Nine-year surveillance of methicillin-resistant Staphylococcus aureus in a hospital suggests instability of mecA DNA region in an epidemic strain

The distributions of the antibiotic resistance patterns in a population of Staphylococcus aureus isolates from a teaching hospital were studied over a 9-year period. The results indicate the existence of successive major epidemic methicillin-resistant strains and the emergence of a methicillin-susceptible strain with an unusual resistance pattern. Our findings suggest that this methicillin-susceptible S. aureus strain could be derived from the dominant gentamicin-susceptible methicillin-resistant S. aureus strain with the loss of a 40-kb DNA fragment.     

Kaposi's sarcoma herpesvirus and HIV-1 seroprevalences in prostitutes in Djibouti

Kaposi's sarcoma herpesvirus (KSHV) is linked causally to Kaposi's sarcoma. Epidemiological studies have shown that KSHV transmission can occur during sex among homosexual men, but heterosexual transmission seems to be very rare in KSHV low prevalence countries. A seroepidemiological study was conducted to determine whether KSHV is transmitted sexually between heterosexuals in an endemic country. Sera from 282 subjects of African origin living in Djibouti were tested for antibodies to KSHV and HIV-1. Among the 282 individuals, 43 were female prostitutes working in the streets (group 1), 123 were female prostitutes working in luxury bars (group 2), 41 were non-prostitute females (group 3), and 75 were non-prostitute males (group 4). KSHV seroprevalence was 26, 20, 17, and 36% in groups 1, 2, 3, and 4, respectively. The seroprevalence of KSHV is not different between street or bar prostitutes and non-prostitute females (OR = 1.67; P = 0.34 and OR = 1.18; P = 0.73). These results suggest that in this endemic country commercial sex work does not seem to be a risk factor for KSHV infection and provides evidence against heterosexual transmission of KSHV in the female population studied.     

Phospholipid scramblase,a new effector of FcepsilonRI signaling in mast cells

The signaling network of the high-affinity receptor for IgE in mast cells involves tyrosine phosphorylation of a number of proteins. Here we report evidence that phospholipid scramblase, a protein involved in the distribution of phospholipids between the two leaflets of the plasma membrane, is a target for tyrosine kinases in this signal. The implication of this observation is briefly discussed.     

Benign paroxysmal positional vertigo in patients with Ménière's disease treated with intratympanic gentamycin

OBJECTIVES: To analyze the incidence and characteristics of benign paroxysmal positional vertigo (BPPV) in patients with Ménière's disease who did not respond to medical treatment and to whom intratympanic gentamycin treatment was proposed. STUDY DESIGN: This is a retrospective analysis of the patients in our database. A complete otoneurologic bedside examination of each patient, including assessment of positional nystagmus, was performed at the time of diagnosis and during the follow-up. RESULTS: Nine of 90 patients with Ménière's disease also had BPPV, which manifested in different ways. In 3 patients, BPPV preceded the onset of Ménière's symptomatology in the same ear; in 1, BPPV manifested after treatment for Meniere's disease had ended and the patient was in complete control of the spontaneous spells of vertigo; in 5 cases, recurrences of both Meniere's disease and the positioning symptomatology coincided. Treatment for each condition was conducted independently and favorable results were obtained after long-term follow-up when Meniere's disease and BPPV did not coincide simultaneously. In the group manifesting symptoms of both disorders at the same time, gentamycin treatment with the Canalith Repositioning Procedure and/or Semont maneuver partially resolved the symptoms. CONCLUSIONS: In the context of Ménière's disease, the sequence of appearance of BPPV relative to the spontaneous episodes must be taken into account when planning the treatment for each of the disorders, which should be considered independently. This pattern could also influence the prognosis for each disorder.     

Quantitative comparison of three different types of anterior cruciate ligament reconstruction methods: laxity and 3-D kinematic measurements

In this project, we compared knee laxity and 3-D knee kinematics after ACL reconstruction on cadaver knees using (1) bone-patellar tendon-bone two-tunnel; (2) synthetic ligament two-tunnel; and (3) synthetic ligament "over-the-top" technique. We used a computer assisted system, based on the acquisition of the knee's movement with magnetic sensors (Polhemus, Vermont, USA). The use of personalised three-dimensional (3D) models of the bones enabled us to ensure a reproducible measurement of three-dimensional kinematic and laxity parameters. Our results showed that even when knee laxity was restored to normal, 3D kinematic measurements revealed that the reconstructions tended to under or over-constrain the knee's movement. This study shows that 3D kinematics is a complementary measurement that can be useful to get a better comprehension of the knee's function after ligament reconstruction.     

Sclerosing mesenteritis in small bowel transplantation: possible manifestation of acute vascular rejection

BACKGROUND: Acute rejection of human small bowel allografts is characterized by clinical symptoms combined with characteristic morphologic alterations. The typical geographic distribution of acute rejection in the bowel is involvement of the intestinal parenchyma, which can be transmural, particularly when the rejection is more severe. However, little is known concerning the potential for donor-derived soft tissue adjacent to the bowel to become involved by the host alloimmune response. METHODS: We describe a male patient who, several weeks after combined small bowel and liver transplantation, demonstrated sclerosing mesenteritis with vasculitis and acute rejection of the bowel. RESULTS: The vascular lesions in the mesentery demonstrated increased IgG deposition and the patient developed an alloantibody to the donor. CONCLUSIONS: The changes described herein may represent a novel presentation of acute vascular rejection.     

Clinical experience with two physiologic bicarbonate/lactate peritoneal dialysis solutions in automated peritoneal dialysis

Clinical experience with two physiologic bicarbonate/lactate peritoneal dialysis solutions in automated peritoneal dialysis. BACKGROUND: Patients on automated peritoneal dialysis (APD) usually receive larger volumes of dialysis solution and more frequent, shorter exchanges than patients on continuous ambulatory peritoneal dialysis (CAPD), and therefore are likely to derive greater benefit from more physiologic solutions. METHODS: Peritoneal dialysis solutions containing 25 mmol/L bicarbonate and either 10 or 15 mmol/L lactate were compared with standard lactate solutions (35 or 40 mmol/L) in two prospective, open-label studies of patients on APD. Each study included a 2-week baseline period (lactate solution), a 6-week treatment period (bicarbonate/lactate solution), and a 2-week follow-up period (same lactate solution as baseline). Biochemical analyses and assessments of vital signs and safety parameters were conducted at baseline, every 2 weeks during treatment, and at the end of the follow-up period. A product use questionnaire was administered in one study at the end of treatment. RESULTS: A statistically significant rise in plasma bicarbonate (approximately 2 mmol/L) occurred when patients switched from a lactate solution to the bicarbonate/lactate solution with equimolar buffer concentration (P < 0.001 for each solution). Plasma bicarbonate decreased by 1.16 mmol/L after a switch from lactate 40 mmol/L to bicarbonate/lactate 35 mmol/L (P < 0.001). When patients switched to bicarbonate/lactate 35, the majority of individual venous plasma bicarbonate values were in the normal range. A switch from a lower calcium (1.25 mmol/ L) lactate solution to a higher calcium (1.75 mmol/L) lactate/bicarbonate solution resulted in a statistically significant rise in serum calcium (0.06 mmol/L, P < 0.018). The product use questionnaire revealed improvements in symptoms, including reduced pain on infusion. CONCLUSION: Bicarbonate/lactate solutions may be used safely and effectively in patients on APD. The availability of 2 formulations with different buffer and calcium content provides flexibility for the control of acidosis as well as calcium balance.     

Prognosis and possibilities of treatment of inaugural metastases

Prognosis depending on clinical presentation The prognosis of carcinomas of unknown primary site (CUP) is poor, with median survival of 8 months. Prognosis is better for specific clinical forms. Recent predictive models rely on the general status of the patient and simple biological parameters (lacticodehydrogenase or alkaline phosphatase levels) refine the prognostic assessment of CUP except in certain specific clinical forms. Treatment of specific clinical forms Cervical node metastases revealing an unfound epidermoid carcinoma require surgical node excision and radiotherapy. Axillary node metastases in woman require lymph node excision and systemic adjuvant therapy, similar to that used in breast cancer. The management of peritoneal serous papillary carcinomatosis in women consists in chemotherapy as in ovarian cancer, combined with debulking surgery. Median line syndrome requires radiotherapy or chemotherapy (with a cisplatin-etoposide combination or the regimen used for treatment of germ-cell tumours). Other therapeutic possibilities Excluding these forms, no chemotherapy regimen is a gold standard. Best supportive care is an acceptable option. There is little data on locoregional treatments.