BACKGROUND: Dyspnea and the decrease in arterial saturation in the upright position in elderly subjects is described as platypnea-orthodeoxia syndrome (POS). POS is secondary to the occurrence of an atrial right-to-left shunt through a patent foramen ovale (PFO). METHODS: This French multicentric study reports on 78 patients (mean age 67 +/- 11.3 years) with POS who had transcatheter closure of the PFO; frequently associated diseases were pneumonectomy (n = 36) and an ascending aortic aneurysm (n = 11). In all patients, the diagnosis was confirmed by transthoracic or/and transesophageal echocardiography. Five different closure devices were used: Amplatz (n = 45), Cardioseal (n = 13), Sideris (n = 11), Das Angel Wings (n = 8) and Starflex (n = 1). Closure was successful in 76 patients (97%). RESULTS: Oxygen saturation increased immediately after occlusion from 84.6 +/- 10.7% to 95.1 +/- 6.4% (p < 0.001) and dyspnea improved from grade 2.7 +/- 0.7 to grade 1 +/- 1 (p < 0.001). A small residual shunt was immediately observed in 5 patients (3 with the Cardioseal device, 1 with the Sideris and 1 with the Amplatz) leading to the implantation of a second device in one case (Cardioseal). Two early deaths occurred unrelated to the procedure (one due to sepsis probably related to pneumonectomy, another due to respiratory insufficiency). Other complications were: a small shunt between the aorta and the left atrium, two atrial fibrillations and a left-sided thrombus which disappeared with anticoagulant therapy. At a mean follow-up of 15 +/- 12 months, there were 7 late deaths related to the underlying disease. CONCLUSION: Percutaneous occlusion of the foramen ovale is safe and gives excellent results thanks to continuing improvement in available devices. This technique enables some patients in an unstable condition to avoid a surgical closure.

Aged↗

PubMedDate not supplied

Expression of human placental G proteins during pregnancy.

OBJECTIVE: Regulatory guanine nucleotide-binding proteins (G proteins) play key roles in the stimulus-response coupling of many important biological systems. Recent studies from our laboratory suggest a functional role for many G proteins in the human placenta. However, the expression of these proteins has not yet been reported. Therefore, the aims of this investigation were to identify the expression of placental G protein alpha subunits in human placenta, and to study their level of variation during pregnancy. METHODS: Western and Northern blot analyses were performed on membrane protein and mRNA preparations, respectively, of human placentas from the first (7-11 weeks), second (16-19 weeks), and third (term) trimesters. RESULTS: The autoradiographs of both proteins and mRNA showed differential expression of placental G proteins during pregnancy. Thus, the relative levels of G alpha i2 and G alpha i3 subunits were highest during the first trimester, whereas no differences were observed between second-trimester and term placentas for both subunits. The levels of placental G alpha o and G alpha s subunits stayed relatively stable during pregnancy. CONCLUSION: The demonstration of human placental G alpha protein expression during pregnancy provides new insight into the components of the signal transduction machinery within trophoblast. However, the physiologic significance of the variations of placental G alpha i protein expression during pregnancy remains to be investigated.

Blotting, Northern↗

PubMedDate not supplied

Expression of G proteins in human placentae from molar pregnancies.

Hydatidiform mole is a conceptus, usually devoid of an intact fetus, with variable proliferation of trophoblast and altered placental protein synthesis, including high human chorionic gonadotropin (hCG) and low human placental lactogen (hPL) production. Little is known about the control of the production of these two placental proteins in molar pregnancies. Regulatory guanine 5'triphosphate (GTP)-binding proteins (G proteins) play key roles in the endocrine control of peptide production by the placenta. The present authors recently demonstrated that Gi2, Gi3 Go, and Gs alpha-subunits were expressed in normal human placenta throughout pregnancy. This study analysed the expression of placental G protein alpha-subunits in molar pregnancies. Western and Northern blot analyses were performed on membrane protein and total mRNA preparations of human placentae, respectively, from hydatidiform mole (n = 5) and normal pregnancies (n = 4). The levels of hPL and beta-hCG mRNAs were 60 and 237 per cent respectively, of those from normal placentae. The autoradiographs for G proteins and their mRNAs showed decreased expression in molar placentae in comparison with normal tissues. Specifically, G alpha i2, G alpha i3, G alpha o, and G alpha s levels reached 39, 4, 42, and 89 per cent, respectively, of those from normal placentae. In parallel with the protein levels, their mRNAs expression were 8, 3, 54 and 65 per cent of normal values for G alpha i2, G alpha i3, G alpha o, and G alpha s, respectively. The results demonstrate important changes in placental G protein expression in hydatidiform moles suggesting alterations in the signal transduction machinery within the molar trophoblast.

Autoradiography↗

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[Extensive cutaneous candidiasis revealing cutaneous T-cell lymphoma: 2 cases].

BACKGROUND: During the course of immunodeficiency diseases, severe candidiasis can occur with extensive cutaneous and mucous membrane lesions. However, blood dyscrasias are very rarely revealed by diffuse candidiasis. We report two case of cutaneous T-cell lymphoma revealed by extensive and atypical cutaneous candidiasis. PATIENTS AND METHODS: Case No. 1:A 72-year-old woman presented a pruritic rash of circinate, serpiginous patches on glabrous skin and skinfolds with multiple intertrigo and rapidly worsening palmoplantar keratoderma. All mycological skin specimens tested positive for Candida albicans. Histological examination of a biopsy sample from a serpiginous patch revealed the presence of fungal elements while palmoplantar keratoderma biopsy showed an epidermotropic lymphocytic infiltrate in the superficial dermis evocative of mycosis fungoides. Blood tests showed a white cell count of 28 600/mm3 with 14% circulating Sezary cells and a T-cell clone. The T-cell lymphoma was treated with methotrexate, but the disease worsened a few months later, progressing to CD30- large T-cell pleomorphic lymphoma. The patient died of severe sepsis. Case No 2:A 60-year-old man presented a macular rash over the face, trunk and skinfolds as well as erythematous scaly annular plaques of the glabrous skin with lymphadenopathy. Cultures of skin scrapings were all positive for Candida albicans. Blood tests showed a white cell count of 15 000/mm3 with 30% circulating Sezary cells. A trunk patch biopsy revealed the histological appearance of mycosis fungoides. There was a T-cell clone in the peripheral blood and skin. DISCUSSION: In both cases, the patients presented with widespread annular and erythematous scaly lesions of the glabrous skin and skinfolds with evidence of Candida albicans on fungal tests of all skin scrapings. The discovery of circulating Sezary cells on a systematic smear for hyperleukocytosis led us to suspect underlying cutaneous T-cell lymphoma, which was confirmed by biopsy of the skin lesions accompanying the mycoses. Widespread cutaneous candidiasis can occur in patients with cell-mediated immunodepression. Cutaneous T-cell lymphoma can enhance such candidiasis through interference with skin integrity and impairment of cell-mediated immunity, with large amounts of IL10 and TGF-B, increased secretion of soluble interleukin-2 receptors (CD25) and impaired CD8 suppressor cell function.

Aged↗

PubMedDate not supplied

Cytotoxic and apoptotic effects of cobalt and chromium ions on J774 macrophages - Implication of caspase-3 in the apoptotic pathway.

The aim of this study was to evaluate the cytotoxic and apoptotic effects of cobalt and chromium ions on macrophages in vitro, and analyze the implication of caspase-3 in the apoptotic pathway. J774 mouse macrophages (5 x 10(5) cells/ml) were exposed for up to 24 h to 0-10 ppm Co2+ and 0-500 ppm Cr3+. The cytotoxic effect of ions was measured by Trypan blue exclusion. DNA analysis on agarose gel was used as a specific test for detection of DNA fragmentation into oligonucleosomes that occurs in apoptotic cells. The proteolytic cleavage of poly(ADP-ribose)polymerase (PARP), closely associated with the induction of apoptosis, was also analyzed along with the appearance of the active fragment of caspase-3, implicated in several apoptosis pathways. Results demonstrated that both Co2+ and Cr3+ ions induce macrophage mortality in a dose-dependent manner. However, Co2+ is more toxic inducing a cell mortality up to 28% with only 10 ppm vs. 37% with 500 ppm of Cr3+. DNA analysis demonstrated that both Co2+ and Cr3+ ions induce DNA fragmentation, between 6-10 ppm Co2+ and 250-500 ppm Cr3+ after 24 h incubation. PARP cleavage and the appearance of caspase-3 active fragment were observed after 6 h with both Co+ and Cr3+ ions, with a stronger signal after 24 h and 10 ppm of Co2+ or 500 ppm of Cr3+. In conclusion, this study demonstrates that after 24 h incubation, both Co2+ and Cr3+ ions can induce macrophage mortality, and more specifically apoptosis. The results also suggest that apoptosis occurs via a caspase-3 pathway. However, the relative importance of necrosis and apoptosis and the effects of longer exposure times on the induction of macrophage death by these metal ions remain to be investigated.

Journal Article↗

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Klebsiella pneumoniae and other Enterobacteriaceae producing novel plasmid-mediated beta-lactamases markedly active against third-generation cephalosporins: epidemiologic studies.

Analysis of the enzymes produced by clinical isolates of multiresistant Klebsiella pneumoniae from hospitals in France revealed two novel broad-spectrum beta-lactamases. The first, characterized by an isoelectric point of 6.3 and a high hydrolytic activity on cefotaxime, is designated CTX-1. This beta-lactamase was encoded by a 95-kilobase plasmid (incompatibility group 7M) and cotransferred with resistance to tetracyclines, sulfonamides, and aminoglycosides (AAC [6']-IV). From 1984 to June 1987, 490 CTX-1-producing strains of Enterobacteriaceae were isolated. The second plasmid-mediated beta-lactamase (CAZ-1) was isolated in 1987 from three K. pneumoniae strains more resistant to ceftazidime than to other third-generation cephalosporins. This broad-spectrum beta-lactamase differed from CTX-1 by its isoelectric point--close to 5.6--and its high hydrolytic activity on ceftazidime and was encoded by a 150-kilobase plasmid. It was demonstrated that these expanded-spectrum beta-lactamases are TEM derivatives.

Cephalosporins↗

PubMedDate not supplied

Interactions of new plasmid-mediated beta-lactamases with third-generation cephalosporins.

The kinetic constants of three recently identified plasmid-mediated beta-lactamases--SHV-2, CTX-1, and CAZ-1--markedly active against third-generation cephalosporins were analyzed in comparison with three better-characterized beta-lactamases--two plasmid-mediated enzymes, TEM-2 and PIT-2/SHV-1, and R-30, a beta-lactamase from Klebsiella oxytoca that has few similarities to the newer enzymes. All of these enzymes are synthesized constitutively, demonstrate efficient hydrolysis of penicillins, are highly susceptible to the action of clavulanic acid and sulbactam, and have no detectable activity against the cephamycins and imipenem. With the methoxyimino cephalosporins, including those of the third generation, the rates of hydrolysis observed for the SHV-2, CTX-1, and CAZ-1 enzymes are high and show no relation to those observed for the other presently known beta-lactamases. Structure-activity relations suggest that the oxime substituent of these cephalosporins is a major structural factor in the catalytic process observed with the three new beta-lactamases.

Cephalosporins↗

PubMedDate not supplied

Novel Ti plasmids in Agrobacterium strains isolated from fig tree and chrysanthemum tumors and their opinelike molecules.

Galls naturally induced on Fig and chrysanthemum plants by strains of Agrobacterium contained, in addition to other well-characterized opines such as nopaline, three tumor-specific opinelike molecules. These molecules were identified as deoxy-fructosyl-glutamine (dfg), deoxy-fructosyl-5-oxo-proline (dfop), and chrysopine (Chilton et al., unpublished). Strains isolated from Fig tree and chrysanthemum tumors harbored different and unrelated Ti plasmids as judged by hybridization with various vir and T-DNA probes. They also exhibited different opine-catabolic properties. The strains isolated from chrysanthemum plants (Chry strains) and Fig trees degraded chrysopine, but only the Chry strains used dfg and dfop. Remarkably, other strains of Agrobacterium catabolized these two molecules: dfg was degraded by most pathogenic and nonpathogenic Agrobacterium strains, and dfop by all Agrobacterium strains degrading the opine agropinic acid. These results have strong ecological and evolutionary inferences which fit previous speculation on the origin of opine-related functions.

Base Sequence↗

PubMedDate not supplied

Association of Marfan's syndrome and Turner's syndrome.

We report on a 12 year-old girl with severe myopia, ectopia lentis, dilatation of the ascending aorta, protrusio acetabulae, arachnodactyly, scoliosis and moderate short stature (-1.7 SD). Her sister and father presented with Marfan's syndrome. Despite short stature, Marfan's syndrome could not be ruled out. Primary amenorrhoea and growth retardation indicated cytogenetic analysis which showed chromosomal aberration 45,X in every studied cell. However, she did not present any other clinical features of Turner's syndrome. We report here for the first time on an association of Turner's syndrome and Marfan's syndrome in the same patient, and discuss particular clinical features.

Adolescent↗

PubMedDate not supplied

[Antibiotic sensitivity and treatment recommendations for Streptococcus pneumoniae].

The aims of present paper were to determine the susceptibility of the strains to the most usual antibiotics in clinical practice and to review the current recommendations to guide the most appropriate treatment. During the period october 2000 to september 2002, the patient's data (age and sex), source of the sample, diagnosis and antibiotic susceptibility were collected on Streptococcus pneumoniae isolates from microbiology laboratories in the Navarra region (555.829 inhabitants). Four hundred and sixty five isolates were identified (166 from invasive infections). Generally, isolates from ear swabs were the most resistant to the antimicrobials tested, while those from blood culture were the most susceptible. Of the Streptococcus pneumoniae tested, 43% were resistant to penicillin, 6.1% to amoxicillin and 6.6% to cefotaxime. Of the 36.3% of Streptococcus pneumoniae isolates that were resistant to erythromycin, 85.45% exhibited the MLSB phenotype while the remaining 14.55% presented with the M phenotype. Multiple-resistance was detected in 32.3% of the strains. The antibiotic resistance rates to beta-lactams (specially penicillin, amoxicillin and cefotaxime/ceftrixone) in Streptococcus pneumoniae don't prevent its clinical use for the most of Streptococcus pneumoniae isolated in our area, except for pneumococcal meningitis.

Anti-Bacterial Agents↗

PubMedDate not supplied

[Thrombotic microangiopathy revealing acute monoblastic leukemia (LAM5)].

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Anemia, Hemolytic↗

PubMedDate not supplied

[Plantar pyoderma due to Stenotrophomonas maltophilia].

INTRODUCTION: Stenotrophomonas maltophilia is a Gram negative, opportunistic bacteria. We describe a case of community-acquired superficial pyoderma due to this bacteria in a immunocompetent host. CASE-REPORT: A 59-year-old man presented with an ulceration of the sole for two months. Several topical and systemic treatments had failed to cure the lesion, including oral ofloxacin for ten days. Microbiological study of the lesion showed numerous Gram negative bacilli with growth of S. maltophilia. This bacterium initially responded to ofloxacin, but became resistant after the oral use of this antibiotic. Finally, a topical treatment with polymyxin/tetracycline ointment resulted in complete healing within two weeks. DISCUSSION: S. maltophilia may be responsible for superficial pyoderma and serious opportunistic infections in immunocompetent persons. Topical antimicrobial therapy is efficient when oral quinolone therapy has failed to cure the lesion.

Administration, Cutaneous↗

PubMedDate not supplied

[Micropapular eruption in a 6-year-old girl].

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Biopsy↗

PubMedDate not supplied

Computerized system for the selection of the most HLA-compatible kidney recipient (France-Transplant).

The RITRAN program is applied to renal transplantation and operates within the framework of France Transplant. It makes it possible to choose the most compatible kidney recipient within the ABO blood group system and within the major histocompatibility system in man (HLA). The file presently comprises the data stored on tape concerning 1800 dialysis patients who are awaiting grafts. It is managed by UNIVAC 1108 computer. More than 25 medical-surgical transplant teams from France, Switzerland, Holland and Spain are connected with the computer. It was five years ago that the first interrogation system began operating in real time 20 hours out of 24, using a telex line, and it continues to provide complete satisfaction. The updating of the data is done by the RITREC system, also using a telex machine. An adaptation of the programs applied for choosing blood and platelet donors is in the process of being realized.

ABO Blood-Group System↗