Long-Term Follow-Up of Renal Transplant Recipients Treated With IVIG for De Novo Donor-Specific Antibodies.

BACKGROUND: Renal allograft survival is negatively affected by the development of de novo posttransplant donor-specific antibodies (dnDSA). We sought to determine whether treatment with intravenous immunoglobulin (IVIG) could remove or reduce the intensity of dnDSA. METHODS: A single-center study of 12 recipients with dnDSA and stable function who received IVIG 1 g/kg monthly for 6 months were compared with a contemporaneous cohort of 24 recipients with dnDSA who did not receive IVIG. RESULTS: The median time to first dnDSA was 6 months (interquartile range [IQR], 1-12), and follow-up was 83 months (IQR, 58-94) posttransplant. Resolution of dnDSA occurred in 27% of IVIG vs 46% of control recipients (P = .48). Fifty-eight percent of recipients in both cohorts demonstrated a reduction in the intensity of the dominant DSA at last follow-up (P =1.0). A reduction in the number of dnDSAs occurred in 58% vs 62% of the IVIG and control cohorts, respectively (P = .81). Post-dnDSA, acute rejection occurred in 8% of the IVIG vs 42% in the control group (P = .06). Forty-two percent of IVIG-treated vs 49% of control recipients had a deterioration in function from first dnDSA until most recent follow-up (P = .81). Actuarial graft survivals were equivalent between groups. CONCLUSIONS: IVIG treatment of dnDSA in recipients with stable graft function had no impact on DSA clearance or MFI reduction, but this outcome may also be owing to sample size. Larger studies or alternate dosing regimens may be required to determine if there is any role for the use of IVIG as a treatment for dnDSA.

An autonomous low-power management system for energy harvesting from a miniaturized spherical piezoelectric transducer.

A new spherical vibrational energy harvesting device with an additional low power management circuit for optimizing the power transfer from the mechanical vibrations to a storage capacitor is presented. The device is devoted to underwater wireless sensor network applications due to its broadband vibrational energy harvesting, sensing, and communicating facilities. The sensing node container consists of two acrylic glass (PMMA) half-spherical shells and a Pz26 piezoelectric ring clamped between the shells. The energy harvesting, the management circuit, and communication electronics were fitted within the hollow portion of the sphere. A simulation model of the energy extraction and management system using spice has been developed. This simulation shows the feasibility and efficiency of the low power extraction circuit; a level of the necessary stored voltage was set at 3 V. The numerical model was validated by underwater experimental measurements; a voltage of 3 V was obtained at the terminals of a storage capacitor (47 µF) which was sufficient to supply the communication electronics. Power harvesting performances were measured relative to the transmitter/sensor distance and the incident acoustical field excitation voltage. Finally, 175 µW of harvested power has been measured with an excitation voltage of 8 Vpp at 5 cm distance from the emitter.

[Orbital subperiotal hematoma associated with extradural hematoma: one case report]. / Hématome sous-périosté orbitaire associé à un hématome extradural: une observation.

Subperiotal hematoma of the orbit associated with extradural hematoma has been rarely reported in the literature. We report a case of an 8-year-old girl who presented after traumatism, a subperiotal hematoma of the orbit with two extradural hematomas. During the first clinical examination realized while the patient was unconscious, left exophthalmia was found, but after conscious improvement, we discovered ophtalmoplegia and a grade I papilla edema. The CT scan showed two extradural hematomas and a left intraorbital hematoma. The intraorbital hematoma was drained by surgical way but the extradural hematomas were not surgical. The outcome has been marked by the neurological improvement and the oculomotricity recovering.

[Posterior migration of a lumbar disc herniation as a cause of cauda equina syndrome]. / Migration postérieure d'une hernie discale lombaire responsable d'un syndrome de la queue-de-cheval.

Posterior épidural migration of a lumbar disc herniation is rare. Clinical symptoms frequently indicate severe radicular compression. Cauda equina syndrome is very unusual. Three cases of cauda equina syndrome from posterior epidural migration of a lumbar disc herniation along with a review of the literature are presented to illustrate the Imaging features of this entity and related diagnostic difficulties. Finaly, early surgical management is the treatment of choice for optimal symptomatic recovery.

[Brain abscess (80 cases)]. / Les abcès cérébraux (à propos de 80 cas).

BACKGROUND AND PURPOSE: Cerebral abscesses are focal suppurations of infectious origin developed within the cerebral parenchyma. This is a rare pathology, with a relatively poor prognosis. Therapy continues to be debated and the results are inconsistent. The objectives of this study were to define the factors influencing prognosis. METHODS: In a search for predictive factors, we analyzed 80 observations of intracranial abscesses compiled between January 1990 and December 2004. RESULTS: We noted a strong male prevalence (7:1) with age ranging from three to 65 years. The duration of symptoms was short in 34 patients (42.5%). A motor deficit existed in 25 cases (31.25%), aphasia in five patients, and seizure in 11. A CT scan in 77 patients and MRI in three patients provided the diagnosis in all patients. The supratentorial location was found in 72.5% of the cases. Otitis ranked first among etiologies, followed by cranial injuries and sinusitis. The pathogenic agent found in the pus from the abscess was seldom found at the entry point. Staphylococcus aureus was found in 12.1% of the cases, followed by Proteus (11.8% of the cases). Seventy-eight patients underwent surgery, two were treated with antibiotics only, with favorable progression in 76.3%. We noted a 13.1% rate of complications and five deaths. CONCLUSIONS: Comparing the data from this study with those of the literature, we observed that progression was better among young patients with a mean age of 20-35 years, a good level of consciousness, and supratentorial location.

New developments for an electron impact (e,2e)(e,3e) spectrometer with multiangle collection and multicoincidence detection.

We describe new developments aimed to extend the capabilities and the sensitivity of the (e,2e)(e,3e) multicoincidence spectrometer at Orsay University [Duguet et al., Rev. Sci. Instrum. 69, 3524 (1998)]. The spectrometer has been improved by the addition of a third multiangle detection channel for the fast "scattered" electron. The present system is unique in that it is the only system which combines three toroidal analyzers all equipped with position sensitive detectors, thus allowing the triple coincidence detection of the three electrons present in the final state of an electron impact double ionization process. The setup allows measurement of the angular and energy distributions of the ejected electrons over almost the totality of the collision plane as well as that of the scattered electron over a large range of scattering angles in the forward direction. The resulting gain in sensitivity ( approximately 25) has rendered feasible a whole class of experiments which could not be otherwise envisaged. The setup is described with a special emphasis on the new toroidal analyzer, data acquisition hardware, and data analysis procedures. The performances are illustrated by selected results of (e,2e) and (e,3e) experiments on the rare gases.

[Intramedullary schwannoma. A case report]. / Schwannome intramédullaire. A propos d'un cas.

The intramedullary localization of schwannoma is rare, corresponding to 0.3% of all intraspinal tumors. We report a case of intramedullary schwannoma without symptoms suggestive of neurofibromatosis. This patient presented with symptoms of spinal compression. Total removal of the tumor was achieved. The literature is reviewed about of this rare localization of schwannoma.

[Gliosarcomas. A case report]. / Gliosarcome. A propos d'un cas.

Gliosarcomas account for 2% of glioblastomas. We report a case of gliosarcoma in a 65-year-old man, which presented as meningioma, and discuss diagnostic, therapeutic and prognostic aspects of this particular entity.

[Cerebellar schistomiasis. A case report]. / La bilharziose cérébelleuse. A propos d'un cas.

Schistomiasis or bilharziosis remains an endemic parasitic disease in many countries world wide. Urogenital, intestinal and hepatic symptoms are common. The brain is exceptionally involved and very few cases have been described in the literature. We report the case of a 35-Year-old male with a history of hematuria and bladder disorders, who developed signs of intracranial hypertension and a cerebellar syndrome over a period of one Month. Brain MRI disclosed a cerebellar lesion and a pelvic CT scan revealed a bladder tumor. Treatment consisted in a ventriculo-peritoneal shunt and corticosteroid therapy. Cystoscopy was performed for total resection of the bladder lesion. Histopathology confirmed the diagnosis of schistomiasis. Surgery was also performed to approach the cerebellar lesion. Histopathology showed the inflammatory nature of the lesion. The patient was given an antiparasitic treatment. Clinical and radiological radiological manifestations regressed.

[Intramedullary tuberculomas. Five cases]. / Les tuberculomes intramédullaires. A propos de 5 cas.

Tuberculosis of the central nervous system is uncommon. The intramedullary localization is exceptional. We report five cases of intramedullary tuberculosis observed in four women and one man with a mean age of 43 years. Two patients had a prior history of tuberculosis. Spinal cord compression was found clinically in all cases. The spinal MRI visualized the tuberculoma in all patients; two had a double tumor. Complete removal of the tuberculoma was possible in only one patient. Outcome was stationary for four patients.

[Epidermoid cyst of the cerebellopontine angle. A surgical series of 10 cases and review of the literature]. / Kyste épidermoïde de l'angle ponto-cérébelleux. Série chirurgicale de 10 cas et revue de la littérature.

Epidermoid cyst or cholesteastoma is a congenital slow growing lesion. It usually arises in the paramedian cisterns of the posterior fossa. Its incidence varies between 0.2 and 1% of all intracranial tumors. The cerebello-pontine angle (CPA) is the most common localization. Our study reports 10 observations of CPA epidermoid cysts, treated in our department between 1989 and 1999. The age of our patients ranged from 20 to 45 years, with male predominance. The patients were admitted with symptoms of cerebello-pontine angle syndrome or signs of posterior fossa tumor. CT-scan was performed in all cases and MRI was performed in 5 patients. The audiometric explorations only provided an orienting contribution. Treatment was exclusively surgical. The retro-sigmoid approach was used in 6 cases, the sub-occipital in 30% and a subtemporal approach in one case. Total resection of the epidermoid cysts was accomplished in 4 cases, and subtotal resection in 4 cases. Two patients underwent partial resection and underwent a revision procedure. The histological examination showed an epidermoid cyst in all cases. The clinical course was controlled in 6 patients: 4 patients recovered and became symptom free. A persisting neurologic deficit was observed in two cases (hearing loss, dysphonia); 4 patients were lost to follow-up. Epidermoid cyst is a benign tumor. Total resection is the ideal treatment, but we have to be aware, taking into consideration the adherence of the tumor to neurovascular structures, of the risks at attempting total resection.

[Subperiosteal hematoma of the orbit associated with subfrontal extradural hematoma]. / Hématome sub-périosté de l'orbite associé à une lame d'hématome extradural sous-frontal.

Subperosteal hematoma is rarely associated with extradural hematoma and orbital roof fracture. We report a case observed in a 16-year-old boy who developed exophthalmos, diplopia and visual loss after blunt head trauma. Computed tomography demonstrated the subperiosteal hematoma associated with a thin extradural hematoma and an orbital roof fracture. The hematomas were removed during the same procedure via fronto-orbito craniotomy. Surgery led to complete recovery without functional sequelae. We stress the importance of early diagnosis and treatment of post-traumatic exophthalmos.

[Sphenotemporal aneurysmal bone cyst. A new case and review of the literature]. / Kyste osseux anévrysmal sphénotemporal. Un nouveau cas et revue de la littérature.

Aneurysmal bone cysts (ABC) are benign tumors of the bones, formed by multiple cysts filled with blood and eroding the bone. They are rarely located at the skull. We report a case of a right temporal ABC in a 5-year-old girl. On admission, the physical examination showed a tough and fixed tumor, with no inflammatory signs nor vascular characteristics. The neurological examination was normal. Imaging studies showed an heterogeneous extracerebral mass, eroding the temporal bone and the greater wing of the sphenoid bone. The treatment consisted in an extensive tumor resection, associated with reconstructive surgery. The outcome was uneventful (follow-up 27 months). We underline the pathogenetic, diagnostic and therapeutic features of this condition.

[Tamoxifen adjuvant delays early breast cancer. Results of a cooperative randomized trial]. / Tamoxifène adjuvant retardé dans le cancer du sein curable. Résultats d'un essai coopératif randomisé.

Adjuvant tamoxifen (TAM) has been proved to reduce recurrence and mortality in early breast cancer, nevertheless many patients did not receive TAM as adjuvant therapy after local treatment. In order to study the efficacy of delayed TAM therapy in patients who were not given immediate adjuvant hormonal treatment, a multicenter randomized trial has been conducted by the French National Cancer Centers (FNCLCC). According to eligibility criterias all women with breast cancer who received curative local treatment at least 2 years before (surgery +/- radiotherapy) with or without adjuvant chemotherapy but no hormonal treatment could have been included. Between September 1986 and October 1989, 494 women were randomized to receive either TAM 30 mg/day for 5 years or no treatment. Patients' characteristics such as age, tumoral stage, number of positive nodes, receptors status and time from local treatment were equally distributed in the 2 groups. An improvement in the disease free survival in the TAM treated patients can be observed with a significative difference (p = 0.05), nevertheless the overall survival is not improved in the TAM group. In the same way, in nodes positive patients although no significative improvement in the overall survival can be observed, a significative improvement in the disease free survival (p = 0.05) can be noted. In estradiol receptors positive patients tamoxifen gives a significative reduction in the odds of death (p = 0.04) and recurrence (p = 0.03). The disease free improvement seems to be limited to 50 and more years old patients. The first results of this trial lead to prescribe tamoxifen to all postmenopausal women previously treated for an early breast cancer without adjuvant tamoxifen treatment.

[Anterior approach of cervical spine in Pott's disease. Apropos of 7 cases]. / Abord antérieur du rachis cervical dans le mal de Pott. A propos de 7 cas.

This study reports 7 cases of cervical Pott's disease, gathered during 6 years in the department of neuro-surgery of Ibn Rochd U.H.C. 4 females and 3 males, aged between 9 and 52 years were included. All the patients complained of cervicobrachial pain and weakness of the limbs. Clinical features were: deterioration of general status, rachidian syndrome and neurological impairement with motor and sensitive deficit. Radiological analysis found a destructive and extensive lesion, cervical kyphosis from 10 degrees to 60 degrees, retropharyngeal abscess and intraspinal canal extension of infection. Diagnosis was confirmed by histological study in all cases. In addition to antituberculous therapy and preoperative cervical traction in 4 cases, all the patients had spinal fusion using an anterior approach. Post operative immobilization in a cervical collar varied from 9 to 12 months. All 7 patients had full neurological recovery, 6 patients had an excellent bony fusion and cervical kyphosis was corrected. For the remaining patient, the bone graft was mobilized without neurological disorders. This study confirms anterior arthrodesis efficiency. This procedure in conjunction with preoperative traction, allowed stabilization of the spine and healing of vertebral lesions with excellent kyphosis correction.

[Thoracic medullary epidermoid cyst. Apropos of a case with MRI and review of the literature]. / Kyste épidermoïde médullaire dorsal. A propos d'un cas avec IRM et revue de la littérature.

We report the case of a 14 year-old patient presenting with a thoracic spinal cord compressing syndrome (T5-T6). The myelography and magnetic resonance imaging showed an intramedullary cystic mass. One year after the surgical excision of the capsule and an easy aspiration of the tumoral content, this patient had a good neurological recovery.

[Anal migration of ventriculo-peritoneal shunt catheter. Apropos of 3 cases]. / Migration anale du cathéter de dérivation ventriculo-péritonéale. A propos de 3 cas.

Three cases of abdominal catheter migration through the anus following ventriculo-peritoneal shunt are described. Two cases involved hydrocephalus secondary to tuberculous meningitis and the third myelomeningocele. Among the reasons for migration, the length of the abdominal catheter, trauma during the operation and infection must be taken into consideration. One patient was suffering from meningitis at the time of admission, while the two others were asymptomatic. Treatment involved removing the peritoneal catheter in 2 cases and the entire shunt system in the patient with meningitis. The shunt was replaced one to two weeks later. The outcome was favourable in all three cases.

[Multiple and bilateral cerebral hydatid cysts. A case]. / Kystes hydatiques cérébraux multiples et bilatéraux. Une observation.

The authors report one case of multiple and bilateral cerebral hydatic cysts in a eight years old child. The disease was revealed by cranial hypertension signs, with homonymous hemianopsia. The diagnosis was based on the cerebral CT scan, and confirmed by surgical operation which was performed in two stages. The evolution was uneventful.

Isolated clustered microcalcifications: diagnostic value of mammography--series of 400 cases with surgical verification.

PURPOSE: To determine the diagnostic value of mammographic criteria in cases of isolated clustered microcalcifications. MATERIALS AND METHODS: Four hundred mammographic studies of isolated clustered microcalcifications for which surgical verification was available were reviewed. A descriptive statistical study was performed to evaluate the distribution of each criterion relative to histopathologic results, followed by a multivariate study to determine statistically significant criteria. Seven breast specialists gave a consensus opinion on the need for surgery. RESULTS: There were 302 benign lesions and 98 cancers. The most useful criteria were vermicular form, linear/branching shape, and irregular size of microcalcification. The number of biopsies recommended with use of these three criteria was 177 instead of the 172 recommended by the experts. CONCLUSION: Use of these three preoperative criteria permits correct diagnosis of most such malignancies (90% in our series vs 67% diagnosed by the experts).