[Poisoning in general practitioner's practice]. / Les intoxications en médecine générale.

Every year the Belgian Poison Center deals with more than 50.000 calls. When a medical evaluation is needed, the patients are often advised to contact their general practitioner. This article gives the general practitioner some clues to face common or severe poisoning situations like benzodiazepines, antidepressants, analgesics (paracetamol, ibuprofen, methadone...), nose drops, bleaches, petroleum distillates, mushrooms or carbon monoxide exposure.

Glycosylation of the phosphate binding protein, PstS, in Streptomyces coelicolor by a pathway that resembles protein O-mannosylation in eukaryotes.

Previously mutations in a putative protein O-mannosyltransferase (SCO3154, Pmt) and a polyprenol phosphate mannose synthase (SCO1423, Ppm1) were found to cause resistance to phage, phiC31, in the antibiotic producing bacteria Streptomyces coelicolor A3(2). It was proposed that these two enzymes were part of a protein O-glycosylation pathway that was necessary for synthesis of the phage receptor. Here we provide the evidence that Pmt and Ppm1 are indeed both required for protein O-glycosylation. The phosphate binding protein PstS was found to be glycosylated with a trihexose in the S. coelicolor parent strain, J1929, but not in the pmt(-) derivative, DT1025. Ppm1 was necessary for the transfer of mannose to endogenous polyprenol phosphate in membrane preparations of S. coelicolor. A mutation in ppm1 that conferred an E218V substitution in Ppm1 abolished mannose transfer and glycosylation of PstS. Mass spectrometry analysis of extracted lipids showed the presence of a glycosylated polyprenol phosphate (PP) containing nine repeated isoprenyl units (C(45)-PP). S. coelicolor membranes were also able to catalyse the transfer of mannose to peptides derived from PstS, indicating that these could be targets for Pmt in vivo.

[Subarachnoidal haemorrhage and myocardial failure: interest of cardiac and cerebral monitoring]. / Hémorragie méningée et défaillance myocardique: intérêt du monitorage hémodynamique par doppler oesophagien.

Spontaneous subarachnoidal haemorrhage can be associated with neurogenic pulmonary oedema and cardiogenic shock. The presentation is an ischemic myocardial dysfunction associated with normal coronary arteries. Hypoxaemia associated with arterial hypotension on patients with brain injury can worsen neurological outcome. The administration of norepinephrine associated with fluid expansion could be deleterious on cardiac function. We report the case of a patient with acute pulmonary oedema associated with post-aneurysmal subarachnoid haemorrhage managed with transoesophageal Doppler monitoring.

[Perineal necrotizing cellulitis disclosing rectal adenocarcinoma]. / Cellulite nécrosante périnéale révélant un adénocarcinome rectal.

We report one case of rectal cancer disclosed by a perineal cellulitis in a diabetic woman. This infrequent association has a bad prognosis. Diagnosis is mainly clinical. Treatment is urgent with large spectrum antibiotic therapy, surgical debridement, colostomy and hyperbaric oxygen if available. Surgical treatment of the rectal cancer can be done immediately or delayed.

[Pudendal hernia of the labia]. / Hernie de la grande lèvre.

A case of hernia is reported with a brief review of perineal hernia.

[Acute severe colitis with recto-vaginal fistula during treatment with non-steroidal anti-inflammatory agents]. / Colite aiguë grave avec fistule recto-vaginale sous anti-inflammatoires non stéroïdiens.

INTRODUCTION: We report the case of severe colitis occurring during treatment with non-steroid anti-inflammatories (NSAI). OBSERVATION: A 57 year-old woman was hospitalized for lumbar pain that had not been relieved by AINS, tramadol and then morphine. The patient presented with septic shock and peritonitis by rectal perforation, followed by acute rectorrhagia. The endoscopic aspect evoked Crohn's disease with a recto-vaginal fistula. Progression was further complicated by two episodes of collapse because of acute rectorrhagia, requiring hemostasis colectomy and abdominal-perineal amputation. CONCLUSION: The diagnosis retained was AINS-induced colitis complicated by acute colectasia on a fecaloma with recto-vaginal fistula.

[Evaluation of regional anesthesia procedure in an emergency department]. / Evaluation de l'utilisation de l'anesthésie locorégionale dans un service d'urgence.

OBJECTIVES: Evaluation of regional anaesthesia procedures for limb traumatic surgery performed in an emergency department. METHOD: Anaesthetic procedures concerning traumatic emergencies have been studied from 1995 to 2000. RESULTS: A 32% increase in anaesthesia practice was observed from 1995 (221) to 2000 (292) with a 52% increase in regional anaesthesia. Since 1996, regional anaesthesia represents more than 80% of the anaesthetic procedures and 90% for the upper limb surgery (66% of the surgical procedures). Axillary block (50%), interscalene brachial plexus block (15%) and combined sciatic and femoral nerve block (17%) were the main regional anaesthesia procedures. Spinal anaesthesia (9 cases) and intravenous locoregional anaesthesia (12 cases) were rarely used. CONCLUSION: In our study, regional anaesthesia is the most used technique when compared to general anaesthesia for emergency procedure. The anaesthetic staff has to be motivated and trained.

Sicca syndrome associated with hepatitis C virus infection.

OBJECTIVE: To determine the prevalence of hepatitis C virus (HCV) infection in patients with sicca syndrome, and to determine the clinical, immunologic, and genetic characteristics of sicca syndrome associated with HCV. METHODS: We conducted a prospective study in a university hospital immunology-rheumatology department. Sixty-two consecutive patients with sicca syndrome according to the European criteria for Sjögren's syndrome were included. HCV infection was diagnosed in patients with positive recombinant immunoblot assay findings and the presence of viral RNA in serum and saliva. Rheumatoid factor (RF), cryoglobulins, antinuclear antibodies, and anti-SS-A/SS-B antibodies were sought. HLA typing was performed on all patients. RESULTS: The prevalence of HCV infection in patients with sicca syndrome was 19%. The incidence of neurologic involvement was significantly increased in patients with sicca syndrome associated with HCV infection (24% versus 4%; P < 0.03), as was elevations in transaminase levels (87.5% versus 16%; P < 0.0001). RF and cryoglobulins were more frequent in HCV-positive sicca syndrome patients (62% versus 30%; P < 0.03, and 56% versus 10%; P < 0.001, respectively). In contrast, anti-SS-A/SS-B antibodies were present in 38% of HCV-negative sicca syndrome patients, but in only 1 HCV-positive sicca syndrome patient (P < 0.01). No significant difference in HLA type was observed. Viral RNA was present in the saliva of 83% of HCV-positive sicca syndrome patients, but in none of the HCV-negative sicca syndrome patients. CONCLUSION: We observed a high prevalence of HCV infection in our patients with sicca syndrome. HCV-positive sicca syndrome patients had specific clinical characteristics and were seronegative for SS-A/SS-B antibodies. Moreover, HCV RNA was present in the saliva of patients with HCV-associated sicca syndrome.

[Thrombosis of the superior mesenteric artery and Behçet's syndrome]. / Thrombose de l'artère mésentérique supérieure et syndrome de Behçet.

The authors describe the third case in the literature of superior mesenteric artery's thrombosis occurring in the course of the Behçet's syndrome according to Mason and Barnes classification. Clinical manifestations in the patient were represented by intestinal angor. The literature data concerning vascular involvement in Behçet's disease, particularly thrombosis are reviewed. The value of noninvasive paraclinic arterial digestive explorations is discussed.

[Pulmonary nocardiosis in a HIV positive African patient]. / Nocardiose pulmonaire chez un Africain VIH positif.

Case report of a pulmonary nocardiosis associated with a pneumocystosis pneumonia and a cryptococcal meningitis in an African not already known as infected with Human Immunodeficiency Virus. Fever reoccurred when cotrimoxazole was stopped for intolerance. Bronchoalveolar lavage gave diagnosis.

[Quality assessment of colonscopies in current practice in the Aquitaine area]. / Qualité des coloscopies réalisées en pratique courante dans la région Aquitaine.

UNLABELLED: Sensitivity of colonoscopy depends on the technical quality of the procedure. The aims of this study were to evaluate the usual of colonoscopy in the French area of Aquitaine and to determinate the factors associated with a procedure of good quality. Thirty four gastroenterologists prospectively recorded indications, conditions of practice and results of the colonoscopies that were performed during 4 consecutive weeks. Six hundred and eighty six colonoscopies were analysed, performed in 387 women and 299 men, mean age: 59.9 years. INDICATIONS: irritable bowel syndrome: 34%, patients belonging to high risk groups: 30%, recent transit disturbance: 27%, rectal bleeding: 23%, positive fecal occult blood test: 4.3%. Preparations: polyethylene glycol (PEG) 78%, in 2 doses: 20%; PEG alone: 43%, associated with enemas and laxatives: 19%, with enemas: 14%, with laxatives: 2%; minimum-residue diet before colonoscopy: 58%. The caecum was reached in 86% of colonoscopies. Ninety-nine colonoscopies were incomplete. Fifty one per cent of colonoscopies reached the caecum with visualization of total colic mucosa, 35% reached the caecum with one at least imperfectly seen colic area.(ABSTRACT TRUNCATED AT 250 WORDS)

[Contraception using a subcutaneous implant, Norplant]. / Contraception par un implant sous-cutané, le Norplant.

The contraceptive device Norplant, not yet commercialized in Belgium, has been studied prospectively on 198 women, which were followed for up to 42 months per patient. All together, 2,643 months of use were surveyed. Norplant consists of 6 silastic capsules, liberating levonorgestrel, a synthetic progestagen. The pregnancy protection lasts for 5 years. Insertion site is the inner part of the upper arm. The Pearl Index was 0.46% women-years (only one pregnancy occurred); the continuity rate was high (86% after 1 year and 60% after 2 years). The main side effects were menstrual disturbances and abnormal intermenstrual blood loss. No other important side effects have been found. There is no absolute contra-indication to the use of Norplant.

Changes in alpha 1-acid glycoprotein serum concentrations and glycoforms in the developing human fetus.

alpha 1-Acid glycoprotein concentrations and reactivity to concanavalin A were measured in maternal and fetal serum and amniotic fluid obtained from 24 women undergoing diagnostic cordocentesis at 20 to 33 wk gestation and in 30 additional fetal sera (19 to 34 weeks gestation). Maternal alpha 1-acid glycoprotein serum levels were five to ten times higher than fetal and amniotic levels. Fetal alpha 1-acid glycoprotein levels were found to increase with advancing gestational age. Using crossed immunoaffino electrophoresis with concanavalin A, alpha 1-acid glycoprotein patterns were identical in maternal serum and amniotic fluid but totally different in fetal serum. The fetal concanavalin A pattern changed progressively during fetal life towards that of the newborn. These data confirm earlier assumptions of fetal synthesis of alpha 1-acid glycoprotein and provide normal reference values for alpha 1-acid glycoprotein in fetal serum. In addition, the specific fetal concanavalin A pattern indicates that the alpha 1-acid glycoprotein glycosylation process during fetal life differs from that in post-natal life.

Polyclonal antibody-based enzyme-linked immunosorbent assay of alpha 1-acid glycoprotein.

This is a noncompetitive enzyme-linked immunosorbent assay for measuring low concentrations (2 to 100 micrograms/L) of human alpha 1-acid glycoprotein (AGP; orosomucoid). The method is based on a simple "sandwich" technique involving polyclonal rabbit antisera against AGP. Mean within-run and total (between-run) CVs were 6.2% and 9.7%, respectively. Analytical recovery, tested in various biological fluids, averaged 101%. The technique has been successfully applied to diluted biological fluids such as bronchoalveolar lavage, cerebrospinal and amniotic fluids, and hepatocyte-culture supernates. Because of its analytical validity and the commercial availability of the reagents, this assay is suitable for large-scale determinations of AGP concentrations in those biological fluids in which its concentration is relatively low.