Immune Reconstitution Inflammatory Syndrome Secondary to Mycobacterium kansasii Infection in a Kidney Transplant Recipient.

Nontuberculous mycobacteria (NTM) infection is a challenging diagnosis for clinicians in solid organ transplantation. Immune reconstitution inflammatory syndrome (IRIS) is so far unreported in this context. We report here the case of a renal transplant recipient who developed Mycobacterium kansasii-associated lymphadenitis complicated by IRIS while undergoing reduction of his immunosuppressive therapy. For IRIS, the patient required low-dose steroids and an increase in global immunosuppression, in association with NTM antibiotherapy.

[Cushing's syndrome induced by combined treatment with inhaled fluticasone and oral ritonavir]. / Syndrome de Cushing induit par la prise concomitante de fluticasone et de ritonavir.

INTRODUCTION: Fluticasone is a corticosteroid drug which is used in inhaled and nasal formulations for the treatment of asthma and allergic rhinitis. It is metabolized in the liver by the cytochrome P450. Ritonavir, an inhibitor of the HIV protease, also acts as an inhibitor of several isoenzymes of the P450 cytochrome. This property explains the many drug interactions observed with this agent. CASE REPORT: We report two cases of Cushing's syndrome with adrenal insufficiency associated with the combined administration of oral low dose ritonavir and moderate to high dose inhaled fluticasone. CONCLUSION: These observations highlight the fact that the combined administration of fluticasone and ritonavir must be avoided as well as the combined administration of fluticasone and other inhibitors of the cytochrome P450.

A population-based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer.

BACKGROUND: The aim of this population-based study was to evaluate the incidence, management and prognosis of patients with hepatic metastases related to colorectal cancer using data from the Digestive Cancer Registry of Calvados, France. METHODS: Of 1325 patients with colorectal cancer registered between January 1994 and December 1999, 358 developed hepatic metastases. Logistic regression was used to analyse prognostic factors. Survival analysis was carried out with Cox's proportional hazards model. RESULTS: Some 18.8 per cent of patients had synchronous metastases, while 29.3 per cent developed metastases at 3 years. Of patients with hepatic metastases, 17.3 per cent had a surgical resection, 40.2 per cent were treated with palliative chemotherapy and 42.5 per cent had symptomatic treatment. Factors associated with receiving symptomatic treatment only were age over 75 years and more than one metastasis, but not place of treatment. Median survival after a diagnosis of hepatic metastases was 10.7 (range 4.6-23.1) months. Significant adverse prognostic factors were: age over 75 years (P = 0.001), lymph node invasion of primary tumour (P = 0.024), bilateral distribution of metastases (P = 0.001), other metastases (P = 0.004) and symptomatic treatment only (P = 0.041). CONCLUSION: Despite improvement in treatment for hepatic metastases, age and extent of disease remain limiting factors for surgical resection and palliative chemotherapy.

[Zenker's diverticulum: diverticulopexy versus diverticulectomy]. / Diverticule de Zenker: diverticulopexie contre diverticulectomie.

STUDY AIM: The aim of this retrospective, nonrandomized study was to compare the results of diverticulectomy and diverticulopexy in the treatment of Zenker's diverticulum. Over the 10-year period between 1988 and 1998, surgery for Zenker's diverticulum was performed in 40 patients. PATIENTS AND METHOD: The study group consisted of 23 men and 17 women with a mean age of 72 years. Only 39 patients were evaluated. In 19 patients, treatment consisted of cricopharyngeal myotomy and diverticulum suspension; in the other 19 patients, treatment consisted of diverticulectomy in addition to myotomy. Only one patient had a diverticulectomy without myotomy. RESULTS: There was no mortality and the morbidity rate was low: one fistula, one pneumonia, three cases of transient dysphonia and one hematoma. The results were excellent in 36 patients, and good in 3 patients. CONCLUSION: Cricopharyngeal myotomy with diverticulopexy is particularly suitable for geriatric patients. Diverticulectomy is proposed in the case of a diverticulum larger than 6 cm and for young patients to prevent the risk of malignant transformation.

[Use of the vacuum-assisted closure system for the treatment of perineal gangrene involving the abdominal wall]. / Utilisation du système vacuum-assisted closure après une gangrène périnéale étendue à la paroi abdominale.

The vacuum-assisted closure (VAC) system is used for the treatment of complicated wounds and large tissular dehiscences. The study aim was to report a case of perineal gangrene extended to the abdominal wall in a 53-year old woman. After several extensive surgical debridments, using of the VAC was followed by a good and rapid healing of the wound.