GOAL:This study had for aim to analyze the epidemiology of strains identified in blood cultures (hôpital d'instruction des armées Percy, Clamart, France, hematology unit) to compare the rate of identified micro-organisms with literature data, and to search for a possible correlation between antibiotherapy management and evolution of resistance profiles.MATERIAL AND METHODS:All the micro-organisms (N = 690) collected over seven years (January 1996 to December 2002), from blood cultures of hospitalized patients in conventional and sterile sector were studied.RESULTS:Gram positive cocci rate (GPC) was 62.6% and Gram negative bacilli (GNB) 31.3%. Evolution in time showed a decrease of GPC and an increase of GNB, notably the non fermenting Gram negative bacilli, leading to an equal rate by 2001-2002. The most frequently identified species were Staphylococcus epidermidis (36.4%), Escherichia coli (8.7%), Pseudomonas aeruginosa (6.8%), and Staphylococcus aureus (4.9%). The rate of methicillin-resistant staphylococci was 63.6%. Fifty-five percent of E. coli strains had a penicillinase phenotype. Pseudomonas aeruginosa resistance was 8.5, 8.5, 6.4 and 8.5%, respectively for ceftazidime, piperacillin-tazobactam, imipenem, and amikacin.CONCLUSION:This study showed a tendency to inversion of former bacteremia epidemiology with increasing negative Gram bacilli. It justifies the antibiotherapy protocols adopted in the hematology unit.

L'hematome du psoas est une affection rare, le plus souvent rencontree au cours des traitements anti-coagulants ou des troubles de l'hemostase tels que l'hemophilie. Evoque devant une cruralgie et/ou un psoitis, le diagnostic est confirme par l'imagerie : echographie ou tomodensitometrie. Les principales complications a redouter sont les sequelles neuro-musculaires et la perte d'autonomie du patient. L'evacuation chirurgicale de l'hematome est preconisee, en l'absence de trouble de l'hemostase evolutif, devant tout signe de souffrance neurologique. Nous rapportons l'observation d'un hematome du muscle psoas iliaque, chez patient de 42 ans, revelant une leucemie myeloide chronique sans trouble apparent de l'hemostase.

Increasingly, enriched populations of hematopoietic progenitors are used in experimental and clinical transplantation studies. The separation of progenitors is based on the expression of CD34, a marker preferentially expressed on progenitor cells. The dog model has been important for preclinical transplant studies, because it has proven predictive for outcomes in human hematopoietic stem cell transplantation. To identify and isolate canine hematopoietic progenitors, we have cloned a cDNA encoding a CD34 homologue from a canine myelomonocytic leukemia cell line, ML2. The CD34 homologue cDNA predicts an amino acid sequence that is highly conserved with human and murine CD34 in the cytoplasmic domain, transmembrane domain, and C-terminal end of the extracellular domain, but shows considerable divergence from these sequences at the amino-terminal end of the protein. In Western blotting studies, canine CD34 homologue (caCD34) appears to be a heavily and variably glycosylated protein with a molecular weight of approximately 100 kD and shows some tissue-specific differences in protein mass. To evaluate the expression of caCD34 protein, the extracellular domain of caCD34 was expressed as an Ig fusion protein and used as an immunogen to generate a rabbit polyclonal antiserum. The antiserum reacted against the fusion protein, against vascular endothelium, and with three leukemic cell lines. Approximately 1% of canine bone marrow cells stained brightly with antibodies to caCD34 and this population was 25- to 50-fold enriched for colony-forming units-granulocyte-macrophage as compared to unfractionated marrow mononuclear cells. These findings suggest that the canine CD34 homologue is expressed on bone marrow progenitor cells and, thus, that this molecule should be a valuable marker for identifying and isolating canine hematopoietic progenitors for experimental hematopoiesis and stem cell transplantation.

The effects of recombinant canine granulocyte colony-stimulating factor (rcG-CSF) and recombinant canine stem cell factor (rcSCF), a c-kit ligand, on the circulation of hematopoietic progenitor and stem cells were studied in a canine model. Administration of rcG-CSF (10 micrograms/kg) for 7 days led to a 5.4-fold increase in CFU-GM/mL of blood, while 7 days of rcSCF (200 micrograms/kg) led to an 8.2-fold increase. Although treatment with low-dose rcSCF (25 micrograms/kg) had no effect on the level of peripheral blood progenitors, 7-day exposure to a combination of G-CSF plus low dose SCF led to a 21.6-fold increase (P = .03). To assess the ability of these factors to increase the circulation of cells capable of rescuing animals after lethal total body irradiation (TBI), 1 x 10(8) peripheral blood mononuclear cells (PBMC)/kg were collected and cryopreserved from animals after 7 days of treatment with G-CSF, SCF or a combination of the two. One month later, animals were exposed to 9.2 Gy TBI and transplanted with the previously collected cells. Control animals transplanted with 1 x 10(8) PBMC/kg collected without pretreatment died with marrow aplasia 11 to 29 days after TBI as did animals treated with only low-dose SCF before cell collection. In contrast, all animals given PBMC collected after G-CSF, high-dose SCF, or a combination of G-CSF plus low-dose SCF recovered granulocyte function. Recovery to 500 granulocytes/microL after transplant took 17, 18.8, and 13.6 days, respectively, (P = .056 for the difference between the combination G-CSF-SCF group and the other two groups). In both the G-CSF and SCF groups, 4 of 5 animals completely recovered while 1 of 5 in each group died with prolonged thrombocytopenia. In the combination group, all 5 animals became long- term survivors. These studies demonstrate that both G-CSF and SCF dramatically increase the level of peripheral blood hematopoietic progenitor and stem cells and support the view that these factors can act synergistically.

Management of bone marrow failure secondary to nuclear accidents lies on haematological intensive cares related to infections or haemorrhagic risks. Allogenic bone marrow transplantation aims to restore hematopoeiesis shattered by the radiations. Possible survival of bone marrow stem cells, according to the doses, allows to consider the use of recombinant hemopoeitic growth factors to shorten autologous restoration. From recent publications about Chernobyl (USSR, 1986) and Goiana (Brazil, 1987) accidents, the authors analyze bone marrow transplantation and, advantages of recombinant cytokines.

Authors present four cases of septicemia with Corynebacterium jeikeium multiresistant to antibiotics among haematological patients. Main promoting factors are important neutropenia, and presence of central indwelling devices. A previous treatment with antibiotics and a long hospitalization authorize the emergence of multiresistant strains from saprophytic flora. Glycopeptides represent first-line treatment without removing central indwelling devices. Systemic treatment does not eliminate skin colonization. Hygienic measures allowing to reduce or avoid central indwelling device contamination are thrown into relief.

The evaluation of residual masses after lymphoma treatment is very important in cases where a decision regarding further treatment is required. Uhe use of SPECT with Gallium 67 gives an answer about that fundamental clinical question.

19 tomoscintigraphies using gallium 67 were performed in 15 patients with Hodgkin's or non-Hodgkin's lymphoma who had a residual mass after treatment. The isotope was never fixed in fibrous masses but was always concentrated in actively growing masses. In five cases histology confirmed these findings. It is recommended that scintigraphy should be considered in every case with a residual mass after treatment, where a decision regarding further treatment is required.