Jejunal versus ileal segmental allografts in the dog: comparison of immunologic and functional results.

Segmental small-bowel grafts have been advocated as a means of reducing the incidence of rejection and graft-versus-host disease in small-bowel transplant recipients. This study compared the results achieved with heterotopic segmental allografts of the jejunum and the ileum that used 120 cm Thiry-Vella loops in a dog model. Immunosuppressive therapy consisted of 25 mg cyclosporine/kg/day. Results were monitored by histologic examinations, function tests (maltose and xylose absorption), and brush-border enzyme assays. Thirty-three dogs were randomized for use as a donor (n = 11) or recipient of a jejunal allograft (n = 11) or an ileal allograft (n = 11). Eight allografts were technical failures and were excluded from analysis. Fourteen allografts were successful (eight ileal, six jejunal). No case of graft-versus-host disease was observed. Six allografts (42.5%, three jejunal [50%] and three ileal [37.5%]) were rejected during the first 3 months (not statistically significant). Eight allografts (five ileal, three jejunal) were tolerated for up to 3 months and were removed. Two ileal and two jejunal allografts appeared grossly normal at surgical removal, but two ileal and one jejunal allografts exhibited signs of chronic rejection, and one ileal allograft showed advanced rejection. The jejunal and ileal allografts had similar clinical courses, as were revealed by immunologic reactions and functional parameters. We conclude that there is no major difference between jejunal allografts and ileal allografts in the dog.

Toxoplasma cystitis associated with acquired immunodeficiency syndrome.

Ante-mortem diagnosis of vesical toxoplasmosis in a patient with acquired immunodeficiency syndrome (AIDS), was made by cystoscopic examination and biopsy of the bladder. Vesical biopsies can be helpful in determining appropriate therapy for AIDS patients with urinary tract involvement/disease.

Human immunodeficiency virus associated Hodgkin's disease: report of 45 cases from the French Registry of HIV-Associated Tumors.

Clinical and pathological characteristics as well as outcome of 45 Hodgkin's disease (HD) cases collected by the French registry of HIV-associated tumors between January 1987 and December 1989 (all clinically staged according to the Ann Arbor system) were analyzed and compared with those of a cohort of 407 patients with clinical stages (CS) IA to IVB enrolled between September 1981 and August 1988 in a multicentric clinical trial. The route of HIV infection, initial CD4 cell count at the time of HD diagnosis and CDC class of HIV infection were studied as well as the progression to AIDS onset were recorded. HIV-HD is characterized by a predominance of advanced CS (75%), B symptoms (80%) and mixed cellularity histology (49%), as well as by early bone marrow involvement (24%); a specific feature is the rare occurrence of mediastinal involvement (13% in HIV-HD versus 71% in primary HD). With standard therapies, 79% of the patients achieved a complete remission, but hematological and infectious complications were very frequent. The proportion of intravenous drug abusers (IVDA) in HIV-HD (38%) is higher than in French HIV-infected population as a whole (20.8%). Median CD4 cell count was 306/microliters at the time of HD diagnosis, while only 5 cases (11%) were preceded by an AIDS manifestation; progression to AIDS rate was 94% at 2 years. Overall 2-year survival was 41%, with 71% for patients with an initial CD4 cell count over 300/microliters and 0% for those with CD4 cell count lower than 300/microliters (p < 0.01); opportunistic infections were the most frequent cause of death. HIV-HD seems to occur preferentially in.(ABSTRACT TRUNCATED AT 250 WORDS)

Investigation of the thoracic aorta in cholesterol embolism by transoesophageal echocardiography.

OBJECTIVES: To examine the thoracic aorta of patients with severe cholesterol embolism (CE) by transoesophageal echocardiography (TOE). METHODS: The thoracic aorta of 20 consecutive patients with CE was compared with that in a control population matched for age and risk factors by TOE. Patients were prescribed steroids after CE was diagnosed. Follow up is reported and compared with results in the literature. RESULTS: Aortic plaques and debris were more common in patients with CE than in the control population (p < 0.001 and p < 0.0001, respectively). The mean (SD) number of aortic plaques in the CE patients was 2.6 (0.7). This aortic atheroma was found predominantly in the descending aorta. One patient died during a mean (SD) follow up of 24 (10) months. CONCLUSIONS: Aortic atheroma, as detected by TOE, should be considered as the main source of CE. In addition, the prognosis in our series, in which steroids were systemically prescribed, is much better than in others reported in the literature.

Intravertebral vacuum phenomenon in multiple myeloma.

Authors report one case of intravertebral vacuum phenomenon associated with a multiple myeloma. Initially, there occurred a collapse and a lysis of the L4 vertebral body. Two months later, after chemotherapy and cobalt-therapy, X-ray examination showed a vacuum cleft phenomenon within the body of L4 and a backward displacement of the L4 posterior wall. At the same time the patient complained of a cruralgia. Recovery occurred after decompression surgery. Histologic sampling of the L4 vertebral body revealed bone necrosis without any abnormal plasmocytosis. Authors draw attention to the neurological complications occurring in the course of the vertebral necrosis and to the fact that, even in case of multiple myeloma, the occurrence of a transverse vacuum cleft may result from osteonecrosis.

Knee arthritis revealing acute leukemia in a patient with rheumatoid arthritis.

We report one case of leukemic synovitis in a patient with a 40-year history of rheumatoid arthritis. The synovial fluid sample and synovial biopsy specimen showed myeloblastic cells. So, leukemic synovitis can be suspected in a patient with inflammatory rheumatism and adequate diagnostic procedures should be carried out.

Lymphoma developing in a patient with rheumatoid arthritis taking methotrexate.

We report one case of non-Hodgkin lymphoma in a patient, with a 30-year history of rheumatoid arthritis, taking low dose methotrexate weekly over a 10-month period. The mild immunosuppression that occurs with methotrexate therapy probably places patients with rheumatoid arthritis at added risk of developing lymphoproliferative diseases, but coincidence cannot be excluded.

Erythema nodosum and Hodgkin's disease.

Erythema nodosum is an unusual manifestation of Hodgkin's lymphoma. One patient with long remission of Hodgkin's disease manifested persistent erythema nodosum beginning one and three months before relapse was clinically evident. So, the diagnosis of Hodgkin's disease should be considered in patients with unexplained recurrent erythema nodosum.

Paraneoplastic Raynaud's phenomenon.

A testicular tumour could be diagnosed by the occurrence of a Raynaud's phenomenon complicated by severe digital arteritis. The arteritis rapidly regressed under prostacyclin therapy. Such vascular manifestations are frequent in testicular carcinoma, but they usually develop after chemotherapy. To our knowledge, this is the first case where they preceded the diagnosis and specific treatment of a tumour of the testis.

Subacute cutaneous lupus erythematosus associated with Hodgkin's disease.

Simultaneous occurrence of subacute cutaneous lupus erythematosus and malignancy has rarely been reported. We report the first case of subacute cutaneous lupus erythematosus associated with Hodgkin's disease. Although our case does not fulfill the criteria of paraneoplastic process, a relationship between the two disorders might be suggested by their simultaneous occurrence and in view of the cases of disseminated lupus erythematosus associated with lymphoma reported so far. The different hypotheses are discussed.

[Venous thrombosis disclosing Marchiafava-Micheli disease]. / Thromboses veineuses révélatrices d'une maladie de Marchiafava-Micheli.

It is established practice in patients with thromboembolic disease without the classical predisposing factors to search for general causes and abnormalities of blood clotting. The authors report a case of paroxysmal nocturnal hematuria or the Marchiafava-Micheli syndrome, a rare but classical cause of venous thrombosis. In this patient, the hemopathy presented with venous thrombosis.

[Cardiovascular manifestations of Cogan syndrome. Apropos of a case]. / Manifestations cardiovasculaires du syndrome de Cogan. A propos d'un cas.

The authors describe a case of Cogan's syndrome in a patient with ulcerative colitis complicated by several cardiovascular manifestations including bilateral coronary ostial stenosis, rapidly progressive aortic regurgitation and aneurysm of the thoracic aorta, thrombosis of the common iliac artery and pericardial symphysis. This rare form of inflammatory arteritis, the diagnosis of which is usually made on the finding of associated ocular and auditory involvement, is distinct from other types of angiitis by the predisposition to severe cardiovascular complications which influence the vital prognosis. The differential diagnosis with more common collagen diseases with cardiovascular complications is discussed.

[An unusual pericardial tumor: bronchogenic cyst]. / Une tumeur péricardique inhabituelle: le kyste bronchogénique.

The authors report the case of an intrapericardial bronchogenic cyst in a 42 year old woman with no cardiac symptoms. Despite extensive investigation, the final diagnosis was made only at anatomopathological examination. A pericardial localisation of this embryological tumour is very rare and a number of features of the condition are described. In this case, the carbohydrate antigen (CA 19-9) was a veritable marker of this tumour. This association, described for the first time, between a simple biological marker and an intrapericardial bronchogenic cyst, could be a valuable diagnostic aid in a pathology in which surgery could reasonably be deferred should the diagnosis of bronchogenic cyst be certain.

[Acute Staphylococcus aureus myocarditis in AIDS. 2 cases]. / Myocardite aiguë à Staphylococcus aureus au cours du sida. Deux observations.

The authors report two cases of acute myocarditis due to Staphylococcus aureus in patients with AIDS. There was no history of opportunist infections in either case but the CD4 lymphocyte levels were very low. The myocarditis caused acute cardiac failure and death. Histological examination showed microabscesses filled with Gram positive cocci throughout the myocardium. Bacteriological studies identified the Staphylococcus aureus. Staphylococcus aureus myocarditis without endocardial or pericardial involvement is very rare. It is the result of septic emboli in the cardiac microcirculation. Bacterial myocarditis has rarely been diagnosed in HIV positive patients. Both our cases featured severe cell-mediated immunodeficiency without associated neutropaenia. The decreased bactericidal activity of the neutrophil polynuclears and/or a deficit in the immunity mediated by the B-cell lymphocytes in AIDS could explain the lethal septic complications observed in our two cases.

[Cardiac insufficiency caused by arteriovenous fistula. An unusual complication of spinal surgery]. / Insuffisance cardiaque par fistule artério-veineuse. Une complication inhabituelle de la chirurgie du rachis.

Arteriovenous fistula is one of the main causes of high output cardiac failure. The authors report a case following lumbar disc surgery. There are a number of features which may suggest this complication both during surgery and in the immediate postoperative period which are important because the patient may only become symptomatic a long time after operation with a clinical presentation which leads to a cardiological rather than to a surgical referral.

[Drug-induced benign intracranial hypertension. Apropos of a case with amphotericin B. Review of the literature]. / Hypertension intracrânienne bénigne médicamenteuse. A propos d'un cas rapporté à l'amphotéricine B. Revue de la littérature.

Benign intracranial hypertension (BICH) is a rare adverse event. We report the case of a 31-year-old female drug addict who had been seropositive for HIV since 1987. She had stage IV C1 AIDS, and was receiving intravenous amphotericin B for generalized cryptococcosis with no neuromeningeal involvement. She developed BICH that regressed when the antifungal drug was withdrawn and treatment for cerebral edema was started. BICH is a clinical entity involving intracranial hypertension with no focal neurological signs or detectable intracranial lesion. The manifestations include headache, transitory or permanent visual disturbances (diplopia, loss of visual acuity) and the perception of intracranial noise. The cerebrospinal fluid is under increased pressure but the composition is normal. The eye fundus examination shows papillary edema, and the neuroradiological workup is normal. BICH can only be diagnosed once an expansive intracranial process, neuromeningeal infection, and non-communicative hydrocephalus have been ruled out. In the majority of cases, no etiology is found. Such cases of idiopathic BICH usually occur in overweight young women, although drugs can be implicated. Amphotericin B has not previously been held responsible for BICH. On the basis of this observation, we present a review of the literature.

[Abdominopelvic actinomycosis in pseudo-tumoral form: diagnosis by ultrasonography-guided biopsy]. / Actinomycose abdomino-pelvienne à forme pseudo-tumorale: diagnostic par ponction sous échographie.

The authors report a case of abdominopelvic actinomycosis, a rare bacterial infection. This case is exceptional for its clinical tumoral expression with fistulization through the skin, and for its rapid diagnosis by ultrasonically-guided needle biopsy. The clinical, bacteriological, histological and therapeutic aspects of actinomycosis are detailed.

[Heparin-like anticoagulant in small cell bronchial carcinoma]. / Anticoagulant circulant "heparine like" au cours d'un carcinome bronchique à petites cellules.

Acquired circulating heparin-like anticoagulants may have different causes, the most frequent being plasmocyte proliferation. The authors report an exceptional case of association between an heparin-like inhibitor and a small-cell anaplastic lung carcinoma, and they review the pathogenesis, laboratory diagnostic methods and treatment of the anticoagulant.

[Hemostasis anomalies and human immunodeficiency virus infection]. / Anomalies de l'hémostase et infection par le virus de l'immunodéficience humaine.

Because hemostasis disorder in HIV infected patients are frequent and have clinical effects, they have aroused the interest of internal medicine. Such anomalies are not yet clearly defined and include various parameters. Thrombocytopenia which is the most widespread and the best documented manifestation, whether of peripheral origin by immunological platelet destruction or of central origin by a shortage in platelet production, responds well to medical treatment, especially to zidovudine. The circulating anti-coagulants frequently observed in HIV infected patients, whether anti-phospholipid antibodies or anti-cardiolipines are mostly asymptomatic. Other coagulation disorders (affection of the inhibitory system or fibrinolysis) are rarely observed and generally have no clinical incidence. Apart from thrombocytopenias and thrombotic thrombocytopenic purpura the incidence of clinical signs (thrombotic or hemorrhagic accidents) in HIV infected patients is not higher than in an HIV-free population and respond to the same treatment.

[Tyrosine kinase: implications in tumor pathology and therapeutic perspectives]. / Tyrosine kinase: implications en pathologie tumorale et perspectives thérapeutiques.

The tyrosine kinase family includes growth factor receptor and cytoplasmic enzymes. It plays a key role in normal cell division and abnormal cell proliferation and differentiation. The most common tyrosine kinases are the epidermal-growth factor (EGFR) and platelet-derived growth factor (PDGF) receptors, and a chromosome Philadelphia product, the Bcr-abl oncogene. Many studies have attempted to correlate clinical evolution of tumors with tyrosine kinase expression. However, clinical application of these new prognostic factors has not yet been demonstrated. More recently, tyrosine-phosphorylation inhibitors (tryphostin) have been developed in phase I studies. Results that were obtained show some objective responses in patients with glioblastoma and polymetastatic cancer. Another approach to block tyrosine kinase expression is the use of monoclonal antibodies. Trials using such antibodies have shown interesting preliminary results.