Pathological features of temporal arteries in patients with giant cell arteritis presenting with permanent visual loss.

BACKGROUND: Permanent visual loss (PVL) is the most feared complication of giant cell arteritis (GCA), and its risk factors are still unclear. OBJECTIVES: The aim of our study was to assess the pathological features predictive of PVL on temporal artery biopsy (TAB) specimens in patients with GCA. METHODS: The slides of 391 TAB specimens from patients with GCA were reviewed by two pathologists without clinical information. RESULTS: A total of 29 patients (26 females and 3 males, mean age 78.3 years) presented with unilateral PVL at the onset of the disease, and 362 patients (258 females, 104 males, mean age 74.7 years), did not. The pathological features strongly predictive for PVL were the presence (p = 0.003), number (p = 0.001) and aggregates of giant cells (p = 0.001), presence of plasmocytes (p = 0.002), thickened intima (p = 0.007), neoangiogenesis (p = 0.001) and degree of arterial occlusion (p = 0.006). Presence of neutrophils, eosinophils, parietal necrosis, calcification in the arterial wall and disruption of the internal elastic membrane were similar in both groups. Total obstruction of the arterial lumen by a thrombus, intensity of the inflammatory cells infiltration and inflammation of small vessels, nerves and veins surrounding the temporal artery were not associated with blindness. In multivariate analysis, only giant cells remained significantly associated with PVL. CONCLUSION: Giant cells are strongly associated with PVL, with a significant gradient between great risk and large number of giant cells. However, PVL was neither associated with the intensity of the inflammatory infiltrate, nor with the presence of arterial thrombosis.

[Incidence of cardiovascular events in giant cell arteritis: preliminary results of a prospective double cohort study (GRACG)]. / Incidence des accidents cardiovasculaires au cours de la maladie de Horton: résultats préliminaires de l'étude prospective en double cohorte GRACG.

UNLABELLED: Giant cell arteritis is the most frequent vasculitis. Cardiovascular events such as cerebrovascular accident or ischemic heart disease may occur in patients with giant cell arteritis. However, their real incidence, as well as their relative risk compared to the general population, remains unknown. PURPOSE: To assess in a prospective, double cohort study, the incidence of cardiovascular events in giant cell arteritis patients compared to controls, after controlling for cardiovascular risk factors. PATIENTS AND METHODS: We included on predefined criteria 432 newly diagnosed patients with giant cell arteritis, each assigned to sex- and age-matched controls randomly selected from the general population. Cardiovascular risk factors (high-blood pressure, diabetes, smoking, hypercholesterolemia and preexisting peripheral vascular disease) were collected at inclusion. During the 24-month follow-up, all cardiovascular events were collected. After stratification for cardiovascular risk factors, a log-rank test was performed to compare cases and controls. A parametric survival model was used for multivariate analysis. RESULTS: Cardiovascular events all combined were significantly increased in patients with giant cell arteritis (RR = 2.15 [1.21-3.81], P = 0.009), and were mainly associated with age (P = 0.0001), past history of cardiovascular disease (P = 0.023) but also with giant cell arteritis (P = 0.009). However, each subset of cerebrovascular accident (RR = 2.42 [0.84-7]) or ischemic heart disease (RR = 1.67 [0.72-3.89]) increased but did not significantly. CONCLUSION: Cardiovascular events incidence is increased in patients with giant cell arteritis, and prescription of preventive antiagregant treatment may be discussed.

Incidence of Severe Infections and Infection-Related Mortality During the Course of Giant Cell Arteritis: A Multicenter, Prospective, Double-Cohort Study.

OBJECTIVE: To assess the incidence of infections leading to hospitalization, the mortality rate related to infections, and the determinants of these factors in patients with giant cell arteritis (GCA). METHODS: In total, 486 patients with GCA (75% women) were enrolled at the time of diagnosis. All patients fulfilled the American College of Rheumatology criteria for GCA. As controls, age- and sex-matched subjects were randomly selected from the general population and matched to patients at the time of diagnosis of GCA. Both groups were prospectively followed up over a 5-year period. RESULTS: Severe infections were more frequent among patients with GCA during the first year after diagnosis, compared to general population controls (incidence rate ratio 2.1, 95% confidence interval [95% CI] 1.2-3.4; incidence rate 11.1/100 patient-years [95% CI 8.3-14.6] in patients with GCA versus 5.9/100 patient-years [95% CI 4-8.4] in controls). Specifically, septic shock and infectious colitis were more frequent among the patients with GCA. Mortality caused by infections was higher in patients with GCA compared to controls (P < 0.0001 by log rank test). In analyses adjusted for age, among patients with GCA, a diagnosis of diabetes (hazard ratio [HR] 3.3, 95% CI 1.4-7.7) and a corticosteroid dosage that was >10 mg/day after 12 months of treatment (HR 4.61, 95% CI 1.38-15.36) were associated with death attributed to severe infection. The observed overall incidence of mortality was increased in patients with GCA during the early period of enrollment in the study (before 1997) (P = 0.0001 by log rank test), but thereafter was the same as that in the general population controls. CONCLUSION: Frequencies of severe infections and rates of infection-related mortality are increased during the first year after the diagnosis of GCA. The risk of infection increases in GCA patients with older age or in the presence of diabetes, or is greater when the dosage of corticosteroids has been increased to >10 mg/day after 12 months of treatment.

Clinical prevalence of glomerular hematuria: a nine-year retrospective study.

The authors evaluated red blood cell (RBC) morphology by phase contrast microscopy and identified casts and lipidic material in 4,448 urine sediments (US). Microhematuria was discovered on systematic examination in 1,186 apparently healthy patients (group I). Another 4,362 patients (group II) with microscopic or gross hematuria were being treated or evaluated for various renal or extrarenal diseases (renal transplantation excepted). Glomerular hematuria (GH) was observed in 93.1% of group I patients and in 58.0% of group II patients. GH and non-GH were observed together in 0.6% of cases. The origin of hematuria remained uncertain in 11.6% of cases. In GH, the other cytological findings were as follows: RBC casts were seen in 5.3% of group I and 20.5% of group II; granular and/or cellular casts were seen in 12.8% of group I and 39.6% of group II; and lipidic material was seen in 0.6% of group I and 8.8% of group II. Both groups showed a higher frequency of RBC casts, granular and/or cellular casts, and lipidic material in patients under 20. This method of investigation of urine, which is simple, rapid, inexpensive, and noninvasive, provides useful information for the clinician and avoids unnecessary investigations.

[Bronchial aspiration in the typing of bronchopulmonary cancers: apropos of 150 cytobiopsy correlations]. / L'aspiration bronchique dans le typage des cancers bronchopulmonaires: à propos de 150 corrélations cytobiopsiques.

We analysed 150 cases of primary lung cancers investigated by bronchial aspirate and biopsy methods with clinical, radiologic and bronchoscopic findings. Among the 150 cases studied, three were characterized by mixed tumor cell components, thus allowing 153 cyto-histological comparisons. The cytologic and histopathologic typing agreed strictly in 102 cases of 153 (66.7%) and was considered as correct in 40 cases (26.1%). Only cases with divergent evaluation between small-cell carcinoma and non small-cell carcinoma were considered as discordant: such misclassification occurred in 11 specimens (7.2%), including two cases with mixed patterns. The cytologic typing was in agreement with the final diagnosis in all epidermoid carcinomas, adenocarcinomas, large-cell carcinomas and poorly differentiated carcinomas. In small-cell carcinomas, cytology was in agreement with histopathology in 20 of 26 cases (77%), and could only indicate undifferentiated features in four cases (15.4%). The analysis of bronchial aspirate specimens gave reliable typing in 92% of cases, and indicated a better tumor cell differentiation than histopathology in 6.5% of cases. The results obtained show that aggressive treatments can be reliably proposed on the basis of cytologic findings, even without tissue corroboration. This proposal is particularly helpful in cases where biopsy cannot be performed (peripheral lesions) or creates a danger to the patient (iatrogenic hemorrhage).

Prospective study of combined use of bronchial aspirates and biopsy specimens in diagnosis and typing of centrally located lung tumours.

OBJECTIVE: To determine the diagnostic accuracy of examining bronchial secretions in pulmonary cytopathology and whether cytology and histopathology can complement each other in routine practice among lung specialists. DESIGN: A prospective study comparing 1225 cytological and biopsy results, conducted during 1987-93. Tumours were confirmed by histopathology, imaging techniques, or clinical outcome and imaging techniques combined. SETTING: 11 lung or internal medicine units, France. SUBJECTS: 1128 patients (874 men; 254 women) aged 65.3 (SD 13.7) years who underwent fibreoptic bronchoscopy for various pulmonary symptoms. RESULTS: Exact concordance between cytological and biopsy results was obtained in 1036/1187 (87.3%) satisfactory specimens. In all 574 lung tumours were diagnosed. One case (0.08%) was a false positive cytological diagnosis in a patient with tuberculosis. Patients with lung cancer were more likely to have positive cytological results than positive biopsy results (P < 0.001). Agreement in tumour typing was observed in 375/424 (88.4%) cases, when non-small cell carcinomas, small cell carcinomas and undifferentiated carcinomas were separated. In the 11 patients with squamous cell carcinomas in situ, eight (72.7%) of the carcinomas were diagnosed cytologically as squamous cell. Unsatisfactory material was obtained in only 20 (1.6%) and 19 (1.6%) cases by cytology and biopsy respectively. Examinations had to be repeated in 86 (7.6%) patients. CONCLUSIONS: Examination of bronchial secretions complements histopathology in both diagnosing and typing lung tumours and could be performed more systematically in patients undergoing fibreoptic bronchoscopy.

[Giant cell arteritis and polymyalgia rheumatica: influence of past pregnancies? The GRACG multicenter case control study]. / Maladie de Horton et pseudopolyarthrite rhizomélique: influence des antécédents de grossesse? Etude cas-témoins prospective GRACG.

BACKGROUND: The overprevalence of giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) in women remains unexplained. Microchimerism pathogenicity has been discussed in some systemic diseases. We tested history of pregnancy as a risk factor for GCA. METHODS: Prospective, multicenter case-control study with multiple, age-matched, control groups. Patients have been included in 40 different centers. The first control group has been randomly selected in the general population, consecutive hospitalized patients in two geographically distant departments of internal medicine made up the second and third ones. RESULTS: Three hundred and fifteen patients (249 GCA and 66 PMR), 242 general population controls, 333 in the first hospitalized control group, and 355 in the second, have been included in the 1991-1998 period. Pregnancy has been constantly protective against GCA/PMR (Wilcoxon rank sum test: P = 0.0001, 0.0005, and 0.054, respectively, for the three control groups), more particularly for parity equal or greater than 4 (OR = 0.32, 95% CI: 0.18-0.57, P = 0.00003; OR = 0.44, 95% CI: 0.26-0.74; P = 0.0009, and OR = 0.42; 95% CI: 0.25-0.71, P = 0.0006, respectively). In multivariate analysis, risk for GCA on pre-existing degenerative, vascular disease is decreased by half for each pregnancy (OR = 0.49, 95% CI = 0.27-0.90, P = 0.022). CONCLUSION: Contrary to the initial hypothesis, multiparity is a protective factor against GCA. Mechanism is unknown.

[Microscopic hematuria in adults. Prevalence and associated factors]. / Hématurie microscopique de l'adulte. Prévalence et facteurs associés.

The finding of microscopic haematuria in the course of systematic screening accounts for 10 percent of consultations in nephrology clinics. We carried out an investigation in a population of 8,194 workers of the metallurgical and chemical industries, 89.6 percent of whom were male and 69.8 percent were under 49 years of age; 51.2 percent were smokers or ex-smokers, 9.9 percent had arterial hypertension and 2.1 percent had diabetes mellitus. Microscopic haematuria was detected by the dipstick method in 3.53 percent of the subjects tested. Phase contrast microscopy, performed in 222 subjects, showed that the origin of the haematuria was glomerular in 90.5 percent, extraglomerular in 2.5 percent and undetermined in 0.9 percent of the cases. Urinary sediment was normal in 6.3 percent. The prevalence of microscopic haematuria was significantly higher in women, in subjects under 49 years of age, in hypertensive subjects, in smokers or ex-smokers, in subjects who has received non-steroidal anti-inflammatory drugs during the past 6 months and in chemical industry workers.

[Urinary sediment in acute renal insufficiency. Diagnostic and prognostic value of phase-contrast microscopic examination]. / Le sédiment urinaire dans l'insuffisance rénale aiguë. Valeur diagnostique et pronostique de l'examen en microscopie à contraste de phase.

Living cells from the urinary tract can be examined by phase-contrast microscopy in a pellet obtained by centrifugation of 10 ml of freshly voided urine. Once these cells have been identified and classified according to their sources, their respective proportions can be evaluated, thus providing some information on the renal structures affected. Urine sediment examination was performed in 60 cases of acute renal failure in order to determine the relationship between the abnormalities encountered and the clinical or histological diagnosis. An abnormal sediment was always associated with parenchymal acute renal failure. Cellular debris and casts were abundant in acute tubular necrosis and less numerous in toxic acute renal failure than in failure resulting from shock. The finding of deformed erythrocytes was strongly suggestive of glomerular nephropathy, a diagnosis which was confirmed by renal biopsy in almost every case.

[Volumetric analysis of urinary erythrocytes in the etiological diagnosis of hematuria]. / Analyse volumétrique des hématies urinaires dans le diagnostic étiologique des hématuries.

Intravenous pyelography and cystography may fail to localize the origin of haematuria. Microhaematuria is known to be present in 2 to 10 percent of the general population, usually without pathological consequences. Study of red cell morphology by phase contrast microscopy is effective in distinguishing between "glomerular" (from renal tissue) and "non-glomerular" (from urinary tract) erythrocytes, but this technique is not currently available in all laboratories. Urinary blood cell volume analysis has been presented as a simple and automatic alternative method. We compared these two techniques in 100 cases of haematuria of various origins. The cut-off point between glomerular and non-glomerular erythrocytes was set at 71 fl. Phase contrast microscopy always confirmed the clinical and/or histological diagnosis, but volume analysis did not: mean erythrocyte volume of glomerular origin was 66.6 +/- 10.4 fl, while non-glomerular volume was 94.5 +/- 17 fl (P < 0.001); cell volume analysis was confirmative in only 72 percent of all diagnoses (65 percent of microhaematurias, 83 percent of macrohaematurias); sensitivity was 65 percent and specificity 85 percent for glomerular erythrocytes. Due to poor performance, urinary red volume analysis is not an acceptable alternative method to phase contrast microscopy when searching for the site of bleeding.

[Kidney biopsy puncture, kidney aspiration puncture with fine needle, examination of urine sediment in phase contrast. Comparative study for the diagnosis of acute rejection in kidney transplantation]. / Ponction biopsie rénale, ponction aspiration rénale à l'aiguille fine, examen du sédiment urinaire en contraste de phase. Etude comparative pour le diagnostic de rejet aigu en transplantation rénale.

The relative importance of renal biopsy and cytological studies (fine needle aspiration biopsy and urine sediment examination by phase contrast) in the diagnosis of acute rejection episode was evaluated in 30 patients who received a kidney transplant. All patients underwent these 3 examinations simultaneously during an acute degradation of graft function. Sensitivity of renal biopsy, fine needle biopsy and urine sediment was 0.86, 0.68, 0.43 respectively. The association of fine needle biopsy and urine sediment examination increased the sensitivity up to 0.73. Renal biopsy is indicated to assess the vascular and glomerular status or in the presence of inconclusive cytological studies.

[Hereditary diseases causing kidney calculi]. / Les maladies héréditaires responsables de lithiase rénale.

Urolithiasis and/or nephrocalcinosis due to hereditary diseases are a rare event which must be kept in mind of physicians who take care of children (10 to 40% of all causes of lithiases) as well as of adults (less than 15% of all causes of lithiases) since a specific management is usually required. The most frequent inborn disorders are idiopathic hypercalciuria, distal tubular acidosis, cystinuria and hyperoxaluria. Stone formation is always secondary to an increased urine concentration of promotors, i.e. calcium, oxalate, phosphate, cystine, xanthine. One of the most informative diagnosis investigation is infrared spectrophotometry which can identify stone composition. When such a technique is not available, biochemical investigations should be adapted to both personal and family history. In addition to high fluid intake (2 to 3 L/m2/24 h) sometimes associated with alcalinisation, the management of hereditary stone disease requires specific procedure. In all cases, the long-term renal prognosis is related to both primary disease and therapeutic compliance.

[Phase contrast microscopy studies of the urine of newborn infants]. / Observation des urines du nouveau-né en microscopie à contraste de phase.

Phase contrast microscopy allows a much better identification of the urinary sediment constituents than conventional bright field microscopy. The urinary sediment of 100 neonates admitted in a care unit has been examined by phase contrast microscopy. In all cases, squamous cells are far more numerous in newborn girls than in boys. An important rate of abnormal sediments has been observed: in 40 patients cytologic symptoms of renal ischaemia have been observed (hyaline or granulous casts and renal tubular cells, but red blood cells are uncommon). Numerous uric acid cristals were persent in 22 newborns, in correlation with a prolonged perinatal hypoxia. A considerable bacteriuria was seen in 21 neonates, without concomitant leucocyturia. In conclusion, only 20% of the investigated neonates had a normal urinary sediment.

[Identification of two cell types in rat brown fat by electron microscopy]. / Mise en évidence de deux types cellulaires dans le tissu adipeux brun du rat. Etude en microscopie électronique

In the Rat brown adipose tissue, the authors have observed by electron microscopy two different cellular aspects : some cells are more dark, they contain numerous glycogen granules, their mitochondrias are pressed close together and the mitochondrial matrix is darker then the cristae ; in the light cells, the mitochondrias are more sparse and moderately electron dense. The two cellular aspects are also observed on thick sections.

[Assay of cortisol and corticosterone in the plasma and adrenal glands of the golden hamster (Mesocricetus auratus)]. / Dosage du cortisol et de la corticostérone dans le plasma et les surrénales de Hamster doré (Mesocricetus auratus)

Corticosterone and cortisol are assayed by fluorometry after separation of the corticoids by chromatography on silica gel in the plasma and in the adrenals of golden Hamster brought up in the laboratory. The ratio cortisol : corticosterone is 2.7 in the plasma and 2.8 in the adrenals.