Hypogammaglobulinemia and risk of severe infection in kidney transplant recipients.

BACKGROUND: Recent data have outlined a link between hypogammaglobulinemia (HGG) and infection risk and suggested that HGG correction may decrease post-transplant infections. METHODS: We analyzed the risk factors of HGG and the relationship between HGG and the risk of severe infection in a cohort of 318 kidney transplant recipients (KTR) who were transplanted between 2003 and 2013. Immunoglobulin (Ig) concentration was measured prospectively at day 15 (D15), month 6 (M6), month 12 (M12), and month 24 (M24) post transplant. RESULTS: The prevalence of IgG HGG was 56% and 36.8% at D15 and M6, respectively. Age was the sole identified risk factors for D15 IgG HGG (odds ratio [OR] 1.02, P = 0.019). Risk factors for M6 IgG HGG were the presence of D15 IgG HGG (OR 6.41, P < 0.001) and treatment of acute rejection (OR 2.63, P = 0.014). Most infections occurred between D15 and M6 post transplant. Only age (hazard ratio 1.03, P < 0.001) was identified as a risk factor of infection between D15 and M6 post transplant. Survival free of infection (overall infections and bacterial or viral infections) did not differ significantly between patients with or without D15 IgG HGG. Only septicemia occurring between M6 and M12 post transplant was more frequently observed in patients with HGG. The low prevalence of severe HGG (<400 mg/dL) did not allow conclusions on the infectious risk associated with this patient subgroup. CONCLUSIONS: This study does not support the existence of a strong link between post-transplant HGG and the risk of severe infections in KTR. Correction of HGG to minimize the risk of severe infections in KTR is thus questionable and needs to be reevaluated in prospective studies.

[Cerebral vascular accidents in French Polynesia]. / Les accidents vasculaires cérébraux en Polynésie Française.

The authors report on the results of a survey on cardiovascular accidents hospitalized between 01 April 1990 and 31 January 1991 carried out in the Services of Medicine and Cardiology in the Territorial Hospital Center of Papeete. This survey was: 56 cardiovascular accidents: 1/4 (hemorrhagic and 3/4 (42) ischemic. Mean age 59 (extremes 23-86). 36 males (64%); 20 females (36%). 50 Polynesians; 6 Chinese people. Among the risk factors recorded, 38 (68%) were hypertensed patients; 17 (30%) were due to tabagism and 15 (25%) to diabetes; 3 (5%) are known to be carriers of a hypercholesterolemia. 59% of the patients had no case history; 25% the cardiovascular accidents have been observed in patients with cardiopathy; 12.5% are recurrent cardiovascular accidents. Clinically, 5 transient ischemic accidents (12%) out of 42 cardiovascular ischemic accidents. High arterial tension was recognized in 12/14 (86%) of hemorrhagic cardiovascular accidents and in 26/42 (62%) of ischemic cardiovascular accidents. In 42 ischemic cardiovascular accidents, 31 patients suffered from cardiopathy (74%) of which 15 (36%) presented an embolic cardiopathy. Interest of echography and electrocardiogram are discussed. Ultrasonic exam of carotid vessels was found abnormal in almost half of the cases when utilized (12/26). Finally, etiological diagnosis was certain in 17 cases, of presumption in 16 cases, and in 9 cases, it was not possible to precise any cardiovascular etiology. Tomodensitometric tests are discussed. 86% of the ischemic cardiovascular accident were treated with anticoagulants/thrombocyte antiagglutination. 24% of the patients died, 50% recovered incompletely and 26% completely.

[Goiter in Tahiti]. / Le goître à Tahiti.

The authors report on a prospective study about goitre in French Polynesia carried out in 1989, dealing with epidemiology and disease characterization in 39 patients. 1. Epidemiology of goitre in Tahiti; In schools: 517 children (236 boys and 281 girls) aged from 10 to 15. Prevalence rate is 1.55 p.c. (8/517); Adults: 226 adults (112 males and 114 females) aged from 50 to 65. Prevalence rate is 4.42 p.c. (10/226). 2. Case study on 39 Polynesian patients (38 females and 1 male) living in Tahiti (mean age: 35.6 years old) showing euthyroidic goitre, detected from 1989 April 1st and October 31; Goitre did not present in Tahiti any particularity. It is a pathology mainly feminine, at low evolution and late local consequences; In 3/4 of the cases, goitre is visible and more it is voluminous more modules are present; There is no iodine deficiency, and the mean value of iodine excretion (536 mcg/24 h) is very high in comparison with what is described in the literature; Presence of a high thiocyanatemia (greater than 100 mmol/l) is found in 1/4 of the patients; There is no correlation between consumption of foods well-known as cyanogenical ones and the level of thiocyanatemia; There is a correlation between the rate of thiocyanatemia and tabagism.

[Hemorrhagic pseudocyst of pancreas. A case of X-ray computed tomography diagnosis]. / Faux kyste hémorragique du pancréas. Un cas de diagnostic scanographique.

Arteriography failed to detect a pancreatic pseudocyst complicated by hemorrhage, a positive diagnosis being established only after CT scanning. Identification of this rare lesion by angioscan imaging illustrates. The value of this technique, which provides data on vascular dynamics, rapidly, in the selected plane of the section. Results in this case demonstrate the very close correlation between Ct scan images and pathological findings.

[Voluminous exogastric myoid tumor. Contribution of echotomography and x-ray computed tomography]. / Volumineuse tumeur myoïde exogastrique. Apports de l'échotomographie et de la tomodensitométrie.

We described a case of voluminous exogastric leiomyoblastoma revealed by abdominal pain and clinical mass. Ultrasonography showed a mixed mass, with both solid and liquid components, without determining specifically the organ of origin. CT body examination showed an intense hypervascularization, associated with cystic components. Laparotomy with tumor excision was done without any metastases. Such US and CT aspects can lead to the exact diagnostic, if they prove the gastric origin of the mass. Otherwise, the discussion is between pancreatic or epiploic tumors.