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We report here a case of primitive plasma cell leukemia with immunoglobulin (Ig) E. IgE myeloma is an exceptional variant of multiple myeloma, with a very poor prognosis. Its biological diagnosis requires specific analyzes in order to detect IgE gammopathy. Plasma cell leukemia (PCL) is also a very rare and very severe form of multiple myeloma. There are two variants: primitive PCL (pPCL) occurring de novo and secondary PCL (sPCL), evolution of a preexisting myeloma. Its diagnosis is essentially biological since it is defined by a blood plasmocytosis greater than 2 G/L or 20% of the leucocytes.

The newly developed, high throughput, Vitros 3600 immunoassay system associates different technologies on board: MicroWell (analytes immunocapture), MicroSensor (visible interference analysis), and Intellicheck (real time process control for analytical error detection). During a three months period, Vitros 3600 system, ease of use, practicability and MicroSensor technology efficiency have been tested using the following assays: betaHCG, troponin, ferritin, aHBcT, HBsAg, aHCV, AFP and CEA. Within-day and within-batch, between-calibration precisions are acceptable. Overall assay correlations versus the methods in use in our laboratory are good, despite small numerical differences that never affect clinical interpretation of the results. We have appreciated the system reliability, reinforced by the ease of use (simple software, on-board VDocs, continuous access to reagent and sample loading, reagent stability, very low noise (60 dB)), the quality of the results, MicroSensor and Intellicheck technologies efficiency, the short maintenance time and its traceability, and the very low liquid waste volume (5 L of liquid waste for 1600 tests). In conclusion and considering its practicability, the Vitros 3600 system is fully validated and well suited for our laboratory.

Between April and October 1997, 21 children of 4 days to 13 years old were admitted to the Pedatric Unit of Aulnay Sous Bois's Hospital for viral meningitidis. The number of white blood cells in the cerebrospinal fluid (CSF) was between 1 and 612 cells/mm3, with, on an average, 56% of segmented cells, 34% lymphocytes and 34% monocytes. Proteins and glucose of CSF were standard. One CSF was normal. Viral meningitidis was confirmed by viral culture of CSF onto MRC5. Enterovirus were identified by direct immunofluorescence (Monoclonal Mouse Anti-Enterovirus, Dako). Serotyping (Enterovirus antisera, Eurobio, Trousses 4) identified an echovirus 30 in all cases. A highly conserved 154 bp sequence at the 5'non-coding region was studied by reverse transcription-polymerase chain reaction (RT-PCR) followed by single-strand conformation polymorphism (SSCP) (GenPhor, Pharmacia) analysis. Two dominant SSCP patterns were observed: the first contained 4/21 strains and the other 10/21 strains. The SSCP patterns of the 7 other strains were different. These results show that 2 echovirus 30 dominant clones were responsible of viral meningitidis admitted to the Pediatric Unit of Aulnay Sous Bois's hospital, between april and october 1997. The PCR-SSCP of the 5'non-coding region of echovirus 30 is a convenient, simple, reproducible epidemiologic method and it's easily applicable in a general hospital.

We report a new case of idiopathic hypereosinophilic syndrome with multivisceral digestive failure. After an erroneous diagnosis of pancreatic cancer, the pathological examination of pancreaticoduodenectomy specimen demonstrated pancreatic fibrosis with eosinophilic infiltration without gastritis or duodenitis. The diagnosis of idiopathic hypereosinophilic syndrome was made three months later upon the classical criteria: a) blood eosinophilia of 1.5 G/L or more, persisting for more than 6 months; b) lack of evidence for any other recognised cause of eosinophilia: c) multiple organ systemic involvement: rheumatologic, cutaneous and digestive (pancreatitis, ascites and diarrhoea): d) previous history of allergic disease and increased plasmatic IgE levels; e) absence of leukemic markers. This case emphasises the difficulty in classifying eosinophilic infiltration of the gut and the possibility of transitional forms between eosinophilic gastro-enteritis and idiopathic hypereosinophilic syndrome. We argue that in case of eosinophilic infiltration of the gut, systematic research of multiple organ systemic involvement is mandatory.

Objective: Prospectively evaluate the effect of cordocentesis on the umbilical, fetal cerebral and aortic circulation., Method: Fetal blood was sampled for diagnostic purposes in 21 pregnant women at 21 to 38 weeks gestation. Ten patients undergoing amniocentesis served as controls. The resistance index (RI) in the umbilical and middle cerebral arteries and the mean blood velocity (Vm) in the descending aorta were measured with pulsed Doppler before and after blood sampling. Variations in umbilical and cerebral RI and in aortic Vm were recorded., Results: There was a significant drop in both umbilical RI (mean +/- SD = -0.049 +/- 0.078; p = 0.009) and middle cerebral RI (-0.077 +/- 0.058; p < 0.0001) after cordocentesis. The drop in umbilical RI was greater when the second Doppler measurement was made early, when the blood was sampled transplacentally and in early gestational age. Reduction in fetal cerebral artery RI was also greater for transplacental puncture. The fetal descending aorta Vm did not change significantly after blood sampling. There were no variations in Doppler index before and after amniocentesis., Conclusions: Changes in blood flow velocity waveforms as measured by pulsed Doppler in the umbilical and fetal cerebral arteries can be induced by fetal blood sampling. Decreased resistance in the placenta and fetal circulation would imply release of nitric oxide.

A retrospective study on 202 consecutive patients with HIV infection was reviewed. A particular syndrome with blood CD8 lymphocytosis > 1 500/mm3, associated with a diffuse lymphocytic infiltrate histologically proved in the tissue of different organs was present in five patients. Clinical findings were variable, depending on the location of visceral infiltrate by activated, polyclonal lymphocytes of CD8 phenotype: interstitial pneumonia (n = 3), parotid gland enlargement with sicca syndrome (n = 2), pseudo-tumoral splenomegaly (n = 1), peripheral neuropathy (n = 1), superficial generalized lymphadenopathy (n = 5). This syndrome occurred early during HIV infection. All patients had a blood CD4 lymphocyte count > 200/mm3. This disorder is a host immune response, sometimes associated with the presence of some HLA antigens: HLA-DR5 or HLA A1 B8 DR3. Whether this immune response is specific or not, whether outcome of HIV infection depends on hyper CD8 lymphocytosis remains to be proved.

During a ten month period (march-december 1989), all streptococcal strains isolated from clinical specimens sent to our laboratory were routinely tested for high-level resistance to aminoglycosides. High-level resistance was detected in 16 out of 475 streptococci: streptomycin (two strains), kanamycin (four strains), streptomycin and kanamycin (ten strains).

Automated differential counting systems deprive laboratories of blood smear study and so malaria risks not to be diagnosed if plasmodium search is not prescribed by the physician. Some abnormalities (atypical lymphocytes called LUC and thrombopenia) can induce a blood smear. But a study of 96 patients shows that, during the first analysis, these abnormalities can miss for nearly a third of one's case. So it is very important to prescribe malaria search on blood smears when there is the least clinical symptom.

The cutaneous leishmaniasis is rampant in an endemo -epidemic way in the region of Thiès, Senegal. At the occasion of an epidemic observed between 1975 and 1978, the ecological study of the focus of Keur Moussa , led by Dedet and al., permitted to discover, for the first time in West Africa, the structure of a cutaneous leishmaniasis focus. The most important part of the present laboratory work consists in the observation of that wild anthropozoonosis due to Leishmania tropica major, having as vector Phlebotomus duboscqi and the rodents Mastomys erythroleucus , Tatera gambiana and Arvicanthis niloticus as reservoir. The close study of the reservoir populations and of the vectors should enable us to avoid a new epidemic outburst.