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Yellow fever is a vector-borne disease transmitted by an endemic mosquito in sub-Saharan Africa and tropical South America. It causes fever and possibly liver and renal failure with hemorrhagic signs, which may be fatal. The yellow-fever vaccine is an attenuated vaccine that is recommended for all travelers over the age of 9 months in high-risk areas. Adverse effects have been reported: minor symptoms (such as viral syndrome), hypersensitivity reactions, and major symptoms such as viscerotropic disease (YEL-AVD) and neurotropic disease (YEL-AND). The yellow-fever vaccine-associated autoimmune disease with central nervous system involvement (such as acute disseminated encephalomyelitis) associates fever and headaches, neurologic dysfunction, seizures, cerebrospinal fluid (CSF) pleocytosis, and elevated protein, with neuroimaging consistent with multifocal areas of demyelization. The presence of antibodies or virus in CSF, within 1-30 days following vaccination, and the exclusion of other causes is necessary for diagnosis. We describe herein the case of a 4-year-old child who presented with severe encephalitis consecutive to a yellow-fever vaccine, with favorable progression. Diagnosis is based on the chronology of clinical and paraclinical signs and the presence of yellow-fever-specific antibodies in CSF. The treatment consists of symptomatic treatment and immunoglobulin injection.

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The CDKL5 gene has been implicated in the molecular etiology of early-onset intractable seizures with infantile spasms (IS), severe hypotonia and atypical Rett syndrome (RTT) features. So far, 48 deleterious alleles have been reported in the literature. We screened the CDKL5 gene in a cohort of 177 patients with early-onset seizures, including 30 men and 10 girls with Aicardi syndrome. The screening was negative for all men as well as for women with Aicardi syndrome, excluding the CDKL5 gene as a candidate for this neurodevelopmental disorder. We report 11 additional de novo mutations in CDKL5 in female patients. For the first time, the MLPA approach allowed the identification of a partial deletion encompassing the promoter and the first two exons of CDKL5. The 10-point mutations consist of five missenses (with recurrent amino acid changes at p.Ala40 and p.Arg178), four splicing variants and a 1-base pair duplication. We present a review of all mutated alleles published in the literature. In our study, the overall frequency of mutations in CDKL5 in women with early-onset seizures is around 8.6%, a result comparable with previous reports. Noteworthy, the CDKL5 mutation rate is high (28%) in women with early-onset seizures and IS.

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During a screening procedure for the discovery of a strong gamma-decalactone producer from ricinoleic acid, we observed that the yeast Pichia guilliermondii accumulated transiently 8-hydroxy-3Z,5Z-tetradecadienoic acid 1 during gamma-decalactone biosynthesis in the stationary phase of growth. The structural elucidation of 1 was based on nuclear magnetic resonance, infrared, ultraviolet and gas chromatography-mass spectrometry experiments. The occurrence of 1 is discussed in relation with previously proposed gamma-decalactone biosynthetic pathways.

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PURPOSE: Evaluate the clinical utility of procalcitonin (PCT) and C-reactive protein (CRP) as diagnostic of paraneoplastic fever. METHOD: A prospective analysis of serum levels of PCT and CRP has been conducted on 68 consecutive febrile patients with solid tumour and no neutropenia. The samples were collected at hospital admission. RESULTS: Out of 68 patients, 57 had head and neck cancer. Forty-three patients had signs of infection and 19 had paraneoplastic fever. CRP was not significantly different between the two groups (infected patients: median: 134 mg/L, extremes: 20-569; paraneoplastic fever patients: median: 154 mg/L, extremes: 26-267; P = 0.75 with Mann-Whitney test). On the other hand, PCT was significantly higher in case of infection (median: 0.44 ng/mL, extremes: 0.09-57.4) than in the case of paraneoplastic fever (median: 0.26 ng/mL, extremes: 0.05-1.17; P = 0.01 with Mann-Whitney test). CONCLUSION: In our study, no paraneoplastic fever patient had PCT level equal or above 2 ng/mL (negative predictive value of 100%).

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PURPOSE: Malignant gliomas display aggressive local behavior and are not cured by existing therapy. Etoposide, a topoisomerase-II-inhibitor agent, is one of the most active and useful antineoplastic agents. However, etoposide is not usually used on these tumors. We undertook an in vitro study to prove that etoposide is a useful drug for malignant gliomas. METHODS: Five human glioma cell lines were the basis for this study. Following exposure to various concentrations of etoposide, the glioma cell lines were found to be sensitive; the median concentration inhibiting the number of cells by 50% (IC50) was 8.76 microg/ml (range 8-15.8 microg/ml). Since topoisomerase II is the critical target for etoposide, it was of interest to determine the topoisomerase II activity (decatenation of kinetoplast DNA isolated from Cryphtidia fasciculata) and the etoposide-induced inhibition of topoisomerase II activity. RESULTS: The topoisomerase II activity was homogeneous in glioma cell lines (average of 50% decatenation with 7,000 cells), and topoisomerase II was the target of the etoposide. CONCLUSIONS: Our results suggest that topoiomerase II-reactive agents may prove to be clinically useful drugs for patients with malignant gliomas.

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Ifosfamide is one of the most efficient antimitotic in soft tissue sarcoma. To try to find a possible dose-effect, 10 patients with advanced pretraited relapsed soft tissue sarcoma received 15 g/m2/cycle ifosfamide in continuous infusion during 5 days. A pharmacokinetic study was done for 2 patients. All patients received growth factors, ondansetron and 8 clonazepam. Renal toxicity was evaluated after the first and the second cycle. Twenty two cycles were delivered to patients who have been already treated with ifosfamid (10 patients with 15 g/m2 to 54 g/m2, median 27 g/m2) or cis platinum (2 patients). No major renal or neurologic toxicity was observed; only subclinical modifications of urinary enzymes excretion were found. Two patients had visual hallucinations at the end of a cycle and just in the 2 following days; another presented a neuropathy of inferior limbs. Hematological toxicity was very limited. Pharmacokinetic study did not show induction mechanism at this dosage and with this type of administration. So ifosfamide 3 g/m2 during 5 days is feasible. The few level of complications observed is perhaps linked to the daily dose of 3 g/m2 instead of 4 g/m2 or more used in the other studies.

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Among high density lipoprotein particles, LpAI particles which contain apolipoprotein A1 alone, appear to be involved in cholesterol transport from peripheral tissues to the liver. The aim of this cross-sectional study was to examine serum LpAI particle concentrations in Type 1 and Type 2 diabetic patients with renal lesions of differing grades, in comparison with normal controls and with nondiabetic patients presenting with chronic renal failure. LpAI concentrations and LpAI-to-apo A1 ratios were increased in Type 1 diabetic patients with normal albumin excretion. In Type 1 and in Type 2 diabetic patients with increased urinary albumin excretion, LpAI concentrations and LpAI-to-apo A1 ratios were found to be not different from those of normal controls. In diabetic and in nondiabetic patients with chronic renal failure, LpAI concentrations were decreased. These abnormalities may contribute to the development of macrovascular complications.

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This preliminary study was conducted to identify a facet joint syndrome in low back pain. Ninety maneuvers and symptoms were compared between patients relieved (responders) and those unrelieved (nonresponders) after intraarticular blocks. Fifty-one patients participated in the study; 11 were excluded from evaluation because of unsuccessful injection into the joints as planned. Of the 40 patients included, 20 had four joints anesthetized, 16 had two joints anesthetized, and four had three joints anesthetized. Twenty-two were responders, 17 of whom had more than 90% relief of pain. Only a few variables were more frequent in the responder group: older age, absence of exacerbation by coughing, relief when recumbent, absence of exacerbation by forward flexion and when raising from this flexion, absence of worsening by hyperextension, and extension-rotation. When four of these seven variables were present in the same patient, sensitivity was 81.8% and specificity 77.8%, but this discriminant power must be evaluated in a new population.

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OBJECTIVE: To examine the distribution of Lp(a) plasma levels in patients with IDDM and NIDDM, and in nondiabetic and IDDM patients with chronic renal failure. RESEARCH DESIGN AND METHODS: Cross-sectional study of Lp(a) plasma levels in a population of diabetic patients with stable metabolic control, with simultaneous determination of plasma lipids, fasting plasma glucose, and HbA1. Thirty-six patients with IDDM, 90 with NIDDM, and 41 with chronic renal failure (20 IDDM, 21 nondiabetic) were compared with 78 control subjects. RESULTS: Lp(a) plasma levels were significantly higher in IDDM and NIDDM patients, as well as in nondiabetic and IDDM patients with chronic renal failure compared with control subjects. No correlation was observed between Lp(a) and lipid plasma levels, fasting plasma glucose, and HbA1. CONCLUSIONS: Lp(a) may contribute to the increased prevalence of atherosclerotic disease in diabetic patients and patients with chronic renal failure, especially in IDDM patients whose lipoprotein pattern was not different from that of the control group.

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INTRODUCTION: This work has been carried out to investigate in an animal model, the possibility of surgical selective reinnervation of the larynx following destruction of the laryngeal branch of the vagus nerve. MATERIAL AND METHODS: In ten dogs, on the right side of the neck only, the recurrent laryngeal nerve was identified, cut and section of the nerve removed. Following this the hemi-larynx on the operated side was reinnervated in the following manner. Using a microsurgical suture (described in the text) the motor nerves from extra-laryngeal muscles were anastomosed onto the nerves supplying the intrinsic abductors and adductors of the larynx. The nerve to sterno-thyroid was anastomosed onto the nerve supplying the posterior crico-arytenoid muscle (vocal cord abductor). Similarly the nerve supplying thyrohyoid was anastomosed onto the cut distal end of the adductor division of the recurrent laryngeal nerve. Clinical, electromyographical and histological evaluations have been used to prove the reinnervation. RESULTS: In the nine surviving animals successful re-innervations, as defined by the return of normal function, has been achieved for posterior crico-arytenoid and 7 adductor muscles. CONCLUSION: This study has demonstrated the feasibility of laryngeal reinnervation after surgical section of the recurrent laryngeal nerve, and give some cause for optimism for its ultimate application in man.

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Always frequent and often misleading, chronic sinusitis are multifactorial. Consequently, the role of teeth apical infection is largely underestimated. The difficulties of interpretation of the sinus radiographic imaging are well established, particularly in the study of the dental with sinus border. The clinical circumstances in which the responsibility of teeth can be involved, are studied. Diagnosis insufficiency are frequent, and inadequate procedures can be undertaken. The particular conditions to obtain good polycyclicidal tomographs pictures are described and demonstrated. In special cases, with the eventual contribution of the bacterial-sensitivity evaluation, these sinusal-dental tomographs allow a relevant diagnosis.

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It would appear that pre-operative radiotherapy early in the treatment of oesophageal cancer has avoided in many cases (especially those in an advanced stage), the appearance of local recurrences, which cause death very rapidly during the first year in those patients having surgical treatment only. This treatment, however, which is only localized to the mediastinum, has not prevented the appearance of metastases at a later date. It is obvious, therefore, that though we have improved local prognosis by localized and regional treatment, and the association of radiotherapy and surgery, we have not been able to act on the residual cancerous disease, and something else is needed. This "something else" must be chemotherapy, but at the present time we do not know which product, at which dose, and at which moment, this chemotherapy should be applied to be most effective.

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The artificial stimulation of biological purification of sea-pollutant hydrocarbons requires phosphorus supply. The concentrations, corresponding to the optimal bacterial growth, depend, in particular on ionic strength. They range between 2 and 8 X 10(-4) M for waters in which the salinity is close to the mean salinity of an oceanic environment and between 1.5 and 3 X 10(-3) M when these waters receive a significant supply of freshwater or when salinity is naturally weak. Inhibition of bacterial development has been observed either with a microflora, or with pure strains for concentrations higher than the upper limits of concentrations so defined.

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Using mineral media with gas oil as sole carbon source, 191 bacterial strains were isolated from the costal area of Marseille. These strains were attributed to Achromobacter, Alcaligenes, Pseudomonas, Acinetobacter and Arthrobacter genera. Amongst isolated strains there was a predominance of the Alcaligenes-Achromobacter group over others genera. Growth and respiratory activity of 5 strains were studied on hexadecane and acetate. Respiratory activity on hexadecane of 32 strains cultured on acetate has been measured. These strains could be placed in two groups. The group 1 shows an immediate respiratory activity which is not abolished by chloramphenicol. The group 2 presents either an immediate or a delayed respiratory activity which is always abolished by chloramphenicol. Maintenance or suppression of respiration by chloramphenicol is a character which is homogenously distributed amongst the species.

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