An unusual cause of acute renal failure in a kidney transplant recipient: salmonella enteritidis post-infectious glomerulonephritis.

BACKGROUND: Salmonella enteritidis-associated acute renal failure has often been described and is usually a result of dehydration or of rhabdomyolysis. A few cases of acute renal failure with glomerular syndrome, caused by S. enteritidis infection, have been reported in the literature, but none have been proven by histological findings. METHODS: Herein, we report on a case of S. enteritidis-related glomerulonephritis that occurred in a 42-year-old male transplant recipient. He was admitted with fever, signs of urinary infection, diarrhea, and nephritic syndrome, i.e. edema, hypertension, increase in serum creatinine, microscopic hematuria, proteinuria. His urine culture tested positive for S. enteritidis. RESULTS: Under light microscopy, the graft biopsy showed proliferative and exudative endocapillary glomerulonephritis. In addition, there was polymorphonuclear infiltration of the interstitium, and extra-capillary proliferation in one glomerulus. Immunofluorescence showed granular deposits of C3 in the mesangium. Electron microscopy showed electron-dense deposits typical of humps. He fully recovered on a double antibiotic therapy that included ofloxacin and amikacin. CONCLUSION: Although acute renal failure related to non-typhoidal Salmonella infections are often related to dehydration or rhabdomyolysis, this case report shows that it might also be related to immune complex-mediated glomerulonephritis manifesting as nephritic syndrome.

Monitoring HCMV infection with quantitative real-time PCR in HCMV-positive orthotopic liver transplant recipients, and predictive factors for treatment of the first episode of HCMV viremia.

We evaluated the relevance of human cytomegalovirus (HCMV) monitoring with quantitative real-time polymerase chain reaction in 42 consecutive HCMV positive liver transplant patients, and we analyzed the factors that determined the treatment of the first episode of HCMV DNAemia. No patients received anti-HCMV prophylaxis. HCMV infection monitoring was assessed every 2 weeks until day 90 and thereafter at every 3 to 4 weeks until day 180. HCMV infection was detected among 27 patients (64%, ie, 92/380 samples). Of these, 12 had their first HCMV DNAemia treated with IV gancyclovir (group I), whereas the other 15 patients were not treated (group II). Immunosuppressive treatment was not modified in cases of HCMV DNAemia. The median time between transplantation to the first CMV DNAemia was 37 days in group I and 52 days in group II (NS). Median HCMV viral load, whatever the treatment group and whatever the time of DNAemia, was 3 log copies/mL (0.48 to 5.80). Median HCMV viral load of the first positive DNAemia was 3.45 log copies/mL (1.69 to 5.80) in group I and 2.70 log copies/mL (1.15 to 3.94) in group II (P = .01). Even though liver enzymes were increased in almost all patients presenting with HCMV infection, comparison of liver-enzyme levels and hematological parameters between the two groups at first HCMV viremia showed that alkaline phosphatase levels were significantly higher (P = .0011) and hemoglobin levels were significantly lower in group I patients (P = .0443). The only factor that predicted treatment for the first episode of HCMV DNAemia was an alkaline phosphatase level >150 UI/mL at the time of the first HCMV reactivation [odds ratio 20 (1.96 to 203.3); P = .01].

Predictive factors for cytomegalovirus infection after orthotopic liver transplantation using an ultrasensitive polymerase chain reaction assay.

The predictive factors for cytomegalovirus (CMV) infection in de novo liver transplant patients were determined at 3 months posttransplantation. We included all consecutive patients except those who died or who had lost their graft within 1 month posttransplant. We recorded both donor (D) and recipient (R) data. Immunosuppression utilized tacrolimus, steroids, with or without mycophenolate mofetil, and/or induction therapy with anti-CD25 monoclonal antibodies. CMV prophylaxis was administered only to those at high risk of CMV infection, namely, D+/R- patients. These cases received intravenous ganciclovir at 500 mg/d for the first 2 weeks followed by oral ganciclovir at 500 mg for the following 3 months. The median time to CMV infection was 1 month. The significant predictive factors for CMV infection were D/R CMV status, (P = .002): D+/R+ versus other patients (P = .01), D-/R- versus other patients (P = .002), D+ versus D- (P = .009). In addition infection was associated with the original liver disease (hepatitis C virus infection or alcohol-related cirrhosis; P = .03), R+ vs. R- (P = .03), donor age (<45 or >45 years; P = .01), lymphocyte count at M2 (< or >1300/mm(3); P = .02), hemoglobin levels at 1 and 3 months, and platelet and white blood cell counts at day 7. The independent predictive factors were recipient CMV sero-status (R+ vs R-; odds ratio = 10.2), donor age >45 years (odds ratio = 11.4) and lymphocyte count at M2 <1300/mm(3) (odds ratio = 7.33). This study showed that the major factors associated with CMV infection were recipient CMV status, donor age, and lymphocyte count.

[Psychological approach to congenital hand deformities. Congenital deformities, the desire to know]. / Approche psychologique de la malformation congénitale de la main. La malformation congénitale, le désir de savoir.

The psychological approach to congenital malformation is determined by the stares of the others and the individual's needs. The relationship of the body of the person afflicted with a congenital malformation is a question of aesthetic suffering and not of functional use. Caught up in a network of a priori and anxiety-based projections, it is difficult for patients, children, adolescents or adults, to express themselves and make themselves heard. This multi-faced issue poses a basic problem for a society, which penalizes physical deformity. Beyond the medical techniques, the subject's ethic has to be considered.

Ungual prostheses.

Whatever the origin and the nature of the trauma, behind every request for ungual prostheses there is always the question of how realistic the effect on others will be. Our publications in 1978, 1988 and 1999 and 30 years of experience in this field have consequently led to a comparative study on the evolution of the quality, fixation and indications of our prostheses. The replacement nail is still a difficult issue as sometimes it is simply a matter for the 'nail boutiques', but can even involve surgery in the more complex cases. Prostheses replicate the volume and shape of the finger. Treating a nail is an intricate task but an essential one for the aesthetic and functional comfort of the patient.

Aesthetic hand prosthesis: gadget or therapy? Presentation of a new classification.

Aesthetic prostheses must fulfill a functional as well as an aesthetic role. The function of these prostheses may be perceived as an additional passive support, or as an instrument of social function and an aid to the patient. This functional role has been observed in the continued use of these prostheses over several years. We reviewed our experience with prescription, fitting and follow-up care in 2847 patients. Classification of these patients was based on their age, level of amputation (with or without functional pinch) and cause of amputation. Analysis of the data ratifies our indications for prosthesis fitting. The long-term wearing of these aesthetic prostheses confirms their use as therapeutic tools.