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OBJECTIVE:Midstream clean-catch urine is an accepted method to diagnose urinary tract infection but is impracticable in infants before potty training. We tested the bladder stimulation technique to obtain a clean-catch urine sample in infants. MATERIALS AND METHODS:We included 142 infants under walking age who required a urine sample in a cross-sectional study carried out during a 3-months period, from September to November 2014, in the emergency department of the University Children's Hospital of Nice (France). A technique based on bladder stimulation and lumbar stimulation maneuvers, with at least two attempts, was tested by four trained physicians. The success rate and time to obtain urine sample within 3 minutes were evaluated. Discomfort (EVENDOL score ≥4/15) was measured. We estimated the risk factors in the failure of the technique. Chi-square test or Fisher's exact test were used to compare frequencies. T-test and Wilcoxon test were used to compare quantitative data according to the normality of the distribution. Risk factors for failure of the technique were evaluated using a multivariate logistic regression model. RESULTS:We obtained midstream clean-catch urine in 55.6% of infants with a median time of 52.0 s (10.0; 110.0). The success rate decreased with age from 88.9% (newborn) to 28.6% (>1 y) (p = 0.0001) and with weight, from 85.7% (10 kg) (p = 0.0004). The success rate was 60.8% for infants without discomfort (p

As seventy-five percent of patients with ovarian cancer are diagnosed at an advanced stage (FIGO stage III/IV), optimal surgery is then difficult to perform. The aim of our study is to assess the interest of thoracoscopy in the management of ovarian carcinoma with pleural effusion.

Endometrial cancer is a tumor associated with a good prognosis as it is often diagnosed at an early stage. Up to 20 % of patients with stage I disease have a nodal involvement. Knowledge of nodal status provides important prognostic information. As preoperative assessment yields a poor value, prognostic lymphadenectomy appears to be indicated. However, therapeutic benefit of pelvic and para-aortic lymphadenectomy remains controversial. Recent randomized trials did not find any impact on survival for patients with low risk of nodal involvement. Thus, lymphadenectomy should no more be systematically performed in this low risk group. Nevertheless, pelvic and para-aortic lymphadenectomy seems to have a benefit in the high risk group, as isolated involved para-aortic nodes have been described.

In the French standard treatment of ovarian cancer in 2007, interval debulcking surgery is an option. The standard treatment is always upfront debulcking surgery when no macroscopic residu is possible. In the recent EORTC randomized study, there was no significative difference between upfront debulcking surgery and interval debulcking surgery after neo-adjuvant chemotherapy. In this paper, we have discussed about the first treatment of ovarian cancer.

Two unusual but similar cases of very high serum iron, extremely high transferrin concentrations (5.4 to 6.5 g/L), and increased transferrin saturation are reported. No anemia or microcytosis was observed. The ferritin concentration remained within the normal range, and no iron overload was observed. In one case, the in vivo half-life of 59Fe-labeled transferrin was shown to be prolonged (206 minutes versus 75 minutes for controls). In both patients, a monoclonal IgG was observed in the serum. The association between serum transferrin and monoclonal IgG was demonstrated by Western blot analysis and affinity chromatography. We suggest that the transferrin bound to the monoclonal IgG molecule has a prolonged half-life in the circulation, leading to high transferrin concentrations, and that the increased serum iron values prevent the onset of anemia. The antitransferrin activity of monoclonal antibody should be added to the list of situations accounting for elevated serum iron with elevated transferrin saturation.

Supraaortic angioplasty is often not feasible in patients with Takayasu's arteritis because of involvement of long segment of arteries. Consequently, the role of surgical treatment in the management of cerebral ischemia is important in this disease. The objective of this work is to specify the indications and surgical techniques in lesions of arteries to the head in this disease and to report our experience.Seven patients with cervical arterial lesions due to Takayasu's arteritis were treated by bypass surgery in the department of vascular surgery, Ibn-Sina hospital on one period of 11 years.It is about 6 women and one man of middle age at the time of the diagnosis of 33,8 years. The revealing signs were essentially of neurological and ocular order. Six of our patients were in inflammatory thrust at the time of the diagnosis, and required a medical treatment first to basis of corticosteroids. Bypasses from the ascending aorta to the carotid artery were performed in six cases. In one case, the bypass was performed between the brachiocephalic artery and common carotid artery. A death in relation with a cerebral hemorrhage occurred 2 days after the revascularisation. A clean improvement of the functional signs was noted among 3 patients, whereas the improvement was partial at two other. A secondary thrombosis of the bypass surgery occurred in 3 cases.The natural history of Takayasu's arteritis and its evolution is badly known. The operative indications must not rest solely on the only anatomical balance, but based on a bundle of arguments in which, the assessment of the cerebral blood flow would be useful. Cerebral hyperperfusion syndrom constitutes a major risk that can be reduced by staged revascularisations.

Objective—To develop a technique for use in investigation of healing of long-bone defects by creation of a critical-size defect in the left metarsal III and IV bone (metatarsus) of sheep. Animals—18 healthy adult sheep. Procedure—Sheep were allocated to 4 groups (3, 3, 5, and 7 sheep in groups 1 to 4, respectively). An ostectomy with various segmental length-to-diaphyseal diameter ratios (0.5, 1.0, 2.0, and 2.0 for groups 1 to 4, respectively) was performed on the left metatarsus of each sheep. The defect was left empty in sheep of groups 1, 2, and 3, whereas the defect was filled with a massive corticocancellous bone autograft in sheep of group 4. Results—All sheep tolerated the surgical procedure well and were able to use the affected limb the day after surgery. Radiographic and histologic examinations conducted 16 weeks after surgery revealed nonunion in all sheep of groups 1, 2, and 3, whereas consistent bone healing with abundant bone formation was observed in all sheep of group 4. Conclusions and Clinical Relevance—Analysis of these findings suggests that the sheep metatarsal model is a critical-size defect model with low morbidity. It should allow the assessment of new technologies for bone regeneration in conditions closely mimicking the clinical setting. Impact for Human Medicine—Use of this technique in sheep should be of benefit for the preclinical study of osteoconductive, osteoinductive, or osteogenic biomaterials for use in humans. (Am J Vet Res 2004;65:1653–1657)

One hundred and twenty-seven Brahman cattle from several locations in Martinique (FWI), reared under different environmental conditions, were followed over three years and checked for clinical signs of dermatophilosis. To confirm that these animals had been in contact with the pathogen Dermatophilus congolensis, their sera were tested by ELISA. On the basis of this epidemiological study, 12 animals were classified as resistant (seropositive without clinical signs), belonging to herds in which the prevalence of the disease ranged from 25 to nearly 98%. Eighteen animals classified as highly susceptible displayed severe characteristic skin lesions. These 30 selected animals were typed for class I antigens of the major histocompatibility complex (MHC). MHC class II genes were analyzed using the polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) techniques, on the exon 2 of the bovine leucocyte antigen (BoLA) DRB3 gene. Several alleles were found, according to patterns provided by the restriction enzymes used: Fnu 4HI, Dpn II, Hae III, and Rsa I. A particular sequence "EIAY" at amino acid positions 66/67/74/78 located in the antigen recognition sites (ARS) was found in the 12 animals classified as resistant, and 10 of them displayed also class I BoLA-A8 specificity. On the other hand, only 3 out of the 18 susceptible animals showed simultaneously the BoLA-DRB3 "EIAY" sequence and BoLA-A8 specificity. Interestingly, a serine residue at position 30 of the ARS was found in 8 of the susceptible animals and was completely absent from all resistant animals. Furthermore, in a same animal, the serine at position 30 and the EIAY sequence were never found simultaneously on the same haplotype. These results show a strong correlation between the resistant character to dermatophilosis and the association of MHC haplotypes: the BoLA-A8 specificity and the BoLA-DRB3 "EIAY" sequence at ARS positions 66/67/74/78 with the lack of serine in position 30. To confirm these results, family segregation studies are in progress and some interesting observations have been obtained.

Arterial complications of hydatic disease are rarely encountered. We report a false hydatic aneurysm of the thoracoabdominal aorta revealed by ischemic embolism of the lower limbs. Surgical treatment included aorto-aortic prosthesis and albendazol for 6 months. Results at 18 months are excellent with negative hydatic serology. In endemic areas, hydatic disease is a possible cause of false aneurysms. Long-term surveillance is required after curative surgery and medical treatment.

An open multicentre study, performed in 340 overweight (body mass index: BMIor = 25), hypertensive (95 mmHgor = DBP115 mmHg) patients, evaluated the clinical and metabolic safety of trandolapril and confirmed its antihypertensive activity. After a two-week washout period, the patients received trandolapril 2 mg as a single morning dose for 12 weeks. Doubling of the dosage was authorized after the first four weeks when the DBP remained higher than 90 mmHg with a fall in DBP10 mmHg. Of the 287 patients who completed the study, 15.1% had to receive a double dose of trndolapril during the second treatment period. After four weeks of treatment, SBP was decreased by 18.6 mmHg, DBP was decreased by 13.4 mmHg and 63.1% of patients were controlled. After three months of treatment, SBP was decreased by 23.3 mmHg, DBP was decreased by 16.8 mmHg and 84.7% of patients were controlled. Subgroup analysis, according to the BMI (BMIor = or30), showed that the fall in blood pressure was identical regardless of the BMI; the proportion of patients treated with a double dose of trandolapril was also independent of the BMI. A second subgroup analysis, according to the waist/hips ratio, did not reveal any difference according to the android or gynoid profile of excess weight. Twelve patients (3.9%) dropped out of the trial because of adverse events, 10 of which were attributable to treatment; 6.5% of patients reported an adverse effect attributable to treatment. Laboratory assays performed before and after three months of treatment demonstrated the very good metabolic safety profile of trandolapril, in view of the slight but significant reduction of total cholesterol, triglycerides and blood glucose. However, an average weight loss of one kilogram was reported. The global safety was considered to be good or excellent by the investigators in 94.8% of cases.

Langerhans' histiocytosis is a proliferation of atypical Langerhans cells which may affect several different organs. Two women had lesions of the vulva which led to the diagnosis. Vulvular involvement is the most frequent in gynaecological localization of Langerhans' histiocytosis. Pathological and immunohistochemical tests confirm the diagnosis.

We have previously shown that basic fibroblast growth factor (bFGF) inhibits the FSH-induced differentiation of cultured rat granulosa cells, as manifested by prominent reduction of the LH receptor expression. We now investigate the possible sites and mechanism of action of bFGF. Whereas bFGF decreased the cAMP formation induced by FSH, it enhanced the cAMP production caused by cholera toxin and forskolin, suggesting that bFGF exerted its inhibitory action on cell differentiation at a step to cAMP production. Photoaffinity labeling with 8-azido-[32P]cAMP revealed that bFGF markedly reduced the FSH-induced increase in the level of regulatory subunit RII beta of the cAMP-dependent protein kinase (PKA) type II. In contrast to its striking effect on RII beta expression (70-80% inhibition), bFGF decreased PKA enzymatic activity by only 30%. On the other hand, transforming growth factor-beta (TGF beta) slightly amplified the stimulatory action of FSH and antagonized the bFGF inhibitory effect on both LH receptor expression and RII beta synthesis. We report that the protein kinase C (PKC) activator 12-O-tetradecanoylphorbol-13-acetate (TPA), which impaired granulosa cell differentiation, also abolished the RII beta synthesis induced by FSH. The activation of PKC by bFGF in granulosa cells was supported by the following findings: (i) bFGF markedly enhanced the production of diacylglycerol (2.3-fold stimulation at 5 min), the intracellular activator of PKC; (ii) bFGF promoted tight association of PKC to cellular membranes, a process that is believed to correlate with the enzyme activation; (iii) bFGF induced the phosphorylation of an endogenous M(r) 78,000/pI 4.7 protein that appears as a specific PKC substrate; (iv) bFGF mimicked the TPA-induced transmodulation of the epidermal growth factor (EGF) receptor, reducing by 36% the 125I-EGF binding on granulosa cells. We conclude that bFGF may exert its repressive action on RII beta synthesis, PKA activity, and granulosa cell differentiation by primarily targeting PKC activation.

Mitral valve prolapse should be considered a benign condition as there are few complications. The natural history is not significantly different to that of a matched control population. There are potentially severe forms of the condition which are mainly observed in specialised centres and this introduces a bias in patient selection when compared with the general population. These forms are relatively rare in clinical practice and can be easily identified by simple echocardiographic criteria of valvular thickness. In any case, patients with mitral valve prolapse should be reassured in order not to create or unduly increase anxiety which in itself may cause incapacity.

Impairment of the left ventricular ejection induced by a mitral prosthesis remains an infrequent complication, perhaps because it often is unrecognized. This complication would mainly be seen with ball prostheses or standard bioprosthesis used in mitral valve replacements with a small ventricle. Two cases have been recently reported during mitral valve replacement. The two patients were successfully re-operated upon, one after five weeks and the second immediately after the first procedure. A review of the literature enable to specify the etiology and diagnostic criteria with the assistance of Doppler-sonocardiography. Early re-operation may prevent death, often due to a post-operative myocardial dysfunction.

Left ventricular ejection impediment is one of the complications of mitral valve replacement, especially in case of isolated mitral stenosis with small left ventricle. The use of a "low profile" valve does not prevent this complication. The diagnosis is based on catheterization but the advent of the ultrasound-Doppler may make it easier.