N-Difluoromethyl-triazole as a constrained scaffold in peptidomimetics.

The N-difluoromethyl triazolo-ß-aza-ε-amino acid present in the core of peptides led to constrained conformations due to CH-F and NH-F interactions. Pseudotetrapeptides were obtained in excellent yields directly by click chemistry between azidodifluoroacetamides and alkynes, both linked to an amino acid. This work demonstrates that the N-difluoromethyltriazole scaffold can induce extended structures to ß-strand mimics.

[Pulmonary migration of an axillary stent in a chronic hemodialysis patient]. / Migration pulmonaire d'une endoprothèse axillaire chez une hémodialysée chronique.

The short-lived results of angioplasty for venous stenosis of a dialysis access led to stent placement. Its migration is a rare but dangerous complication, because of its final destination, that is right heart or pulmonary artery. We report on such a case and compare it with three cases found in literature.

[Severe Schonlein-Henoch nephritis in adults. A report of twenty cases]. / Les néphropathies sévères du purpura rhumatoïde de l'adulte. A propos de vingt observations.

Twenty patients with severe Schönlein-Henoch nephritis were selected on a histologically basis of diffuse proliferative endo- and/or extracapillary glomerulonephritis during a period of 12 years in Champagne-Ardenne. There were 15 men and 5 women, mean age 44.1 years. An infectious history was found in 40%, an urinary tract cancer in 15%. In all cases there was purpura, in 80% joint pain and in 50% digestive symptoms. Clinical presentation at diagnosis included, in all cases, hematuria (gross in 50%) and proteinuria (of nephrotic range in 80%); there was hypertension in 60% and renal failure in 80%. Histology found, in all cases, mesangial IgA and often C3 deposits, with a diffuse endocapillary proliferation in 10%, extra-capillary proliferation in 30% and both endo-extracapillary in 60%; 45% of the patients had crescents in greater than 50% of glomeruli. The outcome, after steroid and immunosuppressive treatment, was end-stage renal failure in 25%, moderate renal failure in 20%, or normal renal function in 55% with a mean follow-up period of 4.6 years. These severe nephritis were associated with repetitive and often necrotic purpura, frequent joint pain and severe digestive symptoms. The analysis of initial renal presentation confirmed the bad prognosis of nephrotic syndrome, renal failure and especially hypertension, which were well correlated with the severity and diffusion of proliferative lesions. Despite a worse known prognosis, these nephritis responded to an aggressive and early treatment.

[Severe renal forms of leptospirosis. Apropos of 6 cases seen in 15 years at one center]. / Les formes rénales graves de la leptospirose. A propos de six cas recueillis en quinze ans dans un même service.

We report on six cases of leptospirosis observed in fifteen years in our department of nephrology. The contamination is two times from professional origin and four times linked to water leisures, during hot season, from june to september for the majority. Two serotypes are found: L. icterohaemorragiae characterized by marked jaundice, and L. patoc with anicteric form. Acute renal failure, five times oliguro-anuric, necessitates in the six cases hemodialysis (two to six sessions). Meningitis is found in four patients, associated in one case to an encephalitis and a polyradiculoneuritis. In one case, there were interstitial pulmonary lesions, in one another, a myocarditis with conduction disorders, responsible of the only death of this series, and finally, in three cases, a gastrointestinal hemorrhage. Bacteriological diagnosis seems little profitable and microagglutination remains the reference technique, helped by the IgM detecting through ELISA, looking forward to the evaluation of PCR (Polymerase Chain Reaction).

[Renal sarcoidosis with a pseudotumoral pyelic localization]. / Sarcoïdose rénale avec localisation pyélique pseudo-tumorale.

BACKGROUND: Renal sarcoidosis exceptionally presents as a unilateral pyelic pseudotumor as in this case where it was associated with granulomatous nephropathy. CASE REPORT: A 33-year-old man had a two-year history of systemic sarcoidosis with no renal involvement. He developed renal failure related to interstitial granulomatous nephropathy associated with a pyelic localization leading to unilateral hydronephrosis. Urine drainage associated with corticosteroid therapy provided a favorable course. DISCUSSION: Renal involvement in sarcoidosis is usually the consequence of hypercalcemia and hypercalciuria related to ectopic secretion of calcitriol by the sarcoidosic granulomas, with urinary lithiasis and nephrocalcinosis leading to renal failure and also granluomatous interstitial nephropathy. Glomerulopathy or obstructive nephropathy are rarely reported. Intraluminal localizations such as the pyelic lesion in our case are exceptional but must be detected early since they respond to corticosteroid therapy.

[Nephrotic syndrome revealing malignant thymoma]. / Syndrome néphrotique révélant un thymome malin.

BACKGROUND: A well-established manifestation of neoplastic disease, nephrotic syndrome is infrequently associated with thymoma. Only 18 cases have been reported in the literature. CASE REPORTS: A 65-year-old man and a 60-year-old woman were seen for nephrotic syndrome. Minimal change renal disease was observed in the first patient whose nephrotic syndrome was steroid resistant. The second patient had membranous glomerulopathy and pure red cell aplasia. In both cases, nephrotic syndrome revealed thymoma. DISCUSSION: The histological lesions in 17 of the 18 biopsied cases reported in the literature were minimal change in 10, focal segmental glomerulonephritis in 4, proliferative glomerulonephritis in 2, and membranous glomerulopathy in only one. The outcome of the nephrotic syndrome was dependent on the success of the thymoma treatment. Some patients responded to steroid and immunosuppressive agents. Pure red cell aplasia is uncommon and prognosis is poor. It can be successfully treated with cyclosporin A as in our second case.

[Repeated studies of the prevalence of Staphylococcus aureus in the nasal cavity in hemodialysed patients]. / Etude itérative de la prévalence du portage nasal de Staphylococcus aureus chez l'hémodialysé.

OBJECTIVES: In order to better establish a prevention strategy based on mupirocin, we evaluated nasal carriage of Staphylococcus aureus in haemodialysis patients over a 15 month period. METHODS: Search for Staphylococcus aureus in the nasal cavities was made every 2 months in 92 chronic dialysis patients. These patients were divided into 3 groups according to the nature of the carriage: non-permanent, intermittent or permanent. RESULTS: Among the 80 patients retained for analysis, there were 27.5% with intermittent carriage and 11.25% with permanent carriage. Factors which appeared to protect against carriage were rural residence and home self-dialysis. CONCLUSION: Repeated long-term search for nasal carriage of Staphylococcus aureus has provided reliable data for each patient and gave information on the effects of epidemiological conditions and health care structures.

[Central venous stenosis in hemodialysis: comparative angiographic study of subclavian and internal jugular access]. / Sténoses veineuses centrales en hémodialyse: étude angiographique comparative des accès sous-claviers et jugulaires internes.

From January 1986 to December 1990, we studied angiographically the subclavian-brachiocephalic vein of 100 patients dialysed on subclavian catheter for 50 (first group) and on internal jugular catheter for the 50 others (second group). These 2 groups are not statistically different for age: 61.6 +/- 11.3 years in the first and 61 +/- 11.1 in the second, for sex: respectively 48% and 56% of women, for time-length of catheter insertion: respectively 31 +/- 21.8 days and 31.7 +/- 16, and for number of dialysis sessions: respectively 13.5 +/- 9.1 and 13.6 +/- 7.1. The type of catheters, the frequency of removal for poor flow (16% in both groups) or for infections (6% in both groups) and the local nursing are similar in the 2 groups. Only the side of cannulation differs: the right side is used in 58% of cases in the first group and 78% in the second one. The angiographic study reveals a stenosis of the vein in 42% of the subclavian group and in 10% of the internal jugular group. The left side presents more risks of stenosis than the right, what can be explained by anatomical features. The strictures, whose severity is variable, are mainly located at and slightly above the junction of jugular and subclavian veins. This significative difference in favour of the internal jugular route asserts its superiority on subclavian route in respect of venous access of dialysed patients.

[IgG kappa myeloma with Fanconi's syndrome and crystalline inclusions. Immunohistochemical and ultrastructural study]. / Myélome IgG kappa avec syndrome de Fanconi et inclusions cristallines. Etude immuno-histochimique et ultrastructurale.

An IgG kappa light-chain myeloma, remarkable for the presence of inclusions in plasmocytes and proximal renal tubular cells, was discovered during investigations for renal failure associated with partial Fanconi's syndrome. An immunohistochemical study showed that the crystalline inclusions were positive for IgG and kappa light-chain in plasmocytes and exclusively for kappa light-chain in the renal tubular cells. An ultrastructural study showed that the inclusions were localized in lysosomes and had a 55 A periodicity. This case is similar to the forty odd myelomas or light-chain diseases reported in the literature and revealed by Fanconi's syndrome. Their prognosis is good, with a slow progression towards late renal failure. In our patient the preference of lesions for proximal tubular cells, the site of protein catabolism, was particular since in myelomas they are usually located in the distal tubular cells.

[Post-catheterization venous stenosis in hemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses]. / Sténoses veineuses post-cathétérisme en hémodialyse: etude angiographique comparative de 50 voies sous-clavières et 50 voies jugulaires internes.

From January 1986 to December 1990, we studied angiographically the subclavian-brachiocephalic vein of 100 patients dialysed on subclavian catheter for 50 (first group) and on internal jugular catheter for the 50 others (second group). These 2 groups are not statistically different for age: 61.6 +/- 11.3 years in the first and 61 +/- 11.1 in the second, for sex: respectively 48% and 56% of women, for time-length of catheter insertion: respectively 31 +/- 21.8 days and 31.7 +/- 16, and for number of dialysis sessions: respectively 13.5 +/- 9.1 and 13.6 +/- 7.1. The type of catheters, the frequency of removal for poor flow (16% in both groups) or for infections (6% in both groups) and the local nursing are similar in the 2 groups. Only the side of cannulation differs: the right side is used in 58% of cases in the first group and 78% in the second one. The angiographic study reveals a stenosis of the vein in 42% of the subclavian group and in 10% of the internal jugular group: a dramatic difference in favour of the internal jugular route, whose superiority on subclavian route is asserted in respect of venous access of dialysed patients.

Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses.

From January 1986 to December 1990 we studied angiographically the subclavian-brachiocephalic vein of 100 patients dialysed by subclavian catheter for 50 (first group) and by internal jugular catheter for the 50 others (second group). These two groups were not statistically different as regards age (61.6 +/- 11.3 years in the first and 61 +/- 11.1 in the second), sex (48% and 56% were women), duration of catheter insertion (31 +/- 21.8 and 31.7 +/- 16 days), and the number of dialysis sessions (13.5 +/- 9.1 and 13.6 +/- 7.1). The type of catheters, the frequency of removal for poor flow (16% in both groups) or infections (6% in both groups), and the local nursing were similar in the two groups. The only difference was the side of cannulation: the right side in 58% of cases in group 1 and 78% in group 2. The angiographic study revealed a stenosis of the vein in 42% of the subclavian group and in 10% of the internal jugular group: a dramatic difference in favour of the internal jugular route, whose superiority over the subclavian route is asserted in respect of venous access of dialysed patients.

[Adult type I primary hyperoxaluria: 2 cases confirmed by liver biopsy at end-stage renal insufficiency]. / Hyperoxalurie primitive de type I de l'adulte: deux cas confirmés par biopsie hépatique au stade d'insuffisance rénale terminale.

It can be difficult to distinguish between primary hyperoxaluria at end-stage renal failure and secondary oxalosis, all the more as primary hyperoxaluria can be latent for a long time and occur at a late stage. A 57 year-old woman, without family nor personal history of urolithiasis, receives regular hemodialysis for a renal failure discovered at end-stage. Eighteen months later, calcium oxalate deposits appear in the skin, bone marrow and both kidneys, suggesting secondary oxalosis. An other 57 year-old woman presents a chronic renal failure due to bilateral urolithiasis, whose surgery has caused a dramatic decrease of renal function requiring regular hemodialysis. Because of apparition of severe bone alterations, a parathyroidectomy is realized, and because of calcium oxalate deposition in the skin and bone marrow, primary hyperoxaluria is suspected. In both observations, the enzyme activity determination in a liver biopsy gives the diagnosis of primary hyperoxaluria.