Biomedical subjects
Publications and source records attributed to R Robert.
Adult onset Still's disease may sometimes be complicated by severe manifestations. We report here a case of adult Still's disease with acute respiratory failure requiring mechanical ventilation.
Statements by caregivers can be beneficial to paediatric burn patients, facilitating their psychological adaptation. However, the concerns of the burned child are not always obvious, and caregivers may flounder, not knowing how to elicit the concerns of the patient. The purpose of this paper is to examine whether universal concerns of the postburn survivor can be detected through one type of psychological assessment tool, a sentence completion task. Sixty paediatric burn survivors, ages 6-19, were administered a 30-item Incomplete Sentences measure. Five major aspects of postburn life were identified and proscribed the following descriptive labels: (1) preoccupation with health; (2) the struggle for internal acceptance; (3) reconstruction of one's life map; (4) changing relationships; and (5) redefining the world. These five dimensions of postburn life are discussed, as well as applications for each.
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A method for identification of Candida albicans within 5 min was evaluated by using 4,643 yeast isolates. Six false-positive and three false-negative reactions were observed. The specificity (99.87%) and sensitivity (99.74%) obtained indicate that the Bichro-latex albicans test is a useful method for the rapid identification of C. albicans colonies.
Ear canal CT scan is widely used in addition to clinical examination, for diagnosis and evaluation of disease extension. Ear mouldings were performed on 11 cadavers (22 mouldings), 5 measurements were taken on each specimen and compared with CT scan measurement. Moulding measurements varied from side to side in one specimen, and moreover from one specimen on another one. Comparison between mouldings and CT scan showed that medial meatus measurements are identical. On the other hand, there are wide gaps for the lateral measurements. Biometrical disparity of the external auditory canal (EAC) was confirmed by this study. CT scan measurements in the lateral portion of the EAC are not reliable. Quantitative usefulness of CT scan is therefore limited to the study of the bony meatus.
MATERIALS AND METHODS: From 1977 to 1996, 49 direct carotido-cavernous fistulae were studied among the sixty some cases diagnosed over these 20 years. Five were caused by spontaneous rupture of an intracavernous aneurysm and the others were caused by trauma. RESULTS: The clinical presentation in 37 patients was exophthalmia with pulsating conjunctival hyperhemia and vascular murmur. Some cases had a neurological syndrome suggesting cavernous involvement. A bilateral presentation was observed in 2 cases. One patient had no ophthalmologic syndrome but had a vascular murmur. Prior to 1982, all patients were treated and cured by occlusion of the internal carotid after direct access via the neck using a 3 F Fogarty catheter. Since 1982, patients have been treated with the detachable balloon technique. The carotid was preserved in 16 cases. In one case, secondary thrombosis occurred due to major dissection. In one case, the size of the breach was too small for the balloon so a coil was used. In one other case, insertion of the guide wire and catheter was sufficient to occlude the fistula. There was one death during treatment due to fistula rupture and one partially regressive right hemiplegia which could not be explained. This patient also developed left hemiplegia two years later, again with no explaining cause. Cure was achieved in the other patients without sequellae. DISCUSSION: Direct carotido-cavernous fistulae due to rupture of an aneurysm or trauma are uncommon. When flow through the breach is minimal, vascular treatment may not be necessary unless clinical signs appear since this type of fistula heals spontaneously. In other cases, an endovascular balloon procedure is indicated. There are few complications. Embolization with coils or other devices should only be used in selected cases when the breach is too small for the balloon.
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We report the case of a 53 year-old woman with paroxystic hypertension and digital ischemia. The only triggering factor was chronic intoxication by a nasal vasoconstrictor:fenoxazoline. The worsening of the lesions required amputation of the third phalanx of the 3rd and 5th finger and the pulp of the 4th finger of the left hand. The review of literature exhibits association between fenoxazoline intoxication and paroxystic hypertension, myocardial ischemia or stroke, but association between fenoxazoline intoxication and digital ischemia has never been reported. We emphasize the extreme caution necessary with the prescription and the chronic consumption of this kind of drug.
The adhesion of Candida albicans to polystyrene and the effect of three monoclonal antibodies (mAbs) reactive with C. albicans cell wall surface antigens on this process was assessed in vitro with several C. albicans strains. In the absence of mAbs, adhesion of C. albicans to polystyrene increased in parallel with germ-tube formation. However, the growth of the strains in the yeast phase at 25 degrees C or the use of an agerminative mutant inhibited adhesion to polystyrene. Serotype A and B strains showed similar kinetics of adhesion to polystyrene and no statistically significant differences in germination or adhesion were observed when strains from the two serotypes were compared. The three mAbs had different effects on both germination and adhesion of C. albicans. mAbs 3D9 showed no influence on either germination or adhesion to polystyrene in two C. albicans strains. mAb B9E decreased both adhesion (45.6%) and filamentation (52.6%), and mAb 21E6 decreased filamentation (34.0%) but enhanced adhesion by 23.3%. This enhancement was also observed with the agerminative mutant and it was dose-dependent. It was not related to the binding capacity of the MAb to polystyrene nor to an increase in cell surface hydrophobicity of the antibody-treated cells. In conclusion, both growth phases of C. albicans can adhere to polystyrene, although the conditions for this process seem to be different in each phase. The two types of adhesion of C. albicans to polystyrene might have a role in the colonization of medical implants. The disparate effects shown by mAbs directed against cell wall mannoproteins of C. albicans on the adhesion of the fungus to polystyrene should be taken into consideration when designing strategies to block the adhesion of C. albicans to plastic materials with mAbs.
Although anaerobic bacteria are frequently isolated from the oropharyngeal flora, their potential pathogenic role in ventilator-associated pneumonia (VAP) has been poorly investigated. In order to evaluate the pathogenic role of Prevotella spp. isolated from protected specimen brushes, we investigated the systemic humoral response with the enzyme-linked immunosorbent assay (ELISA) and Western blot (immunoblot) in 13 patients who developed a VAP associated with Prevotella species (group I). The antigen used was a mixture of whole-cell proteins taken from four reference Prevotella strains. We compared the antibody levels observed in these patients with those measured in 30 patients who developed a VAP unrelated to anaerobic bacteria (group II), in 27 patients with dental stumps (group III), and in 30 healthy patients (group IV) who had Prevotella species on dental plaque. The ELISA levels obtained in the four groups showed significant differences between group I and each of the three control groups (P < 0.05). The antibody profiles obtained by Western blot showed an intensity of response roughly superposable over levels obtained by ELISA and a species specificity. These findings suggested that colonization of these patients with Prevotella species may have been associated with an infectious process leading to a systemic humoral response and that these bacteria could play a role in VAP.
The binding of resting platelets to Candida albicans germ tubes was studied by means of an affinity column in which germ tubes were physically immobilized. Adhesion of platelets to the column was dependent on both the germ tube concentration and the number of platelets applied. It was found that the interaction of C. albicans germ tubes with platelets is specific and should be mediated by a fungal protein receptor. The results obtained by scanning electron microscopy confirmed that resting platelets can fix directly onto germ tubes. In addition, this study showed that attachment of platelets onto C. albicans is associated with morphological changes. Platelets lost their discoid shape, became globular, generated spikes or pseudopods, and then flattened on the yeast cells.
The role of anaerobic bacteria in ventilator-associated pneumonia (VAP) has been little investigated. In this study we analyzed the incidence of anaerobes in patients with a first episode of bacteriologically documented VAP (> 10(3)CFU/ml), using protected specimen brushes (PSB). We particularly took care to preserve anaerobic conditions during transport and the microbiological procedure. Two groups were considered: group A with anaerobic bacteria recovered from PSB, with or without anaerobes, and group B with aerobic bacteria only. One hundred and thirty patients were included, 30 (23%) in group A, and 100 (77%) in group B. The main anaerobic strains isolated were Prevotella melaninogenica (36%), Fusobacterium nucleatum (17%), and Veillonella parvula (12%). Univariate analysis demonstrated that patients in group A were younger than those in group B (p < 0.05) and their simplified acute physiologic score was higher (p < 0.02). The percentage of patients receiving antibiotics before PSB did not differ significantly between group A (57%) and group B (35%). VAP with anaerobes occurred more often in patients orotracheally intubated than nasotracheally intubated (p < 0.02). Episodes of VAP involving anaerobic bacteria occurred more often in the first five days (early VAP) than after the fifth day (late VAP) (p < 0.05). The 3-mo mortality rate was similar in the two groups, but death occurred earlier in group B (p < 0.01). Multivariate analysis demonstrated that presence of altered level of consciousness (p = 0.0002), higher simplified acute physiologic score (p = 0.003), and admission to the medical ICU (p = 0.02) were the factors independently predisposing to the development of VAP with anaerobes.
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Although rare, ischemic necrosis of the head of the radius after fracture is a theoretic possibility. The epiphyseal vascularisation of the proximal end of the radius was studied by dissection and diaphanisation techniques. The main extra-osseous supply is derived from epiphyseo-metaphyseal arteries given off by the recurrent radial a. and the first collateral of the ulnar a. These, to the number of three or four, anastomose together in a peri-cervical arterial circle continuous with the periosteal vessels of the shaft. From the proximal part of this network there arise three main intra-epiphyseal branches, which traverse the head, but nearly the entire periphery of the osteochondral junction is the site of small periosteal branches penetrating the head, though to no great depth. When the head of the radius is fractured, the commonest displacement is posterolateral, and the main vessel-bearing periosteal layer probably remains intact.
A case of pneumonia caused by Streptococcus pneumoniae occurring in a patient receiving pristinamycin is reported. Despite empirical treatment with pristinamycin, 2 g/day for five days, the patient's condition worsened. Protected brush specimen and blood cultures permitted isolation of Streptococcus pneumoniae. MIC testing indicated that the strain was susceptible to pristinamycin and resistant to erythromycin and penicillin. Streptococcus pneumoniae was eradicated by cefotaxime, and pneumonia resolved. This case underlines the fact that pristinamycin may not be suitable for the treatment of multiresistant pneumococcal infections.
A TG 180 non-adherent cell culture with Toxoplasma gondii and spiramycin was performed in order to calibrate TG 180 cells used in a therapeutic assay system. TG 180 cells were infected with the RH strain of T. gondii, and spiramycin was added at final concentrations of 1, 2, 4, 8, 12, 16, 20 and 25 micrograms/ml. A least-squares linear regression with confidence interval was calculated from the experimental curve and allowed the determination of the 50% inhibitory concentration of spiramycin. The IC50 of 13.7 micrograms/ml obtained is comparable with the results of the literature. The system including TG 180 cells (recently cultured in vitro) provides a rapid, accurate and economical determination of the effects of a drug on Toxoplasma gondii.
Monoclonal antibodies were obtained by the classic hybridoma technique with lymphocytes of BALB/c mice immunized with formalin killed Listeria monocytogenes cells. Among 1000 hybridomas issued from the fusion, four monoclonal antibodies (mAbs A6 A E4, C10 A F7, G4 A D6, G7 A D5) gave interesting results. By Western-blot analysis with various soluble extracts of different Listeria species, the four mAbs reacted with two major antigens of 38 and 41 kDa, with all Listeria species tested. The mAb A6 A E4 is an IgG2b with kappa light chains and reacted only with Listeria antigens without any cross reaction with other organisms tested by ELISA, dot-blotting and Western-blotting. With the same conditions, the three other mAbs reacted with Listeria and with other genus extracts, particularly with Streptococcus and Enterococcus. mAb A6 A E4-reactive antigens are proteins, and glycoprotein immunoassay indicated that the epitope is devoid of carbohydrate moiety. This mAb A6 A E4-reactive protein was neither expressed on cell surface nor released outside the bacteria; immunogold electron microscopy showed that these antigens were localized in the cytoplasma area.