Therapeutic value of scapular and pelvic girdle disarticulations in sarcoma

The authors have reviewed 22 cases of proximal disarticulations with the aim of assessing the therapeutic value, taking into account previous radio- and chemotherapy. The following criteria were especially examined: recurrences, survival, quality of life. There were 13/22 soft tissue sarcomas, 9/22 bone sarcomas. In 10 instances, the tumour was primary and treated for the first time whilst, in 12 cases, it was recurrence. Eighteen patients had been previously treated by non radical surgery, 11 by radiotherapy and 10 by chemotherapy. For upper limb tumours, six patients underwent an inter-scapulo-thoracic disarticulation and three an inter-scapulo-thoracic resection according to Tykhor-Lindberg. For lower limb tumours, seven patients were submitted to inter-ilio-abdominal disarticulation, three to coxo-femoral disarticulation and one to internal hemipelvectomy according to Eilber. Mean disease free interval has been 34.5 months and mean survival 38.5 months. Three out of 20 evaluable patients (15%) recurred locally although most of them benefited from second surgery. Quality of life has been excellent in general despite the fact that only seven patients accepted wearing a prosthesis. Karnofsky index ranged between 60 and 100%. No significant difference was seen, whether or not previous radiotherapy and/or chemotherapy had been administered.     

Effect of amantadine on weight gain during olanzapine treatment.

Patients treated with olanzapine may gain weight, especially in the first months of therapy. Amantadine (100-300 mg/day) was started in 12 patients having a mean weight gain of 7.3 kg during olanzapine treatment. The patients' weight stabilised and over 3-6 months they lost an average of 3.5 kg. No clinical deterioration occurred and no adverse effects were reported. These observations merit confirmation in randomised, controlled trials.     

Infantile psychosis, pseudo-Alzheimer syndrome, and trisomy 21. A trial of treatment with folinic acid: preliminary report

Trisomy 21 produces excess sensibility to methotrexate (dihydrofolate reductase inhibitor). A trial of medication with folinic acid (5-formyl-tetrahydrofolate) was realized on 39 trisomic 21 patients. 30 of them were affected by severe infantile psychosis and the other 9 were affected by a severe Alzheimer-like regression. On 69 assays, 37 were favorable and 32 were null. A dose/effect correlation was highly significant. It is proposed that a systematic investigation of the effects of folinic acid (associated or not with monocarbon precursors) be studied in cases of trisomy 21 complicated by precocious psychosis or severe secondary regression.     

Pleurisy in blood diseases: value of thoracoscopic poudrage

Twenty-five pleural effusions which occurred in 21 lymphoma patients (mean age: 50.6 +/- 4.6 years) were treated by pleural poudrage during thoracoscopy. The effusion was either serofibrinous (32%) or haemorrhagic (41%) or chylous (27%). The mean amount of fluid removed before poudrage was 5.2 +/- 0.6 litres. Thoracoscopy confirmed direct pleural invasion in 95.5% of the cases. Permanent pleural symphysis was obtained in all but 2 patients: one who required one single puncture withdrawing 400 cc, the other with mesothelioma on cured Hodgkin's disease, which was a failure. The mean duration of drainage was 4.8 +/- 0.2 days. The results obtained were identical with those reported with pleurisy in solid tumours.     

Distal intracranial arterial aneurysms. Apropos of a case of giant aneurysm of the right angular gyrus artery

A 57 year old man presented with a giant, fusiform, partially thrombosed aneurysm, located distally to the right angular gyrus artery, and revealed by a subarachno?d hemorrhage. There was no history of head trauma, endocarditis or systemic infection, and physical examination was normal. The treatment consisted in simple trapping of the aneurysm, responsible for a transient ischemic parietal syndrome. After a short review of the pathogenesis of peripheral aneurysm of the C.N.S., and previously reported cases of distally located aneurysms of the middle cerebral artery, only one similar case was found concerning a posterior temporal artery aneurysm involving to a giant serpentine aneurysm. The case presented is believed to be a segmentary form of cerebral arterial dolicho ectasia; relations between arterial ectasia or fusiform aneurysms and serpentine aneurysms are discussed.     

Treatment of severe postoperative infections in head surgery. 20 cases

The authors report the management and follow-up of 20 patients with severe postoperative intracranial infections, abscesses and/or empyemas. Clinical neurological diagnosis was difficult in patients with deficits resulting from the first operation but over half the cases had an inflammatory reaction in the operated zone. CT scan showed that the infection was not limited to a single site (e.g. the subdural area) but was more diffuse in the majority of cases. Antibiotics were given alone in 10 patients and in association with empyema aspiration or reoperation in the other 10 patients. There were two fatalities but the other patients made a generally good functional recovery.     

Epidemiology of healthcare-associated infections due to MRSA in Brest University Hospital from 2004 to 2007. Impact of hydroalcoholic gel and antibiotics consumptions

The fight against healthcare-associated infections is based on preventive measures of multidrug resistant bacteria diffusion. Hand hygiene is the simplest and the most effective preventive measure to reduce cross-transmission of infectious agents. Hydroalcoholic solutions for hand hygiene was recently introduced in the University Hospital of Brest (France). The aims of the study were: to describe the epidemiology of healthcare-associated infections due to methicillin-resistant Staphylococcus aureus (MRSA); to determine the annual consumptions of antistaphylococcal antibiotics; and to discuss the relation between consumption of antiseptic products or antibiotics and the epidemiology of MRSA. METHODS: A retrospective epidemiological and pharmaco-epidemiological study was realized from January 2004 to December 2007 in the University Hospital of Brest (France). It allowed to bring to light the cases of healthcare-associated infections due to MRSA and to quantify the consumptions of hang hygiene products and antistaphylococcal antibiotics. RESULTS: this retrospective study showed a decrease of healthcare-associated infections due to MRSA and an increase of the consumption of hydroalcoholic solutions. Antistaphylococcal resistance rates also decreased in a context of fall of the global antibiotics consumption in the hospital.     

Épidémiologie des infections nosocomiales à SARM au CHU de Brest du 1 janvier 2004 au 31 décembre 2007. Impact des consommations de produits hydroalcooliques et d’antibiotiques

The fight against healthcare-associated infections is based on preventive measures of multidrug resistant bacteria diffusion. Hand hygiene is the simplest and the most effective preventive measure to reduce cross-transmission of infectious agents. Hydroalcoholic solutions for hand hygiene was recently introduced in the University Hospital of Brest (France). The aims of the study were: to describe the epidemiology of healthcare-associated infections due to methicillin-resistant Staphylococcus aureus (MRSA); to determine the annual consumptions of antistaphylococcal antibiotics; and to discuss the relation between consumption of antiseptic products or antibiotics and the epidemiology of MRSA.

Methods

A retrospective epidemiological and pharmaco-epidemiological study was realized from January 2004 to December 2007 in the University Hospital of Brest (France). It allowed to bring to light the cases of healthcare-associated infections due to MRSA and to quantify the consumptions of hang hygiene products and antistaphylococcal antibiotics.

Results

this retrospective study showed a decrease of healthcare-associated infections due to MRSA and an increase of the consumption of hydroalcoholic solutions. Antistaphylococcal resistance rates also decreased in a context of fall of the global antibiotics consumption in the hospital.     

The Impact of Preexisting or Acquired Kaposi Sarcoma Herpesvirus Infection in Kidney Transplant Recipients on Morbidity and Survival

The impact of preexisting or acquired Kaposi sarcoma herpesvirus (KSHV) infection in kidney transplant recipients was evaluated in a prospective study. Serum collected from kidney donors and recipients before transplantation were tested for antibodies against KSHV latent nuclear antigen. Three groups of recipients were defined: group A (KSHV+), group B (KSHV−, KSHV+ donor) and group C (donor and recipient KSHV−). Blood was collected from recipients, every 3 months for 3 years, for KSHV viremia (groups A and B), quantitative (group A) and qualitative serology (group B). Data of group C recipients were extracted from a French database. The prevalence of KSHV antibodies was 1.1% in donors and 3.2% in recipients. There were respectively 161, 64 and 4744 recipients in groups A, B and C.
In group A, 13% developed Kaposi's sarcoma (KS). Age >53.5 years (p = 0.025) and black skin (p = 0.0054) were associated with KS development. In group B, three recipients developed clinical manifestations related to KSHV infection. There was no difference in terms of survival and graft loss between the three groups. In conclusion, although kidney recipients should be aware of the additional risk of KSHV morbidity, KSHV+ recipients should not be systematically excluded from kidney transplantation.