Fibrosis of the thyroid gland caused by an IgG4-related sclerosing disease: three years of follow-up.

Immunoglobulin G4-related sclerosing disease (IgG4-RSD) represents a recently identified inflammatory disorder in which infiltration of IgG4 plasma cells causes fibrosis in organs. While IgG4-RSD is well documented in the pancreas and other organs, it is poorly characterized in the thyroid gland. We report a case of a 48-year-old female with a fibrotic thyroid mass associated with a retroperitoneal fibrosis. Diagnosed early as Riedel disease, the high serum IgG4, immunohistopathology and decreased fibrosis with corticosteroid therapy, finally confirm for the first time, the origin of IgG4-RSD fibrosis of the thyroid.

Opportunity of detecting pre-hypertension: worldwide data on blood pressure overswinging.

Overswinging or CHAT (brief for Circadian Hyper-Amplitude-Tension), that is an excessive circadian variation in blood pressure (BP), has been associated with a large increase in cardiovascular disease risk, present even in the absence of an elevated BP itself. This usually asymptomatic condition is usually overlooked by current practice based on spot-checks, because to be diagnosed, measurements need to be taken around-the-clock, preferably for 7 days at the outset. Once diagnosed, however, a usual circadian BP pattern can be restored by means of certain non-pharmacologic or pharmacologic interventions timed appropriately. Thereby, it is possible to reduce the risk of cardiovascular morbidity and mortality, cerebral ischemic events and nephropathy in particular. For the preparation of guidelines regarding the diagnosis of BP disorders and for the institution of primary as well as secondary preventive measures, it is important to know what the incidence of CHAT is on a global basis. We found 191 cases of CHAT among 1602 mostly 7-day/24-h BP profiles, obtained from several centers in different countries participating in an ongoing project on the BIOsphere and the COSmos (BIOCOS). CHAT incidence is about the same between men and women, but it is diagnosed more often among patients with borderline hypertension or with glucose intolerance. It is also more common among MESOR-hypertensive than among MESOR-normotensive individuals. Priority should be given to the development of an unobtrusive and affordable device to automatically monitor BP and to analyze the data as-one-goes, so that cardiovascular disease risk can be prevented.

Comparison between Leukoscan (Sulesomab) and Gallium-67 for the diagnosis of osteomyelitis in the diabetic foot.

OBJECTIVES: The diagnosis of osteomyelitis in patients with diabetic foot is difficult both clinically and radiologically. An early diagnosis is crucial to optimize therapeutic strategy. Among the diagnostic methods currently used, scintigraphy with ex-vivo labelled white blood cells is the gold standard, but cannot be performed in all centers; therefore 67Gallium citrate (67Ga) imaging in combination with a bone scintigraphy is still widely used. METHOD: The results of imaging 24 diabetic patients with 31 suspected osteomyelitic lesions using the antigranulocyte Fab' fragment (Sulesomab or LeukoScan or immunoscintigraphy) were prospectively compared with results from the bone scan coupled with 67Ga. The diagnosis of osteomyelitis was confirmed by either biopsy or follow-up, radiological imaging and clinical outcome. RESULTS AND CONCLUSION: Sulesomab correctly identified 12 of 18 osteomyelitic lesions while 67Ga was able to detect only 8 of 18. Therefore the sensitivity is 67% for Sulesomab and 44% for 67Ga. Among the 13 non-osteomyelitic lesions imaging with Sulesomab was able to rule out infection in 11 cases and 67Ga in 10 cases. The specificity is therefore 85% for Sulesomab and 77% for 67Ga. Image interpretation for Sulesomab in this group of patients is occasionally suboptimal when imaging is performed at 3 hours post injection. High vascular background in the early images may obscure infection especially in small bones. Practically, scintigraphy with Sulesomab is fast and simple due to ease of labeling, no ex-vivo handling of blood, low radiation and provides rapid diagnosis. The diagnosis of osteomyelitis obtained by the antibody fragment scintigraphy influences the management (guided biopsy) and therapy. In several patients, imaging with Sulesomab was able to rule out osteomyelitis, helping to avoid useless antibiotic therapy and its associated side effects.

[Complications of endovascular treatment of aneurysm of the infrarenal abdominal aorta: incidence and treatment]. / Complications du traitement endovasculaire de l'anévrisme de l'aorte abdominale sous-rénale: incidence et traitement.

INTRODUCTION: Abdominal aortic aneurysms are the 13th leading cause of death in the United States. Conventional surgical treatment is associated with a low mortality of 1.4-5% and a higher morbidity in high-risk patients. Endovascular aneurysm repair is now performed in patients considered at too high risk for conventional repair. Although the use of endovascular grafts was initially limited, this method is gaining popularity despite the risk of complications including endoleaks, dislocation and graft thrombosis. METHODS: Between June 1997 and June 2000, 28 patients were treated with endovascular stent grafts. 53 patients were treated by open surgical repair. Six patients presenting with rupture were excluded. Endoleaks were detected by arteriogram and computed tomographic scan. The mean aneurysm diameter, with a mean length of 3.2 cm, was 6.3 cm. The mean proximal neck diameter was not greater than 2.4 cm. RESULTS: There were no conversions to open repair. The mean time of the intervention was 103 minutes. Nine patients with type I endoleaks underwent successful endovascular treatment; 2 patients presented a late type I endoleak treated in one case by dilatation. Four patients presented a type II endoleak after 6, 18, 30 and 32 months respectively, treated in two cases by embolization. Finally, erosion of the material was seen in four cases and a migration in one case. A decreased size of the aneurysms was seen in 10 cases, a stabilization in 12 cases, an augmentation of more than 5 mm in one case and a diminution followed by an augmentation in one case. CONCLUSION: Key to success is restrictive patient selection due to morphological criteria and improvements in surgical techniques and equipment to reduce the incidence of specific treatment complications require a long-term follow-up.

Fate of a renal tubulopapillary adenoma transmitted by an organ donor.

Organ transplantation from cadaveric donors has a risk of cancer transmission. However, some reports indicate that kidneys bearing small carcinomas can be safely transplanted, as can other organs harvested from the same donor. We report herein the case of two allograft recipients (left kidney and heart with no evidence of tumor) who developed a renal carcinoma soon after transplantation. The initial tumor of the donor was a 17-mm tubulopapillary adenoma found on the right kidney, which was not transplanted. The left kidney recipient rejected all residual tumoral cells after graft removal and immunosuppression discontinuation. The heart recipient died 7 months after transplantation from metastasis of a renal carcinoma. This strongly suggests that circulating carcinoma cells were present at the time of organ retrieval and that they were not cleared by in situ perfusion. In contrast with the literature data, this report indicates that patients with small renal tubulopapillary tumors should not be considered for organ donation.

[Appraisal of fungistatic and fungicidal activities of quaternary compounds towards yeasts belonging to the genera Candida and Cryptococcus]. / Evaluation des activités fongistatique et fongicide de composés quaternaires vis-à-vis de levures appartenant aux genres Candida et Cryptococcus.

The fungistatic and fungicidal activities of five quaternary ammonium compounds towards Candida and Cryptococcus strains were determined using a bacteriological method adapted to mycological experiments. It could be deduced from this study that Cryptococcus in spite of the capsule around the cell were more sensitive than Candida and that the benzethonium chloride (BC) exhibited the most effective action against the whole yeasts. No resistance appeared, only Cryptococcus strain was less sensitive than the others.

[Positive antithyroglobulin antibodies in patients with differentiated thyroid carcinoma. What significance?]. / Présence d'anticorps antithyroglobuline chez les patients suivis pour cancer différencié de la thyroïde. Quelle signification?

The aim of this retrospective study was to determine the predictive value of antithyroglobulin antibodies (TgAb) in 238 patients with undetectable thyroglobulin after whole thyroidectomy for differentiated cancer and ablative dose of radioiodine. TgAb titers were elevated in 30 patients with undetectable Tg level after withdrawal of T4 treatment. In 21 patients, initially positive TgAb titers became undetectable without clinical event within 3-84 months after therapy (median 12 months). In 2 cases, TgAb levels became undetectable whereas scintigraphy detected pathologic fixations. In 7 cases, high levels of TgAb titles remained unchanged 5 years after primary diagnosis In 3 of them, clinical course and distant metastases, were associated with an increased TgAb level despite normal Tg values. The investigation confirmed that serum TgAb measurement is one of the most important tools for the follow-up of patients with differentiated thyroid cancer. The presence of metastatic thyroid tissue has to be suspected in positive TgAb patients.

[Seminal vesicle dystrophy as the cause of chronic unilateral pelvic pain in a 20-year-old male]. / Dystrophie d'une vésicule séminale responsable de douleurs pelviennes unilatérales chroniques chez un homme de 20 ans.

The authors report on the case of a male patient referred for unilateral pelvic pain. An enlarged right seminal vesicle was showed by clinical examination and radiological technics. Total relief of symptoms was obtained by surgical excision. Pathological examination concluded on a dystrophic lesion of the seminal vesicle. Obstruction of the right ejaculatory duct, which could not be proved anyway is the most probable hypothesis.

Retroperitoneal fibrosis and membranous nephropathy.

We report on a patient with a past history of Pott's abscess who suffered both from a retroperitoneal fibrosis and a membranous glomerulonephritis. Five cases of retroperitoneal fibrosis and immune complex glomerulonephritis are already reported in the literature. These associations might result from a particular systemic immune response to an unknown antigen. Consequently, we consider the role of tuberculosis in our case.

[Epidermoid cancer of the kidney pelvis]. / Cancer épidermoïde du bassinet.

Squamous cell carcinoma of the renal pelvis is a rare tumour, mainly occurring in elderly patients with neglected and secondarily infected pyelocaliceal stones. It has a poor prognosis. The authors report the case of a 74-year old man with a destroyed and painful kidney containing a staghorn calculus for 30 years. The preoperative diagnosis was pyonephrosis, but nephrectomy, justified by the symptoms, showed that the kidney was invaded by a squamous cell carcinoma of the renal pelvis invading the psoas. The patient died 1 month after the operation. Treatment is essentially preventive by removal of staghorn calculi and management of chronic urinary tract infections.

[Primary lymphoma of the bladder]. / Le lymphome primitif de la vessie.

The authors report two cases of primary non-Hodgkin's malignant lymphoma of the bladder. In contra with secondary site, which are not rare, primary malignant lymphomas of the bladder wall are exceptional. Urinary symptoms are varied and nonspecific. These tumours cannot be distinguished from other bladder tumours on the basis of their radiological or endoscopic appearance. Only histology provides the diagnosis. The pathophysiological hypotheses are discussed. Treatment is mainly based on chemotherapy. Endoscopic drainage procedures are sometimes useful, as in one of the reported cases.

[Study of the behavior of the vegetative meristem of alfa (Stipa tenacissima L.). Cytological and histological approaches]. / Etude du comportement du méristème végétatif de l'alfa (Stipa tenacissima L.). Approches cytologique et histologique.

The biological and cytological studies of the vegetative meristem of Stipa tenacissima L. gave clear indication about its structure. It was similar to what was previously described in several species. This meristem showed an axial apical zone constituted by sommital cells of both tunica and corpus, a sub-apical lateral zone, very chromophilous, representing the initial ring and a medullar meristem. The cytofluorimetric determination of DNA in interphasic nuclei of these three zones revealed that the nuclei of the apical and lateral zones were in S phase, announcing the beginning of mitosis and meaning that these zones were the centers of the foliar initiation. The medullar meristem was in dormancy: all the nuclei were in G1 phase.

Altered balance between matrix gelatinases (MMP-2 and MMP-9) and their tissue inhibitors in human dilated cardiomyopathy: potential role of MMP-9 in myosin-heavy chain degradation.

BACKGROUND: End-stage of human dilated cardiomyopathy (DCM) is characterized by myocyte loss and fibrosis, and associated with ventricular dilatation and reduced cardiac function. Matrix metalloproteinases (MMPs) and their natural tissue inhibitors (TIMPs) have been involved in the myocardial remodeling. AIMS: To evaluate the potential role of matrix gelatinases (MMP-2 and MMP-9) in DCM, the balance between gelatinases and TIMPs and the gelatinase localization were investigated in left free wall ventricles from six normal donors and six patients with DCM at the transplantation time. METHODS: TIMP-(1, 2, 3 and 4) mRNAs were analyzed by quantitative reverse transcription-polymerase chain reaction (RT-PCR). TIMP-1 and -2 protein content was assessed by ELISA. MMP-2 and MMP-9 expression were examined by zymography and immunological techniques. RESULTS: All TIMPs were down-regulated in DCM hearts, especially TIMP-1 (reduced by 80%). Gel zymography revealed similar activity of MMP-2 and MMP-9 in both tissues. By in situ zymography and immunohistochemistry, active and immunoreactive gelatinases were pericardiomyocyte in control hearts and intracardiomyocyte in DCM hearts. Intracellular MMPs were associated with sarcomeric structure in DCM. To estimate a putative role of these gelatinases, several sarcomeric contractile proteins were digested in vitro by purified active MMP-9. Only myosin-heavy chain was cleaved in vitro giving 180-, 120-, 80- and 20-kDa proteolytic fragments. In vivo, two major myosin-heavy chain proteolytic fragments (80 and 20 kDa) were detected by specific monoclonal antibody against myosin-heavy chain in DCM left ventricular homogenates, only. CONCLUSIONS: Taken together, these data highly suggest that MMP-2 and MMP-9 may be involved in the disorganization of the contractile apparatus in DCM hearts.

Adherence of Porphyromonas gingivalis to epithelial cells: analysis by flow cytometry.

Porphyromonas gingivalis, implicated in the pathogenesis of periodontitis, can adhere to epithelial cells and gingival fibroblasts. This study employed flow cytometry to evaluate the adherence of P. gingivalis to epithelial cells under various conditions. The cell lines SK-MES and KB were used in the first experiments. The P. gingivalis strains employed were ATCC 33277, ATCC 49417 and W83. Different adherence conditions were tested (contact time, bacteria/cell ratio, contact temperature). In later experiments, adherence of P. gingivalis to human gingival epithelial cells (GEC) obtained by explant was studied under various conditions. Results showed that P. gingivalis had a high affinity for buccal keratinocytes compared with SK-MES. Adherence showed a level of saturation. The number of receptors may be limited for each epithelial cell line, and there may be more receptors for gingival keratinocytes. Depending on contact time, P. gingivalis showed a higher affinity for GEC, compared with the other two lines. P. gingivalis thus showed specific adherence for a host cell type from a site associated with periodontal disease.

Lymph node metastases: safety and effectiveness of MR imaging with ultrasmall superparamagnetic iron oxide particles--initial clinical experience.

PURPOSE: To evaluate the clinical and biologic safety of ultrasmall superparamagnetic iron oxide particles (AMI-227) as a contrast agent for magnetic resonance (MR) lymphography and to assess their efficacy for the differentiation of metastatic and benign nodes in patients with urologic and pelvic cancer. MATERIALS AND METHODS: Thirty adults suspected of having lymph node metastases underwent MR imaging before and 22-26 hours after intravenous infusion of AMI-227 (1.7 mg Fe/kg). Sixty histopathologically proved lymph nodes were analyzed on MR images, and 29 of these nodes were also analyzed quantitatively. RESULTS: AMI-227 was well tolerated with no major side effects. It allowed the detection of 10 additional nodes relative to those detected at MR imaging without AMI-227. None of the 27 metastatic nodes showed a decrease in signal intensity (SI) on AMI-227-enhanced images; nine of 27 metastatic nodes showed an increase in SI on T1-weighted images, probably resulting from altered capillary permeability in the tumor. A visually perceptible reduction in SI, indicating active AMI-227 uptake, was observed on postcontrast T2- and T2*-weighted images in 16 of 21 benign nodes. The SI ratio of benign nodes was lower than that of metastatic nodes on T2- and T2*-weighted images. The sensitivity of AMI-227-enhanced MR lymphography was 100%, and the specificity was 80%. CONCLUSION: AMI-227 is safe and may facilitate the differentiation of metastatic and benign nodes in patients with urologic and pelvic cancers.

Heart retransplantation: a 23-year single-center clinical experience.

BACKGROUND: The main causes of allograft failure after cardiac transplantation are primary graft dysfunction, intractable acute rejection, and coronary graft disease. Despite the important progress in the last several years in graft preservation, surgical techniques, immunosuppression, and treatment of coronary graft disease, retransplantation in selected cases is the only way to achieve long-term recipient survival. METHODS: We compare here in a case-control study 24 retransplantations with 47 first transplants in patients matched for date of transplantation. RESULTS: Between 1973 and 1996, 1,063 patients underwent cardiac transplantation in our institution. In this cohort, 22 patients had a total of 24 retransplantations (2 second-time retransplantations). The causes of retransplantations were primary graft failure (n=4), acute rejection (n=7), coronary graft disease (n=11), and miscellaneous (n=2). Survival at 1 and 5 years of patients with retransplantations is 45.5% and 31.2%, and survival of control patients is 59.4% and 38.8% (p=0.07). An interval between first transplantation and retransplantation shorter (n=11) or longer (n=13) than 1 year is associated with a 1-year survival of 27.3% and 61.5% and a 4-year survival of 27.3% and 46%, respectively (not significant). Intervals shorter than 1 year between first transplantation and retransplantation were exclusively secondary to primary graft failure or intractable acute rejection. CONCLUSIONS: In the face of lack of donor grafts, these and other data indicate that retransplantation should be considered cautiously, especially when the interval between the first transplantation and retransplantation is short.