[Pyogenic streptococcal omphalitis and foot's cellulitis in an 11 day old infant]. / Omphalite à Streptococcus pyogenes et cellulite du pied chez un nourrisson de 11 jours.

Omphalitis is a rare infection in our countries. Streptoccus pyogenes is one of the most frequently encountered germs. Complications are rare but include septicemia and necrotizing fasciitis with a high mortality rate. The case reported in this article is that of an 11 days old infant with pyogenic streptococcal omphalitis who developed cellulitis of left food. An intravenous antibiotic treatment allowed complete resolution of the symptoms. The article is the opportunity to review of the risk factors of this affection, its complications and treatments.

L'omphalite est une infection rare dans nos pays. Le streptocoque pyogène est un des germes les plus fréquemment rencontrés. Les complications sont rares mais incluent les septicémies et la fasciite nécrosante avec un taux important de mortalité. Le cas rapporté dans cet article est celui d'un nourrisson de 11 jours présentant une omphalite à Streptocoque pyogène ayant développé une cellulite du pied gauche. Un traitement antibiotique intraveineux a permis une résolution complète des symptômes. Cet article est l'occasion d'une revue des facteurs de risques de cette affection, de ses complications et traitements.

HLA-DRB1 and DQB1 allele distribution in the Muong population exposed to malaria in Vietnam.

The distribution of 30 HLA-DRB1 alleles in 85 individuals and of 10 HLA-DQB1 alleles in 91 individuals of the Viet Muong population was studied and compared with those of nine other Asian populations, including 103 Viet Kinh belonging to the major ethnic group in Vietnam. In terms of genetic distance, our data are consistent with a close ethnogeographic relationship between Viet Muong, Buyi and Dai Lue, two Southern Chinese ethnic groups. Conversely, these three populations are distant from the Northern Chinese population. The Viet Kinh belong to an intermediate group, together with North-eastern Thais, Thais and present day Thais. The striking presence of the HLA-DQ1*0502 allele (48% frequency) in the Viet Muongs is possibly anthropological or environmental in origin: the Viet Muongs have been submitted to endemic malaria for centuries, and the survivors carry the protective trait of glucose-6-phosphate dehydrogenase deficiency. This raises the hypothesis of a possible resistance to lethal or severe forms of the disease, where the association with a specific HLA-DQB1 allele may play a role.

Co-expression in Xenopus neurons and neuroendocrine cells of messenger RNA homologues of exocytosis proteins DOC2 and munc18-1.

The proteins munc18-1 and DOC2 are assumed to play a role in docking of synaptic vesicles in neurotransmitter exocytosis at the presynaptic junction. As the proteins are known to interact, they should co-exist within neurons. We have tested this hypothesis for exocytosis of both classical and peptidergic messengers, by investigating the distribution of the messenger RNAs of munc 18-1 and DOC2 homologues in the brain and pituitary gland of the clawed toad Xenopus laevis, using in situ hybridization. For this purpose we cloned a partial complementary DNA encoding Xenopus unc18 (xunc18) and used a corresponding RNA probe, together with an RNA probe for Xenopus DOC2. At the messenger RNA level DOC2 and xunc18 were found to be expressed throughout the Xenopus brain. All brain nuclei expressing DOC2-messenger RNA showed xunc18-messenger RNA expression as well. Co-expression was shown at the individual cell level in consecutive sections of large-sized neurons. A strong expression was demonstrated in the suprachiasmatic and magnocellular nuclei and in peptidergic endocrine cells in the intermediate and anterior lobes of the pituitary gland, suggesting roles of DOC2 and xunc18 in messenger release from peptidergic secretory systems. Combined in situ hybridization and immunocytochemical analyses show that neuropeptide Y-containing cells in the suprachiasmatic nucleus also express DOC2 and xunc18 messenger RNAs. Since these cells have a high secretory activity, controlling the activity of the pituitary pars intermedia, the levels of expression of DOC2 and xunc18 may be indicators for neuronal secretory activity. The present data represent the first evidence for the co-existence of DOC2 and munc18-1 and suggest co-ordinate action of these proteins at the level of brain nuclei, individual neurons and endocrine cells.

[Influence of the anti-HLA immunization profile before grafting on the outcome of renal transplant]. / Influence du profil d'immunisation anti-HLA avant greffe sur le devenir du greffon renal.

A retrospective study of HLA immunization profile before a first graft of unrelated kidney in 212 immunized recipients (with an initial peak greater than or equal to 25%) shows that one can define at least 3 groups of responder with a different graft outcome. Recipients with either weak or strong variance of HLA antibody (VP) before graft (group I: VP less than 230 and group III: VP greater than 830) have a significantly lower graft survival: 54% (p = 0.006) and 45% (p = 0.002) respectively at 4 years, than recipients of group II (230 less than VP less than 830) for whom the prognosis is of 77% after the same time period. If similar results are observed on independent series, VP would be of a great interest for the definition of a new classification of responders, and on a practical level for the choice of renal transplant.

Influence of HLA-A, B, and DR matching on the outcome of kidney transplant survival in preimmunized patients.

The outcome of 893 prospectively typed (HLA-A, B, and DR) and matched cadaveric kidney transplants--all first grafts, with patients being transfused before transplantation--was studied using actuarial survival methods. The effect of HLA-A, B and DR matching was only found to be significantly beneficial to graft survival in the group of 289 presensitized recipients: 70% and 43% graft survival at two years in the case of best-matched (4-6 HLA-A, B, and DR) identities versus mismatched (0 and 1 HLA-A, B, and DR) identities, respectively (P = 0.05). Although a cumulative effect of matching for antigens belonging to the 3 HLA-A, B, and DR series was observed among the group of preimmunized recipients, a trend arose in favor of the prominent role of the HLA-B alleles. No significant difference related to HLA matching was observed in the group of nonsensitized recipients. These results confirm previous observations and support efforts to give priority for matched kidneys to preimmunized patients.

[Role of transfusions and significance of HLA-A, B and DR compatibility in renal transplants]. / Rôle des transfusions et importance de la compatibilité HLA-A, B et DR chez les transplantés rénaux.

The results study of renal allograft performed in the France-Transplant network, shows the beneficial effect of blood transfusions on graft survival; their immuno-suppressive effect allowed the tolerance of the transplant, despite of the presence, at times, of incompatibilities HLA. In this work, we have studied the effect of HLA-A, B, DR incompatibilities in 803 unrelated recipients according to their preimmunized status. In the 303 presensitized patients (by transfusion or transplantation) we show clearly the strong effect of the HLA compatibility and the additive effect of the three loci A, B, DR (94% of graft survival at two years for the best matched v.s. 36% for the worst). In the 500 non responder patients, there is no effect of the compatibility A, B, DR (69% for the best matched v.s. 71% for the worst). Presensitized patients reach currently 50% of the waiting list of dialysed. Cooperative efforts should avoid heavily mismatched transplants in case of preimmunization.

Glomerular lesions in monoclonal gammopathies and mixed essential cryoglobulinemias IgG-IgM.

Histologic studies of renal tissue were performed in 21 cases of IgG or IgA benign monoclonal gammopathy, in 19 cases of IgM monoclonal gammopathy, and in 11 cases of mixed idiopathic IgG-IgM cryoglobulinemias. Except for myeloma, glomerular lesions were very frequent. Amyloidosis was found in one patient with myeloma, in two with benign IgG gammopathy, and in three with Waldenström macroglobulinemia. Intraglomerular deposits were found in 13 patients. In 7 of these patients (6 with Waldenström macroglobulinemia, 1 with benign IgA monoclonal gammopathy), the deposits were isolated without cellular proliferation. In the other 6 patients (one with benign IgG monoclonal gammopathy, five with IgG-IgM cryoglobulinemias) the deposits were associated with severe endocapillary proliferation. Immunohistologic study showed the presence of immunoglobulins in these deposits. The immunoglobulin(s) present in the glomerular deposits was (were) similar to the serum monoclonal immunoglobulin or immunoglobulins of the cryoglobulin. Crystals were found in the glomerular endothelial cells in one case of benign IgG gammopathy. The significance of these lesions is briefly discussed.