Long-term prognosis of cirrhosis after spontaneous bacterial peritonitis treated with ceftriaxone

Spontaneous bacterial peritonitis (SBP) is a frequent infection in cirrhotic patients with ascites, with a poor prognosis. The aims of this study were to determine the long-term survival of cirrhotic patients with SBP treated with ceftriaxone and to identify predictive factors related to survival. We studied 47 first episodes of SBP treated with ceftriaxone with a mean follow-up of 272 days. Nineteen variables were recorded to evaluate their relation to survival. The most frequent organism that caused SBP was Escherichia coli (40%). Spontaneous bacterial peritonitis resolution was achieved in 67% of patients. After resolution, SBP recurrence was observed in 44% of patients. The cumulative probability of survival was 68.1% at 1 month and 30.8% at 6 months. After uni-and multivariate analyses of all cases, SBP resolution ( p = 0.0001) and international normalized ratio (INR) ( p = 0.0057) were found to be related to survival. Another analysis performed after SBP resolution and SBP recurrence showed that ascitic fluid-positive culture ( p = 0.0344) and INR ( p = 0.0218) had statistical significance as variables predictive of long-term survival. We conclude that the survival of cirrhotic patients is very short after the first episode of SBP, a fact probably related to advanced liver disease, as liver dysfunction (INR) is the most important factor related to long-term patient survival.     

Anal sphincter response to distension

Resting anal pressure as determined by manometry is unsuited for assessing the competence of a sphincter. To validate a compliance method of sphincter evaluation we investigated the response of the anal canal to distension. In 20 healthy subjects the anal sphincter was distended using a cylindrical balloon probe subjected to continuous inflation. Two speeds of distension were used: 12 and 80 ml/min. Deflation, at the rate of inflation, immediately followed the inflation at 12 ml/min, and at 80 ml/min was performed after a deformation volume of 12 ml was maintained for 2 min. The response of the anal sphincter to 12 ml/min distension was characterized by an initial phase of resistance followed by relaxation of the anal sphincter in all subjects. In contrast, at 80 ml/min no opening was obtained. During the deformation a biomechanical relaxation curve was recorded. We conclude that the anal sphincter acts as a low-pass filter and not only as a pressure barrier. The response of the anal sphincter to distension is a simple test, which provides functional information on the behavior of the anal sphincteric zone.     

HIV testing and retesting for men and women in Switzerland

This study was conducted to describe voluntary HIV testing in the general population in Switzerland and to estimate yearly HIV test incidence. In 1994, a representative telephone survey of individuals aged 17 to 45 years obtained self-reported information on HIV testing. In addition to describing cumulative HIV test incidence, yearly HIV test incidence over time was estimated by a Bayesian hurdle model allowing for the plausible scenario of test consumption differing between first test and subsequent retests. Overall, 33% of the Swiss population (age 17 to 45 years) has been tested at some time for HIV on a voluntary basis (30% men, 36% women). For the time period 1990–1994, the result showed for 35-year-old individuals with supposedly low risk behavior, that 1) annual test incidence (first test or retest) showed a greater increase for men (4.2 to 5.9%) than for women (5.0 to 6.0% 2) annual first test incidence increased moderately and differed for men and women (2.9 to 3.4% for men, 4.6 to 5.2% for women), and 3) annual retest incidence was twice as high for men (17.6%) as for women (8.6%). In conclusion, a substantial part of the Swiss population has been tested at some stage for HIV on a voluntary basis, and differences exist for testing and retesting between men and women.     

Serum monoclonal immunoglobulins in childhood

Of 18 children with monoclonal immunoglobulins in their sera, 13 had a primary or secondary immunodeficiency. The monoclonal immunoglobulin belonged to each of the three main Ig classes, and in 3 children multiple monoclonal components were detected. The level of the monoclonal component exceeded 0·5 g/100 ml in 7 cases. The monoclonal immunoglobulin disappeared spontaneously in 9 children. The significance of this homogeneous component and the importance of the underlying immunodeficiency are outlined.     

Infiltrating lipoma of the head and neck: a report of one pediatric case

Infiltrating lipomas are rare benign tumors. Several cases have previously been reported in the oral cavity but only three cases have been reported to date in children. We report a case of a 7-year-old child with an infiltrating lipoma of the neck and a posterior extension to the fourth and fifth cervical roots and the vertebral artery. The absence of any neurological signs, negative clinical and radiological examination results, as well as, the surgical risk of total removal and high rate of recurrence suggested a period of watchful waiting. After 5 years, the patient's clinical and radiological characteristics remain stable. A review of the literature regarding this pathology in the head and neck area, in both children and adults is also presented.     

Flow cytometry in primary breast carcinomas. Prognostic impact of proliferative activity

From 1990 to 1996, 607 previously untreated, node-negative, invasive breast carcinomas were sampled by a pathologist for flow-cytometric DNA analysis. The aim of the present work was to study the correlations between flow cytometric results obtained thanks to the American Consensus (AC) guidelines of 1993 and the established clinico-pathological prognostic factors (T, grade, receptors), and despite a short global follow-up (mean of 4 years), to correlate flow cytometry with the outcome of the patients. In this study S-phase fraction (SPF) correlated strongly with tumor size, histological grade, lack of steroid receptors, histological type and was together with the mitotic activity a paramount prognostic factor even after multivariate analysis. This study compared also the technical criteria proposed by the AC with our own more stringent ones and concluded that the criteria of the AC are relevant and allow, thanks to the use of tertiles in the reporting of SPF values, a comparison of values obtained by different teams. Our review of the literature, focused on series using fresh material, enabled us to show that there is a rather wide agreement concerning the relationship between SPF and prognosis most often after multivariate analysis. This despite the lack of standardization in the design of the studies (implementation of the technical steps or reporting of results). When estimated from fresh or frozen material following ACs guidelines, SPF along with mitotic activity should become a prognostic factor used in the daily practice by oncologists in the management of breast carcinomas.