Management of mixed acute rejection driven by a de novo donor-specific complement-binding anti-DQB1*03:01 antibody and intraepithelial CD8 T-cells in a kidney recipient: a case report.

Mixed acute rejection is a clinicopathological entity that is difficult to accurately diagnose, and so may be under-reported. Allografts are lost more often than in either humoral or cellular rejection. The diagnosis requires both histological and immunological studies on renal biopsy and blood specimens from the transplant recipient to provide the required rescue therapy to abolish the allogeneic response against the graft. We present a clinical case report of an active mixed acute rejection driven by a de novo donor-specific complement-binding anti-DQB1*03:01 antibody and intraepithelial CD8 T-cells in a patient with a kidney transplant. The patient was diagnosed, treated, and followed up as per the local institution's procedure with a full recovery of graft function. Our case emphasises the challenge of a mixed acute rejection and supports the need to improve the post-transplant outcome of recipients and their grafts.

CandidaDB: a genome database for Candida albicans pathogenomics.

CandidaDB is a database dedicated to the genome of the most prevalent systemic fungal pathogen of humans, Candida albicans. CandidaDB is based on an annotation of the Stanford Genome Technology Center C.albicans genome sequence data by the European Galar Fungail Consortium. CandidaDB Release 2.0 (June 2004) contains information pertaining to Assembly 19 of the genome of C.albicans strain SC5314. The current release contains 6244 annotated entries corresponding to 130 tRNA genes and 5917 protein-coding genes. For these, it provides tentative functional assignments along with numerous pre-run analyses that can assist the researcher in the evaluation of gene function for the purpose of specific or large-scale analysis. CandidaDB is based on GenoList, a generic relational data schema and a World Wide Web interface that has been adapted to the handling of eukaryotic genomes. The interface allows users to browse easily through genome data and retrieve information. CandidaDB also provides more elaborate tools, such as pattern searching, that are tightly connected to the overall browsing system. As the C.albicans genome is diploid and still incompletely assembled, CandidaDB provides tools to browse the genome by individual supercontigs and to examine information about allelic sequences obtained from complementary contigs. CandidaDB is accessible at http://genolist.pasteur.fr/CandidaDB.

[Incrusted cystitis after Mitomicin-C]. / Cistitis incrustante tras Mitomicina C.

Incrusted cystitis is an infrequent process characterized by precipitation an incrustation of salts on the vesical mucosa. An alkanine urine is required to this precipitation. The urinary infection with urolithic activity microorganisms can also be a very important factor. We present a case of incrusted cystitis after using Mitomicine as vesical chemotherapy.

[Focal peritonitis as a form of clinical presentation of listeriosis]. / Peritonitis focal como forma de presentación clínica de una listeriosis.

Infections by germs of Listeria genus can occur sporadically or in epidemic outbreaks and have different clinical presentations. Abdominal origin is very unusual among them, especially in no immunocompromised patients or without concurrent liver illness. We present a young healthy man who is lacking in underlying diseases, suffering from focal peritonitis caused by Listeria monocytogenes. The patient had to be operated on, requiring immediate colectomy and evacuation of a retroperitoneal abscess. The postoperative evolution was favorable under antibiotic treatment with amoxicillin and clavulanic acid during 3 weeks. The clinical-epidemiological and therapeutic aspects of listeriosis are analysed in the discussion, giving special attention to abdominal infective episodes.

[Cardiac rehabilitation. Other protocols]. / Rehabilitación cardíaca. Otros protocolos.

Cardiac rehabilitation programmes and secondary prevention programmes vary according to the type of cardiopathy, to the functional state and to the physical characteristics of the subject. On many occasions, they depend on the material resources and on the staff of the centre offering this type of therapeutic action. A summary of different ways of performing cardiac rehabilitation in our country is given.

[Anatomical variations of the middle cerebral artery: duplication and accessory artery. Implications in the treatment of acute stroke]. / Variantes anatomicas de la arteria cerebral media: duplicidad y arteria accesoria. Implicaciones en el tratamiento del ictus agudo.

INTRODUCTION: Less than half of all subjects display a normal configuration of the Circle of Willis, according to anatomical studies. Variations of the middle cerebral artery (MCA) such as duplication or accessory MCA are infrequent but nevertheless have important clinical implications. We report the case of two patients with these variations of the MCA and their repercussions in the management of acute stroke are discussed. CASE REPORTS: Case 1: a 53 year old male with a 2 hour history of sensory motor syndrome; a transcranial Doppler (TCD) scan revealed asymmetrical speeds in the MCA. Spontaneous perforation of the MCA was suspected and we therefore decided to perform a magnetic resonance angiography scan before administering fibrinolytics. The magnetic resonance angiography scan showed an accessory MCA lying ipsilateral to the lesion. We interpreted the anomalies in blood flow detected in the TCD recording as being secondary to this anatomical variation and not due to reperfusion. Following the magnetic resonance angiography study, the possibility of fibrinolysis was ruled out. The patient recovered the neurological deficit in a matter of hours. Case 2: a 21 year old female with headaches and transient hemiparesis, who was diagnosed as suffering from migraine with aura. Later, following another stroke, it was shown that the previous clinical symptoms had been secondary to intracranial dissection with embolism in the lenticulostriate arteries and ischemic infarction in that territory. A magnetic resonance angiography scan showed duplication of the ipsilateral MCA. CONCLUSIONS: The double vascularisation of the hemisphere in cases of anatomical duplication can give rise to strokes with a better progression and prognosis, despite the occlusion of one of the MCA. The presence of anatomical variations of the MCA can lead to mistaken interpretations of the transcranial Doppler scan and may affect decision making as regards the therapy to be employed in patients with acute stroke.

[Ischemic brain lesions following carotid revascularisation procedures: a comparative study using diffusion-weighted magnetic resonance imaging]. / Lesiones cerebrales isquémicas tras procedimientos de revascularización carotídea: estudio comparativo con resonancia magnética por difusión.

INTRODUCTION: The risk of cerebral embolism following angioplasty-stent placement (AGP) is higher than that observed after a carotid endarterectomy (CE) using transcranial Doppler ultrasonography. Nevertheless, no studies have been conducted to compare the two revascularisation procedures with the latest neuroimaging techniques. AIMS: To analyse the presence and repercussion of acute cerebral ischemia detected by diffusion-weighted magnetic resonance imaging (DMR) following carotid revascularisation procedures. PATIENTS AND METHODS: Our prospective study included a sample of 20 consecutive patients with atherosclerotic stroke and symptomatic carotid stenosis > 70% according to NASCET criteria and treated by CE (n = 10) or AGP (n = 10). Patients were submitted to a DMR during the 48 hours prior to revascularisation and another within the 72 hours following the intervention in order to evaluate the existence of new acute cerebral ischemic lesions. Patients were explored by a neurologist before and after the intervention. RESULTS: DMR allowed new areas of cerebral ischemia to be detected in 10% of the CE and in 40% of the AGP patients. 50% of the post-AGP ischemic lesions were multiple and 10% of the lesions in each therapeutic group presented some clinical correlation in the form of transient neurological focal signs. No significant differences were observed with respect to the pattern of risk of complications between the two therapeutic groups and no factors associated to a higher risk of new ischemic lesions were detected by DMR in patients submitted to AGP. CONCLUSIONS: Carotid AGP is linked to a higher frequency of new ischemic lesions in the brain than in the case of CE. Nevertheless, these ischemic lesions detected by DMR are usually silent. Symptomatic complications were similar in the two procedures.

Osteochondritis dissecans of the anterior tibial spine.

A 12-year-old boy had a history of pain in the right knee for 2 months, mainly pain in extension. He could not recall any trauma to the knee. The radiograph suggested osteochondritis dissecans in the anterior spine. An arthroscopy was performed and a prominence in the tibial insertion of the anterior cruciate ligament in the anterointernal area was observed, and the fragment resected. The diagnosis of osteochondritis dissecans was confirmed by pathological study. As far as we are aware, this is the first case describing this new location.