Clinical case - We report a case of Dermabacter hominis infection in a female diabetic patient The patient presented a lesion of the sole of the right foot. Despite local care and an adapted antibiotic treatment the patient's right foot was amputated. Bacterial culture demonstrated numerous D. hominis colonies and some Enterobacter cloacae colonies. Microbiological data ensuring an adequate identification of D. hominis strains were: non-pigmented and offensive-smelling colonies, mannitol was neither fermented nor hemolysized, catalase positive, nonmobile, aerobic and facultative anaerobic rods, hydrolysis of esculin and gelatin. Comments - The genus Dermabacter was created recently; today there is only a single species: D. hominis, a gram-positive rod, asporogenous bacterium. This commensal species is isolated from the human skin, but rarely implicated in infectious pathology. CDC group 3 and 5 (Center for Diseases Control and Prevention, Atlanta) coryneform bacteria belong to the species D. hominis. D. hominis appears to be one of the very few taxa, among known coryneforms, which decarboxylates lysine and ornithine This species was recently included in the Api Coryne strip database (bioMerieux), a useful device for the identification of coryneform bacteria. Ifs identification is thus facilitated and clinicians will be able to identify D. hominis more frequently in their daily practice Antimicrobial susceptibility testing revealed the potency of glycopeptides, amoxicillin, of second- and third-generation cephalosporins, rifampicin, and fosfomycin on D. hominis isolates. The susceptibility of D. hominis to fosfomycin should be stressed. (C) 1999 Editions scientifiques et medicales Elsevier SAS.

Les auteurs rapportent les résultats de l'étude de la glycémie à jeun de 406 patients présentant un syndrome canalaire du membre supérieur. Ils ont retrouvé 3,3 % de diabétiques et 15 % de glycémies anormales. Une étude prospective a été réalisée chez 36 patients (HGPO et bilan lipidique) qui a mis en évidence 45 % de troubles de la glycorégulation et 52 % d'hyperlipidémie.

The fasting blood glucose was studied in 406 patients with carpal tunnel syndrome. We found 3.3% patients with diabetes mellitus and 15% with abnormal blood glucose levels. A prospective study was performed in 36 patients (oral glucose tolerance test, and blood lipid parameters). 45% of the patients in this group had an abnormal OGTT and 52% presented with hyperlipoproteinemia.

Affection peu courante, la bullose idiopathique du diabétique peut révéler un diabète, annoncer sa décompensation ou n'être qu'un épiphénomène. Les auteurs rapportent l'observation d'une femme ayant présenté un premier épisode de bullose révélant le diabète puis un second annonçant une décompensation. Les deux épisodes ont été précédés de paresthésies douloureuses. Les bulles contiennent un liquide clair, séreux, le décollement est intradermique, l'immunofluorescence directe n'est positive qu'avec le sérum antifibrine; la fluorescence siégeant dans la lumière de la bulle ainsi que dans les zones dermiques sous-jacentes; la microscopie électronique précise que le décollement s'effectue à la base de la couche cornée. Les auteurs rapportent les cas publiés et les hypothèses pathogéniques de cette entité bénigne ne relevant que d'un traitement symptomatique, par opposition aux autres maladies bulleuses survenant chez des diabétiques, au pronostic parfois plus sombre.

Resume Affection peu courante, la bullose idiopathique du diabetique peut reveler un diabete, annoncer sa decompensation ou n'etre qu'un epiphenomene. Les auteurs rapportent l'observation d'une femme ayant presente un premier episode de bullose revelant le diabete puis un second annoncant une decompensation. Les deux episodes ont ete precedes de paresthesies douloureuses. Les bulles contiennent un liquide clair, sereux, le decollement est intradermique, l'immunofluorescence directe n'est positive qu'avec le serum antifibrine; la fluorescence siegeant dans la lumiere de la bulle ainsi que dans les zones dermiques sous-jacentes; la microscopie electronique precise que le decollement s'effectue a la base de la couche cornee. Les auteurs rapportent les cas publies et les hypotheses pathogeniques de cette entite benigne ne relevant que d'un traitement symptomatique, par opposition aux autres maladies bulleuses survenant chez des diabetiques, au pronostic parfois plus sombre.

Idiopathic bullae occurring in diabetics constitute an uncommon condition which may reveal the diabetes, announce its decompensation or represent a mere epiphenomenon. The authors report the case of a woman who experienced two episodes of idiopathic bullae: the first one disclosed the diabetes, the second one heralded its decompensation. Both episodes were preceded by painful paraesthesia. The bullae contained a clear and serous fluid and the separation was intradermal. Direct immunofluorescence with anti-fibrin serum only showed fluorescence in the lumen of the bulla and in subjacent dermal areas. Electron microscopy demonstrated that the tissue separation was at the base of the stratum corneum. Other clinical cases and pathogenetic theories found in the literature are reported. In contrast with other bullous diseases occurring in diabetics and often of poor prognosis, idiopathic bullae is a benign condition requiring no more than a symptomatic treatment.

Idiopathic bullae occurring in diabetics constitute an uncommon condition which may reveal the diabetes, announce its decompensation or represent a mere epiphenomenon. The authors report the case of a woman who experienced two episodes of idiopathic bullae: the first one disclosed the diabetes, the second one heralded its decompensation. Both episodes were preceded by painful paraesthesia. The bullae contained a clear and serous fluid and the separation was intradermal. Direct immunofluorescence with anti-fibrin serum only showed fluorescence in the lumen of the bulla and in subjacent dermal areas. Electron microscopy demonstrated that the tissue separation was at the base of the stratum corneum. Other clinical cases and pathogenetic theories found in the literature are reported. In contrast with other bullous diseases occurring in diabetics and often of poor prognosis, idiopathic bullae is a benign condition requiring no more than a symptomatic treatment.

We have studied liver biopsies obtained in 12 hyperlipoproteinemic (HLP) patients (type II, 6; type IV, 6) treated with diet and fenofibrate, and in 15 patients (type II, 11; type IV, 4) receiving diet only. Electron microscopy of liver biopsies and the morphometric analysis according to the method of Weibel and Rohr showed mitrochondrial changes in patients treated with fenofibrate, these changes depending on the type of hyperlipoproteinemia. In type II HLP, we found a decreased volume of normal mitochondria (fenofibrate, 125.72 ± 17.04 × 10−3 cm3/cm3; diet only, 185.84 ± 8.96 10−3, P < .05). In type IV HLP we found a decreased number of giant mitochondria (fenofibrate, 0.08 ± 0.03 × 1010 cm−3; diet only, 0.32 ± 0.08 × 1010 cm−3, P < .05) and a decreased volume of altered mitochondria (fenofibrate, 6.00 ± 1.44 × 10−3 cm3/cm3; diet only, 13.61 ± 1.17 × 10−3, P < .05). In contrast with the rodent studies, the present study shows no change in the number of volume of peroxisomes.

We obtained liver biopsies in 4 patients with type IIA and 7 patients with type IIB hyperlipoproteinemia, and also in 7 healthy controls. A morphometric analysis of liver tissue was carried out by light and electron microscopy. Structural alterations of the hepatocyte and its organelles in type IIA and IIB hyperlipoproteinemia seem to fall into different categories: smaller nuclei, enlarged peroxisomes and altered mitochondria are found in both types of hyperlipoproteinemia, while an increase in the volume of hepatocytes is found only in type IIA. The enlargement of liver peroxisomes in untreated hyperlipoproteinemia is noteworthy, since it has been considered as a marker of the liver toxicity of lipid-lowering drugs.

A morphometric study on liver biopsies from patients with primary hyperlipoproteinemia (IIa n = 4, IIb n = 7, IV n = 7) and in controls (n = 7) was performed by light and electron microscopy. We found hypertrophy of peroxisomes in all subjects with hyperlipoproteinemia. As none of our patients had been given lipid-lowering drugs, this increase in volume seems to be due to hyperlipoproteinemia. Hypertrophy of peroxisomes in hyperlipoproteinemia may constitute a response of the hepatocyte to a disturbed metabolic state. Alterations of peroxisomes in hyperlipoproteinemia may thus occur prior to any lipid-lowering therapy.