[Nerve and deep vein compression by femoral artery pseudoaneurysm in a patient with multiple exostosis]. / Compression nerveuse et veineuse profonde par un faux anévrysme de l'artère fémorale superficielle au cours d'une exostose multiple.

The multiple exostosis is a hereditary bone tumour. Generally, its complications are benign and are related to compressing surrounding structures such as nerves and vessels. This is the case of a 52-year-old woman with a family history of multiple exostosis, which was complicated by a pseudoaneurysm of the right superficial femoral artery. The delay in diagnosis was allowed to develop this pseudoaneurysm which caused nervous and deep venous compression.

[IL-2/IL-2R pathway in dendritic cell modulates both their cytokine synthesis profiles and their capacity to activate allogeneic CD4+ T lymphocytes]. / La voie IL-2/IL-2R chez la cellule dendritique module à la fois leur synthèse de cytokines et leur capacité à activer des lymphocytes T CD4+ allogéniques.

The results provide new insights into the role of IL-2/IL-2R pathway in DC. We report that stimulation of human monocyte-derived DC with LPS strongly upregulated CD25 (α chain of the IL-2R) expression. In addition, by using a humanized monoclonal antibody against CD25, we demonstrated that the IL-2 signalling in DC upregulated both IL-12 and γIFN production but decreased IL-10 synthesis. Anti-CD25 treatment reduced the ability of LPS-DC to induce allogeneic CD4(+) T cell proliferation as compared to LPS-matured DC. In addition, LPS-matured DC treated with IL-2 had a higher allostimulatory capacity compared to LPS-DC. We also found that LPS-matured DC produced IL-2. Thus, IL-2 seems to contribute actively to DC activation through an autocrine pathway. Moreover, IL-2 pathway in DC is involved in T helper priming. These findings might be useful for protocols in cellular therapy and a valuable tool to understand graft rejection versus the acquisition of peripheral tolerance.

Creatinine clearance estimation after kidney transplantation: an analysis of three methods.

Surveillance of glomerular filtration rate (GFR) is essential for the management of kidney transplant recipients. We compared the performance of estimation equations with (99m)Technetium ((99m)Tc)-DTPA clearance (TcGFR) in 32 of our patients, using the Modification of Diet in Renal Diseases (MDRD), Nankivell (NK), and Cockcroft-Gault (CG) formulas. All patients were adequately hydrated before study. (99m)Tc-DTPA was injected intravenously (maximal dose = 37 MBq). A second syringe was prepared for an aliquot of the study ("standard"). Blood was sampled at 120 and 240 minutes in various sites. After centrifugation, 1.0 mL plasma was transferred into a counting vial. Both the samples and the "standard" were measured in a well counter. The mean time from transplantation to TcGFR was 47.9 months (range, 4-143 months). The mean serum creatinine level was 124 micromol/L (range, 70-371 micromol/L). The mean TcGFR was 58.6 mL/min/1.73 m(2) (range, 14-100 mL/min/1.73 m(2)). The MDRD equation showed a median difference of 1.4 mL/min/1.73 m(2) with 81.2% of estimated GFR within 20% of TcGFR. Median differences were 8.94 and 11.47 mL/min/1.73 m(2) for NK and CG formulas, respectively. The precision of the NK and CG was such that only 56.25% and 62.5% of estimations, respectively, fell within 20% of TcGFR. In this study, the MDRD equation demonstrated the best overall performance among the 3 tested methods. It should be sufficient for routine clinical practice in kidney transplantation.

Renal transplantation unveils Conn's syndrome: a case report.

Primary hyperaldosteronism or Conn's syndrome is rare after renal transplantation. We present a case of a 34-year-old woman with end-stage renal disease, who had received a living renal transplant and showed persistent hypertension and hypokalemia. The common causes of hypertension after kidney transplantation were excluded and hypokalemia persisted despite potassium supplementation and angiotensin converting enzyme inhibitors. Biochemical findings revealed extremely elevated plasma aldosteron levels, suppressed plasma renin activity, and massive urinary potassium wasting. Abdominal computerized tomography scan showed a left 25-mm adrenal nodule. Her hypertension and hypokalemia was cured by the removal of the adenoma.

[Carotid stenosis: indications and therapeutic approach]. / La stenose carotidienne: indications et conduite therapeutique.

There has not been a peripheral vascular surgical procedure subject to as exquisite scruting as carotid endarterectomy. The last decade gave a new attitude after the analysis and conclusions of the North American Symptomatic Carotid Endarterectomy Symptomatic extracranial lesions were best managed with operative intervention rather than antiplatelet treatment alone. Now, in the first decade of the new millenium, we are embarking on yet another test of carotid endarterectmy--a comparison with percutaneous angioplasty and stenting, which is a most rigorous contest because endarterectomy must now withstand comparison with another "active treatment" rather than the more passive observational modality of antiplatelet therapy. The topic of the authors was to provide a panorama of the contemporay treatment of carotid disease at this pivotal point in the life cycle carotid endarterectomy.

[Epidemiology of chronic arteritis of the lower limbs: multicenter study: report of 531 cases]. / Epidemiologie de l'arterite chronique des membres inferieurs: etude multicentrique: à propos de 531 cas.

Arteritis is a local finding of a general disease: atherosclerosis. To define the risk factors of this disease in Tunisia, 531 patients were collected by a multicenter retrospective study between January 1998 and December 1999. Most of our patients were male with a mean age of 62 years. The most important risk factor was tobacco with an incidence of 90%. Lipids and diabetes were less common. The association of risk factors is particularly dangerous.

[Arterial aneurysms and Behçet's disease: apropos of 3 cases]. / Anévrismes artériels et maladie de Behçet: à propos de trois cas.

PURPOSE: Results that were obtained from three patients and a literature review allow the authors to better define the place of medical and surgical treatments according to the different locations of arterial aneurysm occurring in the course of Behcet's disease. METHODS: Retrospective report of five cases of arterial aneurysm that occurred during Behcet's disease in three patients. RESULTS: Due to the unusual symptoms, diagnosis can be hampered. Though lesions may be observed in various areas, they were mostly aortic (two patients). Surgical revascularization was done in all three patients. It mainly involved prosthetic grafts. Two patients were subsequently treated by postoperative immunosuppressive drugs. The mean follow-up was 22 months. Relapsing aneurysm was observed in one patient, while in another patient aneurysm developed in a new location. CONCLUSION: These types of arterial lesions respond poorly to medical treatment when a combination of colchicine and intermittent intravenous bolus of cyclophosphamide is used. Surgical indications should be given great yet selected weight, using prosthetic rather than venous autologous grafts (due to the risk of spontaneous venous involvement). Since either complication or recurrence is possible, prolonged monitoring is required.

[Extra-adrenal gland pheochromocytoma. Apropos of 3 cases and review of the literature]. / Le phéochromocytome extrasurrénalien. A propos de trois observations et revue de la littérature.

The authors report three new cases of ectopic pheochromocytoma: latero-aortic, bladder and near the kidney. From the review of the literature, they propose a diagnostic and therapeutic strategy for the management of ectopic localisation of pheochromocytoma.

[Late revascularization of the limbs for post-traumatic chronic ischemia]. / Revascularisation tardive de membre pour ischémie chronique post-traumatique.

Chronic post traumatic ischaemia is a specific late complication of vascular injuries. The authors report a four cases series, including three war vascular injuries. They emphasize the surgical management lines and point out the preeminence of vascular restoration on reconstructive bone and joint surgery.

[Gas gangrene: an extreme surgico-medical rather than medico-surgical emergency]. / La gangrène gazeuse: une extrême urgence "chirurgico-médicale" et non pas médico-chirurgicale.

A diabetic woman developed spontaneous gas gangrene of upper limb extending into trunk and due to clostridium septicum. Recovery was obtained after major surgery involving disarticulation of upper limb and excision of soft tissues of left hemithorax, and a difficult intensive care programme (hyperbaric oxygen therapy, assisted ventilation). The presence of this gas gangrene revealed a bipolar colon cancer treated in parallel. The conventional therapeutic hierarchy is discussed: surgery should be carried out as an extreme emergency and should not be delayed to allow transfer to a center equipped with a hyperbaric oxygen therapy apparatus.