[Necrotizing fasciitis of the thoracoabdominal wall complicating Dujarier's bandage: a case report]. / Fasciite nécrosante compliquant un bandage de Dujarier: à propos d'une observation.

The necrotizing fasciitis (NF) means a serious infection of the subcutis, the fascia and superficial dermis secondarily. We report the case of a patient with cellulitis NF of the thoracoabdominal wall complicating Dujarier's bandage. It was monobacterial NF caused by ß hemolytic streptococcus, whose development was supported through an appropriate medical and surgical care. The situation mentioned is the occurrence of secondary infection of skin necrosis occurred in the bandage too tight opposite the support zone of the elbow on the trunk. We point out, through this case, the importance of the medicosurgical and also the importance of making any thoracoabdominal bandage, which could lead, if it is tight, a pressure sore can be a door entry for any NF plus a late diagnosis.

[Electrical burns suffered by copper thieves]. / Les brulures electriques chez les voleurs de cuivre.

Thefts of copper appear to have been on the increase for some time owing to its high resale price. This has led to an increase in the number of high-voltage electrical accidents (HVEA). Such accidents are very serious because they cause deep burns along the neurovascular axis. A report is presented describing a series of nine patients presenting HVEA admitted to the Ibn Sina Hospital Plastic Surgery and Burns Division in Rabat, Morocco, with a study of the epidemiological, clinical, and therapeutic aspects. The patients all belonged to the young and active sector of the population. The burns were secondary to contact with high-voltage cables occurring during the attempted stealing of copper by stripping electric conductors in transformers (67% of the cases) and in attempts to cut overhead lines supplying electric trains on the railway network (33%). Electrothermal treatment of the lesions required repeated surgery with amputation and disarticulation of necrotic limb segments (67% of the cases), the consequences of which were marked by disabling functional sequelae. Preventing this type of HVEA remains fundamental.

[Not Available]. / Les Brulures Electriques par Haut Voltage - A Propos de 10 Cas.

Les accidents électriques par haute tension (AEHT) provoquent des brûlures profondes par effet Joule le long des axes vasculo-nerveux entre les points d'entrée et de sortie, qui sont le siège de lésions délabrantes. Les Auteurs rapportent une série de dix cas d'AEHT admis au service de chirurgie réparatrice et de brûlés de l'Hôpital Ibn Sina de Rabat à travers laquelle ils étudient les caractéristiques épidémiologiques, cliniques et thérapeutiques. Tous les patients étaient des adultes de sexe masculin dont l'âge moyen était de 31 ans. Dans 70% des cas, ces brûlures étaient secondaires à un contact avec les distributeurs d'électricité avec une surface brûlée inférieure à 20%. Le traitement des lésions électrothermiques a nécessité des interventions itératives avec amputation des segments de membres nécrosés dans 70% des cas, dont les suites étaient marquées par des séquelles fonctionnelles invalidantes. La prévention des AEHT, en particulier pour les accidents du travail au sein des professions exposées, reste fondamentale.

Efficacy of DOTS strategy in treatment of respiratory tuberculosis in Gorgan, Islamic Republic of Iran.

We carried out a follow-up cohort study of 260 smear-positive patients [178 on directly observed treatment, short-course (DOTS); 82 on non-DOTS] over a 2-year period to evaluate the efficacy of the DOTS strategy in treatment of tuberculosis (TB). All the patients had had cough for > 3 weeks; 91.9% had fever, 60.8% of them with sputum; and 27.7% had a positive family history. The rate of treatment failure with DOTS was 9.0% at the end of the 2nd month and 1.7% at the beginning of the 5th month. In the control group these rates were 18.3% and 7.3% respectively. The DOTS strategy significantly increased the success rate of TB treatment (P < 0.05).

Efficacy of DOTS strategy in treatment of respiratory tuberculosis in Gorgan, Islamic Republic of Iran

We carried out a follow-up cohort study of 260 smear-positive patients [178 on directly observed treatment, short-course [DOTS]; 82 on non-DOTS] over a 2-year period to evaluate the efficacy of the DOTS strategy in treatment of tuberculosis [TB]. All the patients had cough for > 3 weeks; 91.9% had fever, 60.8% of them with sputum; and 27.7% had a positive family history. The rate of treatment failure with DOTS was 9.0% at the end of the 2nd month and 1.7% at the beginning of the 5th month. In the control group these rates were 18.3% and 7.3% respectively. The DOTS strategy significantly increased the success rate of TB treatment [P < 0.05]

Infection after laparoscopic cholecystectomy: effect of infected bile and infected gallbladder wall.

OBJECTIVE: To assess the incidence of infected bile and gallbladder wall infection at the time of laparoscopic cholecystectomy, and find out if they influenced the rate of postoperative infective complications. DESIGN: Prospective study. SETTING: District hospital, Kuwait. SUBJECTS: All 279 patients who had their gallbladders removed laparoscopically for gallbladder disease between September 1995 and August 1998. INTERVENTIONS: Samples of bile and gallbladder wall were taken from all patients and cultured separately for aerobic and anaerobic bacteria. Patients with complicated gallbladder disease (n = 80) were given preoperative therapeutic antibiotics for five days (cephalosporin plus metronidazole), and other high-risk patients (n = 138) were given prophylactic ceftriaxone either 1 g x 3 starting at induction of anaesthesia (n = 42), or a single dose at induction (n = 96). MAIN OUTCOME MEASURES: Incidence of infected cultures, and infective morbidity. RESULTS: 26 specimens of bile (9%) and 56 specimens of gallbladder wall (20%) were infected. Two patients in whom neither specimen had shown any growth developed minor infections at the umbilical port. No patient in whom either specimen was infected developed an infective complication. CONCLUSIONS: The overall rate of infective complications was negligible, and did not correlate with the presence of bacteria in the bile or gallbladder wall. This is probably a reflection of our aggressive antibiotic regimen in the management of high-risk patients.

Purification and primary structure of low molecular mass peptides from scorpion (Buthus sindicus) venom.

The primary structures of four low molecular mass peptides (Bs 6, 8, 10 and 14) from scorpion Buthus sindicus were elucidated via combination of Edman degradation and matrix-assisted laser desorption ionization mass spectrometry. Bs 8 and 14 are cysteine-rich, thermostable peptides composed of 35-36 residues with molecular weights of 3.7 and 3.4 kDa, respectively. These peptides show close sequence homologies (55-78%) with other scorpion chlorotoxin-like short-chain neurotoxins (SCNs) containing four intramolecular disulfide bridges. Despite the sequence variation between these two peptides (37% heterogeneity) their general structural organization is very similar as shown by their clearly related circular dichroism spectra. Furthermore, Bs6 is a minor component, composed of 38 residues (4.1 kDa) containing six half-cystine residues and having close sequence identities (40-80%) with charybdotoxin-like SCNs containing three disulfide bridges. The non-cysteinic, bacic and thermolabile Bs10 is composed of 34 amino acid residues (3.7 kDa), and belongs to a new class of peptides, with no sequence resemblance to any other so far reported sequence isolated from scorpions. Surprisingly, Bs10 shows some limited sequence analogy with oocyte zinc finger proteins. Results of these studies are discussed with respect to their structural similarities within the scorpion LCNs, SCNs and other biologically active peptides.

Localisation of monoclonal antibodies reacting with different epitopes on carcinoembryonic antigen (CEA)--implications for targeted therapy.

Antibody targeting has potential for selective delivery of cancer therapy. However, there is a wide variation in the degree of antibody localisation in individual patients with colorectal adenocarcinoma. Colorectal adenocarcinomas are composed of glandular structures separated from fibrovascular stroma by a basal lamina which may represent a significant barrier to extravasated antibody. Basement membrane-associated CEA epitopes may be more accessible to antibodies than those which are cytoplasmic or lumenal. We have investigated by immunohistochemistry and in vivo localisation, the extent to which distribution of antigen epitopes influences targeting. Two monoclonal antibodies (A5B7 and EA77) recognising non-overlapping CEA epitopes were reacted immunohistochemically with samples of 39 tumours. Intensity and site of reaction were assessed for basement membrane, cytoplasmic or lumenal surface association. 125I-labelled antibodies were injected into nude mice bearing LS174T tumour. Per cent injected activity per gram was measured in tumour and normal tissues, 24, 72 and 168 h later. Tissues reacted immunohistochemically for CEA were autoradiographed to assess the relationship of injected antibody to target antigen. Immunohistochemistry showed that A5B7 antibody favours basement membrane aspects of malignant glands; in contrast, EA77 concentrated generally on lumenal surfaces. In vivo localisation showed that per cent inj.act g-1 in tumour for A5B7 reached 36.5% at 24 h. EA77 localised to a lesser extent (9.1% at 24 h), despite a longer circulatory half-life. Autoradiography combined with immunohistochemistry showed A5B7 reacting with antigen close to vasculature after 24 h, slowly penetrating deeper parts of the tumour by 72 h. In contrast, EA77 was confined mainly to fibrovascular stroma, showing little labelling of antigen-positive tumour cells. Localisation differences between A5B7 and EA77 may partly be due to accessibility of epitopes on tumour cells.

[Continuity of care and treatment of hypertension at a health center in Tunisia]. / Continuité des soins et contrôle de l'hypertension dans un centre de santé en Tunisie.

This article describes the follow-up of 210 hypertensive patients in Soliman, Tunisia. Five years after starting treatment, two thirds of the patients are still followed-up. The incidence of interruption of treatment is of 0.18 per year of follow-up. Nearly half of these first interruptions occur during the first six months, but most do not result in a final abandon of treatment. The drop in blood pressure is more important among those who stick to their appointment schedules, than among those who do not. The former also present less hypertensive crises.