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Abstract: Aim of the study: To determine the prevalence of C. parapsilosis sensu stricto, C. orthopsilosis and C. metapsilosis among candidemia at Nantes University Hospital and to evaluate the in vitro susceptibility of the isolates against three echinocandin drugs (caspofungin, micafungin and anidulafungin). Material and methods: Retrospective study (march 2004 to july 2009) of 178 cases of candidemia corresponding to 183 Candida spp. strains identified by means of routine phenotypical methods. Re-identification of C. parapsilosis sensu lato isolates was performed by ITS rDNA sequencing analysis. Minimal inhibitory concentrations (MIC) were determined by E-test®. All echinocandin non-susceptible isolates (MIC>2μg/mL) were analyzed for the presence/absence of FKS1 mutations associated with resistance. Results: During this period, C. parapsilosis sensu lato was responsible for 27 candidemia, ranging at the second most common Candida species after C. albicans (n =99, 54.1%). Neither isolates belong to C. orthopsilosis nor C. metapsilosis. According to the literature, all the isolates displayed high MICs against the three echinocandin drugs. All the isolates displayed both susceptibility (MIC≤2μg/mL) and a good agreement between MICs read at 24h and 48h for caspofungin and micafungin (MIC50 =0.75μg/mL, MIC90 =1.5μg/mL). Surprisingly, whereas most of the strains were susceptible to anidulafungin at 24h (MIC50 =1μg/mL, MIC90 =1.5μg/mL), 14 (52 %) displayed non-susceptibility, despite the lack of mutation associated with resistance on FKS1, when reading was performed at 48h (MIC50 =3μg/mL, MIC90 =12μg/mL). Conclusion: Prevalence of C. orthopsilosis and C. metapsilosis in patients with candidemia is low at Nantes University Hospital. The difficulty encountered with MIC reading by E-test® are discussed. [Copyright &y& Elsevier]

Aim of the Study: To determine the prevalence of C. parapsilosis sensu stricto, C. orthopsilosis and C. metapsilosis among candidemia at Nantes University Hospital and to evaluate the in vitro susceptibility of the isolates against three echinocandin drugs (caspofungin, micafungin and anidulafungin)., Material and Methods: Retrospective study (march 2004 to july 2009) of 178 cases of candidemia corresponding to 183 Candida spp. strains identified by means of routine phenotypical methods. Re-identification of C. parapsilosis sensu lato isolates was performed by ITS rDNA sequencing analysis. Minimal inhibitory concentrations (MIC) were determined by E-test(®). All echinocandin non-susceptible isolates (MIC>2 μg/mL) were analyzed for the presence/absence of FKS1 mutations associated with resistance., Results: During this period, C. parapsilosis sensu lato was responsible for 27 candidemia, ranging at the second most common Candida species after C. albicans (n=99, 54.1%). Neither isolates belong to C. orthopsilosis nor C. metapsilosis. According to the literature, all the isolates displayed high MICs against the three echinocandin drugs. All the isolates displayed both susceptibility (MIC ≤ 2 μg/mL) and a good agreement between MICs read at 24h and 48 h for caspofungin and micafungin (MIC(50)=0.75 μg/mL, MIC(90)=1.5 μg/mL). Surprisingly, whereas most of the strains were susceptible to anidulafungin at 24h (MIC(50)=1 μg/mL, MIC(90)=1.5 μg/mL), 14 (52 %) displayed non-susceptibility, despite the lack of mutation associated with resistance on FKS1, when reading was performed at 48 h (MIC(50)=3 μg/mL, MIC(90)=12 μg/mL)., Conclusion: Prevalence of C. orthopsilosis and C. metapsilosis in patients with candidemia is low at Nantes University Hospital. The difficulty encountered with MIC reading by E-test(®) are discussed., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Ferric uptake regulator protein (Fur) is activated by its cofactor iron to a state that binds to a specific DNA sequence called 'Fur box'. Using mass spectrometry-based methods, we showed that Tyr 55 of Escherichia coli Fur, as well as the two thymines in positions 18 and 19 of the consensus Fur Box, are involved with binding. A conformational model of the Fur-DNA complex is proposed, in which DNA is in contact with each H4 [A52-A64] Fur helix. We propose that this interaction is a common feature for the Fur-like proteins, such as Zur and PerR, and their respective DNA boxes.

The technique of vaso-occlusion (or embolisation) consists in occluding one or several vessels which are causing haemoptysis. Either of the pulmonary circulations (systemic bronchial or pulmonary) may be the cause and sometimes both are. In systemic pulmonary hypervascularization the pathological issues are affected by high pressure vascularisation at the expense of functional vascularisation and are the source of frequent episodes of bleeding. Bronchial and systemic vaso-occlusion has proven efficacy and safety on condition that strict rules are respected to avoid complications; the detection of potentially dangerous arteries (spinal, coronary and visceral) and a choice of material for embolisation which is adapted to the therapeutic strategy and the clinical and angiographic presentation. The indications for the procedure are dictated by severe or recurrent haemoptysis. Vaso-occlusion of pulmonary arteries which is a rarer indication dominated by conditions such as arteriovenous malformation (MAVP). The technique is adapted to the number, to the size and to the diffusion of MAVP which is characterised precisely by computed tomography. Vaso-occlusion is the treatment of first choice for MAVP only leaving failures of vaso-occlusion to surgery and certain pedicular forms have a very short afferent of large calibre.

Ischemic spinal cord injury is the major risk of bronchial artery embolization. The spinal artery may be overlooked on initial intercostobronchial trunk arteriography, as a result of reverse flow within the intercostal branch. Its identification, conversely, is easier on postembolization angiography. An illustrative case is presented, with angiographic correlation. The pathophysiology of the reverse flow is discussed. Technical recommendations are proposed for its detection.

Bronchial artery embolization (BAE) is well accepted and widely used for management of massive and recurrent hemoptysis. Recurrent hemoptysis occurs in 20% of cases. It may be due to partial embolization, recruitment of other systemic collaterals, recanalization of an embolized artery, or progression of primary disease. Severe complications of BAE are limited to spinal cord injury, oesophageal necrosis, and bronchial ischemia. The proper application of bronchial arteriography and embolization techniques depends on a thorough knowledge of the arterial anatomy, a meticulous catheterization technique, the use of nonionic or lowosmolarity contrast materials, and adequate positioning of the catheter. In these optical conditions of safety, BAE is the treatment of choice for severe and recurrent hemoptysis.

Objectives: Yersinia enterocolitica infection is a rare cause of intestinal intussusception, especially in adults. We report here a case in a 29-year-old man and review the literature on diagnosis and therapy., Case Report: A 29-year-old man presented with a 2-week history of diarrhea and weight loss. Ultrasonography revealed acute intestinal intussusception localized at the site of enlarged mesenteric nodes. At laparostomy, intestinal resection was not required. Histology examination of the mesenteric nodes showed follicular hyperplasia. Serology was positive for Yersinia enterocolitica. Outcome was favorable after treatment with tetracycline for 15 days., Discussion: Yersinia enterocolitica are Gram negative bacilli that grow at low temperature. Food contamination is the most frequent source of infection in man, usually in children. Clinical manifestations include gastroenteritis or pseudoappendicular syndrome. Intestinal intussusception is rare. Operative reduction by taxis is generally sufficient. Histology examination of the lymph nodes excludes lymphoma. The diagnosis is confirmed by serology. A 10 to 15-day antibiotic regimen is needed.

Background: Aneurysms of the subclavian artery are rare in childhood and may be due to traumatic, infectious or congenital causes., Case Report: A 15 year-old boy presented with a sudden left visual disturbance plus decreased muscle strength and paresthesias of the left arm; these manifestations disappeared within 15 minutes. His neurological examination on admission was normal. The right arm radial pulse was weak and the blood pressures of the right and left arms were significantly different. Doppler showed a right subclavian artery aneurysm containing several clots, that was confirmed by angiography. There were no signs of inflammation or indication of autoimmune disease. This aneurysm might have been caused by trauma as the patient had had a violent cervical traumatism after a diving accident 2 years earlier. The aneurysm was surgically removed and the right vertebral artery arising from it was reimplanted. Histological examination of the aneurysm gave no evidence of etiology. The post-surgical MRI showed no brain abnormaly., Conclusions: This aneurysm is probably of post-traumatic origin. The cerebral disturbance could be due to embolism or transient ischemia; the latter is more compatible with the normal NMR.

Liver metastases are frequent, often large and sometimes very late in skin or choroid metastatic melanoma. Hepatic failure is a rarely described complication in metastatic liver melanoma. We report a case of liver failure in a metastatic liver melanoma in a woman 76 years old, treated 16 years before for a choroid melanoma. About this case, we discuss the frequency, the location of primitive tumors and mechanism of liver failure in metastatic liver.

From animal experiments (n = 10), the authors describe a new technique of pulmonary arterial angioscopy. A balloon-fitted catheter is introduced into the trunk of one of the pulmonary arteries. A small caliber angioscope with an end capable of being propped up is then pushed within the lumen of the catheter. Intraluminal visualization of the pulmonary artery and its branches cannot begin until after the balloon is inflated to arrest blood flow and the visualization chamber is cleared by sterile carbon dioxide. The quality of the image obtained is similar to that of bronchial endoscopy, making is possible to examine at length the walls of the proximal and distal pulmonary arteries up to a caliber of 2.5 mm, and to detect blood clots. Pulmonary angioscopy is tolerated to the same extent as right heart catheterization. Potential applications of this technique are diagnosis of chronic cor pulmonale and treatment of pulmonary embolism.