Attitudinal classification of patients receiving antibiotic treatment for mild respiratory tract infections

The aim of this study was to determine patients’ perceptions of antibiotic therapy and the doctor's skill in the management of ambulatory respiratory tract infections. Standardized face-to-face interviews were used with more than 3000 randomized patients or parents from four European countries. Attitudinal dimensions relating to their doctor identified four patient types: Involved (30%), Deferent (23%), Ignored (13%) and Critical (17%). Involved and Deferent patients were the most satisfied by the information received from their doctor (43%/39% compared with 17%/16% for Ignored/Critical, respectively, P<0.01). They also scored more highly on the accurate use of antibiotics, with 80%/80% vs. 38%/62%, respectively (P<0.01), understanding dosing intervals and 77%/77% vs. 36%/60% (P<0.01), understanding the course length. Involved and Deferent patients showed better compliant behaviour, with 91% of both groups vs. 86% of the Ignored and Critical claiming to have taken every dose (P<0.001) and 92%/87% vs. 84%/85% claiming to have finished the course (P<0.001 for Involved only). Involved and Deferent patients were less prone to save part of a course of antibiotics than the Ignored and Critical (46%/41% vs. 20%/31%, P<0.001), and they perceived the antibiotics prescribed to be more effective (36%/31% vs. 21%/15%, P<0.001). By analysing patient perceptions, this study identifies an important mirror effect, whereby a more sympathetic attitude from the doctor should increase the patient's involvement in disease management, for a more appropriate use of antibiotics in common infections.     

Functional recovery after surgical resection of low grade gliomas in eloquent brain: hypothesis of brain compensation

OBJECTIVES: To describe functional recovery after surgical resection of low grade gliomas (LGG) in eloquent brain areas, and discuss the mechanisms of compensation. METHODS: Seventy-seven right-handed patients without deficit were operated on for a LGG invading primary and/or secondary sensorimotor and/or language areas, as shown anatomically by pre-operative MRI and intraoperatively by electrical brain stimulation and cortico-subcortical mapping. RESULTS: Tumours involved 31 supplementary motor areas, 28 insulas, 8 primary somatosensory areas, 4 primary motor areas, 4 Broca's areas, and 2 left temporal language areas. All patients had immediate post-operative deficits. Recovery occurred within 3 months in all except four cases (definitive morbidity: 5%). Ninety-two percent of the lesions were either totally or extensively resected on post-operative MRI. CONCLUSIONS: These findings suggest that spatio-temporal functional re-organisation is possible in peritumoural brain, and that the process is dynamic. The recruitment of compensatory areas with long term perilesional functional reshaping would explain why: before surgery, there is no clinical deficit despite the tumour growth in eloquent regions; immediately after surgery, the occurrence of a deficit, which could be due to the resection of invaded areas participating (but not essential) to the function; and why three months after surgery, almost complete recovery had occurred. This brain plasticity, which decreases the long term risk of surgical morbidity, may be used to extend the limits of surgery in eloquent areas.     

Risk of recurrent stroke in adults aged under 45 years following a first ischemic stroke: a five-year study of 95 patients

Few data are available concerning the risk of recurrence of cerebral ischemic infarction in young adults (less than 45-years-old) after a first episode of ischemic stroke. From 1992 to 1996, 95 patients less than 45 years old were enrolled in a prospective study in order to define the etiology of their ischemic infarction with systematic and exhaustive explorations. They were recalled five years later (mean follow-up of 67,07 +/- 25,6 months) to determine the risk of stroke recurrence, the rate of cardiac and vascular events and the mortality. At 5 years, 4 patients had a recurrence of ischemic stroke (4.7 p. cent). Seven patients had a coronary event (4 myocardial infarction and 4 angina). Eleven patients died (6 during the acute period). No recurrence of stroke was noticed in patients with stroke of undetermined cause or with minor cardiopathy (abnormalities of the atrial septum). The risk of recurrence of ischemic stroke in young adults appears to be very low.     

Primary dural lymphoma: a report of two cases with review of the literature

Primary lymphoma arising in dura is exceedingly rare. We report the clinicopathologic findings of two patients with primary B-cell lymphoma of dura. Both were female, 38 and 45 years old. Prior to biopsy they were felt to have meningioma on preoperative magnetic resonance imagery. Histologically, tumors were classified as MALT-type lymphoma. Literature describe only 14 reports of similar entity. Primary lymphomas arising in dura appear to have a more favourable clinical course compared to PCNSL and may require a less aggressive treatment.     

Cutaneous metastasis of pleural mesothelioma: two cases

INTRODUCTION: Cutaneous manifestations of pleural mesothelioma are rare, polymorphic, and occur at various stages of the disease. CASE REPORTS: Case 1. A 60 year-old man, 6 months after the initial diagnosis of a pleural mesothelioma, developed a right latero-thoracic subcutaneous nodule. The lesion resulted from an inoculation of tumoral cells to the wall at the time of the initial thoracoscopy. No specific treatment was proposed. Case 2. A 62 year-old man, with a history of pleural mesothelioma developed an inflammatory layer of the left chest wall. The lesion, laid out like an hemi-belt, was centred by the thoracotomy scar and was associated with retraction phenomena of the thoracic wall. The lesion corresponded to a direct extension of the mesothelioma to the wall. At the same time, the pleural disease was progressing. The patient died a few weeks later. COMMENTS: Cutaneous manifestations usually occur when the diagnosis of primitive pleural cancer has been already established. Distant cutaneous metastases are exceptional and involve with predilection the cephalic extremity. The majority of cutaneous lesions are distributed near the tumoral site and represent either a direct extension of the tumor to the thoracic wall, or a malignant seeding by diffusion of the pleural fluid at the time of the diagnostic and therapeutic procedures.     

Comparison of two different PCR amplification products (the 18-kDa protein gene vs. RLEP repetitive sequence) in the diagnosis of Mycobacterium leprae

To determine the best molecular method for diagnosing leprosy, two sets of Mycobacterium leprae-specific primers were compared. Fresh biopsies and slit skin smear samples were obtained from 67 leprosy patients and examined by touchdown (TD) PCR using primers amplifying either a 129-bp fragment of the RLEP repetitive sequence or a 360-bp fragment of the 18-kDa protein gene of M. leprae. Seventeen of 30 (56.7%) biopsy specimens and four of 37 (10.8%) slit skin smear specimens were positive using the primer for the 18-kDa protein gene, whereas 24 of 30 (80%) biopsy and 27 of 37 (73%) slit skin smear samples showed detectable PCR products in the RLEP repetitive sequence. Twenty-one of 31 cases (67.7%) with a bacterial index of zero were PCR positive for the primer RLEP repetitive sequence. These results demonstrate that detection of M. leprae using PCR with primers to a RLEP sequence is more sensitive and specific than PCR with the 18-kDa protein gene primers and also slit smears with acid fast staining. PCR of RLEP repetitive sequences is therefore a useful means of detecting M. leprae DNA even when it is present at very low levels.