[Chikungunya crisis on Reunion Island. Media coverage and conflicting public information]. / La crise du chikungunya a La Réunion: amplification médiatique et discordance de communication publique.

The purpose of this article is to analyze media coverage of the health crisis created by the chikungunya epidemic on Reunion Island in 2005/2006. In reaction to nformation provided to the public, the media overstated the sanitary risk. Analysis of the press corpus corresponding to that period reveals an exaggerated account of the epidemic aimed at echoing the genuine distress expressed by victims and their family. Based on the feedback principle, the article suggests a relationship between this situation and information provided to the public about the crisis.

Primary hyperaldosteronism causing posttransplantation hypertension: localization by adrenal vein sampling.

A 58 year-old man with end-stage renal disease who had received a cadaveric renal transplant presented with persistent hypertension and hypokalemia. Allograft renal artery stenosis, rejection, and cyclosporine effects were excluded. Hypokalemia persisted despite potassium supplementation and antihypertensive medications with hyperkalemic effects. The biochemical findings of primary hyperaldosteronism with a normal adrenal anatomy imaged by magnetic resonance imaging (MRI) necessitated adrenal vein sampling to lateralize a left adrenal adenoma. His hypokalemia was cured by the removal of the adenoma, and his blood pressure (BP) control was easily achieved with a less complex regimen of antihypertensives. We suggest that the concomitant existence of resistant hypokalemia and posttransplantation hypertension, especially in the cyclosporine era, should stimulate a search for hyperaldosteronism; once transplant renal artery stenosis has been excluded, the patient should be investigated for primary hyperaldosteronism. When imaging studies fail to show adrenal pathology, adrenal vein sampling will likely do so.

Trial of intravesical versus extravesical ureteroneocystostomy in renal transplant recipients.

We carried out a trial to evaluate the complication rate of intravesical (LP) versus extravesical (Lich) ureteroneocystostomy in recipients of renal transplantation. Ureteric stenosis was the predominant complication in the LP technique, which was more difficult to correct. Complications by the Lich technique were urinary leaks, which were managed successfully by prolonged bladder drainage. We conclude that the Lich technique is simpler to perform and avoids the complication of ureteric stenosis, and should therefore be the procedure of choice for ureteric implantation in recipients of renal transplants.

Osteomyelitis of symphysis pubis following renal transplantation.

We describe what we believe is the first reported case of osteomyelitis of the symphysis pubis following renal transplantation. Computed tomographic and magnetic resonance imaging scans were useful in establishing the diagnosis.

Profound persistent eosinophilia in a patient with spontaneous renal atheroembolic disease.

We describe an elderly women who died of renal failure secondary to spontaneous renal atheroembolic disease. The sole clinical clue to this diagnosis was a profound eosinophilia up to 19,100/mm3 and a relative eosinophil count of 80%. Renal atheroembolic disease should be a prominent consideration in any patient with both renal insufficiency and peripheral eosinophilia.

Lack of amyloid in abdominal fat aspirates from patients undergoing long-term hemodialysis.

Recent reports describe the carpal tunnel syndrome (CTS) due to amyloid infiltration of the beta 2 microglobulin protein as a frequent complication of long-term hemodialysis. Carpal synovial and cystic bone lesion amyloid deposits have been reported; however, the extent of systemic amyloid deposition has not been determined. We examined 30 patients undergoing long-term hemodialysis for CTS and performed abdominal fat tissue aspiration for amyloid staining to evaluate the presence of systemic amyloid disease. In this group, CTS was frequent (37%) and its prevalence correlated with the duration of hemodialysis. In all patients, the abdominal fat tissue, stained with Congo red, was negative for amyloid deposits. These results confirm that CTS is a frequent complication of long-term hemodialysis; however, in this study, no detectable amyloid deposits were found in abdominal subcutaneous fat tissue. Thus, abdominal fat aspiration may not be a reliable screening test for hemodialysis-associated amyloidosis.

Transplant ureteral obstruction masquerading as recurrent rejection episodes: management by percutaneous antegrade balloon dilatation.

We report a 52-year-old male renal transplant recipient who had three "rejection episodes." The first of these responded to conventional antirejection therapy; however, the next two episodes showed incomplete responses to treatment for rejection. At subsequent presentation with deteriorating renal function, ureteral obstruction was evident and was relieved with percutaneous antegrade balloon dilatation with a return of his plasma creatinine to normal. Obstruction of the ureter was a major component in our patient's course given the lack of response to conventional antirejection therapy and the normalization of renal function with relief of the documented ureteral stenosis. This case illustrates that ureteral obstruction can mimic rejection in the renal transplant recipient. Management of ureteral stenosis in transplant patients with percutaneous antegrade balloon dilatation appears to be an effective procedure and can supplant the need for open surgical procedures.

Local steroids in dialysis-associated pericardial effusion. A single intrapericardial administration of triamcinolone.

Five patients receiving maintenance hemodialysis for end-stage renal disease underwent therapeutic pericardiocentesis for pericarditis manifested by either cardiac tamponade or effusion unresponsive to conservative therapy. Pericardiocentesis was followed by a one-time instillation of triamcinolone hexacetonide, a nonabsorbable corticosteroid, into the pericardial space with subsequent needle withdrawal. All patients had prompt hemodynamic and symptomatic improvement. Serial echocardiograms showed resolution of the pericardial effusion in all patients. Follow-up evaluation for six months to six years has shown no clinical or postmortem evidence of recurrence. This procedure appears safe and effective and potentially can obviate the need for prolonged catheter drainage or more invasive surgical procedures as therapy for these patients.

Anaphylaxis: an unusual complication of hemodialysis.

Anaphylaxis is a rare complication of hemodialysis. Unless there is a high index of suspicion, symptoms may not be immediately recognized as a manifestation of hypersensitivity and prompt attention may be delayed. To improve physician awareness of this problem we report a patient who developed a severe anaphylactic reaction within minutes of beginning dialysis. Review of the literature indicates that hypersensitivity reactions are most commonly associated with Cuprophan dialyzers. Although the etiology has not been established, recurrence can be prevented by selection of a different type of dialysis membrane.

Depressed spontaneous cellular cytotoxicity associated with normal or enhanced antibody-dependent cellular cytotoxicity in patients on chronic haemodialysis.

Lymphocyte function as assessed by spontaneous cellular cytotoxicity (NK) and antibody-dependent cellular cytotoxicity (ADCC) was studied in a group of 23 patients with end-stage renal disease who were being maintained on haemodialysis. The mononuclear cells from 12 (50%) of these patients were markedly reduced in their ability to effect NK activity. When mononuclear cells from 13 patients were examined for ADCC activity, however, only two displayed reduced cytotoxicity. The remainder showed either normal or enhanced ADCC activity against erythrocyte targets. Five patients with consistently low NK cell function demonstrated a significantly enhanced ADCC function when compared with normal controls. Several patients were tested repeatedly over a period of 6 months and we found that these two mononuclear cell functions remained consistent during this time. A reduction in NK activity may reflect a lessened capability for immunosurveillance in these patients.

Norepinephrine and renin activity in chronic renal failure. Evidence for interacting roles in hemodialysis hypertension.

To assess the interaction between adrenergic activity and blood pressure regulation in patients with chronic renal failure, plasma norepinephrine (NE) and plasma renin activity (PRA) were measured before and after vigorous ultrafiltration. The significance of PRA was further assessed by angiotensin blockade with saralasin. Two patterns of response were defined: nine patients had low levels of PRA before and after hemodialysis. These patients showed a net fall in norepinephrine and no angiotensin dependence of any time. Failure to stimulate either PRA or norepinephrine was also observed during periods of marked hypotension. Seven other patients had higher PRA, which rose during hemodialysis. This was associated with an increase in NE and postdialysis angiotensin dependence. Patients experiencing hypotension in this group showed a sharp rise in NE, suggesting baroceptor-mediated adrenergic stimulation. In all patients sustaining hypotension during therapy, postdialysis PRA was closely correlated with NE. These results indicate that hemodialysis mobilizes the renin-angiotensin system to maintain hypertension in a greater proportion of dialysis patients than previously supposed and that impaired renin release following hypotension may represent uremic autonomic dysfunction.

Renal autotransplantation for recurrent renal colic.

Renal autotransplantation as an alternative to ileal interposition has been done successfully in patients with repetitive episodes of renal colic. Urinary tract continuity has been re-established by anastomosis of a Boari tube directly to the renal pelvis. This has resulted in easy egress of recurrent calculi without pain. Furthermore, the musculature of the Boari tube seems to be adequate for prevention of vesicorenal reflux. The procedure has been devoid of electrolyte and mucous urinary retention problems associated with ileal interpositionand it is advocated as an alternative in the management of such patients when medical therapy fails.