Les cancers de l’ouraque

Urachal cancer is a rare pathology (less than 1% among all bladder tumors) with a poor prognosis for all stages, because of clinical delay leading to a late diagnosis, difficult differential diagnosis with bladder cancer, and no consensus for the treatment, mostly about the chemotherapy for advanced stages, because there are no data from prospective studies. A surgical treatment can be performed for the localized stages, but there are no real guidelines for local relapses and metastatic progression treatment. Those cancers are not radio- or chemosensitive; nevertheless data from fundamental research are missing. As this pathology is really uncommon, there are no clinical studies with targeted therapies. The purpose of this review is to introduce the most important clinical and paraclinical features of those cancers, and the usual treatment performed.     

Human CD26 expression in transgenic mice affects murine T-cell populations and modifies their subset distribution

CD26 is a type II transmembrane glycoprotein with dipeptidyl peptidase (DPPIV) activity, constitutively expressed in different cell types and contributing to T-cell activation by acting as costimulatory molecule. Although data suggest an important role for CD26 within the immune system, the physiologic function of this molecule is still unknown. To investigate the role of CD26 in vivo we have produced transgenic mice expressing the human molecule in T cells. Human CD26 (huCD26) is constitutively expressed in all thymocytes and peripheral T lymphocytes of these transgenic mice and is endowed with an enhanced DPPIV activity. CD26 transgene expression induces major phenotypic changes to T-cell populations within the thymus and in peripheral blood. After the onset of sexual maturity, huCD26 expression induces an age-related overreduction of thymus cellularity accompanied by a relative impairment of thymocyte proliferation following lectin stimulation. Also the peripheral blood T-cell pool is reduced in huCD26 transgenic mice and this is accompanied by an increase of the apoptotic rate of CD4+ and CD8+ subpopulations. Taken together these data suggest that CD26 interferes with transduction pathway(s) needed for the maturation of T cells and plays an important role in T lymphocyte homeostasis in peripheral blood.     

Neurocognitive impairment influences quality of life in HIV-infected patients receiving HAART

The objective of the study was to determine the association of neurocognitive impairment with health-related quality of life (HRQoL) in patients receiving highly active antiretroviral therapy (HAART). Seventy subjects were cross-sectionally analysed with a standardized neuropsychological test battery and a questionnaire including an Italian translation of the MOS-HIV Health Survey. The presence of neurocognitive impairment was significantly associated with lower HRQoL scores: pain (P = 0.03), physical functioning (P = 0.01), role functioning (P = 0.01), social functioning (P = 0.029), mental health (P = 0.001), energy (P = 0.036), health distress (P = 0.002), cognitive functioning (P = 0.05), current health perception (P <0.001), physical health summary score (PHS) (P = 0.005), mental health summary score (MHS) (P = 0.002). Years of education (odds ratio [OR] 0.79; 95% confidence interval [CI] 0.65-0.96), PHS (OR 0.71; 95% CI 0.54-0.95) and MHS (OR 0.67; 95% CI 0.51-0.88) were also associated with cognitive impairment. Neurocognitive impairment in patients receiving HAART was associated with reduced HRQoL. Identifying cognitive impairment may provide motivation for additional treatment to help patients to compensate for deficits in functioning.     

A study on the incidence of nosocomial infections in a large University hospital

The results of a study on the incidence of nosocomial infections in a 1800 bed University hospital are reported. The study, carried out over a 9 months period, included: 1) continuous microbiological surveillance, and 2) a clinical and epidemiological survey. On the basis of the microbiological data collected and analyzed by a computer data system, developed and employed for the control of nosocomial infections, a weekly bed-to-bed survey was carried out by the staff of the Institute of Infectious Diseases. Among 2777 suspected nosocomial infections, as revealed by microbiological monitoring, 701 were confirmed after the bed-to-bed survey. The nosocomial infection rate was 6.75 per 100 discharges. It was higher in the surgical than in the medical wards (7.3 and 6 per 100 discharges, respectively).Nosocomial urinary tract infections were the most frequent (74.2%). The urinary infection rate was higher in the surgical than in the medical wards (5.3 and 4.6 per 100 discharges, respectively). Escherichia coli (19.4%), Pseudomonas aeruginosa (19.3%), Proteus spp. (18.4%) were the pathogens most frequently associated with nosocomial infections. They were followed by Klebsiella pneumoniae (7.8%) and Staphylococcus aureus (6.5%) in frequency.Among the risk factors, involved in nosocomial infections, the importance of catheterization was confirmed: among our patients with nosocomial urinary tract infections; 73.4% and 79.5% — in the medical and surgical wards, respectively -underwent urological instrumentation, mainly catheterization.An analogous and more detailled study is now in progress and will be extended in the next years.Corresponding author.     

A case of Guillain-Barrè syndrome following Staphylococcus aureus endocarditis

A 55-year-old man developed an acute myocardial infarction and was bitten by a snake with haemotoxic venom prior to any treatment being given. We discuss our treatment of myocardial infarction in a patient who had been unintentionally anticoagulated.