A rare case of non-traumatic rupture of spleen secondary to Plasmodium ovale malaria.

OBJECTIVE: Plasmodium ovale malaria occurs mainly from mild form of malaria. We present a rare case of a splenic rupture secondary to complication of Plasmodium ovale malaria. CLINICAL PRESENTATION: A 41-year-old female from Mali admitted to intensive care unit with hemorrhagic shock secondary to splenic rupture. A laparoscopic exploration was performed and patient received a massive blood transfusion for a hemodynamic stabilization. The diagnosis of malaria was confirmed by a blood smear test indicating the presence of P. ovale. A treatment of injectable Quinine was initiated with a positive outcome. CONCLUSION: Although usually considered as a cause of a mild form of malaria, P. ovale may be responsible for a ruptured spleen which can lead to a state of life- threatening hemorrhagic shock.

[A priori prediction of gentamicin peak concentrations: Use of a simple and practical tool]. / Prédiction a priori des concentrations en gentamicine au pic : utilisation d'un outil simple et pratique.

Aminoglycosides are concentration-dependent killing antibiotics, so that it is necessary to obtain elevated peak levels to reach the pharmacokinetic-pharmacodynamic objectives. Because of their nephrotoxicity, this class of antibiotics are frequently underprescribed and giving at an insufficient dosage when prescribed. That is why therapeutical drug monitoring (TDM) of aminoglycosides is recommanded to assess efficacy. Unfortunately, this TDM allows not a dosage adaptation on the first dose of aminoglycosides. The aim of the work was to elaborate a model using simple pharmacokinetics formulae to estimate gentamicin peak levels and so to propose an optimal a priori dosage on the first dose of gentamicin. The final model was tested out on 24 patients treated by gentamicin. The model was able to predict gentamicin peak levels in 62% of patients with a 10% precision and in 79% of patients with a 15% precision. Using this simple and practical tool might avoid under-dosage of gentamicin and clinical failure due to the selection of resistant bacteriae.

Variation in Miscanthus chemical composition and implications for conversion by pyrolysis and thermo-chemical bio-refining for fuels and chemicals.

Different species and genotypes of Miscanthus were analysed to determine the influence of genotypic variation and harvest time on cell wall composition and the products which may be refined via pyrolysis. Wet chemical, thermo-gravimetric (TGA) and pyrolysis-gas chromatography-mass spectrometry (Py-GC-MS) methods were used to identify the main pyrolysis products and determine the extent to which genotypic differences in cell wall composition influence the range and yield of pyrolysis products. Significant genotypic variation in composition was identified between species and genotypes, and a clear relationship was observed between the biomass composition, yields of pyrolysis products, and the composition of the volatile fraction. Results indicated that genotypes other than the commercially cultivated Miscanthus x giganteus may have greater potential for use in bio-refining of fuels and chemicals and several genotypes were identified as excellent candidates for the generation of genetic mapping families and the breeding of new genotypes with improved conversion quality characteristics.

[Physicians referent for antimicrobial therapy. Results of a survey conducted during a French Infectious Diseases Society meeting]. / Les référents en antibiothérapie et leurs fonctions. Résultats d'une enquête menée lors de la 5e Journée des référents en antibiothérapie.

We conducted a survey among participants to a French ID Society sponsored meeting for antimicrobial management teams (AMT). We analysed 115 responses. Respondents were mostly physicians (79%) followed by microbiologists (11%), infection control practitioners (9%) and hospital pharmacists (7%). Only 43% were ID board certified while 47% had a university degree on antibiotic use. AMT activities concerning diagnostic and therapeutic advice, residents training and antibiotic use audit were mostly managed by physicians. Antimicrobial resistance and antibiotic consumption were managed, respectively, by the microbiologist and the hospital pharmacist. This survey shows the interest of a multidisciplinary antimicrobial management team. However, the cornerstone of the AMR is clearly the physician. Small hospital could contract part time physician and work through regional teams.

[Primary cutaneous aspergillosis in an immunocompetent farmworker]. / Aspergillose cutanée primitive chez un agriculteur immunocompétent.

INTRODUCTION: Aspergillosis is an uncommon fungal infection in which primary cutaneous sites are very rare. Most cases occur in immunodepressed patients and are disseminated in the blood. We report a case of primary cutaneous aspergillosis in a 37-year-old immunocompetent farmworker presenting as a kerion-like lesion. CASE REPORT: A 37-year-old farmworker presented erythematous and nodular lesions of the face. These lesions were not associated with any general symptoms and failed to respond to antibiotic treatment. Histological examination of a skin biopsy sample showed a granulomatous reaction in the dermis associated with an extensive neutrophilic infiltrate. PAS staining revealed the presence of right-angled branched hyphae with conidia. Aspergillus fumigatus was isolated and identified in cultures. Clinical and biological examinations did not reveal any systemic localisation of aspergillosis, ruling out the hypothesis of blood dissemination. This primary cutaneous infection occurred in an immunocompetent patient, in whom laboratory tests ruled out any underlying immunosuppression. Systemic antifungal treatment with voriconazole led to complete resolution. DISCUSSION: Reports in the literature of primary cutaneous aspergillosis in immunocompetent patients are extremely rare. Clinical lesions may comprise often painful weeping or necrotic macules or papules or subcutaneous nodules that can progress towards abscess or necrosis. The semiological similarity between these lesions and kerions can lead to misdiagnosed cases and delayed treatment.

Spondylodiscitis due to Propionibacterium acnes: report of twenty-nine cases and a review of the literature.

Propionibacterium acnes is the most frequent anaerobic pathogen found in spondylodiscitis. A documented case required microbiological proof of P. acnes with clinical and radiological confirmation of inflammation in a localized region of the spine. Microbiological samplings were obtained by surgery or aspiration under radiological control. Twelve males and 17 females (median age, 42 years) with spondylodiscitis due to P. acnes were diagnosed within the last 15 years. Three patients were immunosuppressed. All patients reported back pain as the main symptom, and most were afebrile. Three patients had a peripheral neurological deficit, one a motor deficit, and two a sensory deficit attributable to the infection; and six patients had an epidural abscess. The most frequent risk factor was surgery, which was present in the history 28 of 29 (97%) patients. The mean delay between spinal surgery and onset of disease was 34 months, with a wide range of 0-156 months. Osteosynthesis material was present in twenty-two cases (76%). In 24 (83%) patients, additional surgery, such as débridement or spondylodesis, was performed. Previous osteosynthesis material was removed in 17 of the 22 (77%) patients where it was present. Total cure was reported in all patients, except one, after a mean duration of antibiotic therapy of 10.5 weeks (range, 2-28 weeks). In conclusion, spondylodiscitis due to P. acnes is an acute infection closely related to previous surgery. The most prominent clinical feature is pain, whereas fever is rare, and the prognosis is very good.

Carbon sequestration in European soils through straw incorporation: limitations and alternatives.

We compared alternate uses of cereal straw (4.25t dry matter ha(-1) containing 1.7t carbon (C)) for their effectiveness in relation to climate change mitigation. The scenarios were (1) incorporation into soil to increase soil organic carbon (SOC) content ("carbon sequestration") and (2) combustion to generate electricity. The Rothamsted Carbon Model was used to estimate SOC accumulation in a silty clay loam soil under the climatic conditions of north-west Europe. Using straw for electricity generation saved seven times more CO2 than from SOC accumulation. This comparison assumed that electricity from straw combustion displaced that generated from coal and used the mean annual accumulation of SOC over 100yr. SOC increased most rapidly in the early years, but then more slowly as a new equilibrium value was approached. We suggest that increased SOC from straw incorporation does not represent genuine climate change mitigation through carbon sequestration. In Europe, most straw not already incorporated in the field where it is grown is subsequently returned elsewhere, e.g., after use for animal bedding and production of manure. Only additional retention of C in soil compared to the alternative use represents sequestration. Maintenance of SOC for soil functioning is a more appropriate rationale for returning straw to soil than climate change mitigation. This analysis shows that considerably greater climate change mitigation is achieved through saved CO2 emissions by burning straw for electricity generation, replacing some use of fossil fuel.

[Subacute ischemia of the lower limb revealing hyperhomocysteinemia in a young woman]. / Ischémie subaiguë d'un membre inférieur révélant une hyperhomocystéinémie chez une femme jeune.

A 51-year-old woman had no known cardiovascular risk factor. She presented with bilateral calf intermittent claudication from February. She was hospitalized in August for acute right leg ischemia without loss of sensorymotor functions, following angiography by one week. She had an occlusion of both superficial femoral arteries and abdominal aorta thrombus, plausible source for embolism. Her condition quickly improved with heparin and iloprost infusion. Since the aortic thrombus was removed on ultrasound, aortic surgery was not performed at this time. Investigations showed hyperhomocysteinemia (25 microg/L after overnight fasting and 115 after methionin load) and decrease in folic acid. This report highlights the occurrence of severe arterial disease in young women with high serum homocysteine levels.

The yield and composition of switchgrass and coastal panic grass grown as a biofuel in southern England.

Switchgrass (Panicum virgatum L.) and coastal panic grass (Panicum amarum A.S. Hitchc. & Chase) are perennial grasses indigenous to North America. Switchgrass has been shown to have good potential as a biofuel crop in both the US and Canada. In the study reported here, seven varieties of switchgrass and one panic grass were evaluated for 5 years under the temperate maritime conditions in Southern England. Both species had 0 or 60 kg N ha(-1) applied annually in spring as treatment. Yield was measured after flowering and when stems were dead in the winter. Yield increased annually for 4-5 years except for the variety Dacotah, and in the fifth year dead stem yields ranged from 8.82 to 13.97 t dm ha(-1). There was no response to N except for one variety in one year. Mineral concentration in biomass was higher at flowering than at dead stem harvest and delaying harvesting further provided more time for P, K and Cl to be leached but yield also declined.

Prevalence and characteristics of Sjögren's syndrome or Sicca syndrome in chronic hepatitis C virus infection: a prospective study.

OBJECTIVE: To describe the prevalence and clinical and laboratory characteristics of sicca syndrome and Sjögren's syndrome (SS) in chronic hepatitis C virus (HCV) infection. METHODS: Forty-five consecutive HCV infected patients referred for liver biopsy were enrolled in a prospective study. Subjective and objective criteria of xerophthalmia or xerostomia were systematically investigated and the patients classified according to 3 sets of criteria (European, Manthorpe, and Fox criteria) for the diagnosis of SS. RESULTS: Sicca syndrome was present in 28 (62%) patients; all had oral dryness and 14 had both oral and ocular dryness. Twenty-four (53%) patients had SS by the European criteria, 25 (56%) by Manthorpe criteria, and 4 (8%) by Fox criteria. Salivary gland biopsy was positive for SS (grade III or IV by Chishom classification) in 21 samples (47%); 9 samples (21%) were classified grade 0, and 15 (32%) grade I or II. No patient had anti-SSA or anti-SSB antibodies. The presence of SS or sicca syndrome was associated with older age and liver disease activity according to the METAVIR scoring system, but not with the presence of other extrahepatic manifestations or with HCV genotype. A high METAVIR activity score was only statistically associated with primary SS. CONCLUSION: HCV infection appears to account for a subgroup of patients with sicca syndrome in which half the cases meet the definition for SS according to European and Manthorpe criteria. This subgroup is characterized by the constant finding of xerostomia, the absence of classical systemic manifestations observed in primary SS, and the absence of anti-SSA or anti-SSB antibodies. Such characteristics delineate a distinctive, virus associated entity that differs from primary SS.

Surgical and nonsurgical management of primary and metastatic liver tumors.

The medical records of 267 patients who had liver tumors, primary and metastatic, from 1988 to 1995 were retrospectively reviewed. Two hundred thirteen patients (80%) had metastatic disease, and 54 patients (20%) had primary liver disease. Their clinical manifestations and laboratory values were evaluated as factors predictive of diagnosis and survival. There was a significant increase in the occurrence of upper abdominal pain, weight loss, extrahepatic symptoms due to the metastatic origin, and hepatomegaly. Metastases from colorectal primary lesions were synchronous in 34 patients and metachronous in 31 patients. Stomach, lung, and pancreatic primaries were more commonly synchronous. Breast metastases were more commonly metachronous. Elevated serum glutamic-oxaloecetic transaminase and alkaline phosphatase and decreased albumin were the most common liver test abnormalities at diagnosis. Carcinoembryonic antigen values were elevated in the majority of colon cancer patients. Eighty-one percent of patients with primary liver cancer had elevated levels of alpha-fetoprotein, 40 per cent were seropositive for hepatitis B, and 23 per cent were seropositive for hepatitis C. Seventy-nine patients (30%) underwent surgery for their cancer, 37 (47%) had resections, 38 (48%) were unresectable, and 4 (5%) underwent liver transplantation. The patients who underwent surgery had a 32 per cent 5-year survival rate compared to a 0 per cent 5-year survival in the patients who did not have surgery (p = 0.0001). The patients who had resections had a better survival rate than those deemed unresectable at surgery (62% versus 0% at 5-years with p = 0.0008). The perioperative morbidity rate was 16 per cent, with lobectomies having the best rate and trisegmentectomies having the worst. Perioperative mortality rate was zero for all liver resections. Hepatic resection and, in selected patients, liver transplantation are the only two available therapeutic modalities that produce long-term survival with a possible cure in patients with primary and metastatic liver tumor.

Large-scale study suggests no direct link between human herpesvirus-6 and primary Sjögren's syndrome.

The aim of this study was to evaluate the role of human herpesvirus-6 (HHV-6) in the development of primary Sjögren's syndrome (PSS). Serum HHV-6 antibody levels, as measured by immunofluorescence assay (IFA) and the prevalence of HHV-6 DNA in peripheral blood mononuclear cells (PBMCs) determined by polymerase chain reaction (PCR), were studied in 49 PSS patients and 50 control subjects, all in-patients in the University Hospital Internal Medicine ward, Limoges, France. In addition, portions of labial salivary gland were obtained from 34 patients and 15 controls, the presence of viral DNA being detected by the same PCR technique. The results were then compared with clinical observations of systemic disease manifestations in patients and a histological study of salivary gland involvement. No significant difference in HHV-6 seroprevalence was found between control subjects (50.0%) and patients (63.3%) nor was there any statistically significant difference between patient and control groups for total viral DNA in PBMCs (22.4%, 12.0%) and salivary glands (8.8%, 6.6%). Analysis of clinical and histological data revealed no detectable correlation between disease severity and viral involvement. Tests for HHV-6A and HHV-6B proved positive in patient and control groups, HHV-6B being the most frequently encountered type in both groups. In conclusion, the results of this large-scale trial does not confirm the suspected direct role of HHV-6 in the etiology of PSS.

[Stenosing esophagitis in Zollinger-Ellison syndrome]. / Oesophagite sténosante au cours du syndrome de Zollinger-Ellison.

Three patients with the Zollinger-Ellison syndrome and severe oesophagitis are reported. Intractable oesophageal stricture developed, leading to oesophago-gastrectomy in two patients and iterative oesophageal dilatations in the third. The retrospective analysis of these 3 cases led us to recommend, in case of oesophagitis in patients who have or might have the Zollinger-Ellison syndrome, to quickly institute a major antisecretory treatment, by parenteral route if necessary, to precociously and repeatedly control the efficacy of the antisecretory treatment mainly by measuring basal acid output and to avoid unjustified treatment discontinuance and gastric intubations.