[Cutaneous calciphylaxis treated by autologous keratinocytes graft and subtotal parathyroidectomy]. / Nécrose cutanée par calciphylaxie traitée par greffe de kératinocytes autologues et parathyroïdectomie partielle.

BACKGROUND: Cutaneous calciphylaxis, seen most often in dialysis patients, is characterised by skin necrosis, and is a disabling and lifethreatening disease. Despite intensive topical treatment, recourse to parathyroidectomy is often necessary. We report the case of a female patient with skin necrosis due to calciphylaxis: pain and necrotic lesions were controlled by grafting of cultured autologous keratinocytes (Epibase). CASE REPORT: A 75-year-old woman with a 5-year history of dialysis-dependent chronic renal failure secondary to nephroangiosclerosis presented a very painful necrotic ulceration on her left leg. In spite of an autologous patch grafts, the lesions rapidly deteriorated. Laboratory data showed high levels of calcium, phosphate and parathyroid hormone and imaging suggested parathyroidal adenoma. Although cutaneous biopsy was not performed, the diagnosis of cutaneous necrosis due to calciphylaxis with tertiary hyperparathyroidism was established. Treatment consisted of a low-calcium and low-phosphorus diet with autologous keratinocytes grafts (Epibase). After the third application of keratinocytes, the pain disappeared, necrosis ceased and wound healing began. Subtotal parathyroidectomy was performed two months after the start of grafts. At three months, the patient was cured. DISCUSSION: . Calciphylaxis is an obstructive vascular disease secondary to calcification of the arterioles leading to ischemic tissue necrosis. Prompt diagnosis is essential since this disease is disabling and life-threatening due to sepsis and ischemic complications. In our case, autologous keratinocyte grafts allowed pain relief to be achieved within large expanses of cutaneous necrosis after correction of calcium and phosphorus levels, thereby allowing parathyroidectomy to be performed under optimal conditions.

[Extra-capillary proliferation complicating the development of an extramembranous idiopathic glomerulonephritis]. / Prolifération extra-capillaire compliquant l'évolution d'une glomérulonéphrite extra-membraneuse idiopathique.

Occurrence of crescentic formation superimposed to idiopathic membranous glomerulopathy worsens severely its prognosis with evolution to end stage renal disease. We report the case of a 65 years old man with nephrotic idiopathic membranous glomerulopathy who subsequently developed an acute renal failure secondary to crescentic formation. Pulse of high dose methylprednisolone administration improved renal function. Seven similar observations are analysed and pathogenic mechanisms discussed.

In vitro study of immunological events in human and experimental schistosomiasis: relationships between cytotoxic antibodies and circulating Schistosoma antigens.

Complement-dependent cytotoxic antibodies were found in 54% of Schistosoma mansoni infected patients from Burundi and in 69 to 78% of Schistosoma mansoni ninfected Brazilian patients. The levels of cytotoxic Ab were not statistically different in sera from infected mothers and from their newborn children, suggesting a transfer through the placenta. A sandwich radioimmunoassay (SRIA) and the Radioimmunoprecipitaion-PEG assay (RIPEGA) technique were used in order to detect respectively total schistosome circulating soluble antigens (CSA) and schistosome antigen '4' in sera from infected patients. An inverse relationship was found between the presence of cytotoxic Ab and both total CSA and antigen '4'. The cytotoxic Ab and total CSA levels were followed in five Erythrocebus patas monkeys for 30 weeks after Schistosoma mansoni infection. As in human schistosomiasis the presence of cytotoxic Ab was found to be inversely correlated with the presence of total CAS. The blocking role of Schistosoma mansoni antigens in a complexed form was suggested by the inhibitory effect of the ultracentrifugation pellet of infected human serum on the cytotoxic activity. Moreover, the CSA absorption of infected monkey serum by passage through an anti-CSA immunosorbent significantly increased the cytotoxic activity. Possible mechanisms for the inhibitory role of circulating immune complexes on complement-dependent cytotoxic activity are discussed.

Evaluation of circulating antigens by a sandwich radioimmunoassay, and of antibodies and immune complexes, in Schistosoma mansoni-infected African parturients and their newborn children.

Circulating Schistosoma mansoni soluble antigens (CSA), circulating anti-S. mansoni antibodies (CAb), and immune complexes (CIC) were studied in three groups of African patients living in the same area. The first two groups were composed of 26 S. mansoni-infected mothers and their 26 uninfected newborn children. The third group included 13 men and 10 non-pregnant women who were also infected with S. mansoni. CSA were quantified by using a solid phase sandwich radioimmunoassay, which was shown to be sensitive, reproducible, and S. mansoni-specific. CAb were studied by indirect hemagglutination. CIC evaluations were performed by using the Clq binding test. A high correlation was shown between the CSA levels in sera from infected mothers and from the umbilical cord of their newborn children, indicating that CSA are probably transferred through the placenta. CSA levels in mothers were significantly higher than in the third group, in which no difference was found between men and women. On the other hand, CAb and CIC were significantly higher in the third group than in the group of mothers, indicating that CSA levels may be modulated by the immune response of the host.