SARS-CoV-2 infection as cause of in-utero fetal death: regional multicenter cohort study

OBJECTIVE

Placental infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to placental insufficiency and in-utero fetal death (IUFD). The objective of this study was to confirm and quantify the extent to which fetoplacental infection with SARS-CoV-2 is a cause of fetal death.

METHODS

This was a multicenter retrospective cohort study of fetal deaths that underwent postmortem examination between January 2020 and January 2022 in three fetal pathology units in Paris, France. All cases of IUFD and termination of pregnancy (TOP) occurring in 31 maternity hospitals in the Paris region undergo detailed placental pathological examination in these units. Databases were searched for cases of IUFD and TOP. Cases with fetal malformation or cytogenetic abnormality were excluded to avoid bias. We included cases of IUFD with a placental or undetermined cause and cases of TOP in the context of severe intrauterine growth restriction (IUGR). Placentas were sent to a single virology unit for reverse-transcription polymerase chain reaction (RT-PCR) testing by a single laboratory technician blinded to the initial postmortem examination report. Our primary endpoint was the proportion of positive placental SARS-CoV-2 RT-PCR tests in the cohort.

RESULTS

Among 147 722 deliveries occurring over 2 years, 788 postmortem examinations for IUFD and TOP for severe IUGR were recorded, of which 462 (58.6%) were included. A total of 13/462 (2.8%) placentas tested positive for SARS-CoV-2 by RT-PCR. Wild-type virus and alpha and delta variants were identified. All positive cases had histological lesions consistent with placental dysfunction. There was a strong correlation between SARS-CoV-2 placentitis and the presence of chronic intervillositis and/or massive fibrin deposits in the placenta. When both lesion types were present, the specificity and negative predictive value for the diagnosis of placental SARS-CoV-2 infection were 0.99 (95% CI, 0.98-1.00) and 0.96 (95% CI, 0.94-0.98), respectively.

CONCLUSIONS

At the height of the SARS-CoV-2 pandemic, the cause of more than half of fetal deaths in the Paris area was determined by postmortem analysis to be of placental or undetermined origin. Of these cases, 2.8% were due to placental SARS-CoV-2 infection with a specific pattern of histological involvement. This study highlights the need for SARS-CoV-2 screening in stillbirth assessment. The impact of vaccination coverage remains to be established. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Facteurs associés à la sévérité de l’infection COVID-19 chez les patients atteints de spondyloarthrite : résultats de la French RMD COVID-19 cohorte

Introduction

Il n’y a pas, à notre connaissance, de publication décrivant précisément la sévérité et l’évolution de l’infection à SARS-CoV-2 dans la spondyloarthrite (SpA). Les données sur la COVID-19 issues des cohortes de patients avec maladies inflammatoires à médiation immunitaire concernent de faibles effectifs de SpA.

Notre objectif était de décrire la sévérité et l’évolution de la COVID-19 dans une large cohorte de patients atteints de SpA (SpA axiale et rhumatisme psoriasique) et d’identifier les facteurs associés aux formes sévères.

Patients et méthodes

Patients : spondyloarthrites (SpA) de la French RMD COVID-19 cohort (cohorte observationnelle, nationale, multicentrique) avec un diagnostic de COVID-19 (clinique, PCR, scanner ou sérologie). Données collectées : démographiques, type de SpA, comorbidités, traitements, gravité de la COVID-19. La gravité de la COVID-19 a été classée en fonction des soins nécessaires : bénin = soins ambulatoires ; modéré = traitement hospitalier non intensif ; sévère = admission en unité de soins intensifs ou décès ; grave = modéré ou sévère.

Analyses statistiques : des modèles de régression logistique ont été utilisés pour identifier les facteurs associés à ces formes graves. Toutes les variables avec p < 0,20 en analyse univariée ont été proposées dans le modèle multivarié. Les variables de traitement (AINS, méthotrexate [MTX], sulfasalazine [SLZ], anti-TNF et anti-IL17) étaient incluses dans les modèles, même si p ≥ 0,20.

Résultats

Entre mars 2020 et avril 2021, 626 SpA ont déclaré une COVID-19 dont l’évolution avait été bénigne dans 508 cas (81,1 %), modérée dans 93 cas (14,8 %) et sévère dans 25 cas (3,9 %), dont 6 décès.

La cohorte analysée comprenait 349 femmes (55,8 %), âge moyen 49,3 ± 14,1 ans, IMC moyen 27,1 ± 5,4 avec 403 SpA axiale (64,4 %), 187 RPso (29,9 %) et 36 autres SpA, durée de la maladie 11,3 ± 9,8 ans ; 352 (56,2 %) avaient au moins une comorbidité dont l’obésité (23,6 %), l’hypertension artérielle (15,5 %) et le tabagisme (10,4 %) étaient les plus fréquentes. Parmi eux, 104 étaient traités par AINS (16,6 %), 186 par csDMARD dont 156 méthotrexate, et 460 (73,5) % par biomédicaments (379 anti-TNF, 57 anti-IL17 : 57, 15 anti-IL12/23, 9 autres).

Les facteurs indépendamment associés à une COVID-19 grave étaient la corticothérapie (OR = 2,83 [IC95 % : 1,41–5,66]) et l’âge (OR = 1,07 [1,05–1,09]) alors le genre féminin (OR = 0,64 [0,41–0,99]) et les anti-IL17 (OR = 0,51 [0,32–0,81]) avaient un caractère protecteur. Un traitement par AINS (OR = 0,91 [IC95 % : 0,47–1,77]), par sulfasalazine (OR = 6,81 [0,59–77,41]) ou par anti-TNF (OR = 0,67 [0,33–1,35]) n’était pas associé à la gravité de l’infection.

Conclusion

L’évolution de la COVID-19 a été bénigne pour la majorité des patients atteints de SpA (81,1 %). La corticothérapie était associée à des infections plus graves alors que les anti-IL17 avaient un caractère protecteur.

Protein expression of angiotensin-converting enzyme 2, a SARS-CoV-2-specific receptor, in fetal and placental tissues throughout gestation: new insight for perinatal counseling

OBJECTIVE

Pregnant women can be infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), yet the incidence of perinatal infection is low. We hypothesized that this could be related to low expression of the membrane receptor for SARS-CoV-2, angiotensin-converting enzyme 2 (ACE2), in the fetoplacental unit. We evaluated protein expression of ACE2 at various gestational ages in both placentae and fetal organs from pregnancies not infected with SARS-CoV-2.

METHODS

In May 2020, using samples from a registered biobank, we performed immunohistochemical analysis for ACE2 in tissue samples from fetal organs and placentae from five cases of second- or third-trimester medical termination of pregnancy in healthy women (performed between 15 and 38 weeks' gestation), as well as a further two placentae, one from a 7-week spontaneous miscarriage in a non-infected woman and one from a symptomatic pregnant woman positive for SARS-CoV-2 delivered by Cesarean section at 34 weeks. Samples were paraffin-embedded and organ tissues included kidney, brain, lung, intestinal tract, heart and testis. Matching tissues (kidney, intestinal tract, lung and testis) from autopsies of four 8-year-old children were tested as controls. Tissue sections were incubated with rabbit monoclonal anti-ACE2, and protein expression of ACE2 was detected by immunohistochemistry.

RESULTS

ACE2 expression was detected in fetal kidney, rectum and ileum samples from 15 weeks onwards and in the pediatric controls. It was barely detectable in fetal lung samples at 15 + 5 weeks' gestation and not detectable thereafter, and, in the pediatric controls, ACE2 was detectable only in type-2 pneumocytes. No ACE2 expression was found in the cerebral ependymal or parenchymal tissues or in cardiac tissues. ACE2 was expressed in placental syncytiotrophoblast and cytotrophoblast samples, but not in the amnion, from 7 weeks onwards. The intensity and distribution of ACE2 staining in the placenta from the symptomatic SARS-CoV-2 woman was similar to that in the non-infected placentae.

CONCLUSIONS

Marked placental expression of ACE2 provides a rationale for vertical transmission at the cellular level. Absence of ACE2 expression in the fetal brain and heart is reassuring regarding the risk of congenital malformation. Clinical follow-up of infected pregnant women and their children is needed to validate these observations. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

[Early diagnosis of omphalocele: Prognostic value of the herniated viscera for associated anomalies]

OBJECTIVES

Prognosis of infants with omphalocele depends on many factors, including associated anomalies. "Small" omphaloceles are believed to have more often WB syndrome, but so far no prenatal criterion has been demonstrated to predict associated anomalies. The aim of this study was to assess the outcomes of omphaloceles with prenatal diagnosis, and to seek for any correlation between the herniated viscera in the first trimester and the risk of associated anomalies.

METHODS

We conducted a retrospective study at the Necker Enfants Malades Hospital between 2008 and 2018. Pregnancy outcomes and post natal data were collected and compared to the omphalocele content in the first trimester.

RESULTS

One hundred and ninety-one women with antenatal diagnosis of omphalocele were included. Twenty-eight percent were isolated at birth, 32% had a polymalformative syndrome with chromosomal anomaly, 13% had a polymalformative syndrome without genetic anomaly, 9% had a Wiedemann-Beckwith syndrome, 7% had an association with cardiopathy, 6% had a limb body wall complex, 3% had OEIS complex and one case had a Cantrell pentalogy. The presence of the liver in the omphalocele during the first trimester was a predictive factor of heart disease (85.7% vs 48.6% P=0.01). The presence of bowel in the omphalocele during the first trimester was a predictor of chromosomal abnormalities (69.6% vs 37.2% P<0.001). Omphalocele content in the first trimester was not predictive of Wiedemann-Beckwith syndrome.

CONCLUSION

Ultrasound analysis in the first trimester of omphalocele content is a valuable clue for prenatal counseling and diagnosis of associated abnormalities.

Evaluation of patients' needs to design and assess a patient education program in cancer pain

Purpose: Patient education constitutes a relevant strategy to improve pain management. In the field of therapeutic patient education (TPE), we aimed 1) to assess pain impact in cancer patients, 2) to identify patients' educative needs in pain management, and 3) to refine research criteria for its future evaluation. Patients and methods: Pain intensity, relief and interference were assessed in 75 cancer patients with unbalanced background pain. Self-assessment questionnaire evaluated i) patients' pain management and ii) their knowledge and needs in TPE. Results: Most patients experienced pain for more than 6 months and 41.6% reported adequate pain relief. Understanding pain and pain management were major patients' preferences (>58%). Most patients declared they knew their pain treatments, but fewer than half of them were able to name them. However, education concerning pain treatment was considered as essential in <30% of patients. Almost all patients (97.1%) stated pain education as beneficial, with a preference for individualized sessions (41.2%). In addition, the assessment criteria for its future evaluation were refined. Conclusion: Targeted population mainly concerned patients with persistent pain. Only half of patients reported pain relief despite antalgics. Patient education was declared as beneficial for almost all participants. Practice implications: Tailoring a pain TPE on patients' needs has the potential to help them to optimally manage their pain daily.

MGIS: managing banana (Musa spp.) genetic resources information and high-throughput genotyping data

Unraveling the genetic diversity held in genebanks on a large scale is underway, due to advances in Next-generation sequence (NGS) based technologies that produce high-density genetic markers for a large number of samples at low cost. Genebank users should be in a position to identify and select germplasm from the global genepool based on a combination of passport, genotypic and phenotypic data. To facilitate this, a new generation of information systems is being designed to efficiently handle data and link it with other external resources such as genome or breeding databases. The Musa Germplasm Information System (MGIS), the database for global ex situ-held banana genetic resources, has been developed to address those needs in a user-friendly way. In developing MGIS, we selected a generic database schema (Chado), the robust content management system Drupal for the user interface, and Tripal, a set of Drupal modules which links the Chado schema to Drupal. MGIS allows germplasm collection examination, accession browsing, advanced search functions, and germplasm orders. Additionally, we developed unique graphical interfaces to compare accessions and to explore them based on their taxonomic information. Accession-based data has been enriched with publications, genotyping studies and associated genotyping datasets reporting on germplasm use. Finally, an interoperability layer has been implemented to facilitate the link with complementary databases like the Banana Genome Hub and the MusaBase breeding database.

Database URL:https://www.crop-diversity.org/mgis/

Mortality risk factors in elderly patients in intensive care without limitation of therapeutic effort

OUTCOME

To determine mortality prognostic factors in elderly patients who are admitted to intensive care units (ICUs) due to acute critical illness.

DESIGN

A prospective cohort study was carried out.

SETTING

A polyvalent Intensive Care Unit at a University Hospital in Argentina.

PATIENTS OR PARTICIPANTS

We included 249 patients over 65years of age who were consecutively admitted to the ICU and required mechanical ventilation for more than 48hours, between January 2011 and December 2012. Patients with degenerative neurological disease, limitation of therapeutic effort or on chronic mechanical ventilation were excluded.

PRINCIPAL VARIABLES OF INTEREST

In-hospital mortality, comorbidity (Charlson index), APACHEII score, and pre-acute illness status were recorded: nutritional status (subjective global assessment), functionality (activities of daily living [ADL] and Barthel index), cognitive abilities (Short Reporting Questionnaire on Cognitive Decline in the Elderly [S_IQCODE]) and quality of life (EQ-5D).

RESULTS

The in-hospital mortality rate was 52%. Logistic regression analysis, after adjusting for APACHEII score and age, identified the following independent variables associated to mortality: male gender (OR: 2.46, 95%CI: 1.37-4.42), moderate malnutrition (OR: 2.07, 95%CI: 1.09-3.94), severe malnutrition (OR: 2.20, 95%CI: 1.06-4.59), and ADL<6 (OR: 2.35, 95%CI: 1.16-4.75).

CONCLUSIONS

In our study, chronological age was not associated to in-hospital mortality. However, loss of functional independence (assessed by ADL) and malnourishment were shown to be strong prognostic factors; knowing these baseline characteristics from ICU admission would be useful when making decisions regarding the intensity of treatment.

Habitat selection by marine larvae in changing chemical environments

The replenishment and persistence of marine species is contingent on dispersing larvae locating suitable habitat and surviving to a reproductive stage. Pelagic larvae rely on environmental cues to make behavioural decisions with chemical information being important for habitat selection at settlement. We explored the sensory world of crustaceans and fishes focusing on the impact anthropogenic alterations (ocean acidification, red soil, pesticide) have on conspecific chemical signals used by larvae for habitat selection. Crustacean (Stenopus hispidus) and fish (Chromis viridis) larvae recognized their conspecifics via chemical signals under control conditions. In the presence of acidified water, red soil or pesticide, the ability of larvae to chemically recognize conspecific cues was altered. Our study highlights that recruitment potential on coral reefs may decrease due to anthropogenic stressors. If so, populations of fishes and crustaceans will continue their rapid decline; larval recruitment will not replace and sustain the adult populations on degraded reefs.

DArT whole genome profiling provides insights on the evolution and taxonomy of edible Banana (Musa spp.)

BACKGROUND AND AIMS

Dessert and cooking bananas are vegetatively propagated crops of great importance for both the subsistence and the livelihood of people in developing countries. A wide diversity of diploid and triploid cultivars including AA, AB, AS, AT, AAA, AAB, ABB, AAS and AAT genomic constitutions exists. Within each of this genome groups, cultivars are classified into subgroups that are reported to correspond to varieties clonally derived from each other after a single sexual event. The number of those founding events at the basis of the diversity of bananas is a matter of debate.

METHODS

We analysed a large panel of 575 accessions, 94 wild relatives and 481 cultivated accessions belonging to the section Musa with a set of 498 DArT markers previously developed.

KEY RESULTS

DArT appeared successful and accurate to describe Musa diversity and help in the resolution of cultivated banana genome constitution and taxonomy, and highlighted discrepancies in the acknowledged classification of some accessions. This study also argues for at least two centres of domestication corresponding to South-East Asia and New Guinea, respectively. Banana domestication in New Guinea probably followed different schemes that those previously reported where hybridization underpins the emergence of edible banana. In addition, our results suggest that not all wild ancestors of bananas are known, especially in M. acuminata subspecies. We also estimate the extent of the two consecutive bottlenecks in edible bananas by evaluating the number of sexual founding events underlying our sets of edible diploids and triploids, respectively.

CONCLUSIONS

The attribution of clone identity to each sample of the sets allowed the detection of subgroups represented by several sets of clones. Although morphological characterization of some of the accessions is needed to correct potentially erroneous classifications, some of the subgroups seem polyclonal.

First description of the neuro-anatomy of a larval coral reef fish Amphiprion ocellaris

The present study described the neuro-anatomy of a larval coral reef fish Amphiprion ocellaris and hypothesized that morphological changes during the transition from the oceanic environment to a reef environment (i.e. recruitment) have the potential to be driven by changes to environmental conditions and associated changes to cognitive requirements. Quantitative comparisons were made of the relative development of three specific brain areas (telencephalon, mesencephalon and cerebellum) between 6 days post-hatch (dph) larvae (oceanic phase) and 11 dph (at reef recruitment). The results showed that 6 dph larvae had at least two larger structures (telencephalon and mesencephalon) than 11 dph larvae, while the size of cerebellum remained identical. These results suggest that the structure and organization of the brain may reflect the cognitive demands at every stage of development. This study initiates analysis of the relationship between behavioural ecology and neuroscience in coral reef fishes.

[How to assess the neutral position of the fetus for the crown-rump length measurement at the nuchal translucency scan]

OBJECTIVES

The objective of this study was to establish a simple and reproducible method for the assessment of the fetal head position when measuring crown-rump length (CRL) at the nuchal translucency scan.

METHODS

Two observers conducted a retrospective analysis of a consecutive series of 570 images of CRL collected by the French College of Fetal Echography (CFEF) national practice assessment program for the first-trimester scan. The images were deemed hyper-flexed if no fluid was visible between the chin and the chest of the fetus. The images were deemed hyper-extended if the angle between the palate and the CRL line was 90° or more. The images were deemed neutral if no hyper-extension nor hyper-flexion was observed.

RESULTS

The proportion of agreement for a non-neutral position of the fetal head was 91.3% (kappa=0.80, 95% CI [0.75 to 0.86]). Images with a non-neutral position corresponded to poor CRL quality images according to the CFEF score (relative risk=4.2, 95% CI [2.9 to 6.1] for one observer and 4.9, 95% CI [3.3 to 7.2] for the other observer). Proportions of agreement for the hyper-flexion and for the hyper-extension were 94.6% (kappa=0.80, 95% CI [0.72 to 0.87]) and 96.8% (kappa=0.81, 95% CI [0.72 to 0.90]), respectively. No additional lines were drawn on the ultrasound images during the evaluation process.

CONCLUSIONS

The proposed method for evaluating the extent to which the fetal head has a non-neutral position at measurement of the CRL appears both simple and reproducible.

Autochthonous case of dengue in France, October 2013

In October 2013, autochthonous dengue fever was diagnosed in a laboratory technician in Bouches-du-Rhone, southern France, a department colonised by Aedes albopictus since 2010. After ruling out occupational contamination, we identified the likely chain of local vector-borne transmission from which the autochthonous case arose. Though limited, this second occurrence of autochthonous dengue transmission in France highlights that efforts should be continued to rapidly detect dengue virus introduction and prevent its further dissemination in France.

Foundation characteristics of edible Musa triploids revealed from allelic distribution of SSR markers

BACKGROUND AND AIMS

The production of triploid banana and plantain (Musa spp.) cultivars with improved characteristics (e.g. greater disease resistance or higher yield), while still preserving the main features of current popular cultivars (e.g. taste and cooking quality), remains a major challenge for Musa breeders. In this regard, breeders require a sound knowledge of the lineage of the current sterile triploid cultivars, to select diploid parents that are able to transmit desirable traits, together with a breeding strategy ensuring final triploidization and sterility. Highly polymorphic single sequence repeats (SSRs) are valuable markers for investigating phylogenetic relationships.

METHODS

Here, the allelic distribution of each of 22 SSR loci across 561 Musa accessions is analysed.

KEY RESULTS AND CONCLUSIONS

We determine the closest diploid progenitors of the triploid 'Cavendish' and 'Gros Michel' subgroups, valuable information for breeding programmes. Nevertheless, in establishing the likely monoclonal origin of the main edible triploid banana subgroups (i.e. 'Cavendish', 'Plantain' and 'Mutika-Lujugira'), we postulated that the huge phenotypic diversity observed within these subgroups did not result from gamete recombination, but rather from epigenetic regulations. This emphasizes the need to investigate the regulatory mechanisms of genome expression on a unique model in the plant kingdom. We also propose experimental standards to compare additional and independent genotyping data for reference.

Prosthetic management 56 years after rotationplasty due to proximal femoral focal deficiency (PFFD)

Proximal femoral focal deficiency (PFFD) is a rare congenital anomaly of the femur. Rotationplasty has been described as a reconstructive procedure in the management of PFFD. A 68-year-old woman with PFFD of the right leg and rotationplasty at the age of 12 years had prosthetic fitting problems after a fall. The authors describe the analysis of the prosthetic fitting problems and the considerations made in prosthetic management. Following a fall, 56 years after rotationplasty, this woman has a good prosthetic fitting and a satisfying level of functioning.

The myocardial sleeves of the pulmonary veins: potential implications for atrial fibrillation

Atrial fibrillation (AF) is the most common abnormal heart rhythm and contributes to cardiac morbidity and mortality. Electrophysiological studies with pacing have shown that AF is initiated by ectopic beats localized in the pulmonary vein (PV) walls. The aim of this work was to look for some anatomical or histological particularities to explain these ectopic beats. Ten autopsied hearts were examined (6 males, 4 females). The myocardium was studied from the left atrium to the PV. Histological sections were made from 39 PVs. Myocardial cells were localized to PV between 9 and 38 mm from the PV-atrial junction. The sleeve was composed of circularly and longitudinally oriented bundles of cardiomyocytes. The peripheral end of the myocardial sleeve was irregular. The longest myocardial sleeves were found in the superior veins and were longitudinally oriented. At the PV-atrial junction, the circular bundles were not often circumferential. PV myocardial architecture confirmed the possibility of initiating AF. This fact is important for therapeutic radiofrequency ablation and explains why PV disconnection is essential.

Rapid detection of aneuploidy in Musa using flow cytometry

We report a procedure for the rapid and convenient detection of aneuploidy in triploid Musa using DNA flow cytometry. From a population of plants derived from gamma-irradiated shoot tips, plants were selected based on aberrant morphology and their chromosome numbers were counted. Aneuploids plants with chromosome numbers 2n=31 or 32 were found as well as the expected triploid plants (2n=3x=33). At the same time, the nuclear DNA content of all plants was measured using flow cytometry. The flow cytometric assay involved the use of nuclei isolated from chicken red blood cells (CRBC), which served as an internal reference standard. The relative DNA content of individual plants was expressed as a ratio of DNA content of CRBC and Musa (DNA index). In order to estimate the chromosome number using flow cytometry, the relative DNA content of plants with unknown ploidy was expressed as a percentage of the DNA content of triploid plants. The classification based on flow cytometry fully agreed with the results obtained by chromosome counting. The results indicated that flow cytometry is a convenient and rapid method for the detection of aneuploidy in Musa.

Influence of occupational exposure to latex on the prevalence of sensitization and allergy to latex in a Swiss hospital

BACKGROUND

Replacement of powdered latex gloves has been recommended in order to prevent the development of latex allergy in health care workers. The conclusion that occupational exposure to latex gloves represents a risk factor for latex allergy is mainly based on studies without exposure controls. Atopy is also thought to be a risk factor for the development of latex allergy.

OBJECTIVE

To determine the prevalence of atopy, sensitization to latex, and symptoms following latex exposure in professionally exposed and nonexposed hospital personnel by means of a cross-sectional study.

METHODS

Six hundred randomly sampled individuals working in medicine and surgery departments and in surgery theaters and 300 sex- and age-matched individuals classified as administrative personnel were selected from the employee data base of the Geneva University Hospital. A questionnaire about exposure to latex and symptoms following this exposure was sent to all individuals. Skin prick test reactions and serum IgE to latex as well as standard environmental allergens were determined in both groups.

RESULTS

Respiratory and skin (local) symptoms but not objective tests of latex sensitization (positive skin prick test and specific IgE to latex) were significantly associated with occupational exposure to latex (p < 0.001). Only among atopics subjects was 15 years or more of occupational exposure associated with a significantly higher prevalence of local symptoms than among those who were exposed from 1 to 9 years (odds ratio: 3.2; 95% confidence interval: 1.6-6.5). Atopy was significantly associated with sensitization to latex (odds ratio: 10.3; 95% confidence interval: 4.0-26.6) but not with local symptoms. Tests of latex sensitization were both frequently positive, less frequently negative, resulting in low kappa values.

CONCLUSION

These results support the current preventive health care recommendation to replace powdered latex gloves. In atopics, increasing years of occupational exposure increase the risk of developing latex allergy. In contrast to questionnaires about local symptoms, skin prick tests and specific serum IgE to latex are of limited value in epidemiologic studies of latex allergy.

Different aminoglycoside-resistant phenotypes in a rabbit Staphylococcus aureus endocarditis infection model

The impact of different types of enzymatic resistance on the in vivo antibacterial activity of aminoglycosides (amikacin, gentamicin, and netilmicin) was studied in the rabbit endocarditis model with four strains of Staphylococcus aureus. Animals were treated in a manner simulating the administration of a single daily human dose. Amikacin had no effect on the three kanamycin-resistant strains despite apparent susceptibility in the disk diffusion test. Gentamicin appears to be the preferable aminoglycoside for treatment of staphylococcal infections.

Fungal contamination of food in hematology units

The prevalence of thermotolerant fungi on non-heat-sterilizable food was determined. Aspergillus spp. were noted in 100% of pepper and regular tea samples, 12 to 66% of fruits, 27% of herbal teas, and 20% of freeze-dried soup samples. All soft cheese samples were contaminated by Geotrichum and yeast (Candida norvegensis) but Candida albicans was never identified.

Ethanol-induced urticaria: elevated tryptase levels after double-blind, placebo-controlled challenge

We present a 48-year-old patient who complained for 1 year about urticarial reactions which appeared always when he ingested alcoholic beverages. Skin prick tests with ethanol were negative but positive with 10% acetic acid in the patient. Normal controls tested negative with acetic acid. Skin prick tests to common immediate-type allergens were negative. The patient underwent a double-blind, placebo-controlled challenge test. A few minutes after challenge with ethanol but not with placebo, the patient developed erythema and wheals on the chest and the upper arms. The tryptase serum level rose from undetectable (0.1 U/ml) before challenge to 3.8 U/ml after skin lesions had appeared. This case demonstrates that increased tryptase serum levels can help in the diagnosis of ethanol-induced urticaria.

[Papillary fibroelastoma. Report of 3 cases]

Papillary fibroelastoma is a rare, benign, primary cardiac tumour. The authors report three cases presenting with transient or full cerebrovascular accidents. The tumours were diagnosed during investigation by echocardiography, especially transoesophageal echocardiography. In view of the severity of symptoms and the high risk of recurrence, the patients were rapidly referred for surgery. In two cases, the tumour was located on the aortic valve at several sites. In one case, the tumour was single and implanted on the mitral valve. Surgery was successful with the pathology reports confirming complete ablation. The patients have not had any recurrence to date. The multiple nature of these tumours raises the questions of local spread, secondary degeneration of valvular nodes? The problem of possible recurrences is discussed.

Pulmonary function tests and high resolution computed tomography of the lungs in patients with rheumatoid arthritis

OBJECTIVE

To compare the results of pulmonary function tests (PFTs) and high resolution computed tomography (HRCT) of the lungs in rheumatoid arthritis (RA) patients.

METHODS

Sixty eight patients (54 women, 14 men) fulfilling the revised criteria for RA were consecutively included in a transversal prospective study. Their mean age was 58.8 years (range: 35-82) and the mean duration of the disease was 12 years (range: 5-16). Rheumatoid factor was positive in 52 patients (76.5%). Fifty two patients (76.5%) were lifelong non-smokers. Detailed medical and drug histories were obtained. PFTs comprised spirometry and gas transfer measurements. Results for PFTs were expressed as percentage of predicted values for each individual adjusted for age, sex, and height. HRCT was undertaken with a Siemens Somatom Plus.

RESULTS

A significant decrease of FEV1/ FVC, FEF25%, FEF50%, FEF75%, FEF25-75%, and TLCO was observed (p < 0.05) and 13.2% of the patients had a small airways involvement defined by a decrease of FEF25-75% below 1.64 SD. The most frequent HRCT findings were: bronchiectasis (30.5%), pulmonary nodules (28%), and air trapping (25%). The patients with small airways involvement had a high frequency of recurrent bronchitis (75% v 34%, p = 0.05) and bronchiectasis (71% v 23%, p = 0.019). The patients with bronchiectasis were characterised by low values of FEV1, FVC, FEF25-75%, and TLCO (p < 0.01), a high prevalence of small airways involvement (29% v 5%, p = 0.019), and a low prevalence of HLA DQA1 *0501 allele (14% v 33%, p < 0.05).

CONCLUSION

This study suggests a significant association between small airways involvement on PFTs and bronchiectasis on HRCT in unselected RA patients.

Usefulness of longitudinal evaluation of Cyfra 21-1 variations in advanced lung cancer monitoring

To investigate the usefulness of Cyfra 21-1 as an indicator of therapy effectiveness and prognosis in advanced primary lung cancer, sixty-three patients were selected on the basis of a high Cyfra 21-1 serum level (> 3.3 ng/ml) at the time of diagnosis. Serial assays of Cyfra 21-1 were performed during the first three courses of chemotherapy among 63 patients. The serial-values were analysed according to response to treatment and overall survival. After three courses of chemotherapy, a 70% reduction under the initial marker's value or a return to normal was observed for 36 patients. Twenty-two (61%) of these patients presented an objective response to therapy, making Cyfra 21-1 a moderate indicator in terms of positive predictive value (PPV). However, a significant decrease of Cyfra 21-1 was observed in 88% (sensitivity) of the 25 objective responders. Cyfra 21-1 changes after one course of chemotherapy (61 patients) were not sufficient to predict the future response after three courses (sensitivity 52%, specificity 56%, PPV 45%). Among 30 clinical or radiological relapses, a 10% increase or a return upper reference limit in Cyfra 21-1 level was observed in 18 cases (sensitivity 60%, specificity 100%, PPV 100%). Survival data were available for 61 patients. No significant statistical difference (P > 0.05) was found between survival curves depending on a significant decrease of Cyfra 21-1 after the first course of chemotherapy. We can conclude that the only interest of serial Cyfra 21-1 assays may be the detection of relapse, where one observes a significant decrease of the marker correlated with an objective response to first treatment.

Pneumocystis carinii pneumonia in rheumatoid arthritis patients treated with methotrexate. A report of two cases

Use of methotrexate to treat rheumatoid arthritis is associated with pulmonary adverse effects in 3% to 5% of cases. In addition to immunoallergic lung disease, bronchitis and pneumonia due to pyogenic organisms, opportunistic lower respiratory tract infections have been reported, including, to our knowledge, 18 cases of Pneumocystis carinii pneumonia. We report two new cases of P. carinii pneumonia in methotrexate-treated rheumatoid arthritis patients. One case occurred in a 62-year-old woman with a nine-year history of seropositive rheumatoid arthritis treated for the last seven months with methotrexate, 15 mg per week, and prednisone, 10 mg/d. The other patient was a 58-year-old woman who had been diagnosed with rheumatoid arthritis 18 months earlier and had been receiving 15 mg per week of methotrexate for eight months in combination with 12.5 mg of prednisone per day. Both patients had negative tests for the human immunodeficiency virus. Symptoms consisted of fever, cough and dyspnea, with interstitial infiltrates on chest films, hypoxia, and lymphopenia (700 and 600/mm3, respectively). The diagnosis was confirmed by bronchoalveolar lavage. Both patients recovered under treatment with trimethoprim-sulfamethoxazole. An analysis of the 20 cases of P. carinii pneumonia reported to date in methotrexate-treated rheumatoid arthritis patients demonstrated a number of characteristics: the rheumatoid arthritis was of recent onset in some cases (a few months in one patient); lymphopenia was present in two thirds of cases; one-third of patients were not receiving corticosteroid therapy; the dosage and duration of methotrexate therapy varied widely, from 5 to 30 mg per week and two to 48 months; and four patients died.

Prevalence and symptoms at onset of bipolar illness among adolescent inpatients

The records of 236 adolescents (116 males and 120 females) admitted to an inpatient psychiatric unit over an eight-year period were retrospectively reviewed to determine the characteristics of patients with a discharge diagnosis of bipolar disorder. Forty-two patients had a diagnosis of an affective disorder, including 18 patients (nine males and nine females) with bipolar disorder. Mean age at onset of illness for patients with bipolar disorder was 15.7 years, and their onset of illness was likely to have been associated with psychotic symptoms. On admission, they were more likely to show symptoms of mania than of depression.

[Pericardium and heart transplantation]

The authors emphasise the role of the pericardium in the post-operative complications of cardiac transplantation: its role is as important as it is underestimated in its frequency, severity and the pathogenic discussions that it induces. This study, based on a retrospective analysis of 191 anatomo-clinical cases (156 autopsies and 35 retransplantations) of patients undergoing cardiac transplantation before the 1/03/1993 including macroscopic and histopathologic analysis of the pericardial lesions, histochemical analysis of the lymphocytic populations, and analysis of associated coronary and myocardial lesions. The results were classified as early or late (after the 75th postoperative day) complications. Early complications included 27 suppurating mediastino-pericarditis (13 aspergillosis and 14 bacterial), 16 autonomous non-infective pericardial complications (6 haemopericardiums, 6 organised compressive haematomas, 4 early constrictive pericarditis) and 9 lymphocytic epicarditis associated with acute myocardial rejection. Late complications included one common constrictive symphysis and 14 reactivated epicarditis associated with transplantation coronary disease (chronic rejection) with associated lymphoplasmocytic nodules and a myocardial vasculitis. These observations suggest two important conclusions: 1) the need for active diagnostic measures to detect pericardial complications in cases of cardiac transplant dysfunction in the early postoperative period with no signs of acute rejection on myocardial biopsy: the presence of epicardial lesions on biopsy should be taken into account and not just assumed to be a postoperative epiphenomenon; 2) the presence of epicarditis due to reactivated epicarditis may cause inextensible hardening of the epicardium which adds to the effects of restrictive cardiomyopathy of chronic rejection.

[Late anatomical lesions after cardiac transplantation. Study of 44 autopsies beyond 6-months survival]

The aim of this study was to attempt to determine which anatomical lesions were found late after cardiac transplant and could be fatal. A series of 44 autopsies, beyond a 6 month survival time, revealed the types of cardiac and extra-cardiac lesions encountered. They were viewed in the context of clinical findings. Three lesion patterns accounted for more than 9 cases out of 10: coronary disease affecting the transplant (accelerated atherosclerosis or chronic cardiac rejection: 48% of cases), infectious lesions (29%), more than half of which were due to aspergillosis, and neoplasia (14%), favourised by immune-depression. Three results show that graft coronary disease is currently the essential long term problem in the many patients who survive the early postoperative period of cardiac transplant.

Phase I pharmacokinetics study of high-dose fotemustine and its metabolite 2-chloroethanol in patients with high-grade gliomas

The pharmacokinetics of high-dose fotemustine followed by autologous bone-marrow transplantation during a phase I-II clinical trial in 24 patients with glioblastoma or astrocytoma (grade III-IV) was investigated. Plasma levels of fotemustine were determined by high-performance liquid chromatography (HPLC) and UV detection. The metabolite, 2-chloroethanol, was simultaneously followed in six patients by gag liquid chromatography and electron capture detection (GLC-ECD) assay. The drug was given as a 1-h infusion on 2 consecutive days. In all, 40 pharmacokinetic determinations of fotemustine were made at dose levels ranging from 2 x 300 to 2 x 500 mg/m2. Plasma drug elimination was best described by a bi-exponential model, with short distribution and elimination half-lives of 4.15 +/- 2.57 and 28.8 +/- 12.1 min being observed, respectively. No significant difference in half-lives or clearance was seen between the first and the second administration. During dose escalation, the mean area under the concentrationtime curve (AUC) increased from 5.96 +/- 2.89 to 12.22 +/- 3.95 mg l-1 h. Drug clearance was independent of the dose given and equal to 109 +/- 65 l/h, indicating no possible saturation of metabolism and elimination mechanisms at these high-dose levels. The metabolite 2-chloroethanol appeared very early in plasma samples. Its elimination was rapid and rate-limited by the kinetics of the parent compound, giving the same apparent terminal half-life. A close relationship between AUC and C45 values was evidenced (r = 0.890). Associated with the stability of fotemustine kinetic parameters, this could be used in future studies for individual dose adjustment, particularly for high-dose fractionated regimens.