[Tableau d'insuffisance cardiaque congestive révélant une myocardite lupique : cas clinique]

Systemic lupus erythematosus (SLE or lupus) is a disease in which the immune system attacks healthy cells and tissues throughout the body. Lupus myocarditis is a life-threatening condition, observed clinically in 3-9 % of patients with SLE. We report the case of a patient followed for multisystem SLE, presenting with de novo heart failure with severe left ventricular dysfunction revealing lupus myocarditis.

Effect of Agaricus blazei Murill on exploratory behavior of mice-model

Increased anxiety and depressive symptoms have reported to be its association with long term illness. Because of having unwanted effects of newly available drugs, patients administering anxiolytic drugs usually discontinue the treatment before they are completely recovered. Therefore, there is a serious need to develop new anxiolytic drugs. The anxiolytic effect of hydro-alcoholic extract of Agaricus blazei in animal models was assessed. 24 male mice (Mus musculus genus) were included in the study. Four groups were prepared and each group contained six animals. The groups were vehicle control, positive control (diazepam 1.0 mg/kg, i.p.) as well as two treatment groups receiving Agaricus blazei hydro-alcoholic extract at a dose of 136.50 mg/kg and 273.0 mg/kg orally. The Marble burying test, Nestlet shredding test and Light and Dark box test used to assess anxiolytic activity. Mice administered with diazepam 1.0 mg/kg, i.p. while hydro-alcoholic extract of AbM (136.50 and 273.0 mg/kg, respectively) was administered via oral route which exhibited marked reduction in number of marbles-burying as compared to vehicle control group. Mice administered with diazepam 1.0 mg/kg, i.p. and Oral administration of hydro-alcoholic extract of AbM (136.50 and 273.0 mg/kg, respectively) exhibited significant decrease in nestlet shredding in comparison to vehicle control group. The oral administration of hydro-alcoholic extract at a dose of 136.5mg/kg and 273mg/kg showed elevation in time spent in light box and was comparable to standard treated group while time spent by mice following oral administration of hydro-alcoholic extract of Agaricus blazei at a dose of 273.0 mg/kg also showed elevation and was found to be more near to standard treated group (diazepam 1 mg/kg, i.p.).

Simultaneous removal of potent cyanotoxins from water using magnetophoretic nanoparticle of polypyrrole: adsorption kinetic and isotherm study

Cyanotoxins, microcystins and cylindrospermopsin, are potent toxins produced by cyanobacteria in potable water supplies. This study investigated the removal of cyanotoxins from aqueous media by magnetophoretic nanoparticle of polypyrrole adsorbent. The adsorption process was pH dependent with maximum adsorption occurring at pH 7 for microcystin-LA, LR, and YR and at pH 9 for microcystin-RR and cylindrospermopsin (CYN). Kinetic studies and adsorption isotherms reflected better fit for pseudo-second-order rate and Langmuir isotherm model, respectively. Thermodynamic calculations showed that the cyanotoxin adsorption process is endothermic and spontaneous in nature. The regenerated adsorbent can be successfully reused without appreciable loss of its original capacity.

Evaluation of staff, patient and foetal radiation doses due to endoscopic retrograde cholangiopancreatography (ERCP) procedures in a pregnant patient

The use of endoscopic retrograde cholangiopancreatography (ERCP) in pregnant patients is not rare. Most studies on the safety and efficacy of these procedures report short- and long-term pregnancy outcomes and but not foetal absorbed doses. This investigation reports on an ERCP procedure for a 40-y-old woman who was 32-34 weeks pregnant. Thermoluminescent dosemeters (TLD 100) were used to measure doses received by the patient and the staff. Additionally, Monte Carlo calculations were performed using a 3D computational phantom representing a 9-month pregnant patient to estimate the foetal absorbed dose. The results show that the spleen of the mother received the largest absorbed dose of 12.18 mGy since it was closer to the source than other internal organs. For the foetus and uterus, the lowest absorbed dose was found to be 0.01 mGy to the foetal brain, while the largest absorbed dose was estimated to be 0.13 mGy to the placenta.

Employment after liver transplantation: a review

BACKGROUND

Return to productive employment is often an important milestone in the recovery and rehabilitation process after liver transplantation (OLT). This literature review identifies factors associated with employment in patients who underwent OLT.

METHODS

We searched PubMed for articles that addressed the various factors affecting employment after OLT.

RESULTS

The studies demonstrated improvement in the quality of life and examined factors that predicted whether patients would return to work after OLT. Demographic variable associated with posttransplant employment included young age, male sex, college degree, Caucasian race, and pretransplant employment. Patients with alcohol-related liver disease had a significantly lower rate of employment than did those with other etiologies of liver disease. Recipients who were employed after transplantation had a significantly better posttransplant functional status than did those who were not employed.

CONCLUSION

Economic pressures are increasing the expectation that patients who undergo successful OLT will return to work. Thus, transplant teams need to have a better understanding of posttransplant work outcomes for this vulnerable population, and greater attention must be paid to the full social rehabilitation of transplant recipients. Specific interventions for OLT recipients should be designed to evaluate and change their health perceptions and encourage their return to work.

Radiation exposure to patients and medical staff in hepatic chemoembolisation interventional procedures in Recife, Brazil

The purpose of this study was to evaluate patient and medical staff absorbed doses received from transarterial chemoembolisation of hepatocellular carcinoma, which is the most common primary liver tumour worldwide. The study was performed in three hospitals in Recife, capital of the state of Pernambuco, located in the Brazilian Northeastern region. Two are public hospitals (A and B), and one is private (C). For each procedure, the number of images, irradiation parameters (kV, mA and fluoroscopy time), the air kerma-area product (PKA) and the cumulative air kerma (Ka,r) at the reference point were registered. The maximum skin dose (MSD) of the patient was estimated using radiochromic film. For the medical staff dosimetry, thermoluminescence dosemeters (TLD-100) were attached next to the eyes, close to the thyroid (above the shielding), on the thorax under the apron, on the wrist and on the feet. The effective dose to the staff was estimated using the algorithm of von Boetticher. The results showed that the mean value of the total PKA was 267.49, 403.83 and 479.74 Gy cm(2) for Hospitals A, B and C, respectively. With regard to the physicians, the average effective dose per procedure was 17 µSv, and the minimum and maximum values recorded were 1 and 41 µSy, respectively. The results showed that the feet received the highest doses followed by the hands and lens of the eye, since the physicians did not use leaded glasses and the equipment had no lead curtain.

Role of Magnetic Resonance in Understanding the Pathogenesis of Hepatic Encephalopathy

A spectrum of neuropsychiatric abnormalities caused by portosystemic venous shunting occurs in hepatic encephalopathy (HE) patients with or without liver dysfunction. It is not completely clear how the astrocyte swelling leads to glial-neuronal dysfunction, and how the symptoms are manifested in HE. A major goal of this work is to review the current status of information available from the existing magnetic resonance (MR) modalities including MR imaging (MRI) and MR Spectroscopy (MRS) as well as other modalities in the understanding the pathogenesis of HE. First, we discuss briefly neuron-histopathology, neurotoxins, neuropsychological and neurophysiological tests. A short review on the progress with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) is then presented. In the remaining part of the manuscript, the following topics pertinent to understanding the pathogenesis of HE are discussed: MRI, diffusion tensor imaging (DTI), one-dimensional MRS based single- and multi-voxel based spectroscopic imaging techniques and two-dimensional MRS.

Longitudinal study of interferon-gamma, serum antibody and milk antibody responses in cattle infected with Mycobacterium avium subsp. paratuberculosis

During a 2-year study period, 252 animals from dairy herds infected with Mycobacterium avium subsp. paratuberculosis, and 119 animals from non-infected herds were subjected to repeated blood and faecal sampling. Animals were retrospectively grouped by infection status as infected, exposed (culture negative animals from infected herds), or non-infected animals, and by age, 12-23 months (1+ year), 24-35 months (2+ years), or 36 months and older (3+ years). Samples were collected for culture of faeces, assessment of interferon-gamma (IFN-gamma) secreted by M. paratuberculosis antigen stimulated whole-blood lymphocytes (IFN-gamma test), and measurement of antibody responses against M. paratuberculosis in serum and milk by an in-house absorbed ELISA. The IFN-gamma test diagnosed higher proportions of infected and exposed animals than the antibody ELISAs. The highest sensitivity of IFN-gamma test was in infected cattle of 2+ years of age. Receiver-operating characteristic (ROC) analyses supported the assumption that the IFN-gamma test had a better performance than antibody tests of animals of 1+ and 2+ years of age. However, for animals of 3+ years all tests performed equally well. Application of single sampling compared with repeated samplings showed better performance of the IFN-gamma test by repeated samplings, and the milk antibody ELISA in animals of 3+ years of age performed significantly better with repeated sampling compared with single sampling. In conclusion, the IFN-gamma test may be applied for screening of cattle of 1 and 2 years of age for exposure to M. paratuberculosis and the antibody ELISAs from 3 years of age.

Comparison of Histopathology, Cultivation of Tissues and Rectal Contents, and Interferon-gamma and Serum Antibody Responses for the Diagnosis of Bovine Paratuberculosis

The diagnosis of infection with Mycobacterium avium subsp. paratuberculosis was studied in 12 cattle from infected dairy herds and four from non-infected herds. A comparison was made of (1) histopathological examination and bacterial culture of tissues, (2) culture of serial samples of rectal contents, and (3) examination of repeated blood samples for interferon-gamma (IFN-gamma) and antibody responses. Tissue samples were taken from the small and large intestine and corresponding mesenteric lymph nodes, and from the pharyngeal tonsil and other lymphoid nodes (retropharyngeal, mediastinal, hepatic and supramammary). Histopathological examination and bacterial culture of tissues each revealed that six of the 16 cattle were infected, whereas repeated culture of rectal contents revealed only five infected animals. Except for the hepatic lymph node of a single animal, culture-positive tissues were confined to the intestinal tract and related lymph nodes. Bacterial culture of tissues from the ileum, caecum and lymph nodes draining the jejunum revealed the highest number of infected animals. Moreover, slightly greater numbers of positive tissues were revealed by culture than by histopathological examination. For both the IFN-gamma response and the antibody response, the means of the values for the final three samples before slaughter were significantly higher in infected than in non-infected cattle. However, these immunological responses were too variable to provide a reliable indication of infection.

Analysis of repeated tests for interferon-gamma (IFN-gamma) response and faecal excretion for diagnosis of subclinical paratuberculosis in Danish cattle

A total of 315 cattle were tested for infection with Mycobacterium avium subsp. paratuberculosis (M. paratuberculosis) at three consecutive samplings, using the interferon-gamma (IFN-gamma) test on whole blood and bacteriological culture of faecal samples. Of 205 cattle from 10 infected herds 99 (48%) were positive in the IFN-gamma test on at least one sampling using "IDEXX-criteria" for interpretation, and of 110 cattle from five non-infected herds three (3%) were positive. Forty-four animals from infected and one from non-infected herds tested positive at all three samplings. Although support for the specificity of the IFN-gamma test was provided by these results, they also indicate problems with false positives. Approximately half of the positive animals did not give the same result at all three samplings, indicating that repeated testing increases the chance of detecting reactors. Changing, or fluctuating, IFN-gamma test results occurred most frequently in animals younger than 1 year, indicating that the IFN-gamma test should be applied only to animals 1 year and older. M. paratuberculosis was isolated from 16 (4%) of 371 cattle, all from infected herds. Fifteen culture-positive cattle tested positive at least once in the IFN-gamma test. It was not possible to predict from the IFN-gamma test result the number of animals that would eventually develop disease. However, the test may be useful to detect animals that have been exposed to M. paratuberculosis earlier in their lives, and the testing of young cattle could be included in a control program to check for the effectiveness of preventing transmission of infection to calves and to identify animals at risk of developing disease later in their lives.

Interpretation of the gamma interferon test for diagnosis of subclinical paratuberculosis in cattle

A group of 252 cattle without clinical signs of paratuberculosis (paraTB) in 10 herds infected with paraTB and a group of 117 cattle in 5 herds without paraTB were selected. Whole-blood samples were stimulated with bovine, avian, and johnin purified protein derivative (PPD) and examined for gamma interferon (IFN-gamma) release. For diagnosis of paraTB, satisfactory estimated specificities (95 to 99%) could be obtained by johnin PPD stimulation irrespective of interpretation relative to bovine PPD or no-antigen stimulation alone, but numbers of test positives in the infected herds varied from 64 to 112 with different interpretation criteria. For a limited number of test-positive animals, no change in the test results could be observed with increasing antigen concentrations but IFN-gamma responses were significantly reduced (P < 0.0001) and four out of seven reactors tested negative when stimulation was performed on day-old samples. Denmark is free of bovine tuberculosis, but cross-reactivity with paraTB could be documented for cattle more than 14 months old in paraTB-infected herds compared with those in non-paraTB-infected herds. In both paraTB-free and paraTB-infected herds, false positives were observed when the test was applied to calves less than 15 months of age. Until novel antigen formulations more specific for these diseases are available, interpretation of the IFN-gamma test must be individually adjusted to fit specific needs and the context within which the test is applied and, for paraTB, the test seems most appropriate for use as a supportive tool for evaluation of disease-preventive measures in young stock.

Differences between Danish bovine and human Staphylococcus aureus isolates in possession of superantigens

PCR-assays for the detection of staphylococcal enterotoxins A-E, and H, toxic shock toxin 1, and exfoliative toxins A and B were evaluated against phenotypic methods, and performed well. Four hundred and fourteen isolates of Staphylococcus aureus from Danish cases of bovine mastitis were screened for genes encoding these superantigens. One hundred isolates from Danish human carriers were also included in the study. In contrast to the frequent presence of genes encoding and in vitro expression of superantigens among the human carrier isolates, only one of 414 isolates from bovine mastitis carried the genes encoding enterotoxin C and toxic shock toxin-1. These results further support the hypothesis that the bovine and human S. aureus reservoirs constitute two separate sub-populations of the species S. aureus. The results also show that these superantigens are generally not present in Danish S. aureus isolates from bovine mastitis, and thus play no essential role in the pathogenesis of bovine S. aureus mastitis.

Cerebral 1H MR spectroscopy and neuropsychologic status of patients with hepatic encephalopathy

OBJECTIVE

Our objective was to assess the metabolite levels (myo-inositol [ml], choline [Cho], creatine [Cr], glutamate or glutamine [Glx], and N-acetyl-L-aspartate [NAA]) visible on 1H MR spectroscopy in patients with subclinical and mild hepatic encephalopathy before and after liver transplantation and to correlate these data with the results of neuropsychiatric tests and related clinical findings.

SUBJECTS AND METHODS

A stimulated-echo sequence was used to localize a single voxel in the parietal region. Seventeen patients and 13 healthy volunteers were investigated. Nine of the 17 patients also were investigated after liver transplantation. A battery of neuropsychologic tests also was administered to patients to assess frontal, memory, and motor functions.

RESULTS

Before liver transplantation, significant reductions in mI:Cr (51%) and Cho:Cr (11%) and a significant increase in Glx:Cr (20%) were observed in patients compared with the respective ratios in healthy subjects. Patients also were significantly impaired on neuropsychologic tests measuring frontal and motor performance, but not memory. Impairment on the frontal index showed a significant correlation with mI:Cr levels; likewise, performance on the motor index showed a significant correlation with serum ammonia levels before transplantation. MR spectroscopy after liver transplantation showed changes in the metabolite ratios compared with the pretransplantation status. Even though the Glx:Cr ratios decreased after transplantation, the mI:Cr ratio remained lower than those of healthy subjects.

CONCLUSION

The relationship of changes in the metabolite ratios recorded from a voxel in the posteromedial parietal lobe to the neuropsychologic findings before and after liver transplantation is a major finding.

Clinical correlation of neuropsychological tests with 1H magnetic resonance spectroscopy in hepatic encephalopathy

OBJECTIVE

The purpose of this project was to correlate neuropsychological test results with in vivo measures of regional cerebral biochemistry determined by 1H MRS in patients with subclinical and mild hepatic encephalopathy.

METHODS

Baseline 1H MRS scans and neuropsychological testing of patients occurred at entry into the study. The primary localized volume chosen for the 1H MRS study was the posteromedial parietal cortex, which consisted predominantly of white matter. Some of these patients were scanned again if they received a liver transplantation. In a subset of patients, the effect on cerebral biochemistry and neuropsychological test performance due to a dietary intervention of reduced protein intake was monitored. These patients underwent a baseline examination and a repeat examination after 2 weeks of dietary intervention. Measures were made of the correlation between the dietary intervention and 1H MRS determined biochemistry and the results of neuropsychological tests. Results in both patient groups (dietary intervention and no dietary intervention) were compared with healthy control subjects.

RESULTS

Subclinical and low grade HE patients showed a significant reduction in mI/Cr and Cho/Cr ratio when compared with healthy control subjects. These patients also showed impairment in frontal lobe mediated cognitive tasks and in motor ability that were not appreciated in a bedside examination. The patients did not return to normal cerebral metabolic states within 30 to 60 days of liver transplantation. In fact, reductions remained in mI/Cr. Cho/Cr values increased after transplantation compared with healthy control subjects.

CONCLUSIONS

1H MRS studies showed changes in regional cerebral biochemistry associated with all grades of HE. There was a reduction in mI/Cr and a reduction in Cho/Cr in patients with low grade and subclinical forms of HE compared with normal subjects. The reduction in mI correlated well with abnormalities observed in neuropsychological tests. Liver transplantation was not associated with significant improvement in these variables.

Identification of Prototheca from bovine mastitis in Denmark

In the present study, algal isolates recovered during the period 1991 through 1996 from Danish cases of bovine mastitis were characterized and identified. Sixteen isolates of Prototheca were obtained, all of which were identified as Prototheca zopfii according to assimilation pattern, absence of capsules and resistance to clotrimazole.

Bovine mammary protothecosis due to Prototheca zopfii

Mastitis due to Prototheca zopfii was diagnosed in three of 28 cows in a dairy herd. As two cows continued to shed algae after 45 days they were slaughtered and organs were examined by cultivation, histology, immunohistochemistry and electron microscopy. Algae were restricted to the mammary glands and regional lymph nodes in which a granulomatous inflammation was seen. Algae were predominantly seen in macrophages but neutrophils also contained organisms. In macrophages both sporangiospores and sporangia were found, suggesting that intracellular proliferation may be responsible for the failure to overcome the infection. Serum samples from all cows were assayed for antibodies against P. zopfii in an enzyme-linked immunosorbent assay (ELISA). Although the highest titre was found in an infected cow the difference between the mean values of the titre in infected and non-infected cows was not significant.

Evolution of compliance within a fall prevention program

When evaluating the effectiveness of a fall prevention program, it is useful to first determine whether the program is being uniformly administered. Members of a medical-surgical unit's Quality Assurance/Product Improvement Team studied both processes as well as outcomes over a two-year implementation of a fall prevention program. They discovered that initial attempts at implementation underestimated the quantity of resources necessary to ensure full implementation of the program. This article chronicles the series of audits and program modifications that eventually brought about success to this unit.

Decommissioning of a university research reactor

The objective of the UCLA Boelter Reactor Decommissioning Project was the release of the Boelter reactor facility for unrestricted use. The facility included a 100 kW Argonaut type research reactor that operated from 1963 to 1985, providing general reactor research. The decommissioning was planned as a two-phase program. Phase I involved removal of the reactor core structure for better access and assessment of the biological shield. Phase II decommissioning activities included structural steel removal, activated concrete removal, process equipment pit piping dismantlement, and clean concrete removal. The final release survey of the Boelter reactor facility demonstrated that all areas satisfied the project's release criteria. The total person-Sv for the project was 3.87 x 10(-2) (3.87 person-rem), most of which was received during the structural steel and activated concrete removal tasks and the disassembly of the reactor core.

Mycotic and algal bovine mastitis in Denmark

A one-year examination of mammary secretions (n = 2,896) from Danish cattle with clinical or subclinical mastitis revealed 45 strains of fungi and algae. The strains originated from 44 mammary secretions of 42 cows in 40 herds. The following species of fungi were identified: Candida catenulata (n = 2), Candida kefyr (n = 6), Candida krusei (n = 17), Candida rugosa (n = 6), Candida tropicalis (n = 3), Candida valida (n = 1), Geotrichum capitatum (n = 5). The algal species Prototheca zopfii was demonstrated in five samples.