[Aortic prosthesis infection treated by using cryogenically conserved allograft]. / Utilisation d'une allogreffe artérielle cryopréservée dans le cadre d'une infection de prothèse aorto-bifémorale.

Infections of aortic prosthesis are quite unusual. When occurring, they represent a real challenge for both medical and surgical care, and their morbidity and mortality rates are high. Initially, these infections can be treated with antibiotics, but, in case of failure, the infected prosthesis must be removed and a new aorto-iliac system has to be reconstructed surgically. We report, the case of a woman affected by infection of an aortic prosthesis and whose problem has been solved by means of a new aorto-iliac graft by using cryogenically conserved allograft. Epidemiology, potential complications and treatment will be discussed.

Les infections de prothèses aortiques sont rares. Lorsqu'elles surviennent, leur prise en charge est un défi médico-chirurgical associé à un taux de morbi-mortalité élevé. Le traitement repose en première intention sur une antibiothérapie systémique ; le choix de l'antibiotique est empirique dans un premier temps et ciblé par la suite, après identification du germe responsable par des prélèvements bactériologiques. En cas d'échec, l'exérèse de la prothèse infectée et son remplacement par une greffe biologique (veines saphènes ou fémoro-poplitées, allogreffe artérielle) pouvant résister à l'infection est le traitement idéal. En ce qui concerne le choix du greffon, la littérature scientifique ne permet pas de départager l'allogreffe artérielle de l'allo- ou autogreffe veineuse dans l'évolution à long terme. Nous rapportons le cas d'une femme ayant présenté une infection de prothèse aortique, et qui a bénéficié d'une allogreffe aorto-bifémorale cryopréservée. L'épidémiologie, les complications potentielles et la prise en charge thérapeutique sont discutées.

[Thrombosis of a popliteal pseudoaneurysm secondary to an osteochondroma of the femur: an uncommon clinical case]. / Thrombose d'un pseudoanévrysme poplité secondaire à un ostéochondrome du fémur: un cas clinique atypique.

Osteochondroma are the bone tumors most frequently found in adolescents or young adults. Most often discovered by accidental findings, they however may be diagnosed while some complications. They are commonly described as solitary findings while multiple exostoses are rather included in an inherited disease. We report the rare case of a 24-year-old patient with acute ischemia of popliteal artery pseudoaneurysm caused by a femur bone exostosis. He presented a severe and supported pain in the left leg. Clinical examination found acute limb ischemia. An angio-CT-scan showed a pseudoaneurysm thrombosis of popliteal artery with distal emboli. An exostosis of the femur bone just above the aneurysm was also found. In this dramatic presentation, a surgical treatment was performed and consisted of thrombectomy, excluding the popliteal aneurysm with a distal saphenous vein graft, excision of the exostosis, fibrinolysis and preventive anterior and posterior compartements fasciotomy.

IL10 GGC haplotype is positively and HLA-DQA1*05-DQB1*02 is negatively associated with radiographic progression in undifferentiated arthritis.

OBJECTIVE: In rheumatoid arthritis (RA), many genetic markers, such as the shared-epitope (SE) alleles, are described in association with radiographic progression, but limited data are available on undifferentiated arthritis (UA). We investigated whether single-nucleotide polymorphisms (SNP) and haplotypes in immune response genes and HLA class II alleles are associated with radiographic progression in patients with early UA. METHODS: Progression of radiographic damage was determined in white Dutch patients with early UA after 2 years of followup. Severe progression was defined as an increase in Sharp/van der Heijde Score > or = 5 points after 2 years of followup. The remainder was classified as mild. These SNP were genotyped by Taqman technology: tumor necrosis factor (TNF) -1031, -863, -857, -308, -238; lymphotoxin-alpha (LTA) +368, +252; interleukin 10 (IL10) -2849, -1082, -819; IL1A -889, IL1B -31, +3953; and IL1RN +2018. Carriage of SE alleles and HLA-DQA1*05-DQB1*02 haplotype was established. These markers were analyzed in relation to radiographic progression. RESULTS: Forty-eight out of 151 patients with early UA had severe radiographic progression. Severe radiographic progression was associated with an increased carrier frequency of SE alleles (OR 5.12, 95% CI 2.0-13.1, p < 0.001) and IL10 GGC haplotype (OR 2.8, 95% CI 1.4-5.8, p = 0.003). Mild radiographic progression was associated with the HLA-DQA1*05-DQB1*02 haplotype (OR 0.3, 95% CI, 0.1-0.8, p = 0.013) and with allele TNF -308A (OR 0.4, 95% CI, 0.2-0.9, p = 0.02). CONCLUSION: The SE and the IL10 GGC haplotype are associated with severe progression of radiographic damage, in contrast to the DQA1*05-DQB1*02 haplotype and the TNF -308A allele, which are associated with mild radiographic progression in early UA.

Ulnar artery false aneurysm: temporary ultrasound-guided compression closure in an unusual case.

A case of traumatic false aneurysm located in an unusual portion of the ulnar artery is presented and the clinical findings, diagnosis and treatments are considered. The authors report the first use of ultrasound-guided compression closure, as an alternative to surgical management of ulnar artery false aneurysms.

[Rupture of an abdominal aortic aneurysm in a nonagenarian]. / Rupture d'un anévrisme de l'aorte abdominale chez un nonagénaire.

Rupture of an infrarenal aortic aneurysm occurring in a 94- year old man is reported. Eight months after surgery the patient is still alive. Indications of elective surgery for asymptomatic abdominal aneurysm in the elderly are discussed.

[Solitary splenic metastasis of endometrial adenocarcinoma. A case report and review of the literature]. / Métastase splénique unique d'un adénocarcinome de l'endomètre. A propos d'un cas et revue de la littérature.

The authors report one case of solitary metastatic endometrial carcinoma of the spleen. Carcinomatous metastatic involvement of the spleen usually indicates widespread malignant disease. Solitary metastatic lesions in this organ are exceedingly rare and the literature reveals up today only three cases having a endometrial origin. The authors take this opportunity to make a review of the literature.

[Cystadenoma of the pancreas. Apropos of a case and review of the literature]. / Les cystadénomes du pancréas. A propos d'un cas et revue de la littérature.

With reference to a new case of pancreatic cystadenoma, the authors review the literature on the subject. These tumors are a relatively uncommon form of cystic lesion of the pancreas. They find the origin from pancreatic acinar cells or from ductal epithelium. Histologically, there are two different forms: benign, serous, microcystic adenoma and potentially malignant, mucinous, macrocystic adenoma. The type of the tumor is demonstrated by ultrasonography and computed tomography. but these examinations could not make a difference between benign and malignant form. Treatment of choice is complete tumor resection. Internal or external drainage of these cysts should not be done.

[Dermoid cyst of the bladder. Case report]. / Kyste dermoïde de la vessie. Case report.

Dermoïd cyst of the bladder is an exceptional pathology. One case of hairy bladder tumors is describe with short review of the literature.

[Tuberculous peritonitis. Description of 2 cases associated with another infection and literature review]. / Péritonite tuberculeuse. Description de deux cas associés à une autre infection et revue de la littérature.

The authors report two cases of peritoneal tuberculosis observed in Belgium: a 28-year-old black man, immigrant from Ghana and a 24-year-old caucasian woman. In both patients, tuberculosis was associated with another infection. The first patient had a retroperitoneal amoebic cyst and in the second patient Chlamydia trachomatis was found with Koch bacillus in the ascitic fluid. Both patients were successfully treated with appropriate antibiotics. Following the review of recent literature, it appears that the incidence of extrapulmonary tuberculosis is increasing in the industrialized part of the world, peritoneal tuberculosis now representing 0.5% of all cases of tuberculosis. Mortality approaches 7%. The diagnosis is difficult and should be evoked more often in order to be confirmed by appropriate means, such as ascitic fluid adenosine desaminase, bacteriology and peritoneoscopy.

An auto-reactive A-like ovarian determinant distinct from xeno-reactive A-like structures.

The "natural" anti-A antibody of the mouse is an autoantibody due to the age-dependent appearance of an A-like auto-reactive determinant, which is predominantly displayed by ovarian tissue and probably occurs in other tissues below the level of detection. The present study shows that this determinant is distinct from murine structures which react with xenogeneic anti-A antibody, and that it does not involve the widespread heterogenetic (Forssman-type) A-related specificity. Whereas xeno-reactive A-like structures, which combine with the human "natural" anti-A antibody, are exhibited by several murine tissues and Forssman-type structures by all of them, the murine "natural" anti-A antibody solely reflects the autoantigenic power of the particular determinant discovered in ovarian tissue. This determinant, which undergoes a unique genetic regulation, is present in both the ovary of the C57BL/10 inbred mouse and that of the NMRI outbred mouse and may thus represent a common murine component.

Age-dependent appearance of A-specific ovarian glycolipids and syngeneic "natural" anti-A hemolysin in mice.

C57BL/10 inbred mice produce a "natural" antibody which in the presence of complement selectively lyses human blood group A erythrocytes, and the sera of females display significantly higher levels than the sera of males. This pronounced anti-A hemolysin production in females follows the appearance of specific endogenous A-determinants which are associated with water-soluble ovarian glycolipids specifically blocking the syngeneic anti-A hemolysin activity. Moreover, this hemolysin activity develops poorly in mice ovariectomized at the age of 20 days. The coincidental production of (auto)antigenic structures in morphologically and functionally normal ovarian tissue and of antibodies against them is thought to be tolerated through the modulation of a thymusdirected control mechanism.

Significance of specific ovarian receptors for syngeneic naturally-occurring haemagglutinating anti-A antibodies.

Haemagglutinins which specifically combine with membrane determinants of human blood group A erythrocytes and which are distinguishable from any other haemagglutinin specificities display marked sex dependency in C57BL/10 mice. All the sera of 80-day-old C57BL/10 females exert moderate to strong anti-A haemagglutinin activities which could be detected only in approximately half of the sera of the males of the same age. Investigations of the murine tissues revealed that the production of anti-A haemagglutinins in females is reflected by simultaneous synthesis of strong endogenous receptors detected in the ovaries and associated with water-soluble glycolipid fractions. The receptor activity was demonstrated by means of haemagglutination inhibition in comparison with appropriate controls and glycolipid preparations from seventeen other different male and female tissues, and the inhibitory effects exerted by the ovarian glycolipids were statistically significant on the basis of multiple comparisons at the 1% level in each possible pair of effects.

Comparative studies of the activity of ciclacillin and dicloxacillin.

The penicillins ciclacillin and dicloxacillin demonstrate marked similarities in biological activity but, as far as can be determined, differ substantially in respect to the degree of protein binding, which is relatively low for ciclacillin and relatively high for dicloxacillin. In mice infected with Staphylococcus aureus Smith, ciclacillin is considerably more active than dicloxacillin, although both drugs are similarly effective in vitro and similarly absorbed and eliminated in vivo. The high degree of protein binding exhibited by dicloxacillin could therefore very probably explain its relatively low chemotherapeutic activity. Moreover, the in vitro and in vivo findings of the study are inconsistent with the tenets of the tau/2 thesis.

Relationship between the chemotherapeutic effectiveness of ciclacillin and ampicillin and the time of their administration in experimental infections.

In an attempt to explain the discrepancy between the weak in vitro activity and good clinical efficacy of ciclacillin, a time-dosage-efficacy study was made in order to investigate the relationship of the effectiveness of this antibiotic to the interval between experimental infection and administration in comparison to ampicillin, which because of its similar antimicrobial spectrum and completely different pharmacokinetic properties was particularly suitable for use in the study. Various single oral doses of both antibiotics were administered once to NMRI (SPF) mice at various intervals (0, 1, 2 or 3 h) following experimental infection with E. coli WT 102, E. coli 3033 or E. coli 026:B6 and the CD50's determined and compared statistically. It was demonstrated that the chemotherapeutic effectiveness of both antibiotics was markedly dependent on the interval between experimental infection and administration. Whereas ampicillin was superior to ciclacillin when drug and infective organism were administered simultaneously (0 h), ciclacillin was superior to ampicillin when it was administered 3 h after experimental infection. Both antibiotics were about equally effective when administered 1 or 2 h after infection. The difference in the serum concentrations and rates of absorption and excretion of the two drugs is assumed to be the reason for this phenomenon, and the pharmacokinetic characteristics of ciclacillin, in particular its rapid and almost complete absorption and rapid attainment of high peak serum levels, are discussed as at least a partial explanation of the difference in its in vitro and in vivo activities.