The role of infection in the precipitation of periarteritis nodosa

Circulating immune complexes are thought to play an essential part in the pathogenesis of necrosing angiitis. This theory also allows a role to be attributed to certain infectious agents (viral, bacterial, parasitic) in the development of periarteritis nodosa (PAN). An infectious syndrome was found in all our 9 patients, aged 26 to 69 years, with histologically confirmed PAN: previous infection (over 15 days before hospital admission): otitis, hepatitis B, tonsillitis, ascaris (Case n.7), pulmonary tuberculosis, brucellosis, seropositivity for Chlamydia trachomatis (Case n.9), paratyphoid (Case n.5), seropositivity for Yersiniosis pseudo-tuberculosis (Case n.2), seropositivity for Chlamydia trachomatis (Cases 3 and 4), seropositivity for toxoplasmosis (Cases 4 and 6), seropositivity for rubella (Case n.8). Recent infection (less than 15 days before hospital admission): staphylococcus aureus septicaemia (Case n.1); Group A betahemolytic streptococcal urinary infection (Case n.2); Group A betahemolytic streptococcal otitis media; pseudomonas aeruginosa and Klebsiella septicaemia; enterococcal cystitis (Case n.4); progressive pulmonary tuberculosis (Case n.6), acinetobacter pneumonia (Case n.9). The HBs antigen was only found in one patient (Case n.6), who had an active hepatitis.     

Clinical and pharmacokinetic study of ceftriaxone in the treatment of 14 episodes of ascitic fluid infection

A clinical study and dosages of ceftriaxone were performed during the treatment of 14 ascitic fluid infections. Fourteen cases of ascitic fluid infection were treated with ceftriaxone at doses of 2 grams daily. The isolation of the causative organisms was obtained in 11 out of 14 cases by systematic culture of the ascitic fluid in hemoculture bottles with aerobic and anaerobic medium. Of 11 evaluable infectious episodes ten were cured. Ceftriaxone diffuses rapidly in the ascitic fluid because, within the first hour; mean concentrations were already of 18.6 micrograms/ml largely exceeding the usual MIC for these organisms. A good tolerance for the drug, the well spaced rythm of infections preventing unnecessary parenteral treatment in cirrhotic patients, and its effectiveness against Enterobacteriaceae justify its choice in the treatment of ascitic fluid infections with sensitive organism.     

Factors influencing neurological outcome of children with bacterial meningitis at the emergency department

We performed a cohort study of children who survived bacterial meningitis after the neonatal period at a single pediatric center in France over a 10-year period (1995-2004) to identify predictors of death and long-term neurological deficits in children with bacterial meningitis. We performed multivariate regression to determine independent predictors of death and neurologic deficits. We identified 101 children with bacterial meningitis of which 19 died during initial hospitalization. Need for mechanical ventilation [hazard ratio (HR) 11.5, 95?% confidence interval (CI) 2.4-55.5)] and thrombocytopenia defined as a platelet count <150?×?10(9)?per liter (HR 0.6, 95?% CI 0.4-0.9) at presentation were associated with death during initial hospitalization. At final assessment, 42 of the 70 survivors had no neurologic deficits identified; 20 had a single deficit, and eight had multiple deficits. A delay in initiation of antibiotics (HR 1.3, 95?% CI 1.1-1.7) and hydrocephalus on computed tomographic scan (HR 2.6, 95?% CI 1.1-6.0) were associated with having one or more long-term neurologic deficits. Identification of children at risk of death or long-term neurologic sequelae may allow therapeutic interventions to be directed to children at the highest risk.     

A familial case of Keratitis-Ichthyosis-Deafness (KID) syndrome with the GJB2 mutation G45E

Keratitis-Ichthyosis-Deafness (KID) syndrome (OMIM 148210) is a congenital ectodermal defect. KID consists of an atypical ichthyosiform erythroderma associated with congenital sensorineural deafness. A rare form of the KID syndrome is a fatal course in the first year of life due to severe skin lesion infections and septicaemia. KID appears to be genetically heterogeneous and may be caused by mutations in connexin 26 or connexin 30 genes. GJB2 mutations in the connexin 26 gene are the main cause of the disease. Most of the cases caused by GJB2 mutations are sporadic, but dominant transmission has also been described. To date, the rare lethal form of the disease has been only observed in two Caucasian sporadic patients with the GJB2 mutation, with the p.Gly45Glu (G45E) arising de novo. We have reported an African family with dizygotic twins suffering from a lethal form of KID. The dizygosity of the twins was confirmed by microsatellite markers. The two patients were heterozygous for the G45E mutation of GJB2, whereas the mutation was not detected in the two parents. The unusual transmission of the disease observed in this family could be explained by the occurrence of a somatic or more probably a germinal mosaic in one of the parents.     

Teaching with audiovisual recordings of consultations

The experience gained from two years' teaching with audiovisual recordings of consultations of both undergraduates and postgraduates is presented. Some basic teaching rules are suggested and further applications of the technique are discussed.     

Demonstration and solubilization of antigens expressed primarily on the surfaces of Candida albicans germ tubes.

Antisera against mycelial-phase, but not yeast-phase, Candida albicans absorbed with yeast-phase organisms preferentially stained germ tube segments of several strains of mycelial-phase C. albicans by the indirect fluorescent-antibody staining technique. Germ tube segment antigens were not found in significant amounts on blastospore segments or on yeast-phase organisms. Absorption of the mycelial-phase reference sera with yeast-phase C. stellatoidea, but not with C. tropicalis, C. guillermondii, or Saccharomyces cerevisiae, resulted in preferential germ tube segment staining of C. albicans. A dithiothreitol extract of mycelial-phase C. albicans organisms blocked staining of the germ tube segment, but a dithiothreitol extract of yeast-phase organisms did not. When dithiothreitol extracts from both phases were reacted against yeast-absorbed reference sera in tandem crossed and crossed line immunoelectrophoresis, a cross-reacting arc and several arcs unique to the mycelial-phase extract were noted. Immunofluorescent staining tests were performed, using appropriately absorbed sera from patients with candidiasis to stain a laboratory strain of C. albicans. Human tissue slices infected with C. albicans were used as targets for appropriately absorbed rabbit antisera. These human data indicated that antigens preferentially expressed on the germ tube in vitro were also expressed on filamentous structures of the fungus in infected human tissues. In vitro and in vivo, the invasive mycelial phase of C. albicans expresses certain antigens that are highly concentrated on the germ tube.     

Continuous venovenous hemofiltration improves cardiac performance by mechanisms other than tumor necrosis factor-alpha attenuation during endotoxic shock.

OBJECTIVE: To assess the effects of continuous venovenous hemofiltration (CWH) on global and regional hemodynamics, plasma lactate, and tumor necrosis factor-oa (TNF-a) levels during endotoxic shock in dogs. METHODS: Thirty pentobarbital-anesthetized and mechanically ventilated dogs were divided into six groups of five dogs each. Group 1 served as a control, undergoing CWH at 3 Uhr without endotoxin. Group 2 served as the endotoxin-alone time-matching group. Group 3 received CWH 1 hr after endotoxin at 3 Uhr for 270 mins. Group 4 received CWH 1 hr after endotoxin at 3 Uhr for 150 mins and at 6 Uhr for an additional 120 mins. Group 5 and group 6 received the ultrafiltrate from group 1 and group 3, respectively. MEASUREMENTS AND MAIN RESULTS: Three hours after endotoxin challenge, dogs treated with CWH at 3 Uhr had a higher cardiac output (4.9 + 0.6 vs. 2.9 + 0.6 Umin; p < .05) and stroke volume (35 + 7 vs. 20 + 4 mL; p < .05) and a lower pulmonary vascular resistance (116 26 vs. 331 + 126 dyne-sec/cm5; p < .05) than the endotoxin-alone group. Five hours after endotoxin, dogs treated with CWH at 6 Uhr also had higher hepatic (464 + 164 vs. 126 + 75 mUmin; p < .05) and femoral (95 + 46 vs. 30 + 34 mL/min; p < .05) blood flow. Moreover, dogs treated with CWH at 6 Uhr had higher mean arterial blood pressure (84 + 24 vs. 40 + 15 mm Hg; p < .05) and left ventricular stroke work index (1.1 + 0.6 vs. 0.2 + 0.2 g/kg; p < .05) than the endotoxin-alone group. Plasma lactate levels were lower in the CWH group at 6 Uhr (2.7 + 1.1 mmol/L) than in the endotoxin-alone group (4.4 + 0.6 mmol/L; p < .05). Plasma TNF-ao levels were unaffected, and only minor amounts of TNF-o were found in the ultrafiltrate. CONCLUSION: In this acute endotoxic shock model, CWH at 3 Uhr improved cardiac performance and decreased pulmonary vasoconstriction. Moreover, CWH at 6 LUhr also increased arterial blood pressure and left ventricular stroke work, increased hepatic and femoral arterial blood flow, and decreased blood lactate levels. These effects were not attributable to TNF-alpha removal.