[Psychosocial aspects of breast cancer]. / Aspects psycho-sociaux du cancer du sein.

In occidental countries, breast cancer is the most frequent cancer in women. In the last 30 years, the therapeutical progresses have improved the prognosis and the survival rate. However, despite this hope of recovering, women continue to face the fear of death and vulnerability. Moreover, treatments can induce cognitive, emotional and behavioral reactions in patients but also in their relatives. Therefore, the treatments are associated with physical and psychosocial dysfunctioning influencing quality of life.

In vitro activity of the new ketolide telithromycin compared with those of macrolides against Streptococcus pyogenes: influences of resistance mechanisms and methodological factors.

One hundred and seven clinical isolates of Streptococcus pyogenes, 80 susceptible to macrolides and 27 resistant to erythromycin A (MIC >0.5 microgram/ml), were examined. The erythromycin A-lincomycin double-disk test assigned 7 resistant strains to the M-phenotype, 8 to the inducible macrolide, lincosamide, and streptogramin B resistance (iMLS(B)) phenotype, and 12 to the constitutive MLS(B) resistance (cMLS(B)) phenotype. MICs of erythromycin A, clarithromycin, azithromycin, roxithromycin, and clindamycin were determined by a broth microdilution method. MICs of telithromycin were determined by three different methods (broth microdilution, agar dilution, and E-test methods) in an ambient air atmosphere and in a 5 to 6% CO(2) atmosphere. Erythromycin A resistance genes were investigated by PCR in the 27 erythromycin A-resistant isolates. MICs of erythromycin A and clindamycin showed six groups of resistant strains, groups A to F. iMLS(B) strains (A, B, and D groups) are characterized by two distinct patterns of resistance correlated with genotypic results. A- and B-group strains were moderately resistant to 14- and 15-membered ring macrolides and highly susceptible to telithromycin. All A- and B-group isolates harbored erm TR gene, D-group strains, highly resistant to macrolides and intermediately resistant to telithromycin (MICs, 1 to 16 microgram/ml), were all characterized by having the ermB gene. All M-phenotype isolates (C group), resistant to 14- and 15-membered ring macrolides and susceptible to clindamycin and telithromycin, harbored the mefA gene. All cMLS(B) strains (E and F groups) with high level of resistance to macrolides, lincosamide, and telithromycin had the ermB gene. The effect of 5 to 6% CO(2) was remarkable on resistant strains, by increasing MICs of telithromycin from 1 to 6 twofold dilutions against D-E- and F-group isolates.

Solvation study of the non-specific lipid transfer protein from wheat by intermolecular NOEs with water and small organic molecules.

Intermolecular nuclear Overhauser effects (NOEs) were measured between the protons of various small solvent or gas molecules and the non-specific lipid transfer protein (ns-LTP) from wheat. Intermolecular NOEs were observed with the hydrophobic pocket in the interior of wheat ns-LTP, which grew in intensity in the order cyclopropane (saturated solution) < methane (140 bar) < ethane (40 bar) < acetonitrile (5% in water) < cyclohexane (saturated solution) < benzene (saturated solution). No intermolecular, NOEs were observed with dioxane (5% in water). The intermolecular NOEs were negative for all of the organic molecules tested. Intermolecular NOEs between wheat ns-LTP and water were weak or could not be distinguished from exchange-relayed NOEs. As illustrated by the NOEs with cyclohexane versus dioxane, the hydrophobic pocket in wheat ns-LTP preferably binds non-polar molecules. Yet, polar molecules like acetonitrile can also be accommodated. The pressure dependence of the NOEs between methane and wheat ns-LTP indicated incomplete occupancy, even at 190 bar methane pressure. In general, NOE intensities increased with the size of the ligand molecule and its vapor pressure. NMR of the vapor phase showed excellent resolution between the signals from the gas phase and those from the liquid phase. The vapor concentration of cyclohexane was fivefold higher than that of the dioxane solution, supporting the binding of cyclohexane versus uptake of dioxane.

Solution structure of Ace-AMP1, a potent antimicrobial protein extracted from onion seeds. Structural analogies with plant nonspecific lipid transfer proteins.

The three-dimensional solution structure of Ace-AMP1, an antifungal protein extracted from onion seeds, was determined using 1H NMR spectroscopy and molecular modeling. This cationic protein contains 93 amino acid residues and four disulfide bridges. Its structure was determined from 1260 NOE-derived distance restraints and 173 dihedral restraints derived from NOEs and 3JCaHNH coupling constants. The global fold involves four helical segments connected by three loops and a C-terminal tail without regular secondary structures, except for a 3(10)-helix turn and a beta-turn. The most striking feature is the absence of any continuous cavity running through the whole molecule as found in recently determined structures of nonspecific transfer proteins extracted from wheat and maize seeds, although their global folds are very similar. Consistent with the absence of a cavity in the core of Ace-AMP1, it was found that this protein, in contrast to ns-LTPs, does not bind fluorescently labeled phospholipids in solution. On the other hand, Ace-AMP1 is able to interact with phospholipid membranes as shown by the release of carboxyfluorescein from the lumen of artificial liposomes and by the induction of alterations in fluorescence polarization of fluorescently labeled phospholipids embedded in artificial liposomes.

[Wartenberg's disseminated sensory neuropathy]. / La neuropathie sensitive disséminée de Wartenberg.

We studied ten cases of disseminated sensory neuropathy. Both sexes were similarly involved. Except in one case, the first symptoms appeared between ages 20 and 50. The clinical disorders, their evolution and similar cases previously reported suggest and autonomous benign disease. The deficits resulted from a selective involvement of superficial cutaneous nervous fibers and appeared in different cutaneous areas. Some territories were more frequently affected (nervus peroneus, sural, radialis, cutaneous femoralis lateralis). Tinel's sign was often present. Patients sometimes described a sensation of electric discharge when elongating nerve trunks. In half of the cases the attacks of dysesthesia or of sensory loss followed one another within less than one year. The deficits were fully reversible in a third of the cases after a mean total evolution of 4 to 8 years. Blood and cerebrospinal fluid were always normal. Electromyography and motor conduction velocities were normal. Sensory conduction velocities were uncommonly decreased. On the other hand, the aspect of somesthetic potentials which were evoked from cutaneous areas involved by the disease were modified in most cases. Pathological examination of nerve biopsies which were performed in 5 cases showed non specific axo-myelinic degeneration in 3 cases and a severe sclerosis of the perineurium in one case. The etiopathogenesis of the disease is discussed.

Idiopathic recurrent myoglobinuria and persistent weakness.

The case of an adolescent with idiopathic recurrent myoglobinuria is reported. The following features are emphasized: (1) persistence of limb weakness and elevated CK levels between the attacks, (2) a constant myopathic pattern in EMG, and (3) chronic morphologic abnormalities of myopathy in two muscle biopsies. All known causes of myoglobinuria were investigated and ruled out.

[Ultrastructural elementary lesions in muscular pathology (author's transl)]. / Les lésions élémentaires ultrastructurales en pathologie musculaire.

The authors present and illustrate most of the ultrastructural abnormalities encountered in skeletal muscle in cases of neuromuscular disease. The diagnostic significance of the changes are discussed but emphasis is laid on the nonspecific character of most of them. For diagnostic purposes, examination by light microscopy remains the preferred approach, but electron microscopy enables the nature and origins of the lesions to be better defined and is a very valuable technique in exploring the pathogenesis of muscular diseases.

[Mononeuritis multiplex in a case of primary macroglobulinemia (author's transl)]. / Mononévrite multiple dans un cas de macroglobulinémie de Waldenström.

A case of Waldenström's disease with peripheral nerve involvement resembling mononeuritis multiplex is described. The various etiopathogenic mechanisms generally cited in connection with peripheral neuropathies observed in cases of macroglobulinemia, most often of the polyneuritic type, are discussed in turn : nerve infiltration by lymphocytes, intervention of an immunologic mechanism through the agency of paraprotein links with amyloidosis. However, the reported case differs from habitual cases on account of the asymmetry of the nerve involvement and the discovery of vasculitic lesions on muscle biopsy. The hypothesis of ischemic neuropathy associated with serum hyperviscosity is proposed and confirmed by the clinical improvement and reduction of macroglobulin obtained by repeated plasma exchanges and administration of Chlorambucil.

Histochemical and ultrastructural analysis of the mitochondrial changes in a familial mitochondrial myopathy.

Two familial cases of progressive external ophthalmoplegia with involvement of pharyngeal and distal muscles are presented. 'Ragged-red' fibres were found in both cases. Excessive amounts of RNA, as evidenced by the acridine orange-induced fluorescence, were noted in many muscle fibres, mostly in the 'ragged-red' fibres. At the ultrastructural level, numerous mitochondrial changes with paracrystalline formations were noted. Those formations were observed in three forms and three-dimensional reconstruction is proposed which suggests that the paracrystalline formations consist of undulating parallel leaflets joined along the top of the undulations. Small transverse bridges between neighbouring cristae and between cristae and paracrystalline formations are also emphasized. All those mitochondrial abnormalities are thought to represent the morphological expression of a biochemical deficiency in the inner membrane. They are interpreted thus: firstly, the biochemical defect leads to a multiplication of the mitochondria with increase in their volume and proliferation of the cristae in order to improve energy production; secondly, bridges between the modified inner membranes induce attachment of the neighbouring cristae and result in paracrystalline formations.