Age-specific analysis of normal cytokine levels in healthy infants.

While pathophysiology of elevated cytokines is well delineated, reference values for children are unknown, although they may vary physiologically with age and differ from those of adults. Between June and November 2001, interleukin (IL)-6, IL-10 and tumor necrosis factor-alpha (TNF-alpha) concentrations from blood samples of 79 healthy children in six different age groups (group I: 0-3 months; group II: 4-12 months; group III: 13-24 months; group IV: 25-36 months; group V: 37-48 months; group VI: 49-60 months) were measured with ELISA. TNF-alpha was within 2.2-3.5 pg/ml in all groups with a trend toward higher values in groups II and III (p = ns). IL-6 was significantly lower in group III than in groups IV (p = 0.0165) and VI (p = 0.0147). IL-10 was within 3.3-5.5 pg/ml in all groups (p = ns). In regression analysis no correlation between age and cytokine concentrations was found. Although not statistically significant, IL-6 was lower and TNF-alpha higher than the adult reference values provided by the kit manufacturer. Although reference cytokine levels seem not age-related during early infancy, IL-6 is significantly lower during the second year of life than later. In infants aged 5 years or younger, reference levels of IL-6 should be chosen lower, and those of TNF-alpha higher, than the adult reference values.     

Source monitoring deficits in hallucinating compared to non-hallucinating patients with schizophrenia.

In two source memory tests, hallucinating patients with schizophrenia (N=30), compared to non-hallucinating (N=31), are impaired in recognizing internal self-generated items and misattribute them to an external event. They are not impaired in recognizing events from two internal sources. Results support a selective source-monitoring deficit in the occurrence of auditory hallucinations.     

Embolie graisseuse cérébrale après traumatisme fermé de la jambe

A 21-year-old man sustained a closed fracture of the leg from an industrial accident, without associated head trauma. The orthopaedic treatment consisted of immediate immobilization by setting leg in plaster. Two hours after admission, the Glasgow coma scale score was 10. Four hours after admission he developed a coma (Glasgow coma scale score = 7) with repetitive seizures. No lesion was visible on cerebral CT scan. Chest X-ray was unremarquable. Petechiae on the anterior chest wall and abdomen with bilateral mydriasis occurred. Thrombocytopenia with prothrombine time increase were observed. Magnetic resonance imaging, 27 hours after admission, showed high-intensity areas on T2 weighted views due to fat embolism. Retinal haemorrhages were observed. The bronchoalveolar lavage showing fat staining of tracheal aspirates confirmed the diagnosisof fat embolism. This case report emphasizes the possibility of predominant neurologic manifestations of a fat embolism and the diagnostic help of cerebral magnetic resonance imaging.     

Routine use of mupirocin at the peritoneal catheter exit site and mupirocin resistance: still low after 7 years.

OBJECTIVE: The purpose of this study (the third in a series of similar studies) is to evaluate the prevalence of Staphylococcus aureus (SA), methicillin-resistant SA (MRSA) and mupirocin-resistant SA (MuRSA) carriers in a peritoneal dialysis centre where patients have been instructed to use prophylactic mupirocin ointment at the catheter exit site over the last 7 years. METHODS: Swabs were taken from catheter exit site, nares, axillae and groin in 147 chronic peritoneal dialysis out-patients between November 2003 and January 2004. Axillae/groin and nasal samples were pooled and cultured in the same medium, whereas exit site swabs were cultured separately. All SA isolated were tested for methicillin and mupirocin resistance using oxacillin screening plates and E-test strips. RESULTS: Sixteen of 147 patients (10.9%) were found to be SA carriers: of these 13 (8.8%) had a positive nasal/axillae/groin culture; two (1.4%) had both nasal/axillae/groin- and exit site-positive culture; and one (0.7%) had only exit site-positive culture. In these 16 SA carriers, we found mupirocin-resistant strains (MuRSA) in four patients (25%) and MRSA in two patients (12.5%). Among the four MuRSA carriers, one had both nasal/axillae/groin- and exit site-positive culture and three had only nasal/axillae/groin-positive culture. Three high-level resistance and one low-level resistance MuRSA carriers were isolated. One MuRSA strain was also methicillin resistant. All MRSA strains were sensitive to vancomycin and rifampicin. CONCLUSION: After 7 years' routine use of prophylactic mupirocin ointment at the catheter exit site in non-selected chronic peritoneal dialysis patients, MuRSA was found in 25% of SA strains isolated or in 2.7% of the patients. Compared with our previous study, 3 years earlier, there is no significant increase in the MuRSA prevalence in peritoneal dialysis patients who routinely apply mupirocin ointment at the catheter exit site.     

On the calculation and interpretation of signal intensity in echo-shifted sequences.

Echo-shifted sequences have been shown to be useful in applications where strong T*2-weighting and short repetition times are wanted, such as BOLD-contrast fMRI, MR thermometry, and perfusion studies. However, a full understanding of signal formation with such methods, which is mandatory to optimize sequence parameters for particular applications, has still not been achieved. Here, two methods are proposed to calculate the steady-state signal intensity in coherent TR-periodic and TR-shifted gradient-echo sequences. The integration method, which consists of averaging the steady-state magnetization over all isochromats in a voxel, is shown to be a particularly efficient way of obtaining the analytical expression of the measurable signal. The partition method, based on a physical decomposition of the steady-state magnetization into a sum of contributions from past excitation pulses, reveals that the net transverse magnetization results from a destructive interference between the wanted component and a series of stimulated echoes. The analysis includes off-resonance effects and is illustrated by phantom measurements. Relationships with previous publications on this subject are discussed.     

Development of an in vitro screening model for the biosynthesis of acyl glucuronide metabolites and the assessment of their reactivity toward human serum albumin.

An in vitro screening model was developed to determine the reactivity of acyl glucuronide metabolites from carboxylic drugs. This assay is composed of two phases. The first is a phase of biosynthesis of acyl glucuronides by human liver microsomes (HLM). The second, during which acyl glucuronides are incubated with human serum albumin (HSA), consists of assessing the reactivity of acyl glucuronides toward HSA. Both phases are performed successively in the same experiment. This model was validated using eight carboxylic drugs that were well known for their reactivity, their extent of covalent binding, and their immunological potential. These products were representative of the scale of reactivity. Each compound was incubated with HLM at 400 microM and metabolized into acyl glucuronide to different extents, ranging from 5.6% (tolmetin) to 89.4% (diclofenac). The first-order aglycone appearance rate constant and the extent of covalent binding to proteins were assayed during the incubation of acyl glucuronides formed with HSA for 24 h. Extensive isomerization phenomenon was observed for each acyl glucuronide between the two phases. An excellent correlation was observed (r(2), 0.94) between the extent of drug covalent binding to albumin and the aglycone appearance constant weighted by the percentage of isomerization. This correlation represents an in vitro reactivity scale, which will be helpful in drug discovery support programs to predict the covalent binding potential of new chemical entities. This screening model will also allow the comparison of acyl glucuronide reactivity for related structure compounds.     

Compte-rendu de la première journée de réflexion sur l’endoscopie digestive en France organisée par la SFED — Le 16 janvier 1999

Acta Endoscopica - En préambule, Jean-Marc Canard, organisateur de cette première journée de réflexion sur l’endoscopie digestive, en expose les objectifs. Il s’agit...     

Les possibilités de verticalisation et de marche chez l'enfant dans les séquelles de poliomyélite en milieu africain

Résumé Les auteurs présentent une expérience de prise en charge des séquelles de poliomyélite chez l'enfant en milieu africain. Six cent trente enfants ont été examinés; la moitié d'entre eux étaient non marchants avec paraplégie totale ou subtotale. Deux cent cinquante-deux enfants ont été opérés, essentiellement pour correction d'attitudes vicieuses articulaires par ténotomie des fléchisseurs de la hanche ou du genou et allongement du tendon d'Achille. Les gestes osseux et articulaires ont été éliminés de principe en dehors de la double arthrodèse. Des appareillages de fabrication locale ont été utilisés, sans corset ni pièces de hanche. La durée moyenne du traitement a été de 3 mois. Les complications ont été peu fréquentes (1 ischémie de la jambe, 5 paralysies sciatiques, 4 fractures métaphysaires supérieures du tibia). La correction des déformations n'a le plus souvent été obtenue que progressivement. Cent enfants non marchants en pré-opératoire ont été revus. Une marche autonome et fonctionnelle permettant leur scolarisation a été obtenue dans 65 cas. Les résultats ont été d'autant meilleurs que l'enfant était plus jeune, l'âge de 12 ans paraissant une limite au delà de laquelle les résultats sont plus incertains.

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Walking in children after poliomyelitis

Summary Between 1983 and 1990 the authors examined 630 children who had suffered from poliomyelitis, mostly between the age of one and three, at an average age of 9 years 3 months. Half were unable to walk because of residual paralysis. Operation was carried out on 252 children. Most underwent soft tissue release at the hips, knees or tendo Achilles. Triple arthrodesis was carried out on 24. Calipers, produced locally, were used, and trunk bracing was not employed. The average duration of treatment was 3 months, with gradual achievement of correction. Vascular complications occurred in one leg, there were 5 paralyses of the sciatic nerve and 4 fractures of the upper tibia. One hundred children who were not able to walk before operation were reviewed. Sixty five were walking and able to go to school. The best results were achieved before the age of 12.