The long‐term impact of subclinical acute rejection (SCAR) on renal graft function remains poorly understood. Furthermore, the interpretation of borderline lesions is difficult and their incidence is ...variable. The aim of this study was to analyze the characteristics of subclinical inflammation (SCI) in protocol biopsies performed 1‐year after renal transplantation. SCI was defined as the presence of borderline lesions or SCAR according to the Banff 2005 classification. The patients included were a subpopulation of the CONCEPT study in which patients were randomized 3 months after transplantation to receive either sirolimus (SRL) or cyclosporine A (CsA) in combination with mycophenolate mofetil. At 1 year, we observed SCI in 37 of the 121 patients observed with an evaluable biopsy. The incidence was more frequent in the SRL group (SRL 45.2% vs. CsA 15.3%). At 30 months , SCI was associated with a significantly lower level of estimated glomerular filtration rate (mean MDRD 50.8 ±13.3 vs. 57.7 ±16.3 mL/min/1.73 m2, p = 0.035). In conclusion, SCI at 1‐year posttransplantation is associated with worsening renal function and is more frequent in SRL‐treated patients. Therefore, evaluation of SCI may be a valuable tool to allow the optimization of immunosuppressive regimens.
Subclinical inflammation, as diagnosed by protocol biopsy at 1 year, in renal transplant patients switched from cyclosporin A to sirolimus at month 3, is significantly more frequent in the sirolimus arm and associated with subsequent lower renal function.
Vascular malformations (VMs) are rare congenital anomalies that develop during embryogenesis in different types of vessels. Several triggering factors of cutaneous VMs include trauma, infections, or ...hormonal changes. We investigated the expression of hormonal receptors (androgen, estrogen, progesterone) in tissue samples of well-characterized VMs. A secondary objective was to identify self-reported triggering factors for these VMs, including hormonal changes, in the cohort of patients. We included patients with VM samples obtained in the tertiary center for vascular anomalies of the University Hospital Center of Tours, France, from January 1, 2007, to August 1, 2018. Immunohistochemistry was used to detect the expression of hormonal receptors (estrogen, progesterone, androgens). We obtained 51 samples from 51 patients: 13 cystic lymphatic malformations (CLMs), 16 venous malformations (VeMs), 11 arteriovenous malformations (AVMs), 4 combined VMs, 4
PIK3CA
-related overgrowth spectrum, 1 Parkes-Weber syndrome, 1 Gorham syndrome, and 1 multiple lymphangioendotheliomatosis with thrombopenia. In total, 38 (74.5%) samples were positive for androgen receptor: 11 (84.6%) CLMs, 12 (75.0%) VeMs, 8 (72.2%) AVMs, and 7/11 (63.5%) other samples. All samples were negative for estrogen and progesterone receptors. Triggering factors were self-reported in 7 cases and were most frequently hormonal changes (
n
= 6, 18.2%). Hormonal triggers were frequent in AVMs (
n
= 4). Among patients with identified hormonal triggers, VM samples were positive for androgen receptor in 3 and negative in 3. Three-quarters of our VM samples expressed androgen receptor, and most CLM, VeM, and AVM samples were positive. Hormonal triggers were identified in 6/33 patients, mostly with AVMs.
La périartérite noueuse (PAN) cutanée est une entité à reconnaître, son évolution étant possiblement défavorable. Nous en rapportons deux nouvelles observations associées à une maladie de Crohn.
Dans ...la première observation, une patiente ayant une maladie de Crohn depuis neuf ans était adressée pour nécrose d’orteil. Le diagnostic d’angéite nécrosante était affirmé par l’examen histologique d’une biopsie cutanée. Malgré une corticothérapie générale, les lésions s’aggravaient, nécessitant un traitement immunosuppresseur. Dans la seconde observation, une patiente avec une maladie de Crohn diagnostiquée depuis deux mois était adressée pour une ischémie de l’avant-pied. L’histologie cutanée affirmait le diagnostic d’angéite nécrosante évoluant favorablement sous corticoïdes.
La PAN cutanée diffère de la PAN systémique par l’absence d’atteinte viscérale. Son association à la maladie de Crohn est rare, mais doit être connue. Elle conditionne le traitement et la surveillance.
Cutaneous polyarteritis nodosa (CPAN) is an entity which needs to be acknowledged, since it can have a spontaneously adverse outcome. We report two cases of CPAN associated with Crohn's disease.
The first patient was suffering from Crohn's disease for 9 years when she was referred for a necrotic toe. A diagnosis of necrotizing angeitis was confirmed by histological examination of a skin biopsy. Despite systemic corticosteroids, the lesions became more severe, requiring immunosuppressive treatment. The second patient was a female patient referred with forefoot ischemia. Cutaneous histology confirmed the diagnosis of necrotizing angeitis that responded favourably to corticosteroid treatment. The patient had been diagnosed with Crohn's disease 2 months previously.
CPAN differed from systemic PAN by the absence of visceral involvement. Its association with Crohn's disease, although uncommon, must be recognized as it affects treatment and monitoring.
The efficacy of ‘Good Agricultural Practices’ (GAP) for reducing nitrate pollution is tested on the scale of a small catchment area (187
ha) which is almost entirely under arable agriculture. GAP ...have been introduced on all fields since 1990. They consist in applying carefully planned N fertiliser recommendations, establishing catch crops (CC) before spring crops and recycling all crop residues. Soil water and mineral nitrogen (SMN) were measured three times each year on 36 sites representative of crops (wheat, sugarbeet, pea, barley, oilseed rape) and soil materials (loam, loamy clay and rocks, sand loam and limestone, sand) during 8 years (1991–1999). These measurements (about 3600 soil samples) were used in LIXIM model to calculate water and nitrogen fluxes below the rooting zone. The model could reproduce satisfactorily the water and SMN contents measured at the end of winter. It simulated reasonably well the nitrate concentration measured in the subsoil (3–10
m deep) of nine fields. The mean calculated amounts of drained water and leached nitrogen below the rooting depth were 231
mm
year
−1 and 27
kg
N
ha
−1
year
−1, corresponding to a nitrate concentration of 49
mg
L
−1. Leached N varied by a five-, four- and three-fold factor according to the year, crop and soil type, respectively. Nitrate concentration was primarily affected by soil type: it varied from 31
mg
L
−1 in deep loamy soils to 92
mg
L
−1 in shallow sandy soils, and was linked to the soil water holding capacity. The sugarbeet–wheat rotation gave the lowest concentration (38
mg
L
−1) and the pea–wheat rotation the highest one (66
mg
L
−1). In spite of their moderate growth (mean biomass
=
0.8
Mg
ha
−1), the catch crops allowed to reduce the mean concentration by 50% at the annual scale and 23% at the rotation scale. Straw incorporation was also beneficial since net mineralisation between harvest and late autumn was reduced by 24
kg
N
ha
−1 when straw residues were incorporated. Reducing fertilisation below the recommended rate did not significantly reduce further nitrate leaching. Although GAP were not all optimal and therefore less efficient than in well controlled experiments, they appear essential in intensive agriculture in order to comply with the EU standard for nitrate concentration.
Background and aims The recycling of plant residues can be an important source of available sulphate in soils. This study investigates the effects of soil sulphate availability on residue ...decomposition and the relationships between plant residue quality and S and C mineralization Methods A soil incubation experiment examined rape-seed straw mineralization after adding sulphate at rates of 20 and 50 mg S-SO4 kg−1 soil in a loamy soil. Soils amended with wheat straw, tall fescue, mustard or beech leaf residues were incubated. Net C and S mineralization were measured continuously during a 175-day incubation at 20 °C and gross S mineralization and immobilization were quantified using 35S soil labeling. Results The addition of sulphate did not change C mineralization, indicating that soil S supply was high enough to supply microbial needs during decomposition. The chemical quality of the residue significantly modified the rate of decomposition and the gross and net S mineralization, with a high release of sulphate from mustard and fescue residues but little net change in soil sulphate with the other residues. Conclusions The chemical composition and C/S ratio of plant residues are important criteria for predicting both the dynamics and the amount of sulphate available during residue decomposition.
Prolapsus rectal chez un enfant de 3 ans 8 mois Frollo de Kerlivio, C.; Willot, S.; Machet, M.-C. ...
Archives de pédiatrie : organe officiel de la Société française de pédiatrie,
9/2008, Letnik:
15, Številka:
9
Journal Article
Recenzirano
À partir de la description d’un cas récent, nous abordons les différentes causes à rechercher devant un prolapsus rectal, ainsi que leurs prises en charge. Dans notre cas, le lien avec une colite ...infectieuse est discuté.
Un garçon, âgé de 3 ans 8 mois, présentait des prolapsus rectaux à répétition dans un contexte de diarrhée glairosanglante, de réduction de plus en plus difficile. Alors que l’analyse des selles était négative, la coloscopie montrait un aspect de colite pseudomembraneuse confirmée par les biopsies.
Les règles hygiénodiététiques sont les mesures primordiales de la prise en charge d’un prolapsus. Les colites pseudomembraneuses sont le plus souvent liées aux toxines de
Clostridium difficile et font partie des formes sévères de diarrhée post-antibiotique. Leur traitement repose sur une antibiothérapie par voie orale par métronidazole ou vancomycine pendant 10
j. Après traitement, les prolapsus chez l’enfant guérissent sans récidive dans 98 % des cas.
Dans notre observation, l’absence de récidive du prolapsus après guérison de la diarrhée grâce à l’antibiothérapie suggérait un lien de causalité avec la colite pseudomembraneuse.
Starting from a recent clinical case, we present the different causes of rectal prolapse and their specific treatments. In this case, the relation to infectious colitis was questionable.
This 3-year-8-month-old boy had repetitive rectal prolapses with phlegmy and bloody diarrhea, with reduction increasingly difficult. Stool analysis was negative but pseudomembranous colitis was found with coloscopy and was confirmed by biopsy.
Hygienic and dietary measures are the first steps in the treatment rectal prolapse. Pseudomembranous colitis, often related to
Clostridium difficile toxins; is a severe form of postantibiotic diarrhea. Its treatment is based on oral antibiotic therapy with metronidazole or vancomycin for 10 days. Rectal prolapsus in children is cured without recurrence in 98% of cases.
In the case reported herein, rectal prolapse did not recur after diarrhea recovery with antibiotic therapy, suggesting a causative link with pseudomembranous colitis.
Ischaemic fasciitis (IF) is a rare pseudosarcomatous proliferation initially described on the pressure points of long-term bedridden patients. Healing is the rule after surgical excision. No ...multifocal localisations have been reported to date. Herein, we describe the case of a patient with FI affecting two sites and having recurred at one of them.
A 50-year-old woman with scoliosis and mental retardation consulted for a hard skin lesion next to her right scapula. Elastofibroma was diagnosed on the basis of a surgical biopsy sample. Early local recurrence led to a second resection four months later. Histologically, central fibrinoid necrosis was observed, surrounded by collagenous tissue containing occasionally atypical fibroblasts and numerous capillaries. The diagnosis of ischaemic fasciitis was made by a national expert. Six months later, we observed a 13-cm purplish erythematous infiltrated mass with a 6-cm ulceration at the surgical site. A second 6-cm non-ulcerated indurated purplish lesion was visible next to the right greater trochanter. The scan showed deep soft-tissue infiltration with subfascial extension and contact with the greater trochanter. Superficial biopsies of both lesions showed only an appearance of granulation tissue. MRI performed after five months showed an extension of lesions at the two sites with an appearance evocative of ischaemic fasciitis. Surgical excision was refused by the patient and her family.
We report a rare case of ischaemic fasciitis at two separate sites with local relapse after surgical excision.
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