Biomedical subjects
Publications and source records attributed to B Leng.
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A group of 63 patients infected by HIV and presenting with CD8 hyperlymphocytosis (CD8+) has been studied. CD8 hyperlymphocytosis was defined by the presence, during at least three months, of at least 1,500 CD8 circulating lymphocytes. The CD8+ patients (n = 63) were identified and followed within the cohort (1,444 patients) of the "Groupe d'Epidémiologie Clinique du SIDA en Aquitaine " (GECSA). CD8+ patients were compared with a control group of 126 HIV infected patients without CD8 hyperlymphocytosis recruited within the GECSA cohort and followed in the same manner during two years. The occurrence of opportunistic infections was less frequent in CD8+ patients. The proportion of patients with a CD4 lymphocyte count below 200/mm3 was lower in the CD8+ group than in the CD8- group at inclusion and at the last check-up (P less than 0.01). A tendency for longer survival and delayed onset of AIDS was noted in CD8+ patients. Such a difference in prognosis might be due to a peculiar cytotoxic response against HIV among CD8+ patients. Further follow-up of a larger group of patients is needed to confirm this hypothesis.
The study deals with the infectious diseases department of the university hospital of Bordeaux where most of the AIDS patients in south western France are admitted. In 1986, the department counted 64 admissions (and readmissions) from 35 AIDS patients and 1376 admissions (and readmissions) from 707 other patients. Taking into account admissions of AIDS patients into other hospital departments, the average cost of a hospital day of an AIDS patient was estimated at 1815 French francs in 1986. The length of stay, per AIDS patient and per year, was of 31.5 days in Bordeaux (1986), as compared to 18 days in San Francisco, USA (1984) and 33 days in the Massachusetts, USA (1984). In Bordeaux, the length of stay for other patients in the same department was 17 days. The consumption of diagnostic-related biological exams of AIDS patients in Bordeaux was twofold that of other patients. Per capita, overall hospital costs incurred by AIDS patients increased by 56 percent, as compared to other patients. For the time being, there is no need to build a new department, the existing facilities being sufficient to cope with the AIDS epidemic. If a new department has to be established, the hospital cost of AIDS patients would of course be much higher.
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The authors report one observation of endocarditis due to Hemophilus para-influenzae associated with mitral valve prolapsus. This germ is difficult to isolate and is found late in cultures using standard techniques. The dicovery of germs resistant to ampicillin requires the search for the presence of a betalactamase. When resistant germs are found, the antibiotic of choice is chloramphenicol or cefamandole. This type of endocarditis different from the others on account of the risk major of embolism (60-85 p. 100) which justifies valve replacement when the echography reveals persistant vegetations.
Variegata or mixed porphyria, an hereditary disease with autosomal dominant transmission occurs rarely in France. It associates, at the same time or during the evolution, the cutaneous manifestations or porphyria cutanea tarda hereditaria with the abdominal and neuropsychiatric symptoms of acute intermittent porphyria. The diagnosis evoked by the urine color requires confirmation by the dose of the porphyrins in the urine and above all in the feces. The danger in this disease results essentially from untimely prescription of medication which may lead to death by neurological problems. Prevention and detection in asymptomatic carriers of this disease is imperative. The treatment of an acute attack is symptomatic and etiopathogenic trying to reduce the ALA synthetase activity by giving glucose and hematin.
With reference to the observation of a diffuse hemangioma of the liver in an adult patient, the authors note the various means of diagnosing the disease and list existing therapeutic possibilities. In the typical case, a laparoscopy points out the tumour but is not sufficiently precise to detect a possible extension. The angiography shows pathognomonic images. Isotopic methods are not specific. Treatment is poorly codified and may take the form of a ligature of the artery, embolization or irradiation. The latter, the most widespread type of treatment may cause more or less severe complications.
Four new cases of adult Still's disease have been observed in the past three years. Clinical and biological features are high fever, polyarthralgia, macular rash on forearm, pericarditis, splenomegaly, lymphadenopathy, alopecia, anemia, hyper-leucocytosis, raised ESR. Transient neurological findings may also be observed with abnormal reflexes, cranial nerve paralysis. High dose steroids treatment can be used in case of systemic involvement. The long term prognosis is usually good with treatment. In conclusion, the diagnosis of Still's disease is essentially clinical and should not be mistaken for septicemia.
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