[Small cell lung cancer revealed by extramembranous glomerulonephritis]. / Carcinome à petites cellules révélé par une glomérulonéphrite extramembraneuse.

We describe a case of small-cell lung cancer limited to the thorax but with malignant pleural effusion in a 47-year-old man that was revealed by a nephrotic syndrome due to membranous glomerulonephritis (MGN). Chemotherapy led to a partial tumor response with total resolution of the nephrotic syndrome. Tumor relapse did not provoke proteinuria. Primary lung cancer is the cause of about 3% of all cases of MGN and 40% of tumor-related MGN. There are 49 cases of tumor-related MGN in the literature, including 9 cases of small-cell lung cancer.

[Retinopathy caused by interferon. Apropos of a case]. / Rétinopathie à l'interféron. A propos d'un cas.

Toxic retinopathy due to alpha interferon in a 20-year-old female is reported. This was an unusual case due to its severity in a non diabetic patient. Recovery of visual acuity was incomplete though angiographic tests normalized. Retinal toxicity in nondiabetic patients is usually reversible, suggesting careful surveillance of high risk patients with retinal microangiopathy given interferon therapy.

[Homozygote deficiency of thiopurine methyltransferase. A contraindication to the use of azathioprine in kidney transplantation]. / Déficit homozygote en thiopurine méthyltransférase. Une contre-indication à l'utilisation de l'azathioprine en transplantation rénale.

Azathioprine-induced myelosuppression is the most important side effect observed in kidney transplantation. We report a case of severe neutropenia after kidney transplantation due to a thiopurine methyltransferase deficiency. This cause of azathioprine-induced myelotoxicity is rare, but its infectious consequences may be severe. Thiopurine methyltransferase deficiency must therefore be suspected when early and severe leukopenia occurs during azathioprine therapy. Erythrocyte thiopurine methyltransferase activity measurement confirms the diagnosis. Azathioprine and 6-mercaptopurine must afterwards be definitively avoided.

Detection of hepatitis C viral RNA: comparison of Amplicor single PCR and nested set PCR processes with HCV serology for hemodialyzed patients.

Multicentre quality control studies demonstrated that optimization and standardization of HCV RNA reverse transcription polymerase chain reaction (RT-PCR) amplification techniques were possible: thus, a nested HCV RNA RT-PCR assay was described as a reliable tool for the detection of hepatitis C viral RNA. Besides this, another procedure, the Amplicor HCV RNA qualitative test, a standardized RT-PCR assay, became available. In order to assess the relationship between seropositivity and potential infectivity and to compare both RT-PCR assays, all patients undergoing maintenance hemodialysis were evaluated at hospital de Meaux (Meaux, France) during one year. We conclude that both assays are equally sensitive and that acid guanidinium thiocyanate based methods, which are used to prepare RNA prior to PCR, are more efficient than the usual phenol extraction protocols. Care should be taken with sera from hemodialyzed patients as the presence of inhibitors of the PCR has been demonstrated during the course of HCV RNA testing.

[Primary signet ring adenocarcinoma ofa diverted neurogenic bladder]. / Adénocarcinome primitif à cellules en bague à chaton sur vessie neurologique exclue. A propos d'un cas.

Primary signet-ring cell carcinoma of urinary bladder is an uncommon primitive bladder tumor. We report the first case occurring on a diverted neurogenic bladder. Except of adenocarcinoma of urachal origin, about 60 cases have been reported to date. The histogenesis of these tumors remains controversial.

Laser hazards in research laboratories.

Laser use is expanding rapidly in laboratories, where multiple use strategies of research are not often amenable to laser engineering safeguards employed in industry. We report on five cases of laser-associated incidents requiring medical follow-up from a single research institution, and present exposure circumstances from four other incidents. Eye injuries from direct and reflected beams resulted from open alignment procedures in the absence of appropriate eye protection. Nd:YAG lasers operated with doubling crystals appear to create a considerable risk. For several reasons, we believe the importance of laser-associated injuries are underestimated and the incidence underreported in the research setting. Although knowledge personnel are shown to suffer lapses in standard operating procedures, most incidents and all injuries involved relatively inexperienced personnel. We propose that research laser users be registered and required to undergo formal training in laser safety. Student researchers are a key target population. Collaborative implementation between the equipment supplier and research user will be required to achieve this widespread implementation of effective training.

[Long term course of idiopathic extramembranous glomerulonephritis. Study of predictive factors of terminal renal insufficiency in 82 untreated patients]. / Evolution à long terme des glomérulonéphrites extra-membraneuses idiopathiques: etude des facteurs prédictifs de l'insuffisance rénale terminale chez 82 malades non traités.

In a retrospective study of 82 adults with idiopathic membranous nephropathy, we have studied the predictive factors of renal death. Thirty one patients developed renal failure, sixteen of them progressed to end-stage renal failure (ESRF) (13 males and 3 females). Nine patients developed ESRF in the first 5 years following the renal biopsy. The males and the patients with a nephrotic syndrome have a high risk of ESRF. The age is not a predictive factor of poor outcome. Hypertension seems to be more frequent in patients who developed early but slowly progressive renal failure. Extensive renal interstitial lesions are indicative of poor renal prognosis.

[Ankylosing spondylitis with type AA amyloidosis. 6 cases]. / Spondylarthrite ankylosante avec amylose de type AA. Six observations.

The authors have studied 6 cases of systemic AA amyloidosis associated with ankylosing spondylitis. Renal failure occurred in all patients a mean of 19 years after the clinical onset of the rheumatic disease. Three patients progressed rapidly (between 3 months and 3 years) to end-stage renal failure. Such an outcome did not depend upon early onset of the renal impairment, degree of inflammation or treatment with colchicine. All patients were alive 2 to 10 years later, and this confirms a better prognosis than with AL amyloidosis. The utility of combining Wright's permaganate reaction with immunological methods to characterize the amyloid deposits was also confirmed. It is concluded that amyloidosis is a rare complication of ankylosing spondylitis and probably depends on a genetic predisposition. The possibility of amyloidosis should be kept in mind when proteinuria or renal failure appear in the course of ankylosing spondylitis.

[Does the ferritin level have a practical value in chronically hemodialized patients?]. / Le dosage de la ferritine a-t-il un intérêt pratique chez les malades en hémodialyse chronique?

In order to determine whether serum ferritin assay has any advantages compared with usual hematologic parameters, serum ferritin was assessed in 70 hemodialysed patients. It was positively correlated with the number of blood units infused, but there was no correlation with iron treatment, serum iron or the degree of anemia. However, the interpretation of the results is difficult, because of the large dispersion of serum ferritin levels. Therefore, the determination of serum ferritin concentration cannot be recommended as a current method to follow-up and manage anemic chronic hemodialysed patients, especially when the cost of the test is taken into account.

[Long-term evolution of membranoproliferative glomerulonephritis in adults : spontaneous clinical remission in 13 cases with proven regression of glomerular lesions in 5 cases (author's transl)]. / Evolution à long terme des glomérulonéphrites membranoprolifératives de l'adulte : rémission spontanée durable chez 13 malades avec étude de biopsies rénales itératives dans 5 cas.

188 patients with type I MPGN were followed from 1957 to 1975. At last examination, 53% of patients with pure MPGN and 66% of those with lobular MPGN had renal insufficiency; 28 other patients showed clinical improvement and 13 of these had permanent complete remission. In all of these 13 cases, (10 pure MPGN and 3 lobular forms), the clinical remission was spontaneous and occurred 2 to 16 years after the apparent onset. At the time of the first renal biopsy, 7 of these patients had a nephrotic syndrome, 2 had hypertension and 1 had renal failure. A second biopsy was obtained in 5 patients during the clinical remission period and showed in all cases a clear regression of the glomerular lesions. The possibility of spontaneous permanent clinical remission in MPGN should be considered in the indications and methods of treatment and the interpretation of their results.

Hereditary nephritis associated with May-Hegglin anomaly.

Hereditary nephritis associated with hematologic abnormalities seems to be an exceptional occurrence. We have observed a family which nephritis was combined with May-Hegglin anomaly. A girl and her father suffered from proteinuria; a paternal uncle received kidney graft; a paternal grand aunt died on periodic hemodialysis. The girl, the father and the uncle presented macrothrombocytopenia (40-100 X 10(9)/l, size 4-8 mum) with prolonged bleeding time (which precluded renal biopsy) and cytoplasmic inclusions in neutrophils (Döhle bodies). These hematologic abnormalities characterize the May-Hegglin anomaly. This kind of association has not been reported so far.

Is renal transplantation involved in post-transplantation liver disease? A prospective study.

Various lesions of the liver commonly observed in renal transplant recipients are usually considered as a consequence of the transplantation procedures (immunosuppression, drug toxicity, alteration of immune responses to various viruses). A group of 64 patients all treated with corticosteroids and azathioprine was studied prospectively, and serial liver biopsies were performed on the day of transplantation and at 1 and 3 years after transplantation. Chronic hepatitis was already present in 40% of the patients on the day of transplantation and an increase of only 15% in the frequency of this condition was observed 3 years later. The presence of HBsAg in 45% of the patients at the time of transplantation was significantly associated with liver lesions. In about 3% of the cases, transplantation was directly responsible for a liver disease (peliosis hepatitis). During the followup period an evolution from chronic persistent hepatitis to chronic active hepatitis was observed with an abnormally high frequency (25%). We conclude that most of the liver diseases observed in transplant recipients are the consequence of events before transplantation and probably related to hemodialysis.

Hepatitis B antigen-associated periarteritis nodosa in patients undergoing long-term hemodialysis.

Periarteritis nodosa was observed in three of 266 persistent hepatitis B antigen (HBsAg) carriers undergoing long-term hemodialysis; no cases of necrotizing vasculitis occurred among 384 other patients undergoing dialysis having either no or transient antigenemia. Circulating e antigen, but no e antibody, was found in two of these three patients. The serum level of the third component of complement (C3) was normal in two patients and low in the third. Circulating immune complexes were demonstrated in all three patients, using polyethylene-glycol (PEG) precipitation, PEG-C4, and solid phase C1q tests. HBsAg and anti-hepatitis B antibody (HBsAb) were identified in the PEG precipitates using radioimmunoassay and electron microscopy technics. Direct immunofluorescence performed on a muscle biopsy specimen from one patient was positive for HBsAg, but not for immunoglobulin G (IgG), immunoglobulin M (IgM), C3 or C1q. These data support the hypothesis that circulating immune complexes involving HBsAg may be involved in the pathogenesis of periarteritis nodosa.