Apoptosis participates to liver damage in HSV-induced fulminant hepatitis.

Background: HSV fulminant hepatitis is a rare pathology. Rapid hepatic failure, as a consequence of extended liver damage, has generally been attributed to necrosis. As apoptosis can constitute another way for hepatocytes to die, we decided to investigate whether programmed cell death took place during HSV fulminant hepatitis.

Methicillin-resistant Staphylococcus aureus (MRSA) in rehabilitation and chronic-care-facilities: what is the best strategy?

Background: The risk associated with methicillin-resistant Staphylococcus aureus (MRSA) has been decreasing for several years in intensive care departments, but is now increasing in rehabilitation and chronic-care-facilities (R-CCF). The aim of this study was to use published data and our own experience to discuss the roles of screening for MRSA carriers, the type of isolation to be implemented and the efficiency of chemical decolonization.

Discussion: Screening identifies over 90% of patients colonised with MRSA upon admission to R-CCF versus only 50% for intensive care units.

[Contribution of antibiotic pressure in the acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in a university hospital].

Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen, which causes severe morbidity and mortality in hospitals. Antibiotic pressure is recognised as an individual risk factor in the acquisition of MRSA, however, some authors suggest that antibiotic use must be considered as an ecological and collective problem on a unit or hospital scale. The objective of our study was to determine whether antibiotic pressure affects the acquisition of MRSA.

[Small intestinal stromal tumors with skenoid fibers. Clinicopathological study of three cases].

Gastrointestinal stromal tumours (Gist) are mesenchymal tumour with uncertain prognosis occurring in the gastrointestinal tract wall. For clinicians, these tumours raise two problems: to establish the diagnosis and to determinate the future behaviour for the choice officient therapeutics. For the diagnosis the new marker c-KIT is useful.

[Detrusor-sphincter dyssynergia and botulinum toxin].

Objective: Botulinum toxin (BT) injection into the external urethral sphincter is a promising therapy for neurogenic voiding disorders due to detrusor-sphincter dyssynergia (DSD). However the optimal treatment protocol remains unclear.

Method: A PubMed reference search and manual bibliography review were performed, along with a search in the Annales de réadaptation et de médecine physique and in the reports of the International French-language Society of Urodynamics and the International Continence Society, which allowed us to select twelve pertinent articles with PubMed, two articles from the Annales and two conference reports.

Relationship between molecular epidemiology and antibiotic susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) in a French teaching hospital.

The objective of this study was to investigate the relationship between molecular epidemiology and antibiotic susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) over a period of 4 years. The antibiotype of all MRSA isolates that were identified during a yearly period of 3 months was determined; 50 consecutive non-replicate MRSA isolates were typed each year. Susceptibility rates to gentamicin, tobramycin and ofloxacin remained stable (95, 16 and 4 %, respectively).

[Pseudomonas aeruginosa epidemiology in intensive care units: importance of cross-transmission].

Objectives: To update the local epidemiological data of Pseudomonas aeruginosa in intensive care units (ICU) by assessing the colonisation incidence rate and the level of cross-transmission.

Methods: Study carried out in both adult ICUs of the university-hospital of Besançon during a 2 years period. Clinical and surveillance specimens were screened for P.

[Value of eosinopenia in inflammatory disorders: an "old" marker revisited].

Purpose: The value of eosinopenia as a test in favour of an infectious disease was suggested by Schilling since 1929. We tried to verify this hypothesis with a prospective and multicentric study.

Patients And Methods: One thousand and thirty-eight patients were included (82 females and 56 males, means age: 71.

Modelling the usefulness of a dedicated cohort facility to prevent the dissemination of MRSA.

The aim of this retrospective study was to determine whether or not a surgical dedicated cohort facility, mainly dedicated to the care of orthopaedic patients, can control the risk of infection caused by methicillin-resistant Staphylococcus aureus (MRSA). We tested this hypothesis on the orthopaedic surgery ward of a university-affiliated public hospital with 1228 beds by determining whether there was a significant correlation between the colonization pressure exerted by MRSA and the number of cases of acquired MRSA. This was then used as a tool to predict the number of patients contaminated with MRSA in hospitals with and without dedicated cohort facilities.

[Classification of acute coronary syndromes].

The classification of acute coronary syndromes takes into account new data concerning pathophysiology and management. Acute coronary syndromes have a common substrate, namely rupture or erosion of an atherosclerotic plaque leading to thrombus formation and distal embolization, which is responsible for microinfarction with release of myocardial proteins (enzymes and troponins). In the context of acute chest pain, two different presentations of acute coronary syndromes are distinguished on the basis of electrocardiographic findings, according to wether or not there exist persistent ST-segment elevation.

Relationship between spread of methicillin-resistant Staphylococcus aureus and antimicrobial use in a French university hospital.

The objective of our study was to determine whether antibiotic pressure in the units of a teaching hospital affects the acquisition of methicillin-resistant Staphylococcus aureus (MRSA), independently of the other collective risk factors previously shown to be involved (MRSA colonization pressure, type of hospitalization unit, and care workload). The average incidence of acquisition of MRSA during the 1-year study period was 0.31 cases per 1000 days of hospitalization, and the use of ineffective antimicrobials reached 504.

[Medical management of cervical arterial dissections].

Medical management of cervical arterial dissections is not standardized and has not been the subject of randomized trials. Management is mainly based on the presumed pathophysiology of secondary cerebral infarcts associated with dissections and the individual experience of each treating team. First, a review of the literature regarding medical management of acute and chronic dissections is presented.

[Treatment of rheumatoid arthritis by interleukin-1 receptor antagonist].

Purpose: Interleukin -1 receptor antagonist ( IL-1Ra ) is a new option among biotherapies against rheumatoid arthritis ( RA ).

The Aim: of this review is to recall the rationale of use of IL-1Ra and to analyse the results available in the current literature.

Current Knowledge And Key Points: Pathophysiological data of RA give a specific position for IL-1 as a potential target for immunotherapy in this disease, confirmed in animal models.

[Bacteremia caused by coagulase-negative staphylococci: incidence, frequency of teicoplanin resistance and molecular epidemiology].

All the patients hospitalised at Besançon Hospital between October 2000 and December 2000 were included in a prospective study in order to determine the incidence of bloodstream infections caused by coagulase-negative staphylococci (CNS), the prevalence of decreased susceptibility to glycopeptides and the molecular epidemiology of these pathogens. CNS isolates from bloodstream infections were collected and characterised by analysis of antibiotic susceptibility and restriction fragment length polymorphism using pulsed field gel electrophoresis. Forty-five episodes of CNS bacteremia occurred in 43 patients.

Characterization of methicillin-resistant Staphylococcus aureus strains susceptible to tobramycin.

Gentamicin-susceptible, methicillin-resistant, Stapylococcus aureus strains (GS-MRSA) emerged in 1992 in various Parisian hospitals and have subsequently been isolated from all French hospitals. This new GS-MRSA epidemic clone accounted for 50% of MRSA strains in 1996 and for 85% in 2000 in our hospital. We have observed a parallel increase in the prevalence of tobramycin and amikacin-susceptible GS-MRSA (TKS-MRSA).

Characterisation of coagulase-negative staphylococci isolated from blood infections: incidence, susceptibility to glycopeptides, and molecular epidemiology.

The purpose of this study was to determine incidence of coagulase-negative staphylococci (CNS) bacteraemia and to characterise the epidemiology of isolates with reduced susceptibility to glycopeptides. CNS isolates from bloodstream infections were collected and characterised by determination of the species, analysis of antibiotic susceptibility, and restriction fragment length polymorphism using pulsed-field gel electrophoresis. The medical records of patients with positive cultures and the trends in glycopeptide use were reviewed to determine the effect of previous antibiotic treatment on the susceptibility profile of these organisms.

Bacteraemia caused by coagulase-negative staphylococci exhibiting decreased susceptibility to teicoplanin.

The purpose of our study was to assess the prevalence of coagulase-negative staphylococci (CoNS) isolates with reduced susceptibility to glycopeptides among the isolates responsible for bloodstream infections and to describe the epidemiology of these isolates. CoNS isolates from bloodstream infections were collected and characterized by analysis of antibiotic susceptibility and restriction fragment length polymorphism using pulsed-field gel electrophoresis. The medical records of patients with positive cultures and trends in glycopeptide use were reviewed to determine the effect of previous antibiotic treatment on the susceptibility profile of these organisms.

[Isolated pontine infarction: vascular anatomy helps understand clinical signs].

Clinical findings of pontine infarcts are more frequently described as classical crossed-syndrome. The aim of this study was to analyse clinical presentation of isolated pontine infarcts. From the Besancon Stroke Registry, we retrospectively studied 34 patients with isolated pontine infarcts documented on MRI with a strict centro-bicommissural plane as the reference.

Pseudomonas aeruginosa: antibiotic susceptibility and genotypic characterization of strains isolated in the intensive care unit.

A prospective study was carried out to assess the incidence and the local antibiotic susceptibility of Pseudomonas aeruginosa in intensive care units (ICUs) and to characterize cross-transmission by using pulsed-field gel electrophoresis as an epidemiologic tool. For this purpose, we screened surveillance cultures and routine clinical cultures from patients admitted to two adult ICUs during a 2-year period. Antibiotic susceptibility was determined by a disk diffusion method.

[Risk factors and prevention of the acquisition and transmission of glycopeptide resistant enterococci].

We reviewed the literature concerning the role of antibiotic use as a risk factor for glycopeptide-resistant enterococci (VRE) infection/colonisation, to enable us to develop measures for preventing the acquisition and transmission of VRE. We found that the length of stay, the number of stays in hospital and the transfer of patients between hospitals and units were all risk factors for acquiring VRE infection. However, analysis of group and individual data showed that there was also a clear link between vancomycin and third-generation cephalosporin use and the prevalence of VRE colonisation/infection.

Small bowel obstruction secondary to phytobezoar CT findings.

A rare cause of small bowel obstruction due to a phytobezoar is reported. CT demonstrated an ovoid intraluminal mass with mottled gas pattern within the small bowel and intestinal obstruction signs. We believe that these CT findings are pathognomonic of this condition.

Preoperative chemotherapy for non-small cell lung cancer.

Surgery has been considered the standard of care in patients with early-stage non-small cell lung cancer (NSCLC), as well as in some cases of stage III, for a long time. Poor survival after complete resection has led to the search for new therapeutic strategies such as combining anticancer treatments. However, at the present time, attempts to combine chemotherapy and radiotherapy after surgery have failed to show any significant impact on survival among patients with completely resected NSCLC.

Antibiotic susceptibility and genotypic characterization of methicillin-resistant Staphylococcus aureus strains in eastern France.

We studied changes over four years in the characteristics of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated in a French university hospital by analysis of antibiotic susceptibility and restriction fragment length polymorphism using pulsed field gel electrophoresis. Changes were considered in relation to regional and national frameworks. The proportion of gentamicin-susceptible methicillin-resistant S.

Clinical and molecular epidemiology of chromosome-mediated resistance to third-generation cephalosporins in Enterobacter isolates in eastern France.

Objective: To determine both the prevalence of group I beta-lactamase-related resistance and the clinical setting in which resistance to expanded-spectrum cephalosporins occurs.

Methods: Isolates of Enterobacter spp. were sensitivity tested to a range of antibiotics, and selected isolates were DNA fingerprinted by pulsed-field gel electrophoresis.