A case of arthritis caused by cytomegalovirus after kidney transplantation.

Cytomegalovirus (CMV) is the leading cause of infectious complications after organ transplantation. We report the case of a 55-year-old renal transplant recipient who presented with CMV infection 2 months after transplantation. During oral ganciclovir treatment (5 weeks after interruption of intravenous ganciclovir), he experienced a sharp pain in the right shoulder. Examination was normal, but CMV antigenemia remained positive with 30 cells/300,000. He underwent a shoulder puncture, which confirmed the presence of CMV in the articular fluid after evaluation by polymerase chain reaction gene amplification. The patient recovered from his arthritis of the shoulder, and antigenemia became negative after 3 weeks of parenteral ganciclovir. We describe a CMV arthritis that occurred despite a curative treatment for CMV disease, and comment on the pathogenesis of this infection, the pharmalogical failure, and dosing or treatment duration.

[Stomatitis and ageusia induced by candesartan]. / Stomatite et agueusie induites par candésartan.

Cases of dysgeusia or ageusia have been reported in patients treated with angiotensin II receptor antagonist such as losartan (5 cases), valsartan (1 case), eprosartan (1 case). This is the first case-report of ageusia following candesartan. A 46-year-old-male patient, with a medical history of renal chronic reject allograft disease, started candesartan 4 mg once daily to treat high blood pressure. Six months later, a progressive ageusia occurred with a burning mouth syndrome. He also developed aphthous ulcers of the mouth, stomatitis and perleche, which led him to lose 8 kilos within 13 months. Thirteen months after the beginning of the treatment candesartan was stopped. The symptoms and lesions required 2 to 3 weeks to disappear. Subsequently, appetite was found again as well as the sense of taste. The temporal sequence of events suggests a causal relationship between ageusia and candesartan.

[Effects of the magnetic field in magnetic resonance imaging on 15 tested cardiac valve prostheses]. / Effets des champs magnétiques en imagerie par résonance magnétique sur 15 prothèses valvulaires cardiaques testées.

The effects of static magnetic fields used in MR imaging at 0.5 Tesla have been studied on 15 different types of cardiac valves. The displacement of the valves was insignificant at 0.5 Tesla. No significant heating effects was observed with the standard sequences used in cardiac imaging. The image artefacts remain confined to the area immediately surrounding these different valves. It seems possible to perform MRI examinations on patient with the prosthetic heart valves without any risk.

[Digestive complications of oral contraceptives: a case of extensive digestive necrosis in a young woman]. / Les accidents digestifs des contraceptifs oraux: un cas de nécrose digestive étendue chez une femme jeune.

PIP: A case of acute intestinal vascular necrosis in a 19-year-old user of oral contraceptives (OCs) is described, and hypotheses explaining the digestive complications of synthetic estrogens are reviewed. The patient had originally presented with a violent gastric pain that subsequently spread to the entire abdomen. An abrupt worsening of her condition involved cardiovascular collapse associated with a peritoneal syndrome, vomiting and dehydration, and hyperleukocytosis. Emergency opening of the peritoneum was followed by evacuation of a large quantity of fetid gas and alimentary debris, and observation of a completely necrosed stomach. A careful lavage of the entire intestinal cavity led to temporary improvement, but it became clear during an attempt at gastrectomy that further treatment would be unavailing and the patient died shortly thereafter. Estrogens were believed to be responsible for the digestive necrosis because it occurred in a young woman who had used an estrogen-rich OC for 3 years and who smoked; a hapatic biopsy confirmed the diagnosis. No traces of other risk factors such as hypertension, hyperlipidemia, diabetes, neoplasia, or obesity were observed. Recent publications indicate that OCs are responsible for a certain number of digestive problems, which may include acceleration of intestinal transit, severe diarrhea, rectorrhagia, ischemic or ulcerative colitis, intestinal infarct which is usually localized, and hepatocellular problems ranging from moderate hepatic insufficiency to malignant tumor and Budd-Chiari syndrome. OCs do not modify hemodynamic regimes, but they may cause elevation of fibrinogen and thrombin, diminution of antithrombin III acitivty, increased platelet adhesivity, and decreased fibrinolysis leading to hypercoagulability. These modifications in hemostasis occur in all OC users and are not statistically correlated with occurence of thrombotic accidents. OCs are probably responsible for parietal vascular lesions; experimental injection of synthetic estrogens is associated with both arterial and venous lesions. The most characteristic anomaly is at the level of the intima, with proliferation of smooth muscle cells and increased conjunctive tissue fibers associated with proliferation of the media or the endothelium. The absence of lipid deposits, the simultaneous appearance of arterial and venous lesions, and other evidence argues against and atheromatous origin of parietal lesions. A significant correlation has been found between high levels of anti-synthetic ethinyl estradiol antibodies and the presence of vascular lesions. It is hypothesized that these circulating immune complexes penetrate the vascular walls of OC users and produce lesions, which may depend on factors such as smoking.^ieng

[Aortic and tricuspid valve involvement caused by myxoid degeneration associated with a severe mitral prolapse. Apropos of 2 patients undergoing a double valve replacement]. / Atteintes valvulaires aortique et tricuspidienne par dégénérescence myxoïde associées au prolapsus mitral grave. A propos de 2 patients ayant bénéficié d'un double remplacement valvulaire.

Idiopathic mitral valve prolapse due to severe myxoid degeneration may be associated with aortic and/or tricuspid valve disease of the same aetiology. These localisations, which usually give rise few symptoms, can be detected by echocardiography. Sometimes, however, they may give rise to serious valvular regurgitation requiring surgical correction at each diseased valve. The authors report two cases of "floppy" mitral valve prolapse, the first requiring mitral and tricuspid, and the second, mitral and aortic, valve replacement. These cases underline the value of especially by echocardiography, in view of their serious complications.

[Microbiological contamination of enclosed air spaces. Origin, methods for studying]. / La contamination microbiologique des atmosphères closes. Origines, méthode d'études.

The authors make a bibliographical review of methods for studying the microbiological contamination of closed atmosphere. In a first part, they study the origins of bacterial emission (emissions from nose and pharynx, aerosolization by hospital hands manipulations, skin's emissions). In a second part, the study concern the measure of atmospheric contamination. The authors insist on the correlation may be existed between the counting of all dimensions particles and the bacteria's presence in air. They analyse in details the biological methods of measure (sedimentation, centrifugation, filtration impact) and suggest a room classification according to theirs biological contaminations.

[Septicemia following infection of an endocardial electrode lead (author's transl)]. / Septicémie secondaire à l'infection d'une sonde de pacemaker endocavitaire.

The authors report one case of septicemia following the infection of a remaining endocardial electrode lead. From this observation and the literature's data, they are thinking that it is essential to remove the entire pacemaker system (electrode lead and generator) to cure this complication. They remind the different technics used to remove the endocardial leads.

[Traumatic rupture of the isthmic region with bowel ischemia (author's transl)]. / Rupture traumatique de l'isthme aortique compliquée d'ischémie mésentérique.

One case of traumatic rupture of the isthmic region of the aorta is reported. Acute ischemia of the inferior limbs, anuria and paraplegia have led to the diagnosis. During the first hours after the trauma bowel ischemia appeared. The repair of the aorta was achieved within the seven hours after the accident but the bowel ischemia stayed irreversible. A such complication has not been reported in the literature as long as we know and we are think that it is possible to range this complication among some of the ischemic enterocolitis.

Evaluation of myocardial metabolism after prolonged circulatory arrest and under profound hypothermia. An experimental study in young dogs.

15 young dogs between the ages of 2 and 4 months and weighing less than 6 kg underwent circulatory arrest for 1 h combined with profound hypothermia and extracorporeal circulation. During reperfusion, myocardial metabolism was studied by comparing the oxygen arteriovenous content difference and lactate balance at different temperatures. As the myocardial temperatures rose, the oxygen arterial venous difference increased from 4 vol/100 ml at 25 degrees C to 10 vol/100 ml; lactate balance changed from -19.3 to +8% which because of a large rise in arterial lactate indicates a considerable increase in lactate consumption. This study shows that profound and generalized hypothermia ensures good myocardial protection during at least 1 h of ishcemia and confirms results obtained with other forms of cardiac hypothermia.

[Left superior veina cava and endocardial stimulation (author's transl)]. / Veine cave supérieure gauche et stimulation endocavitaire.

A left superior veina cava may be troublesome for endocardial lead's placement during permanent pace maker's implantation. We have operated upon one patient with this anomaly. We report the anatomic frequency of this congenital malformation and the technics used to obtain a satisfactory permanent pacing.

[Artificial left ventricle in paracardiac position between the apex of the heart and the ascending aorta (author's transl)]. / Ventricule gauche artificiel en position paracardiaque entre la pointe du coeur et l'aorte ascendante (I).

A device for assistance of the left side of the heart in acute failure is placed in the paracardiac position. The blood is drained into the apparatus through the apex of the heart and is reinjected into the ascending aorta by an artificial pump. The flow of blood within the prosthesis and at the level of the inlet and outlet values is studied by a system of lighting in thin layers. Several types of original valve have been tested but the most satisfactory results were obtained with a classical bead valve.

[Artificial left ventricle between the apex of the heart and the ascending aorta (author's transl)]. / Ventricule gauche artificiel entre la pointe du coeur et l'aorte ascendante (II).

The artificial left ventricule is placed in the paracardiac position to ensure a short circuit of the natural left ventricule which is left in position. The prosthesis is implanted on the tip of the heart to ensure wide drainage of the left ventricule and on the ascending aorta to obtain systolic injection under physiological hemodynamic conditions. On both sites of implantation are sutured dacron tubes which permit insertion of the prosthesis without interrupting the general circulation and its withdrawal by simple ligature of the tubes of dacron.