concentration increased in the gastric juice whereas pepsin concentration remained constant. A negative correlation was calculated between acid and lipase or pepsin and lipase output. A positive correlation was obtained between acid and pepsin. Our data show that pepsin and lipase secretions which come from distinct chief cells, in the rabbit, responded to the same stimulants but with quantitative and timing differences.