Vascular expression of annexin A2 in lupus nephritis.

AIMS: To evaluate vascular expression of annexin A2 (ANXA2) and its subunit S100A10 in lupus nephritis (LN). METHODS: The present histological study included 14 patients with LN and 11 controls (patients with non-lupus kidney diseases). Kidney biopsies from patients with lupus were scored for lupus glomerulonephritis (according to the International Society of Nephrology/Renal Pathology Society 2003 classification) and vascular lesions (such as microthrombi and antiphospholipid syndrome nephropathy (APSN)). ANXA2 and S100A10 expression in glomerular and peritubular capillaries was evaluated by immunohistochemistry on tissue sections. The staining intensity score ranged from 0 (no expression) to 4 (intense expression). RESULTS: In patients with LN, the median age (range) at first kidney biopsy was 36 (18-49). Vascular lesions were observed in six patients (including two with APSN). We observed intense expression of ANXA2 in glomerular and peritubular capillaries while expression of S100A10 was weaker. However, one of the patients with APSN showed strong S100A10 expression. Patients with LN and controls differed significantly in terms of S100A10 expression in peritubular capillaries. We also observed a statistical difference between patients who had LN with renal vascular lesions and those without renal vascular lesions in terms of ANXA2 expression in peritubular capillaries. CONCLUSIONS: The presence of vascular lesions in LN appears to be associated with significant differences in the vascular expression of ANXA2. Vascular expression of ANXA2 was somewhat higher in LN. Vascular expression of S100A10 was somewhat lower in LN (except one of the two patients with APSN). Further studies of ANXA2's putative value as a biomarker of active LN or of vascular lesions in LN are required.

Imaging of the fetal bony pelvis by computed tomography in a case of bladder exstrophy.

We describe the findings on computed tomography (CT) in a prenatally diagnosed case of bladder exstrophy, and compare them with the findings on two- and three-dimensional sonography. The CT data of the affected fetus were compared with the CT findings of 14 fetuses with normal bony pelvises. The CT images showed differences in the structure of the bony pelvis in the case of bladder exstrophy, with a wide gap between the iliopubic and ischiopubic rami and a widening of the iliac bones. CT scanning was useful in confirming the sonographic diagnosis of bladder exstrophy, and it may also be helpful for planning early surgery following delivery.

Prenatal diagnosis of a patent urachus cyst with the use of 2D, 3D, 4D ultrasound and fetal magnetic resonance imaging.

Patent urachus cyst is a rare umbilical anomaly, which is poorly detected prenatally and frequently confounded with pseudo bladder exstrophy or omphalocele. A 27-year-old woman was referred to our prenatal diagnosis centre at 18 weeks of gestation after diagnosis of a megabladder and 2 umbilical cord cysts. Subsequent 2D, 3D and 4D ultrasound examinations and fetal magnetic resonance imaging (MRI) revealed a typical umbilical cyst and an extra-abdominal cyst, communicating with the vertex of the fetal bladder through a small channel that increased in size when the fetus voided urine. Termination of pregnancy occured at 31 weeks because of associated cerebral septal agenesis, and autopsy confirmed the prenatal diagnosis of urachus cyst. Few cases of urachus cyst diagnosed prenatally are reported in literature, but none were associated with other extra-abdominal disorders and none used 3D, 4D and fetal MRI. Our case illustrated the efficiency in prenatal diagnosis of 3D and 4D ultrasound examinations. This could help pediatrician surgeons to explain to a couple about neonatal surgical repair and plastic reconstruction in the prenatal period.

[Organ doses from CT examinations in children]. / Evaluation des doses d'irradiation aux organes en scanographie pédiatrique.

PURPOSE: To estimate radiation doses from routine pediatric CT scans (body) and to propose dose reduction protocols. MATERIAL AND METHODS: [corrected] Study performed with a phantom equivalent to the body of 5 year old child with evaluation of doses delivered to breast, gonads, bone marrow (sternum, T12) and thyroid for CT examinations of the chest, abdomen, pelvis and spine. Extrapolation is made to estimate the doses for 1 year old and 10 year old children. Finally, dose reduction protocols are evaluated. RESULTS: CT of the chest delivers significant doses to breast tissue and bone marrow, CT of the abdomen and pelvis delivers significant doses to the ovaries and CT pf the spine delivers significant doses to thyroid and bone marrow. Optimization can be achieved without degradation of the image quality, by reducing Kv and mAs within reasonable limits. This study may be used in order to evaluate the doses delivered by multi-detector CT units.

Frequency and cost of serious adverse drug reactions in a department of general medicine.

AIMS: To assess the frequency and cost of drug reactions causing or prolonging hospitalization. METHODS: All patients admitted to an internal medicine ward over 6 months were evaluated to identify serious adverse reactions. The number of drug classes on admission or at the time of the adverse drug reaction (ADR) was counted. Excess ADR-related hospital stay was computed using a) raw excess duration of hospital stay, b) correction of duration of hospital stay by age, sex, and number of drug classes, and c) estimation by investigator of excess hospital stay. RESULTS: Three hundred and twenty-nine patients were evaluated: 212 male, 117 female, mean age 57.2 (males: 52.2, females: 66.2 (P < 0.05)), range 17-95 years. They stayed a total of 3720 hospital days (mean stay 11.3 days). 298 had no ADR (mean age 55.8, taking a mean of 2.7 drug classes, 10.7 days hospital stay); 31 had ADRs: in 10, the ADR caused admission in patients with a mean age of 84 (P < 0.01 vs the two other groups), taking 6.3 drug classes, who stayed a mean of 15.1 days; 21 occurred in hospital in patients with a mean age of 63.6, taking 4.2 drug classes (P < 0.01), who stayed a mean of 19.2 days (P < 0.01 vs patients without ADRs). In four the ADR was fatal (13% of ADRs, 40% of deaths). Raw ADR-related excess hospital stay was 318 days (8.6% of all hospital days), after multivariate correction 282 days (7.6% of all hospital days), and with investigator estimation 197 days (5.3% of all hospital days). Point prevalence of ADRs at admission was 3%, incidence rate in hospital was 5.6/1000 patient-days. CONCLUSIONS: 3% of the admissions were related to ADRs. In addition, 6.6% of hospitalized patients had significant ADRs. Between 5 and 9% of hospital costs were related to ADRs. In 24 of the 31 patients with ADRs (77%), these were related to the pharmacological properties of the involved drugs, and may possibly have been avoidable.

[The question of anhaptoglobinemia in immigrants from West Africa (author's transl)]. / Le phenomene d'anhaptoglobinemie chez l'Africain de l'ouest immigre.

Studying the plasmatic level and the phenotype of haptoglobine (Hp) in 71 West Africans living in France, the authors did not record any case of absence of Hp (Hpo) and did not see any significant correlation between the Hp and the duration of stay in France. They conclude that Plasmodium falciparum likely does not play any role in the origin of the Hpo peculiarity in West African immigrants.