Biomedical subjects
Publications and source records attributed to B Hubert.
The surveillance of meningococcal disease in France is based on four complementary sources of data. 1. Meningococcal disease has been a notifiable disease since 1902. A case definition for surveillance was introduced in 1985, based on the isolation of Ne
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Several factors have been demonstrated to play a role in triggering acute episode of migraine headache. On the basis of observation, others have been suggested but not confirmed. Variations in climate are among the latter. Over a one-year period, we observed a population of 304 patients with migraine residing in a precise climatic zone. The frequency of acute episodes could be analyzed for 148 among them. There were 4,421 acute episodes recorded during the year. The periodicity during the year was compared with climate parameters: temperature (maximal, minimal, average), wind (force and direction), atmospheric pressure, rain, sunshine, relative humidity, and icy, foggy and stormy weather. Moon cycles were also assessed. No correlations were found between climate parameters or variations there of and onset of migraine. Variations in climate would thus appear to have no effect on migraine. Inversely, the results of this study demonstrated a day effect with a higher number of episodes on Saturday and less on Monday and Tuesday. The triggering effect of catamenia on many acute episodes was also confirmed.
Until now, the need for wide exposure and nonmanipulative dissection of pheochromocytoma has dictated the use of a large intraperitoneal transabdominal approach, which unfortunately results in a significant incidence of morbidity. A unilateral retroperitoneal approach guided by the refinements of new imaging techniques is less invasive but is associated with a small risk of incomplete cure. In one case report, we tested the hypothesis that laparoscopic surgery could combine the beneficial effects of both operative strategies without their respective side effects. We concluded that a laparoscopic approach combined with exclusive intraoperative infusion of nicardipine, a calcium-channel blocker, can be used to surgically remove pheochromocytoma under stable hemodynamic conditions. This provides better exposure of the anatomical structures than open surgery and allows a visual exploration of the entire abdominal cavity to exclude tumor multicentricity or ectopic sites in the case of inconclusive preoperative imaging investigations. Moreover, conversion to open surgery is always possible if needed.
cDNAs prepared from total RNA extracted from plaques of multiple sclerosis were amplified by the polymerase chain reaction. The 11-bp degenerate primers used were derived from conserved sequences of reverse transcriptase. Amplified cDNAs were fractionated according to size by electrophoresis in polyacrylamide gels under denaturing conditions. cDNAs of the proper size were cloned, grouped according to the sequence of their insert by differential hybridization, and sequenced. Six cDNAs were isolated and found to belong to new members of two groups of human endogenous retroviruses: the group related to ERV9 and that related to HERVK10 and HUMMTV. These sequences were expressed in all human organs tested, including normal white matter of brain. The approach described in this article is a powerful tool with which to isolate new members of the reverse transcriptase gene family.
OBJECTIVES: To calculate the incidence of surgical treatment of benign prostatic hyperplasia (BPH) in two French departments, Indre-et-Loire and C her, in order to deduce the incidence in France. METHODS: All patients operated for BPH by transurethral resection or transvesical prostatectomy were counted prospectively over a 6-month period by all surgeons of the Indre-et-Loire and Cher departments. Collection of case files was complete and based on BPH resection specimens sent to pathology. 506 patients were included in this survey. RESULTS: The mean age of the patients was 71.8 years. 78% of patients were operated by a private urologist, and 93% by a specialist urologist. The mean postoperative stay was 7.1 days and varied according to the patient's age, the weight of the prostate and the site of the operation (university hospital, private establishment and general hospital). This study allowed calculation of the annual incidence of surgery for BPH in these 2 departments: 822/100,000 men over the age of 50 years. The maximal incidence was observed during the 7th decade of life: 1,742/100,000. In our study, private urologists operated 76 patients for BPH per year. CONCLUSION: Extrapolation of these results to the French population indicates an annual incidence of surgery for benign prostatic hyperplasia in France of 776/100,000 men over the age of 50 years. On the basis of this incidence, an estimated 55,000 to 65,000 men are operated for BPH per year in France.
SETTING: France, 1990. OBJECTIVE: To measure the incidence and describe the characteristics of bacteriologically-confirmed tuberculous meningitis (TBM) and to estimate the protective efficacy of BCG vaccination in children aged less than 5 years. DESIGN: An active surveillance of TBM cases confirmed by positive cerebrospinal fluid (CSF) culture was conducted through a network of microbiology laboratories serving 99.8% of regional and district general hospitals and other large private hospitals. RESULTS: A total of 70 cases were reported: 61% were adults over 44 years, 64% were males and 77% were born in France. 7 patients were known to be infected with HIV. 6 cases were observed in children aged less than 5 years, 2 of whom had been vaccinated with BCG. 3 of the 6 children died (one had been BCG-vaccinated). Given the 80% coverage of BCG in this age group, the protective efficacy of BCG vaccination was estimated to be 87.5% (95% CI: 30-98), which indicates that 14 TBM cases may have been prevented by BCG vaccination in 1990. CONCLUSION: Results are consistent with the number of TBM cases expected on the basis of a 0.04% annual risk of infection. Current BCG vaccination policy in France still has a measurable impact on the incidence of tuberculous meningitis in children under 5 years of age. Given the probable continuous decrease of the annual risk of infection in future years, alternative policies should be considered.
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To determine the current rates of vaccination and seroprotection against rubella of French preadolescents, a survey was conducted among children in their first year of junior schools of the department of Indre-et-Loire (prefecture: Tours). The rate of vaccination against rubella during infancy or childhood was 58.8% for the girls and 9.4% for the boys, as compared with 99.5% for both sexes for the vaccination against diphteria, tetanus and poliomyelitis. An effective seroprotection against rubella was found more frequently in girls than in boys (90.4% vs 78%), and was also more frequent among vaccinated than non vaccinated preadolescents (98% vs 77%). From these data the authors recommend that a stronger policy of vaccination against rubella should be be adopted, ie. order to obtain the eradication of rubella in France.
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OBJECTIVES: Epidemiological surveillance can be used to identify problems, suggest hypotheses, and assess the effectiveness of preventive actions. These objectives are pursued in the analysis of the dynamic evolution of Salmonella enteritidis infections. In this analysis, development of the epidemic in France and the United States is compared. METHODS: This analysis is based on the formulation of a simple deterministic compartmental model, in which human contact with contaminated food is expressed in terms of a baseline transmission rate. RESULTS: In France, the baseline transmission rate, stable up until 1986, is multiplied by 2.3 in 1987 and by 4.1 in 1988. There is no evidence of a slowdown of the linear rate of increase. In the Middle Atlantic region of the United States, the linear increase of the epidemic is similar to that observed in France. From 1990 a potential effect of the preventive measures is observed. CONCLUSIONS: The pattern of increase of the baseline transmission rate is similar in France and in the Middle Atlantic region of the United States. However, preventive measures, used in both areas, appeared more effective in the United States.
If surveillance data is to be correctly interpreted, the degree of exhaustiveness and representativeness of the surveillance system must be known. The capture-recapture method, which can be used for this evaluation - provided that at least two data sources are available - was applied to the surveillance of meningococcal infections in France. To identify those cases common to both surveillance systems, cases of the disease occurring in 1989 and 1990 and appearing on detailed Mandatory Notification (MN) records (702 cases) or reported to the National Reference Centre (NRC) (727 cases) were compared. The total number of cases of meningococcal infection was estimated at 1,367, using the capture-recapture method. Exhaustiveness rates, which did not differ for the various bacterial strains, were 51% for MN and 53% for NRC, although large regional differences were found for both systems. More cases were notified to MN in the age group 5-24 (60%), than in other age groups (49%). Quarterly exhaustiveness rates were unrelated to incidence of the disease. A district by district analysis of the correlation between exhaustiveness rates for each system suggests that the two data sources were probably independent. Scrupulous identification of common cases and study of the independence of the two systems are indispensable prerequisites for using this method, which provides a good alternative to exhaustive studies.
Of 2.139 cases of meningococcal infections notified in France from 1985 to 1989, 10% died. The risk factors for death and for purpura fulminans (extensive purpuric rash associated with cardiovascular collapsus) were studied using multifactorial analysis. The purpura fulminans was the major risk factor for death (representing 22% of the cases and 77% of the deaths in our study). In the absence of purpura fulminans, significant risk factors for death were: serogroup A or infrequent serogroup infection, an age over 50 years, and the occurrence of a septicaemia. In the presence of purpura fulminans, significant risk factors for death were an age under one year or over 10 years, and an infection with negative cultures from blood and cerebrospinal fluid. The main risk factor for purpura fulminans was the occurrence of septicaemia. Purpura fulminans appears to be a simple and specific clinical entity reflecting the high level of endotoxin released during meningococcal septicaemia.
Epidemiological data concerning non Typhi salmonella infections in France and other industrialized countries are characterized by the important increase of S. enteritidis salmonellosis due to raw or insufficiently cooked eggs products since 1987, increase of salmonellosis among immunosuppressed patients, particularly patients with AIDS. There is a new interest for non typhi salmonellosis instead of typhoid fever which is regularly declining in industrialized countries.
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We analyzed 814 cases of meningococcal disease notified in 1987 and 1988 to the Ministry of Health. Data were obtained by report forms including informations about possible additional cases among contacts. Coprimary cases (occurring within 24 hours after the index case) and secondary cases (occurring more than 24 hours after index case) were all reviewed. Twenty eight clusters of meningococcal disease were identified involving 65 cases (8% of total cases). Twelve of the 814 cases (1.5%) were coprimary cases of an index case and 25 (3%) were secondary cases. The secondary attack rate was 530/100,000 among household contacts and 31/100,000 among school contacts. Seventy two per cent of the secondary cases occurred in the first week after index case. Thirty-eight percent of the secondary cases occurred in the 15-20 age group as opposed to 15% of single cases. Serogroup A was more often found in coprimary (33%) and secondary cases (17%) than in single cases (6%). In France, prophylaxis of secondary cases is administered to the classroom contacts of a case of meningococcal infection but is not required for the entire school except under epidemic conditions.
The temporal and spatial association of meningococcal disease and influenza-like syndrome (ILS) was assessed from surveillance data on these diseases in France for a 6-year period (1985-1990). Using time series methods to account for the usual seasonal pattern meningococcal disease, the incidence of meningococcal disease in a given week was found to be linked to incidence of ILS in the 5 previous weeks but not to that in subsequent weeks. Geographic spread of meningococcal disease correlated with spread of ILS. This study also suggests that meningococcal disease is more severe for a 2-month period during and after an ILS epidemic: The proportion of cases with purpura fulminans increased by 24% and those resulting in death by 26% during this period. No shift in the age distribution was observed. When an ILS epidemic is identified, medical practitioners should be informed of the likelihood of an increased incidence and severity of meningococcal disease.
Among the 251 foodborne outbreaks investigated by public health officers in France in 1989, 62 (25%) used a case-control study to identify the responsible food. This survey aims to analyse the results of these 62 investigations. Thirty eight (61%) investigations found the responsible food(s); 10 investigations (16%) lacked power because of the small size of the population studied, but allowed to suspect the food with the highest odds ratio; 13 investigations (21%) gave results inconsistent with bacteriological studies or with hypothesis generated by the descriptive study: in 5 of it, food origin is questionable and in 8 investigations, methodological errors are likely. We could not conclude for one study. Among the surveys with case-control studies, 74% identified the food responsible with bacteriological or epidemiological confirmation, as opposed to 17% of other surveys which had only bacteriological confirmation. This study allowed us to give recommendations on the management of investigation and the interpretation of results to improve the efficiency of this practice.