Fulminant meningitis due to Bacillus anthracis in 11-year-old girl during Ramadan.
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Biomedical subjects
Publications and source records attributed to B Grignon.
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The purpose of this paper was to assess the relationship of the anatomical terms employed in the radiologic literature to the International Nomenclature derived from the Nomina Anatomica. A critical analysis was made of the anatomical terminology employed in three French and two American journals of radiology. In about 40% of the French journals, the International Anatomical Nomenclature was not adhered to, whereas in 50%, there was no difference in the terms encountered between the French traditional terminology and the French adaptation of the Nomina Anatomica. In contrast, a close adherence to the Nomina Anatomica was observed in the two American journals. The exceptions most frequently encountered are detailed. The aim and principles of the Nomina Anatomica, based on the Latin terminology and aimed at clarification and systematisation, are stressed. The advantages of employing the International Anatomical Nomenclature in medical papers, allowing easy understanding by foreign readers in a world of rapid information exchange are highlighted.
Radiographic, CT, bone scan and MR patterns of the infarcts of the metaphyses and diaphyses of tubular bones and their main complications are presented. Bone marrow infarcts are located in the medullary cavity of long bones. They most often involve the lower limbs. They are commonly associated with necrosis of the epiphyses and have common origin. In contrast to necrosis of the epiphyses, bone infarcts may present specific complications. They are most often detected incidentally, because of their clinical latency. Radiographic and CT changes appear late, showing localized areas of increased density with irregular rims, or sharply demarcated shells of calcification. Earlier changes are demonstrated by bone scan and MRI. MR pattern is characteristic, showing an area of hyposignal on T1- and T2-weighted sequences, with irregular rims, and sometimes small areas of fat signal. Their complications include cystic formation and malignant degeneration (sarcoma and particularly malignant fibrous histocytoma). An unusual complication, infection involving bone infarcts is also presented.
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The purpose of this paper is to review the main data on the structure of the intervertebral disc, which are illustrated by personal documents. Applications in understanding the degenerative pathology are highlighted. The nucleus pulposus is the "central" component of the disc, highly hydrophilic, deformable but remaining of constant volume. It can be compared to a hydraulic chamber within the disc, sealed by the annulus fibrosus, which is a dense peripheric ring of concentric fibrous lamellae. The cartilaginous end plates (cranial and caudal) separate the disc from the adjacent subchondral vertebral bone. (Their involvement in the discal metabolism as well as the blood supply of the disc are developed elsewhere (see our companion article)).
We studied the disco-vertebral interface and the blood supply of the intervertebral disks L3-L4, L4-L5, and L5-S1 of 5 human adult columns. Moreover, in order to investigate the discal vasculature, infusion of Japanese ink was used in 2 other adult columns, as well as immuno-histological methods in the L5-S1 disk of 4 adults and 2 infants. Our study confirms the paucity of discal vasculature in adults, by contrast with that of infants, but shows numerous defects in the subchondral vertebral plate, which are filled by vascularised medullary soft tissue and are in contact with the cartilaginous discal end plate. By these contacts, nutrients could reach the intervertebral disk, as suggested by other works, and as is the case in other cartilaginous structures of the body.
The collections encountered around the renal transplant are mainly lymphoceles, more rarely hematomas, abscesses and urinomas, the frequency of which constituting 12% of cases. Their diagnosis is usually made by sonography; the percutaneous puncture is guided by US or CT in order to define its nature and drain the cavity. Urinary obstruction (6% of the cases) may be detected by sonography or scintigraphy, but percutaneous pyelography is often required to confirm the obstruction, to precise its level and nature, and to guide the percutaneous procedure. In the case of urinoma (3% of the cases), ultrasound may be unclear and the urinary extravasation must be then confirmed by scintigraphy, postinjection delayed plain or CT scan films.
The value of scanning electron microscopy (SEM) in the study of crystals in articular diseases is underlined in several cases of examination of joint fluid, or crystal deposits in articular or periarticular tissues obtained by percutaneous or surgical treatment with chemical and crystallographic correlations. Apatite crystals. Two deposits of hydroxyapatite of the rotator cuff were studied by SEM, crystallographic techniques and chemical analysis. SEM study showed spherical aggregates of various size. Urate crystals. Three tophi were observed by SEM, with crystallographic techniques and chemical analysis. Their needle-shape and their great size (20 m) were characteristic. Calcium pyrophosphate crystals. In a case of typical clinical and radiological features, examination of joint fluid, with chemical correlation showed shorter and thicker crystals than those or urate. The precise identification of crystals is based on sophisticated crystallographic techniques such as X-ray diffraction, although SEM allows an accurate and quite simple morphologic study, most often sufficient.
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The development of the knee joint in Wistar rats was observed from the 14th fetal day to the 40th postnatal day by light microscopy, transmission electron microscopy and scanning electron microscopy. The differentiation of the capsular ligamentous and tendinous attachments, synovial cavity, and A and B cells were particularly compared. Capsular attachments appeared for the first time at the 15th day of fetal life. The formation of the cavity started at the 17th day of fetal life. The differentiation of A and B cells was observed by the 20th fetal day by T.E.M., and only by the 15th postnatal day by S.E.M.
A closed sterile prefilled humidifier ('Aquapak 310') and a multiple-use humidifier ('Nebal 2') were evaluated in hospital departments to determine their susceptibility to bacterial contamination and cost. No bacterial contamination was found in the 389 samples of 'Aquapak 310' water. However, 54/164 (32.9%) samples of 'Nebal 2' water were found to be contaminated. Pseudomonas aeruginosa was the bacterium most often isolated. The cost analysis was highly influenced by the average use time. In the haemodialysis and respiratory medicine departments the average use times for the 'Aquapak 310' +/- SD were 61.6 +/- 36.2 days and 4.1 +/- 1.7 days, respectively. Using the 'Aquapak 310' system, there was a 51% financial saving in the haemodialysis department but a 2% loss in the respiratory medicine department. In these two departments we found a similar cost saving as far as staff time was concerned (88% vs. 89%). The major difference came from the cost of consumables: 26% saving in the haemodialysis department vs. 70% loss in the respiratory medicine department. Use of the prefilled sterile humidifiers represents a three-fold benefit, a lower infection risk for the patient, an important financial saving in the haemodialysis department and a decreased staff work load.
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The bactericidal rate of amikacin in vitro was established by varying bacterial cell density (10(5) and 10(6) CFU/ml) and physiological state (lag phase and onset of exponential growth) at the moment the antibiotic was introduced. This was done with nine strains belonging to five different species. Antibiotic concentrations were those obtained in vivo at the valley (4 micrograms/ml) and the peak (20 micrograms/ml) with a dosage of 5 mg/kg. The concentration of 40 micrograms/ml is the peak value in the context of hypothesis of a short-term treatment with reinforced dosage (10 mg/kg). The bactericidal effect of amikacin, generally rapid, increased with increasing drug concentration. A bactericidal effect of 99.9% or even 99.99% was obtained in one hour or less at the concentration of 40 micrograms/ml. Above all, this concentration prevented regrowth or rebound, observed at lower concentrations. This results from a rapid but above all powerful bactericidal effect, practically total and constitutes a bacteriological argument in favor of an increase in dosage combined with a reduction in the length of treatment.
A 41 years old patient on hemodialysis for 17 years with a clinical and radiological picture of osteoarticular beta 2 microglobulin amyloidosis, is presented. The patient had skeletal involvements, included cystic lesions of the left hip and both humeral heads and a C5/C6 spondylarthropathy. She had also associated carpal tunnel syndrome. Radiological exploration of the atlanto-occipital articulation demonstrated destructive changes. Histology documented osseous and periarticular deposition of beta 2 microglobulin derived amyloid. This is an unusual location of destructive spondylarthropathy in a patient on chronic hemodialysis.
The fractures by bony insufficiency are particularly well seen on MRI. On T1 weighted images they are detected as a very hypointense line surrounded by a hypointense area. On T2 weighted images, the hypointense line is also recognized and represents the fracture surrounded by a hyperintense area due to oedema or hemorrhage. Five cases of bony insufficiency fracture of the femoral head are reported. The features of the superior subchondral locations of these fractures and some primary and limited epiphyseal osteonecrosis are similar and consistent with a common pathogeny.
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Fluoroquinolones are antibiotics that act principally on DNA gyrase. At the moment, resistance to these antibiotics is purely chromosome-mediated. As regards pharmacokinetics, these compounds have a high bioavailability and penetrate extremely well into tissues and cells. Therapeutic concentrations are obtained in bronchial mucosa and lung tissue. In severe lower respiratory tract infections fluoroquinolones must be given in combination with other antibiotics to prevent the emergence of resistant mutants. The indications of fluoroquinolones in lower respiratory tract infections depend on their antibacterial spectrum. They are particularly useful in the treatment of infections caused by methicillin-sensitive or resistant staphylococci, Pseudomonas spp. (notably in cystic fibrosis) and intracellular organisms. They are not indicated for streptococcal infections, notably those due to Streptococcus pneumoniae, and for anaerobic infections. Fluoroquinolones are currently used mainly in hospital-acquired lower respiratory tract infections, in infected cystic fibrosis and in some acute episodes of chronic bronchitis since they are active against Haemophilus influenzae and Branhamella catarrhalis.