[Pregnancy and hemodialysis]. / Grossesse en hémodialyse chronique.

Pregnancy is a rare occurrence in patients on chronic hemodialysis (CHD). The rate of successful pregnancies amounts to almost 60%, thanks to modifications of the dialysis schedule and a specifically adapted obstetrical and neonatal management. We report on seven pregnancies occurring between 1995 and 2001 in six women with a mean age of 32 years (22-39 years), on HD for a mean period of 36 months (12-96 months). Maternal and fetal complications, and the long-term outcome of mothers and children are reported, and the collaborative approaches adopted by obstetrician, pediatrician and nephrologist are discussed. The frequency and length of HD was systematically increased. One patient chose to terminate her pregnancy at 20 weeks of gestation. The mean gestational age for the six other pregnancies was 31 weeks (24-34 weeks) with an average weight at birth of 1495 g (660-1920 g). One neonate born at 24 weeks died 2 days following delivery. One patient was treated with uterine artery embolization for post-partum haemorrhage. Pediatric evaluation of the five children, who were followed up for a period ranging between 2.5 to 5.5 years, showed a good long-term outcome. In conclusion, pregnancy needs not be counterindicated or systematically terminated in patients on CHD, particularly if transplantation is not possible, if the patient refuses it, or if she is relatively old and there is a long waiting period before transplantation.

Early treatment of posthemorrhagic hydrocephalus in low-birth-weight infants with valveless ventriculoperitoneal shunts.

The surgical treatment of posthemorrhagic hydrocephalus (PHH) in low-birth-weight infants (LBWI) is debated. In a few cases, hydrocephalus progresses rapidly and requires early drainage, but valves and ventriculostomy have a high rate of complications in the early phase. Temporary valveless shunt (VLS) is proposed as an alternative treatment of acute PHH in LBWI. Thirteen infants with PHH, weighing less than 2,000 g at birth, were treated with VLS, which was systematically converted into a valve-regulated shunt (VRS) after a few weeks; during the same period, 27 others were treated with VRS initially. The use of VLS presented significantly more shunt obstructions, but not more shunt infections, than VRS. Although placement of VLS was performed earlier, and in smaller babies than VRS, the outcome after a mean 9.1-year follow-up period was comparable in both groups, and only shunt infection was correlated with a poor outcome. We conclude that VLS is a valuable treatment of rapidly evolving PHH in LBWI.

Septoria Leaf Spot of Banana: A Newly Discovered Disease Caused by Mycosphaerella eumusae (Anamorph Septoria eumusae).

ABSTRACT A previously undescribed leaf spot disease of banana has been discovered in southern and Southeast Asia. The fungus identified as the causal agent of this leaf spot has a Mycosphaerella teleomorph stage and a Septoria anamorph stage. Isolation and reinoculation of the fungus to banana reproduced symptoms and confirmed its pathogenicity. Phylogenic analysis based on sequences of the internal transcribed spacer and 5.8S ribosomal DNA regions from the different leaf spot pathogens of bananas was consistent with the definition of a new species. M. eumusae (anamorph S. eumusae) is the name proposed for the causal agent and Septoria leaf spot as the name for the disease. The presence of the pathogen has been confirmed in leaf specimens from southern India, Sri Lanka, Thailand, Malaysia, Vietnam, Mauritius, and Nigeria.

Endoscopic ultrasonography in chronic pancreatitis: a comparative prospective study with conventional ultrasonography, computed tomography, and ERCP.

The usefulness and accuracy rate of endoscopic ultrasonography (EUS) in the diagnosis of chronic pancreatitis (CP) were prospectively evaluated in 81 patients with suspected pancreatic disease. All underwent EUS, abdominal ultrasonography (AUS), and computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) was performed in 55 of the cases. The diagnosis of CP was established in 44 patients (CP group) including 24 with a calcified form. No pancreatic disease was observed in 18 patients (control group), and 19 patients had a pancreatic tumor. In the CP group AUS was less accurate than EUS in visualizing the pancreas, performances of CT scan being identical to EUS in this respect. A good correlation was observed between EUS and ERCP for visualization and measurement of the Wirsung duct. The most significant changes observed by EUS in the CP group were dilatation of the main pancreatic duct, heterogeneous echogenicity of the pancreatic parenchyma, and cysts < 20 mm in size even in noncalcified CP or with normal pancreatograms. Sensitivity of EUS for diagnosis of CP was 88% (AUS, 58%; ERCP, 74%; CT scan, 75%), the specificity being 100% for ERCP and EUS, 95% for CT scan, and 75% for AUS. The good performances of EUS allow early diagnosis of CP in symptomatic patients since heterogeneous echogenicity of the pancreatic parenchyma seems to be almost specifically associated with the disease.

[Different methods of percutaneous desobstruction of peripheral arteries]. / Les différentes méthodes de désobstruction des artères périphériques par voie percutanée.

Chronic arterial occlusion of the iliac and femoro-popliteal vessels has been considered, until recently, to be a contraindication to percutaneous transluminal angioplasty. However, recent advances in radiological and catheterisation equipment and the introduction of new methods of recanalisation (laser, mechanical devices) have increased the therapeutic possibilities. The immediate and long-term results of iliac recanalisation are usually excellent with conventional angioplasty methods. The success rate of recanalisation of the femoro-popliteal segments is about 80% irrespective of the method used, the failure rate increasing with the length of the occlusion. However, the long-term patency rate is poor, about 50%. These methods of percutaneous recanalisation are technically difficult and require special training and sophisticated equipment. The indications should be carefully evaluated in a pluridisciplinary manner taking into account the potential clinical benefits, the technical difficulties, the risks and other therapeutic possibilities.

[Unresectable hepatic adenomas. Management by selective hepatic artery embolization]. / Adénomes hépatiques non résécables. Place de l'embolisation artérielle dans la conduite thérapeutique.

Four patients with unresectable hepatic adenoma underwent selective hepatic artery embolization. Non-operability was related to the size and the situation of the tumor, and the clinical background. The only subsequent postembolization syndrome was one case of acute renal failure, reversible after diuretic treatment. In 3 cases the decrease in tumoral size was delayed and appeared six months after the first embolization, allowing surgical resection in 2 cases. Because of lack of tumoral devascularization and presence of residual nodules on the resected specimen, this technique is not a satisfactory alternative to surgery, at least with the employed technique. However, preoperative selective hepatic artery embolization can play an important role in the management of hepatic adenomas as it may permit safer surgical resection.

[Computerized tomographic diagnosis of hepatocarcinoma after injection of lipiodol into the hepatic artery]. / Diagnostic scanographique des hépatocarcinomes après injection de lipiodol dans l'artère hépatique.

Iodized oil (lipiodol) injected into the hepatic artery is selectively retained by hepatocarcinomas, as demonstrated by computerized tomography (CT) performed one week after the injection. The value of this technique for the diagnosis of hepatocarcinoma was assessed in a retrospective study of 45 patients. In 39 per cent of the cases intrahepatic tumoral extension was determined by the iodized oil which showed tumoral nodules that had not been detected by conventional methods, such as ultrasonography and CT alone. The lesions revealed by the iodized oil were small nodules around the main tumour. The combined iodized oil-CT technique plays an important role in the choice of treatment, especially when surgical excision is contemplated. It might also contribute to an early diagnosis of hepatocarcinoma in patients at risk, as illustrated by four of our cases where conventional morphological examinations had been negative.

High diagnostic value in rheumatoid arthritis of antibodies to the stratum corneum of rat oesophagus epithelium, so-called 'antikeratin antibodies'.

Serum antibodies to the stratum corneum of rat oesophagus epithelium, so-called 'antikeratin antibodies', have been largely demonstrated in rheumatoid arthritis (RA). IgM and IgG antibodies to this epithelium were studied by semiquantitative immunofluorescence in 528 patients with perfectly characterised rheumatic diseases, including 178 with classical or definite RA. Histological analysis of IgG antibodies showed that only antibodies which produce a linear laminated pattern restricted to the stratum corneum (IgG antikeratin antibodies) are highly specific for RA; all the other labelling patterns are not disease specific. By a semiquantitative evaluation of the stratum corneum fluorescence intensity it was shown that the diagnostic value of IgG antikeratin antibodies closely depends on their titre and it was established in objective conditions that the sensitivity is 43.26% when the specificity reaches 99.14%. A high titre of IgG antikeratin antibodies was actually pathognomonic for RA. Both the histological and semi-quantitative analyses showed that IgM antibodies to rat oesophagus epithelium, though frequently detected, are of no diagnostic value, either for RA or for any other rheumatic disease that was studied. From a review of all the international reports on IgG antikeratin antibodies it was found that, to date, 4080 patients, including 1694 with RA, have been assayed for antikeratin antibodies by 11 different research groups. Analysis of all the results obtained under comparable technical conditions showed that IgG antikeratin antibodies constitute the most specific serological criterion for the diagnosis of RA. Furthermore, it was found that their incidence does not depend on disease duration: they are present in one third of rheumatoid factor negative patients with RA, and they seem to be related to disease severity or activity, or both. Their detection in the diagnosis of rheumatic diseases should become systematic.

[Anti-stratum corneum antibody in the rat esophagus, anti-epidermal keratin and anti-epidermis autoantibodies in rheumatoid polyarthritis and other rheumatic diseases. Diagnostic value and basic aspects]. / Anticorps anti-stratum corneum d'oesophage de rat, auto-anticorps anti-kératines épidermiques et anti-épiderme dans la polyarthrite rhumatoïde et différentes affections rhumatologiques. Intérêt diagnostique, aspects fondamentaux.

Eight immunological parameters were explored in 257 patients with various rheumatic diseases including 107 rheumatoid arthritis (RA). IgG and IgM antibodies (AB) reactive with the Stratum Corneum (SC) of rat oesophagus or with the SC of human skin were assayed by 1/2 quantitative indirect immunofluorescence, IgG and IgM auto AB to epidermal keratins by a specific ELISA, and total serum G and M immunoglobulins by radial immunodiffusion. At the threshold we chose (99 p. cent specificity), IgG anti SC of rat oesophagus, were found in 50 of 107 (46.7 p. cent) RA patients: 52.5 p. cent in sero + and 39.6 p. cent in sero - ones. The other parameters, separately considered, had no diagnosis value. In Paget disease serum IgM and IgG and all the AB of M isotype were found to be broken down. In all the groups, the isotype AB were found strongly correlated to each other and to serum IgM. The RA sera with specific AB to the rat oesophagus SC, also labeled human skin SC but these labeling were unrelated to the anti-keratins auto AB level. On the contrary, the anti SC AB of G isotype, detectable on human skin in psoriatic rheumatism did not label rat oesophagus. These results confirm the diagnosis value of IgG AB to SC of rat oesophagus, usually called anti-keratins, who appear as a marker for RA. This work shows the relevance of associating specific immunochemical techniques to immunofluorescence, in order to unravel the antigenic complexity of tissular substrata.

[Genetics of idiopathic scoliosis]. / Génétique de la scoliose idiopathique

Families of 241 patients among 913 cases of idiopathic scoliosis were surveyed. The data suggest two possible modes of inheritance: either an autosomal dominant inheritance with incomplete penetrance and more frequent manifestation in girls than boys, or a genetic heterogeneity with a mixture of dominant and multifactorial modes of inheritance.

[Frequency of birth defects. Study of a maternity hospital in Paris]. / Frequence des malformations à la naissance. Etude d'une maternite Parisienne

A retrospective study of 20,591 live born babies and still birth was made in order to estimate the incidence of congenital malformations total and by type diagnosed at birth. The total incidence is 1,74 p. 100. The sex ratio, the mean birth rank and parental ages were computed for the different types of malformation and in the control group. The birth weight was low in case of severe malformation. It was found that malformations were associated with significantly raised abortions and still birth rates among previous pregnancies.