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Objective: To determine the carriage rate of Streptococcus agalactiae in a group of pregnant women and evaluate its role in a neonatal infections., Design: Prospective study between December 1992 and May 1993., Setting: University hospital., Participants: 166 patients aged 17 to 41 years (m = 28 yrs) with a gestational age of 32 to 42 wks (m = 39.99 +/- 1.73) were admitted to the delivery suite. All patients had a vaginal swab on admission before any lavage., Results: The recovery rate of Streptococcus agalactiae (group B) was found to be 7.8% (13/166) in our population. Twelve of the thirteen newborn to colonized mothers (92%) were term newborn as compared to 141 of 153 (92.1%) newborn to non-colonized mothers (p = 0.72). Three of thirteen (23%) colonized mothers had premature rupture of membranes and 23% (3/13) had prolonged labor > 12 h as compared to of 38 (25.1%) and 8 (5.1%) non-colonized mothers (respectively p = 0.58; NS; p = 0.035). No intra-partum fever was reported. All neonates born to colonized mothers had a birth weight > 2,800 g, an average Apgar score of 8.6 while neonates of non-colonized women had a weight > 2,800 g in 89.4% of cases and an average Apgar of 8.8 (p = 0.9). Two (15.4%) newborn infants born to colonized mothers had an early neonatal infection: one had a pneumonia and had a favorable outcome, the other one developed sepsis and meningitis and died on day 3., Conclusion: Despite the low rate of Streptococcus agalactiae (group B) colonization (found in our population), regular identification of the organism is recommended because of the high risk of neonatal infection with a high mortality. Further studies on a larger group are needed to confirm such an approach.

1000 patients with myocardial infarction between 1975 and june 1991 were admitted in the cardiac unit at the university hospital in Sfax. The mean age is 60 years, with a masculine predominance (86%). The time between, onset admission is long, 47.4% were admitted within 24 h after onset and 16.5% within 6 h after onset. The site of MI was more often in anterior region (58.6%) against 36% in the posterior region. Evolution was favorable in 34.7% of cases, 36.5% cases of left cardiac failure were noted, and 11.7% of cardiogenic shock rhythm disorders were noted in 34.6% of cases (under estimated) and conduction disorders were noted in 22% of cases. Early mortality is about 17.4% occurring more often during the first 3 days.

We have investigated the influence of long term oral anticoagulants (OAC) upon the plasma levels of prothrombin fragment 1 + 2 (F1 + 2), of thrombin-antithrombin III complexes (TAT) and of D-Dimer in 20 patients affected by a proximal deep vein thrombosis (DVT) diagnosed by ultrasonic duplex scanning. Patients (63 +/- 17 years, mean +/- SD) were sampled at the beginning of the OAC treatment (day 1), which was started 1 to 6 days after diagnosis confirmation and full heparinization, and then 8, 35 and 92 days after. The results were compared to those obtained in a blood donor population (39 +/- 10 years) and to an age-matched healthy population (63 +/- 19 years). The mean INR determined on days 8, 35 and 92 were almost identical (2.8 +/- 0.7, 2.9 +/- 0.9 and 2.8 +/- 0.6 respectively). In contrast, highly significant variations of the three markers were recorded during the observation period. Eight days after the beginning of OAC, increased levels of TAT complexes were associated with subnormal levels of F1 + 2 suggesting persistence of a hypercoagulable state. On the further sampling times, TAT complexes were in the normal range while F1 + 2 were far below the normal range. Between day 1 and day 92, the levels of D-Dimer continuously decreased reflecting a long-term fibrinolytic process. This study clearly indicates that high INR are not systematically associated with very low F1 + 2 levels, particularly in the acute phase of thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)

1. The effect of perfusion at pH 5.5 of a Heidenhain pouch on acid and pepsin secretion was studied in cats and rabbits. 2. In basal conditions, acid secretion was not modified by the perfusion while pepsin secretion was increased in both species. 3. After a meal, the perfusion did not modify the stimulation of acid secretion in cats nor the absence of secretions in rabbit. Stimulation of pepsin secretion was the same with or without perfusion in both species. 4. In rabbit, in contrast to cat, pepsin and acid secretions were independent during the meal-induced phase of gastric secretion.

Acid, pepsin and lipase secretions were simultaneously studied in awake rabbits with a Heidenhain pouch during cholinergic (carbamylcholine 20 micrograms.kg-1 x h-1) or maximal pentagastrin stimulation (64 mu.kg-1 x h-1). To avoid lipase inactivation by low pH, the pouch was perfused at a constant pH, with a solution irrigating the pouch without inducing any pressure. Acid and pepsin outputs were equally activated by both stimulants. Lipase output was stimulated much more by pentagastrin (x26) than by carbamylcholine (x6). The maximal lipase output preceded that of acid output. Lipase concentration increased in the gastric juice whereas pepsin concentration remained constant. A negative correlation was calculated between acid and lipase or pepsin and lipase output. A positive correlation was obtained between acid and pepsin. Our data show that pepsin and lipase secretions which come from distinct chief cells, in the rabbit, responded to the same stimulants but with quantitative and timing differences.

The kinetics of the gastric secretion of lipase, pepsin and acid were studied after a meal in Heidenhain-pouch rabbits. After a 24-h fast, feeding immediately stimulated (< 15 min) lipase (x 4.1) and later on pepsin (x 1.8) output which reached respectively 16 and 47% of the output observed after pentagastrin stimulation (64 micrograms.kg-1.h-1 for 1 h), and which were significantly correlated. Lipase concentration was enhanced earlier and to a greater degree (x 7.3) than pepsin concentration (x 2.5). No stimulation of high basal acid secretion occurred. It was concluded that: 1) gastric lipase secretion is stimulated by feeding in the rabbit; 2) pepsin secretion is stimulated by feeding. The modalities of the secretion of lipase and pepsin are compatible with the existence of distinct secretory cells; 3) acid secretion is not stimulated by feeding. The decrease in acid secretion during the post-prandial phase favors a physiological role for lipase which is altered by low pH. The absence of acid stimulation by feeding in the rabbit, in contrast to other species, requires additional studies on the release of gastrointestinal hormones, namely gastrin, cholecystokinin and somatostatin.

During a 30 months period, 70 patients (60-84 years old) underwent a renal artery angiographic investigation, either by combined intravenous angiography and pyelography, either by intravenous or intra-arterial digital angiography. Thirty-nine were males, 31 were females. All patients were hypertensive. Thirty-three had a normal renal function and 37 had a renal insufficiency arbitrarily definite as creatinine clearance lower than 60 ml/min (m = 33 +/- 15 ml/min). Eight aortic anevrysms were discovered. Thirteen patients (18.6%) had atherosclerotic renovascular disease. Criteria which led to undertake these investigations and results are listed in the following table. [table; see text] Transluminal percutaneous angioplasty and surgical treatment were performed 7 and 3 times respectively. In one case, nephrectomy was done. In all these patients but one, improvement of hypertension and/or renal function occurred. In patients with renal impairment, difference in size between the two kidneys detected by echography or plain abdominal X-rays were noted in 8 among the 9 patients with renovascular disease; six among them had proteinuria less than 0.5 g/day. In conclusion, in hypertensive patients older than 60, criteria for detection of renovascular disease are the same as in younger patients. When renal function is decreased, difference in size between the two kidneys requires an angiographic evaluation. Proteinuria does not exclude renovascular pathology.

The authors report the case of a 22 year old patient with brucella endocarditis on a Starr-Edwards aortic valve prosthesis implanted 5 years previously. Six blood cultures were positive for Brucella melitensis biovar I. Antibiotic therapy associating Rifampicin and Tetracycline and then Rifampicin and Ofloxacine did not prevent abscess formation and valve dehiscence. The poor haemodynamic status and persistent infection led to replacement of the valve prosthesis. Culture of the infected prosthesis grew a colony of brucella melitensis resistant to fluoro-quinolones. Valve replacement and antibiotic therapy led to clinical improvement and constant apyrexia with a 12 month follow-up. Brucella endocarditis on a valve prosthesis is a very rare occurrence. The combination of valve replacement and antibiotic therapy is usually required.

UW (University of Wisconsin) solution, formulated by Belzer's team in Madison, has already been proved to increase cold ischemia time in liver and pancreas preservation. A multicentre clinical trial is being conducted to compare renal preservation in human transplantation using two different solutions: UW and Eurocollins (EC). This paper, whose results will be included in the multicentre trial, reports local comparative results between UW and EC perfused Kidneys. The two donor populations UW (28 cases) and EC (47 cases) were not randomized. They were however comparable in renal function prior to harvesting but not in age (35 +/- 13.4 years EC versus 27.7 +/- 12.4 years UW). The two recipient populations (48 EC versus 48 UW) were more homogeneous. Comparative results were significant with better graft function in the UW group: creatinine at one week: 499.2 +/- 296.3 EC versus 277.6 +/- 226.2 mumol/l, p less than 0.0001; creatinine at one month: 228.7 +/- 135 EC versus 159.7 +/- 135.6 mumol/l, p less than 0.02 and a decrease in acute tubular necrosis (39.5% EC versus 14.5% UW) and hospital stay. These results justify the use of UW solution by intraaortic flush especially during multi-organ procurement.