[TAFRO syndrome and cutaneous necrotizing vasculitis]. / Syndrome TAFRO et vascularite nécrosante cutanée : une association inédite.

INTRODUCTION: TAFRO syndrome is a systemic inflammatory syndrome in the spectrum of Castleman's disease, associating thrombocytopenia, anasarca, fever, renal failure and/or reticulin myelofibrosis and organomegaly. Its association with necrotizing cutaneous vasculitis has not yet been reported. CASE REPORT: A 69-year-old woman presented with weight loss, fever, anasarca, organomegaly, lymphadenopathy, anuria and extensive necrotic livedo occurring after acute diarrhea. Biology showed anemia, thrombocytopenia, renal failure, hypergammaglobulinemia, a circulating B-lymphocyte clone, hypoparathyroidism and autoimmune hypothyroidism. The skin biopsy showed small vessel vasculitis with fibrinoid necrosis. Methylprednisolone infusions associated with tocilizumab were ineffective and the patient became anuric. Rituximab and plasma exchanges associated to corticosteroids allowed remission for 2 months. Combination of rituximab, cyclophosphamide and dexamethasone resulted in a prolonged remission. CONCLUSION: We report here the first case of severe cutaneous necrotizing vasculitis in a patient suffering from TAFRO syndrome. The possible resistance to tocilizumab should be known.

Ulcer of Lipschutz, a rare and unknown cause of genital ulceration.

Acute genital ulcers are painful and distressing to women. Lipchutz Ulcer is an uncommon disease that typically occurs in sexually inactive young women. The main differential diagnosis are sexually-transmitted or non-infectious diseases which cause genital or oro-genital ulcerations. This article aims to review the diagnosis of acute genital ulcers and, through a rare case of acute genital ulcerations, to discuss diagnostic procedures.

A reversible posterior leucoencephalopathy syndrome including blindness caused by preeclampsia.

Complications of (pre)eclampsia may involve multiple systems and organs. Neurological symptoms may occur. Visual symptoms concern up to 25% the of patients with severe preeclampsia and 50% of the patients with eclampsia. An uncommon effect of severe preeclampsia is sudden blindness. Blindness may be part of a clinical and radiological presentation named Posterior Reversible Encephalopathy Syndrome (PRES). PRES may lead to permanent neurological deficit, recurrences or death. We report the case of a 24-year-old Caucasian patient, gravida 5 para 2 who developed preeclampsia and PRES complicated with blindness at 32 weeks of gestation. Optimal care allowed visual symptoms to resolve within 24 hours and a favourable maternal outcome and no long- term sequelae. We describe different causes and manifestations of PRES and highlight the need for immediate care in order to optimize the chance of symptoms reversibility.

[Decompression retinopathy with maculopathy after trabeculectomy with mitomycin C]. / Retinopatía por descompresión con maculopatía tras trabeculectomía con mitomicina C.

CASE REPORT: We present a case of decompression retinopathy with retinal haemorrhages, optic nerve haemorrhages, maculopathy, and decreased visual acuity after trabeculectomy with mitomycin-C. DISCUSSION: Decompression retinopathy is a potential complication after glaucoma surgery but has been rarely reported in the world literature. Although these four characteristics have been described separately, in this patient all four occurred together.

[Erythema multiforme caused by a Mycoplasma infection: a case report]. / Le cas clinique du mois. Erythème polymorphe sur infection a Mycoplasma.

Erythema multiforme (EM) is an immune-mediated disease categorized into EM minor and EM major, also called Stevens-Johnson syndrome (SJS), not to be confused with toxic epidermal necrosis (TEN), as physiopathological pathways are throughly different. Mycoplasma pneumoniae is an intracellular germ, generally responsible for atypical respiratory infections. It may be associated with erythema multiforme, eventually recurrent, illustrated by the present case report.

Revisiting silicate substituted hydroxyapatite by solid-state NMR.

Silicon-substituted hydroxyapatite (Si-HAp) has shown promising properties such as high-bone remodeling around implants. So far, the techniques used for the structural characterization of the Si-HAp have given indirect evidence of the presence of silicon inside the structure (by X-ray and neutron diffraction). In this paper, we focus on Si-HAp derivatives obtained by a precipitation method (widely described in the literature). We demonstrate here by solid-state NMR spectroscopy that only a fraction of the silicon atoms are incorporated into the HAp lattice in the form of Q(0) (SiO(4) (4-)) species, for 4.6 wt% Si-HAp. A large amount of silicate units are located outside the HAp structure and correspond to silica-gel units. All results were established through (29)Si MAS, (1)H -->(29)Si CP MAS and T(1)rho((1)H) edited (1)H -->(29)Si CP MAS experiments. This last pulse scheme acted as a powerful editing sequence, leading to unambiguous spectroscopic conclusions, concerning the location of the SiO(4) (4-) moieties.

Extensive emphysematous pyelonephritis.

We report an unusually severe case of emphysematous pyelonephritis with very extensive kidney necrosis that led to unilateral nephrectomy. We discuss the diagnosis and treatment options in this very rare complication of pyelonephritis almost exclusively encoutered in diabetic patients.

First principles NMR calculations of phenylphosphinic acid C6H5HPO(OH): assignments, orientation of tensors by local field experiments and effect of molecular motion.

The complete set of NMR parameters for (17)O enriched phenylphosphinic acid C(6)H(5)HP( *)O(*OH) is calculated from first principles by using the Gauge Including Projected Augmented Wave (GIPAW) approach [C.J. Pickard, F. Mauri, All-electron magnetic response with pseudopotentials: NMR chemical shifts, Phys. Rev. B 63 (2001) 245101/1-245101/13]. The analysis goes beyond the successful assignment of the spectra for all nuclei ((1)H, (13)C, (17)O, (31)P), as: (i) the (1)H CSA (chemical shift anisotropy) tensors (magnitude and orientation) have been interpreted in terms of H bonding and internuclear distances. (ii) CSA/dipolar local field correlation experiments have allowed the orientation of the direct P-H bond direction in the (31)P CSA tensor to be determined. Experimental and calculated data were compared. (iii) The overestimation of the calculated (31)P CSA has been explained by local molecular reorientation and confirmed by low temperature static (1)H-->(31)P CP experiments.

Global models from the Canadian lynx cycles as a direct evidence for chaos in real ecosystems.

Real food chains are very rarely investigated since long data sequences are required. Typically, if we consider that an ecosystem evolves with a period corresponding to the time for maturation, possessing few dozen of cycles would require to count species over few centuries. One well known example of a long data set is the number of Canadian lynx furs caught by the Hudson Bay company between 1821 and 1935 as reported by Elton and Nicholson in 1942. In spite of the relative quality of the data set (10 undersampled cycles), two low-dimensional global models that settle to chaotic attractors were obtained. They are compared with an ad hoc 3D model which was proposed as a possible model for this data set. The two global models, which were estimated with no prior knowledge about the dynamics, can be considered as direct evidences of chaos in real ecosystems.

Application of the MAS-J-HMQC experiment to a new pair of nuclei {29Si,31P}: Si5O(PO4)6 and SiP2O7 polymorphs.

We report the results of the two-dimensional MAS-J-HMQC experiment providing scalar correlations between 29Si and 31P nuclei in solid state NMR, and we give the first evaluation of the 2JSi-O-P coupling constants (approximately 15 Hz) for a crystalline silicophosphate phase Si5O(PO4)6. The experiment is applied to the characterization of complex mixtures of SiP2O7 phases, through editing of 31P spin pairs by the heteronuclear 2JP-O-Si interaction.

Protocol for mitomycin C use in glaucoma surgery.

PURPOSE: To evaluate the results of a protocol described for mitomycin C (MMC) use in trabeculectomy or combined surgery (phacoemulsification and trabeculectomy). METHODS: A total of 143 eyes (60 trabeculectomies and 83 combined surgeries) of 124 patients were divided into four groups: group 1 (without MMC); group 2 (with 0.1 mg/ml MMC); group 3 (with 0.2 mg/ml MMC), and group 4 (with 0.4 mg/ml MMC). Two-minute MMC was used in every case in groups 2, 3 and 4. The results were analysed after 1 year of follow-up. Intraocular pressure (IOP) and complications were evaluated. Successful IOP control was defined when IOP was <21 mmHg and <16 mmHg if advanced glaucoma was present, always without additional medical treatment. RESULTS: Mean preoperative IOP decreased from 24.60 mmHg (SD 1.40 mmHg) to 13.47 mmHg (SD 0.37 mmHg) (p < 0.00001), 12 months postoperatively. Control in IOP was achieved in 79.02% of eyes. No significant differences were found in final mean IOP values (p > 0.196) or in postoperative complications (p > 0.120) in groups 2, 3 and 4. CONCLUSION: With the protocol described, a selection of concentration of MMC has been made in different clinical forms of glaucoma. No significant differences in IOP control and postoperative complications were noticed among the groups.

Modeling maps by using rational functions

Rational functions are not very useful for obtaining global differential models because they involve poles that may eject the trajectory to infinity. In contrast, it is here shown that they allow one to significantly improve the quality of models for maps. In such a case, the presence of poles does not involve any numerical difficulty when the models are iterated. The models then take advantage of the ability of rational functions to capture complicated structures that may be generated by maps. The method is applied to experimental data from copper electrodissolution.

Value of logistic discriminant analysis for interpreting initial visual field defects.

PURPOSE: The authors evaluate logistic discriminant analysis as a method for interpreting visual field results in initial stages of several ophthalmic diseases. METHODS: The authors retrospectively studied the visual field defects of 96 patients with early glaucomatous damage and prospectively studied 84 subjects with normal eyes (n = 28), cataracts (n = 27), diabetic retinopathy (n = 14), or hypertensive retinopathy (n = 15). The visual fields were examined at least twice with program G1 of Octopus 500 (Interzeag AG, Schlieren, Switzerland). Only one eye per patient was randomly selected and included in the study. The authors created a database with all visual field information provided by Octopus and applied logistic discriminant analysis (SAS Logistic Procedures, SAS Institute, Cary, NC) to obtain classification rules capable of qualifying visual field defects as glaucomatous or nonglaucomatous. The rules were tested with an independent sample. RESULTS: There were significant differences between the groups in the distribution of visual field defects tested by program G1. Logistic discriminant analysis correctly identified the glaucomatous or nonglaucomatous origin of the defects with a sensitivity of 65% to 85% and a specificity of 60% to 92%. CONCLUSIONS: Logistic discriminant analysis is a useful tool to aid in the interpretation of early glaucomatous and nonglaucomatous visual field defects.

Reduced variation of the diurnal curve after the subscleral scheie procedure for primary open-angle glaucoma.

We report the results of a one-year prospective study of the maximum intraocular pressure and the range of the oscillations of the diurnal curve after a subscleral Scheie procedure in 21 eyes (13 patients) with chronic primary open-angle glaucoma. Pressure curves were recorded preoperatively, during the immediate postsurgical period, at one month postoperatively, and every three months thereafter up to one year after surgery. Our results showed that this procedure reduced the maximum intraocular pressure and the oscillations of the diurnal curve (P < .001). This effect was maximum during the immediate postoperative period and decreased one month after surgery (P < .001).

Screening for prostate cancer. Comparison of transrectal ultrasound, prostate specific antigen and rectal examination.

In seeking to define the relative value of transrectal ultrasound (TRUS), prostate specific antigen (PSA) and digital rectal examination (DRE) in the diagnosis of prostatic cancer, 863 patients were studied and the findings compared. DRE detected malignancy in 0.3% of the population of asymptomatic "normal" men undergoing routine health screening, and in 1.6% of patients who consulted their General Practitioner for one reason or another. In patients who attended our out-patient department with a variety of urological symptoms (not necessarily prostatic), TRUS suggested malignancy in 2% of those glands which were pronounced normal on DRE. Significantly elevated PSA detected malignancy in 0.3% of the patients undergoing routine health screening. (Although this figure equals the pick-up rate by DRE in this group, they were not necessarily the same patients). When these 3 investigations are summated, the pick-up rate is twice as high as when a single parameter is used.

[Circulating prostate cancer specific antigens in benign hypertrophy and localized cancer of the prostate]. / L'antigène prostatique spécifique circulant dans l'hypertrophie bénigne et le cancer localisé de la prostate.

In benign hypertrophy of the prostate (88 patients) there is a good correlation between the circulating specific prostate antigen (SPA) and the size of the prostate or of the adenoma. This correlation disappears with an adenocarcinoma where tumor volume increases (46 patients). Used as a screening test for cancer, serum levels of SPA, with a threshold value of 2.5 ng/ml, has a 91 per cent sensitivity and a 37 per cent specificity. At 15 ng/ml the sensitivity is 50 per cent and the specificity is 85 per cent. Alone, the SPA level is a poor diagnostic tool: using the low threshold (2.5 ng/ml) leads to needle biopsy in most all benign hypertrophies; with the high threshold (15-23 ng/ml), 50 per cent of the localized cancers go undetected. However, for a level greater than 15 ng/ml, SPA is an argument strongly suggesting prostate adenocarcinoma. The capacity of benign hypertrophy of the prostate to "secrete" SPA is 5 times greater than the normal peripheral prostate; the capacity of cancer is 20 times greater than that of the adenoma. Individual variability in serum levels of SPA, expressed per cm3 of prostate tissue is too great to give a precise interpretation as a function of volume.

[Circulating prostatic-specific antigen in benign hypertrophy and localized prostate cancer: can PSA be considered a screening examination for localized cancer?]. / Le PSA circulant dans l'hypertrophie bénigne et le cancer localisé de la prostate: le PSA peut-il être considéré comme un examen de dépistage du cancer localisé?

Prostate-specific antigen (PSA) is increasingly used in the diagnosis of prostatic pathology. Its usefulness in the early diagnosis of prostatic cancer is controversial. The aim of the study is to evaluate the sensitivity and specificity of PSA in a population with prostate diseases. Moreover, we wanted to know if the measure of the prostate volume may increase the sensitivity of the test. In benign prostatic hypertrophy (88 patients), a good correlation exists between circulating PSA and the prostatic volume or the volume of the adenoma. This correlation disappears in the presence of an adenocarcinoma at the profit of the tumor volume (46 patients). Used as a means of screening for cancer, the serum level of PSA with a threshold value of 2.5 ng/ml has a sensitivity of 91% and a specificity of 32%. The sensitivity is 50% and the specificity is 85% at a level of 15 ng/ml. Taken alone, the level of PSA is inadequate for diagnosis: If the lower level is chosen (2.5 ng/ml), the majority of benign prostatic hypertrophies will be the object of a biopsy. If the higher level is chosen (15-23 ng/ml), 50% of localized cancers of the prostate will escape detection. Nevertheless, a level of PSA < 15 ng/ml is an argument for a strong suspicion in favor of an adenocarcinoma of the prostate. The capacity of BPH to "secrete" serum PSA is five times greater than that of the normal peripheral prostate, and the capacity of cancer is 20 times greater than that of an adenoma. The individual variability of serum PSA per cubic centimeter of prostatic tissue is too great to allow a precise interpretation as a function of volume.