Acquisition of hepatitis C virus in hemodialysis patients: a prospective study by branched DNA signal amplification assay

Serological data indicate that hepatitis C virus (HCV) infection is very common among chronic hemodialysis (HD) patients. Circumstantial evidence suggests that hemodialysis per se is an important risk factor for this infection. We used a novel methodology, the branched DNA (bDNA) signal amplification assay, which is capable of detecting HCV RNA and of quantifying HCV viral load in serum, to prospectively determine the rate of acquisition of HCV infection in 274 anti-HCV-negative patients undergoing HD treatment in four hemodialysis units. Moreover, we used bDNA testing to analyze the dynamics of HCV acquisition among HD patients, a high-risk group for HCV infection with immune compromise conferred from uremia. Two patients were identified with de novo acquisition during 1 year of prospective bDNA testing. Thus, the HCV incidence was 0.73% per year. De novo acquisition of HCV infection was observed in the absence of identifiable parenteral risk factors. Both patients showed the same pattern of HCV acquisition: they underwent an initial viremic phase that was associated with an increase in alanine transaminase (ALT) activity and that preceded the anti-HCV seroconversion. This was followed by HCV RNA clearance and normalization of ALT activity. Anti-HCV positivity occurred 1 and 2 months after the ALT increase in the first and second patients, respectively. Although HCV incidence was low (0.73%), further research is warranted to set the optimal policy for eliminating the risk of nosocomial transmission of HCV in the HD setting. Our findings show the pattern of HCV acquisition in chronic HD patients and emphasize the need to screen the HD population for ALT measurement combined with anti-HCV testing for detecting hepatitis C. HCV RNA testing can identify HCV before seroconversion in individuals with deranged liver function tests. The acquisition of HCV in HD patients without identifiable risk is confirmed.     

Les prothèses mammaires et leurs complications

Reported complications of breast implants.In the past few years silicone breast implants have been a highly charged and controversial topic for psychologic, health and politico-legal reasons for patients and for surgical, medical and research concern for professionals. Both sides are interested in knowing about the complications encountered with these implants on one hand and to find the ideal device needed for mammary reconstruction on the other. Indeed silicone does not fulfill the characteristics initially expected for a synthetic soft-tissue substitute. The local cellular response leads to the formation of a capsule around the implant with frequently unsatisfying cosmetic results. The well described leakage occurring through the silicone envelope allows the silicone gel to diffuse to multiple anatomic areas in the body. Scientific works demonstrated that silicone gel acts as a potent immunologie adjuvant and can induce antibodies to silicone surface-associated antigens. Breast implanted women who present with systemic clinical symptoms can be included either in the group of well defined connective tissue diseases or in the atypical connective tissue diseaselike syndrome. The largest epidemiologic studies have shown reassuring evidence against large hazards but have documented a low but statistically significant risk of connective-tissue diseases in women with silicone gel filled implants. Practicioners must manage these patients with the awareness that reliable objective tests to identify the useful problem are not yet available.     

Childhood migraine in general practice: clinical features and characteristics

Previous studies have evaluated the clinical features and characteristics of migraine in selected children attending hospital clinics. There have, however, been no community studies on the prevalence and characteristics of migraine in children aged 3-11 years in British general practice. In this study, a total of 1,083 children (from 1,104 registered with a general practice) and their parents were interviewed. Possible migraine sufferers took part in an extended interview that assessed various characteristics of the patients and their attacks. The survey showed that migraine attacks started in infancy, and migrainous children were more likely to have mothers with migraine. Some clinical features were found to be age-dependent. Compared with similar hospital surveys there was a lower frequency of attacks recorded but the prevalence of aura was similar to that found in previous studies.     

牛奶和钙盐在胃肠道内的钙吸收

目的和方法目前尚不清楚，摄入非水溶性钙盐的钙吸收是否比摄入水溶性差的钙盐钙吸收更好；另外也不清楚，牛奶制品的钙吸收是否比钙盐钙吸收更好。作者采用一种单次服用就能精确测定钙的净吸收率的方法，给８例健康空腹受试者服用含５００mg钙的５种不同水溶性的钙盐和牛奶，服用顺序是随机的。结果按钙盐的水溶性递减次序排列，以平均钙的净吸收率±标准误表示：醋酸钙（３２±４）％，乳酸钙（３２±４）％，葡萄糖酸钙（２７±３）％，柠檬酸钙（３０±３）％；碳酸钙（３９±３）％。按方差分析，钙盐和牛奶的钙吸收率差异无统计学意义…