ABSTRACT
Although large retrospective studies have identified the presence of donor-specific antibodies (DSAs) to be a risk factor for rejection and impaired survival after liver transplantation, the long-term predicted pathogenic potential of individual DSAs after liver transplantation remains unclear. We investigated the incidence, prevalence and consequences of DSAs in maintenance liver transplant (LT) recipients. Two hundred sixty-seven LT recipients, who had undergone transplantation at least 6 months previously and had been screened for DSAs at least twice using single-antigen bead technology, were included and tested annually for the presence of DSAs. At a median of 51 months (min-max: 6-220) after an LT, 13% of patients had DSAs. At a median of 36.5 months (min-max: 2-45) after the first screening, 9% of patients have developed de novo DSAs. The sole predictive factor for the emergence of de novo DSAs was retransplantation (OR 3.75; 95% CI 1.28-11.05, p = 0.025). Five out of 21 patients with de novo DSAs (23.8%) developed an antibody-mediated rejection. Fibrosis score was higher among patients with DSAs. In conclusion, monitoring for the development of DSAs in maintenance LT patients is useful in case of graft dysfunction and to identify patients with a high risk of developing liver fibrosis.
Subject(s)
Graft Rejection/etiology , HLA Antigens/blood , Isoantibodies/blood , Liver Cirrhosis/etiology , Liver Diseases/surgery , Liver Transplantation/adverse effects , Adolescent , Adult , Aged , Female , Follow-Up Studies , Graft Rejection/epidemiology , Graft Rejection/mortality , Graft Survival , HLA Antigens/immunology , Humans , Incidence , Isoantibodies/immunology , Liver Cirrhosis/epidemiology , Liver Cirrhosis/mortality , Liver Diseases/complications , Liver Diseases/mortality , Male , Middle Aged , Prevalence , Prognosis , Prospective Studies , Reoperation , Retrospective Studies , Risk Factors , Survival Rate , Young AdultABSTRACT
Mediastinal cysts are uncommon prenatal findings. As isolated and non-compressing entities, they don't compromise the course of gestation. Massive lesions can compress vital structures, resulting in fetal demise. Thus, close follow-up with sonographic monitoring is recommended until birth. Non-hydroptic fetuses can be managed expectantly. Definitive etiology is known after surgical resection only. We present the first case of posterior mediastinal teratoma associated with severe vertebral abnormalities. After CT scan and fetal MRI, medical termination of pregnancy was decided. Histological examination revealed an immature teratoma. With this unique case report, we discuss the optimal prenatal management of mediastinal cysts.
Subject(s)
Mediastinal Cyst/diagnostic imaging , Mediastinal Neoplasms/pathology , Teratoma/pathology , Ultrasonography, Prenatal , Adult , Female , Humans , Magnetic Resonance Imaging , Male , Mediastinal Cyst/complications , Mediastinal Neoplasms/complications , Pregnancy , Spine/abnormalities , Teratoma/complications , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: Chronic histiocytic intervillositis of unknown etiology (CIUE) is a rare placental lesion characterized by an intervillous mononuclear inflammatory infiltrate of maternal origin. Although the mechanism and origin of these lesions are currently not understood, they appear to be related to an immune conflict between mother and fetus cells. AIM: To clarify the inflammatory cell profile and evaluate the T regulatory lymphocyte (Treg) status in CIUE. MATERIALS AND METHODS: All cases of CIUE that occurred over an 8-year period were analyzed using immunohistochemistry. RESULTS: The inflammatory profile of CIUE was characterized by a clearly predominant component of histiocytic cells (80% ± 6.9) associated with some T cells (24% ± 5.7). The ratio of CD4+ versus CD8+ T cells was close to 1. This profile differs from infectious disease and chronic histiocytic villitis, the main differential diagnoses of CIUE. As for normal pregnancies most regulatory T cells were localized in the decidua basalis. Nevertheless, their appearance was also noted in the intervillous space. In both the intervillous space and the deciduas the number of Tregs gradually increased from grade 1 to 3. CONCLUSION: We found that CIUE is associated with an increase in Treg lymphocytes in the decidua basalis and the intervillous space. Contrary to previously published data on human miscarriage, this result appears to be specific to CIUE and would support the hypothesis of an immunopathological disorder for CIUE.
Subject(s)
Placenta Diseases/immunology , Placenta Diseases/pathology , T-Lymphocytes, Regulatory/immunology , T-Lymphocytes, Regulatory/pathology , Case-Control Studies , Chorionic Villi/immunology , Chorionic Villi/metabolism , Chorionic Villi/pathology , Chronic Disease , Female , Forkhead Transcription Factors/metabolism , Histiocytes/immunology , Histiocytes/pathology , Humans , Immune Tolerance , Immunohistochemistry , Maternal-Fetal Exchange/immunology , Placenta Diseases/metabolism , Pregnancy , Retrospective Studies , T-Lymphocytes, Regulatory/metabolismABSTRACT
We report the case of an 18-month-old boy operated on for a right lower lobe bronchopulmonary sequestration. At the immediate postoperative check-up, a septic right thoracic effusion appeared, connected to a cystic mediastinal retrocrural formation on CT. After a drainage attempt and medical therapy, the abdominal lesion was resected. Histological examination showed that the cyst cavity was lined with pseudostratified non-ciliated epithelium, without cartilage, consistent with an enteric cyst. Regardless of the embryological theory, a literature review confirmed that in presence of one of these two lesions, one should systematically look for the other.
Subject(s)
Bronchopulmonary Sequestration/diagnostic imaging , Bronchopulmonary Sequestration/surgery , Mediastinal Cyst/diagnostic imaging , Mediastinum/abnormalities , Bronchopulmonary Sequestration/complications , Follow-Up Studies , Humans , Infant , Intestines/embryology , Male , Mediastinal Cyst/complications , Mediastinal Cyst/surgery , Pneumonectomy , Radiography , Thoracic Surgical Procedures , Treatment OutcomeABSTRACT
Colorectal cancer is one of the most frequent cancers worldwide. As the tumor-node-metastasis (TNM) staging classification does not allow to predict the survival of patients in many cases, additional prognostic factors are needed to better forecast their outcome. Genes involved in DNA replication may represent an underexplored source of such prognostic markers. Indeed, accidents during DNA replication can trigger 'replicative stress', one of the main features of cancer from earlier stages onward. In this study, we assessed the expression of 47 'DNA replication' genes in primary tumors and adjacent normal tissues from a homogeneous series of 74 patients. We found that genes coding for translesional (TLS) DNA polymerases, initiation of DNA replication, S-phase signaling and protection of replication forks were significantly deregulated in tumors. We also observed that the overexpression of either the MCM7 helicase or the TLS DNA polymerase POLQ (if also associated with a concomitant overexpression of firing genes) was significantly related to poor patient survival. Our data suggest the existence of a 'DNA replication signature' that might represent a source of new prognostic markers. Such a signature could help in understanding the molecular mechanisms underlying tumor progression in colorectal cancer patients.
Subject(s)
Colorectal Neoplasms/pathology , DNA Replication , Disease Progression , Cell Cycle Proteins/genetics , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/genetics , DNA-Binding Proteins/genetics , DNA-Directed DNA Polymerase/genetics , Gene Expression Regulation, Neoplastic , Humans , Minichromosome Maintenance Complex Component 7 , Multigene Family , Nuclear Proteins/genetics , Prognosis , DNA Polymerase thetaSubject(s)
Stomach Diseases/etiology , Syphilis/complications , Syphilis/diagnosis , Humans , Male , Middle AgedABSTRACT
AIM: To assess the consequences of graft steatosis on postoperative liver function as compared with normal liver grafts. PATIENTS AND METHODS: From January 2005 to December 2007, liver transplant patients were prospectively included, excluding those who experienced arterial or biliary complications or presented acute rejection. All patients had a surgical biopsy after reperfusion. Patients were compared according to the rate of macrovacuolar steatosis: namely above or below 20%. RESULTS: Fifty-three patients were included: 10 in the steatosis group and 43 in the control group. No significant difference was observed in terms of morbidity, mortality, and primary non- or poor function. Nevertheless, biological changes after the procedure were significantly different during the first postoperative week. Prothrombin time, serum bilirubin, and transaminases were significantly increased among the steatosis group compared with the control group (P < .05). CONCLUSION: This case-controlled study including a small number of patients, described postoperative biological changes among liver transplantations with steatosis in the graft.
Subject(s)
Factor V/analysis , Fatty Liver/epidemiology , Liver Transplantation/physiology , Postoperative Complications/epidemiology , Prothrombin Time , Alanine Transaminase/blood , Aspartate Aminotransferases/blood , Bilirubin/blood , Female , Humans , Liver Transplantation/adverse effects , Male , Middle Aged , Patient Selection , Prospective StudiesABSTRACT
Hepatitis E virus (HEV) infection was thought to be responsible for acute hepatitis that did not become chronic. However, we have recently reported that HEV infection can evolve to chronic hepatitis, at least in solid-organ transplant patients. We report on two cases of rapidly progressive of HEV-related cirrhosis that occurred in two organ-transplant patients. Case 1: A kidney-pancreas-transplant patient developed acute HEV hepatitis 60 months after transplantation, which evolved to chronicity as defined by persisting elevated liver-enzyme levels and positive serum HEV RNA. At 22 months after the acute phase, she presented with cirrhosis and portal hypertension, that is ascites and esophagus varices. Case 2: A kidney-transplant patient developed acute hepatitis 36 months after transplantation, which persisted and remained unexplained for 38 months. Then, HEV RNA was searched for in their serum and stools, and was found to be positive in both. Retrospective analysis of available stored serum, mainly the serum obtained at the acute phase, confirmed the diagnosis of chronic hepatitis E. In both cases, a liver biopsy showed cirrhosis. We conclude that HEV infection cannot only evolve to chronic hepatitis, but can also be responsible for rapidly progressing cirrhosis in organ-transplant patients.
Subject(s)
Hepatitis E virus/isolation & purification , Hepatitis E/diagnosis , Liver Cirrhosis/virology , Adult , Female , Humans , Kidney Transplantation , Liver Function Tests , Male , Middle Aged , Pancreas Transplantation , RNA, ViralABSTRACT
We report a case of secondary syphilis hepatitis in a liver-transplant patient. This homosexual male patient presented, 15 years after orthotopic liver transplantation, with non-squamous papulomacular rash, mild cytolysis, and anicteric cholestasis. Laboratory tests showed syphilis seroconversion with a venereal diseases research laboratory (VDRL) titer of 1/256, a Treponema pallidum hemaglutination assay (TPHA) of 1/5120, and a positive IgM fluorescent Treponemal antibody absorbance (FTA-abs). A liver biopsy performed 13 months after the diagnosis showed low-grade hepatitis with a Metavir score of A1F1; it also showed non-specific portal moderate inflammation consisting primarily of neutrophils, with no evidence of cholestasis. He was given benzathine-penicillin at 2,400,000 IU with a transient increase in prednisolone doses. Cytolysis rapidly, and cholestasis progressively disappeared. IgM FTA-abs became negative, whereas VDRL and TPHA titers decreased slightly over time.
Subject(s)
Hepatitis/etiology , Liver Transplantation , Postoperative Complications/microbiology , Syphilis/complications , Azathioprine/adverse effects , Azathioprine/therapeutic use , Cyclosporine/adverse effects , Cyclosporine/therapeutic use , Hepatitis/microbiology , Hepatitis, Viral, Human/surgery , Homosexuality , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Liver/microbiology , Male , Middle Aged , Postoperative Complications/diagnosis , Risk-Taking , Syphilis/diagnosis , Treponema pallidum/isolation & purificationSubject(s)
Deglutition Disorders , Esophageal Neoplasms/secondary , Lymphoma, Non-Hodgkin/complications , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Cyclophosphamide/administration & dosage , Deglutition Disorders/diagnostic imaging , Deglutition Disorders/drug therapy , Deglutition Disorders/etiology , Doxorubicin/administration & dosage , Esophageal Neoplasms/diagnostic imaging , Esophageal Neoplasms/drug therapy , Humans , Lymphoma, Non-Hodgkin/diagnostic imaging , Lymphoma, Non-Hodgkin/drug therapy , Male , Prednisone/administration & dosage , Radiography , Vincristine/administration & dosageABSTRACT
We report the case of a 26-year-old male who was operated on after an acute episode complicating a long history of seizures. The resected temporal lesion was an anaplastic ganglioglioma. Ganglioglioma is a tumor of children and young adults, characterized by two cell components, neuronal and glial. It is usually a benign lesion. The present case is remarkable in several aspects. Hemorrhage led to the discovery of a supra-tentorial tumour. Microscopic examination revealed anaplastic foci in an otherwise typical lesion. There was a long past medical history but outcome was rapidly unfavorable after surgical resection and associated with dissemination along the spinal cord.
Subject(s)
Brain Neoplasms/diagnosis , Ganglioglioma/diagnosis , Ganglioglioma/secondary , Spinal Cord Neoplasms/secondary , Adult , Brain Neoplasms/pathology , Brain Neoplasms/surgery , Ganglioglioma/pathology , Humans , Male , SeizuresABSTRACT
CASE REPORT: The authors report the case of a ten-year-old girl, who had been treated for a malignant germinal tumour five years before, presenting with a leukaemia-like syndrome associating bone pain, liver and spleen nodules and bone marrow involvement. The cyto-pathological analysis showed undifferentiated cells and CD56 and protein S100 were found as the only positive markers. The child received several subsequent lines of chemotherapy and ultimately died of the disease. COMMENTS: Particular cytogenetic abnormalities were observed (iso1q10, iso6p10) and were in favor of an unusual NK cell lymphoma. CONCLUSION: This analysis revealed a XY genotype (testicular feminization syndrome).
Subject(s)
Androgen-Insensitivity Syndrome/genetics , Killer Cells, Natural , Leukemia, Lymphocytic, Chronic, B-Cell/genetics , Leukemia/genetics , Ovarian Neoplasms/genetics , Teratoma/genetics , Androgen-Insensitivity Syndrome/diagnosis , Androgen-Insensitivity Syndrome/pathology , Bone Marrow/pathology , CD56 Antigen/genetics , Cell Transformation, Neoplastic/genetics , Cell Transformation, Neoplastic/pathology , Child , Female , Genotype , Humans , Killer Cells, Natural/pathology , Leukemia/diagnosis , Leukemia/pathology , Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Liver/pathology , Male , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/pathology , S100 Proteins/genetics , Teratoma/diagnosis , Teratoma/pathologyABSTRACT
Isolation of Mycobacteria on Loewenstein-Jensen medium lasts many weeks. The use of Radiometric method (Bactec TB 460) reduces the delays. Results of 79,064 cultures are reported from a multicentric study associating 16 laboratories. The average was 4.8% of positivity and 2.51% of contamination. The comparison of the results with conventional method previously obtained shows that radiometric method is more sensitive and contaminations are less numerous. Concerning hemocultures the Bactec method is very usefull. Among 11,277 tests performed 907 were positive (8.04%). Mycobacterium avium was identified in 89% of the cases. Identification test utilizes Biochemical and NAP tests, but also more and more Nucleic probes. The antibiotic sensitivity is performed in five days. The mean delay of analysis is about 25 days, lessening by half the conventional method delays. Nevertheless, Bactec method has the following inconveniences: syringe inoculation, use of radiolabelled products, expensive cost.
Subject(s)
Mycobacterium avium Complex/isolation & purification , Mycobacterium avium-intracellulare Infection/diagnosis , Mycobacterium tuberculosis/isolation & purification , Tuberculosis/diagnosis , Anti-Bacterial Agents , Bacteriological Techniques , Drug Therapy, Combination/pharmacology , Humans , Mycobacterium avium Complex/drug effects , Mycobacterium tuberculosis/drug effectsABSTRACT
In a number of cases of true rheumatoid arthritis, it is not possible to demonstrate the presence of 19 S "heavy" rheumatoid factors by the Waaler-Rose and globulin latex techniques. However, in some of them, 7 S rheumatoid factors are suspected. Three techniques for the detection of these "light" rheumatoid factors are described and critically evaluated. The authors report their own experience of the immuno-absorption and indirect immunofluorescence technique performed on 156 sera from RA patients. Immuno-absorption is not felt to be a reliable technique on several grounds. Indirect immunofluorescence is of value only in the diagnosis of seronegative rheumatoid arthritis where it provides information in addition to that offered by classical techniques. It is positive in 53.3% of seronegative rheumatoid arthritis sera.