Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency.

Femoral venous catheterization is associated with a greater risk of infectious and thrombotic complications than subclavian catheterization in ICU patients.

The presence of definite clinical evidence of coronary artery disease and older age were the most important preoperative predictors of an adverse cardiac outcome after abdominal aortic surgery. These results suggest that the routine use of dipyridamole-thallium SPECT and radionuclide angiography for screening before abdominal aortic surgery may not be justified.

Trichomonads closely related to the bovid parasite Tritrichomonas foetus were identified in the bronchoalveolar lavage sample from a patient with AIDS in association with Pneumocystis pneumonia. This human case of T. foetus-like infection emphasizes the zoonotic potential of trichomonads, although the existence of a human-host-adapted T. foetus strain cannot be excluded. CASE REPORTA 54-year-old woman was admitted to the intensive care unit of Mantes-la-Jolie hospital, presenting with fever, severe fatigue, and dyspnea with polypnea that had been increasing over the previous month. The patient was known to be seropositive for human immunodeficiency virus, which was revealed 3 years previously following pneumocystosis. At that time, an antiretroviral therapy was proposed but the patient denied the diagnosis. Since the patient had no history of blood transfusion or injection of illicit drugs, transmission by unprotected sex remained the presumed mode of human immunodeficiency virus contamination. In addition, the patient was overweight and had type 2 diabetes. Hemodynamic parameters were within normal limits. Blood gases were 52 mm Hg O 2 and 36 mm Hg CO 2 . A chest X-ray showed bilateral interstitial syndrome and several alveolar opacities. Bronchoalveolar lavage (BAL) was performed by fiber optic bronchoscopy and confirmed pneumocystosis. Interestingly, microscopic examination of a MayGrünwald-Giemsa-stained cytospin slide revealed numerous cells assumed to be trichomonad organisms, mixed with Pneumocystis parasites. The BAL sample was therefore immediately frozen for further analysis. Nasal oxygenation, intravenous injection of trimethoprim-sulfamethoxazole and methylprednisolone hemisuccinate, and subcutaneous injection of insulin were started, and recovery was rapid. On day 4, the patient was transferred to the Department of Infectious Diseases of the same institution where the investigations were completed. The CD4 cell count was 60 per mm 3 , with a CD4/CD8 ratio of 0.06.Plasma viral load was 5.34 log 10 copies/ml. Hypercalcemia with hyperparathyroidism was also noticed. The patient returned home 13 days after her hospitalization with trimethoprim-sulfamethoxazole per os. Antiretroviral therapy and exploration of hyperparathyroidism were scheduled.

No abstract