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Soft tissue calcification are common in chronic hemodialysis patients and often affect the periarticular tissues, where they occasionally form tumoral masses. In a retrospective study of 254 hemodialysis patients we identified three such cases. Affected sites were the wrist, shoulder, and chest wall. None of the patients had secondary hyperparathyroidism. A discussion is provided of the roentgenographic and clinical features of tumoral calcinosis, of current pathogenic hypotheses, and of available treatments.

Background: Moderate anticoagulation may be proposed to reduce the risk of hemorrhage for certain patients with a mechanical prosthesis, but the consequences for risk of thromboembolism are debated., Methods and Results: The purpose of the AREVA trial was to compare moderate oral anticoagulation (international normalized ratio [INR] of 2.0 to 3.0) with the usual regimen (INR of 3.0 to 4.5) after a single-valve replacement with a mechanical prosthesis, either Omnicarbon or St Jude. Patients included were between 18 and 75 years old, in sinus rhythm, and with a left atrial diameter < or = 50 mm on the time-motion echocardiogram. Patients were randomized for INR after surgery. From 1991 to 1994, 433 patients underwent valve replacement (aortic, 414; mitral, 19) with 353 St Jude and 80 Omnicarbon prostheses; 380 patients were randomized for INR: 188 for INR 2.0 to 3.0 and 192 for INR 3.0 to 4.5. Mean follow-up was 2.2 years (1 to 4 years). Analysis of 18001 INR samples showed that the mean of the median of INR was 2.74 +/- 0.35 in the 2.0 to 3.0 group and 3.21 +/- 0.33 in the 3.0 to 4.5 group (P < .0001). Thromboembolic events, as assessed from clinical data and CT brain scans, occurred in 10 patients in the 2.0 to 3.0 INR group and 9 patients in the 3.0 to 4.5 INR group (P = .78). Hemorrhagic events occurred in 34 patients in the 2.0 to 3.0 INR group and 56 patients in the 3.0 to 4.5 INR group (P < .01), with 13 and 19 major hemorrhagic events, respectively (P = .29)., Conclusions: In selected patients with mechanical prostheses, moderate anticoagulation prevents thromboembolic events as effectively as conventional anticoagulation and reduces the incidence of hemorrhagic events.

We report a case of Aspergillus arthritis of the shoulder in a renal transplant recipient. Cultures of three joint fluid specimens grew Aspergillus fumigatus. Itraconazole as sole treatment resulted in initial clinical and roentgenographic improvements but failed to prevent deterioration in joint function. A relapse with fatal neurologic involvement occurred. Immune deficiency-inducing risk factors for aspergillosis include neutropenia and corticosteroid therapy. Previously published cases of Aspergillus arthritis of limb joints are reviewed. The advantages and limitations of itraconazole as single drug therapy are outlined.

The effects of corticosteroid on bone were examined in female growing rabbits treated with 0.7 mg/kg per day prednisolone for 5 months. The evolution of whole-body total bone mineral measured by dual-photon absorptiometry showed a significant difference between the prednisolone-treated group and the control group from the first to the fifth month. The histomorphometric profile of corticosteroid-induced osteoporosis was observed, in particular the lower bone volume and thinner and fewer trabecular plates. Mechanical tests are possible on rabbit vertebrae and showed a very significant difference in bone strength between the prednisolone-treated and control groups, and a good correlation between mechanical tests and histomorphometric or densitometric results. This bone corticosteroid model shows that vertebral compression tests are possible on rabbit lumbar vertebrae. It may contribute to a better evaluation of corticosteroid treatments.

In order to assess the prevalence and prognosis of ventricular arrhythmias in patients with surgical mitral regurgitation, a prospective cooperative study was undertaken in 14 French cardiological centres. Seventy-nine patients (45 men, 34 women, average age 62.8 +/- 12.8 years), who underwent mitral valvuloplasty (44 cases) or valve replacement (35 cases), were included. Three 24 hour Holter recordings were performed before, 15 days and 6 months after surgery. Etiology of mitral disease was dystrophic in 49 patients, degenerative in 11, rheumatic in 10, post-endocarditis in 3 and undetermined in 6. Only 5 patients had a left ventricular ejection fraction < or = 45 %. Complex ventricular arrhythmias (Lown > or = 4) were recorded before surgery in 22 patients (28 %), more often in dystrophic disease (17/49 versus 5/30, p = 0.04). No significant correlation was observed between the ventricular arrhythmias and the other preoperative findings, except for a tendency to an inverse correlation between the left ventricular ejection fraction and the Lown grade. Two patients died in the immediate postoperative period (Lown 1); 1 died of a non-cardiac cause at the 2nd month (Lown 4A). The prevalence of complex arrhythmias was unchanged after surgery (34 % on early Holter and 22% on late Holter recordings) with no difference between valvuloplasty and valve replacement. In conclusion, these results indicate that ventricular arrhythmias do not influence the early and 6 month postoperative prognosis in mitral regurgitation with good left ventricular function.

Early transesophageal echocardiography (TEE) after mitral valve replacement can detect symptomless, non-obstructive thrombus on prosthetic valves and also small filamentous abnormal echoes (SAE). The object of this study is to evaluate their respective frequency and predisposing factors. Between October 1988 and June 1992, 129 consecutive patients underwent mitral valve replacement with a bileaflet prosthesis and had transesophageal echocardiography at an average of 15 +/- 7 days (range: 6-35 days) after surgery. Details of postoperative anticoagulation were analyzed in 99 patients from five surgical centers having comparable postoperative anticoagulation protocols. Among those patients presenting with SAE, 76% had a second transesophageal echocardiography at an average of 145 +/- 166 days after the first examination. Mean age was 56 +/- 13 years. Small filamentous echoes were found in 55 patients (43%). In univariate analysis, independent predictors were age, absence of systolic regurgitation across the mitral prosthesis as observed with continuous Doppler, and the presence of spontaneous echo contrast (SC) in the left atrium: 54 +/- 14 years in the absence vs. 59 +/- 10 in the presence of SAE (p < 0.05); 54% of systolic leak vs. 36% (p < 0.05); 43% of SC vs. 75% (p < 0.00001). In multivariate analysis, spontaneous echo contrast was the only independent predictor for SAE (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

The molecule E2 is present on T lymphocytes and thymocytes and is implicated in rosette phenomenon most probably via interaction with CD2. The discrepancy observed between rosette levels and lymphocyte phenotypes in the follow-up of kidney-transplanted patients treated with antilymphocyte globulins (ALG), methylprednisolone and azathioprine leaded us to study the effect of ALG on E2 molecule.

5-Fluorouracil (5-FU) and d,1-folinic acid (FA) are used in association to treat a wide variety of malignancies. The stability and the compatibility of 5-FU and FA in combination in intravenous admixtures were studied under various storage conditions and with drug concentrations matching their clinical use (0.9% sodium chloride, 5% dextrose, protected from light or not). 5-FU and FA concentrations (mg/ml) were 6.5 or 50 and 4.0 or 30.8, respectively. Successive aliquots of the drugs mixtures were withdrawn during 60 h from 500 ml glass bottles and 500 ml polyvinyl chloride (PVC) bags (at room temperature) and during 120 h from cassettes (at 32 degrees C). Drug concentrations were measured by high performance liquid chromatography. For all conditions tested, the changes in 5-FU and FA relative to the initial concentrations remained within the assay reproducibility (10%). In complement, infrared Fourier transformation spectrophotometry has not shown a significant fixation of FA or 5-FU on the PVC bags, in all tested conditions. Under the conditions examined above 5-FU and FA can be mixed in the same container for their use in cancer chemotherapy. This can have practical consequences by simplifying the widely used treatment protocols associating 5-FU and FA.

We report on a case of Sharp syndrome which was diagnosed late in on 11-year old boy. After 5 years of corticosteroid treatment, he presented with myopericardic aggravation, glomerular disease, and seizures with delirium, which responded to high-dose steroid therapy with early switch using synthetic antimalarial drugs. Six years later the results are still satisfactory.

The authors present the preliminary results of an experimental study of the biocompatibility of materials used in oro-maxillo-facial surgery (filling in of detects and implants). These preliminary results concern sintered ceramic implants and confirm their good acceptability by soft tissues and bone.

The prevalence of renal lithiasis and the rate of recurrences in affected patients raises the problem of the minimum number of investigations really needed to arrive at an accurate diagnosis and establish a potentially effective treatment. Stone recuperation is very important as it allows to carry out an accurate analysis of its constituent(s) (frequently heterogenous). Such analysis already brings forth accurate indications as to the etiology. Other biological investigations should be limited after a first episode of kidney stone disease, but recurring lithiasis will necessitate a much more thorough work-up. Recurrences in certain lithiases, such as those caused by urate calculi, are readily prevented by conventional therapy (uricosuric agents, alkalinization of urine). Withdrawal of certain medicines is paramount in iatrogenic lithiasis. Regarding calcium stones associated with hypercalciuria, results from dynamic tests and their pertinence for differentiating between hypercalciuria due to abnormally high digestive absorption and that due to excessive elimination are currently strongly contested. The role of alimentary factors seems extremely important and prescription of adapted diets appears to be quite effective in view of the present lack of crystal formation inhibitors.

The polyamines, putrescine (P) and spermidine (S), have been measured in 185 cancer patients. Patients in remission exhibited significantly different levels from those with active disease. In a dynamic patient study, followed over a period of 5-6 months, the urinary polyamine levels correlated closely with the clinical status. Furthermore, polyamines have been measured 24 h before beginning chemotherapy (P1, S1) and 48 h after its onset (P2, S2). The value of the ratio, (S2/P2)/(S1/P1), was found to correlate with the type of response to chemotherapy.

The urinary polyamines putrescine and spermindine were evaluated in a population of 49 patients with malignant lymphomas (40 with non-Hodgkin's lymphoma and 9 with Hodgkin's disease). Analyses were performed on a regular basis during the course of treatment. Polyamine levels were found to increase significantly with the disease stage. Results show that: (a) polyamines closely reflect disease evolution (clinical deterioration/clinical improvement); (b) comparison of polyamine measurements effected 24 h prior to and 48 h after initiation of a chemotherapy course allows evaluation of the response to treatment.

Fourteen patients with polyarteritis nodosa complicated by histologically confirmed glomerulopathies were included in a prospective multi-center study comparing corticotherapy (group 1, n = 8) with combined cyclophosphamide and steroids (group 2, n = 6). Plasma exchanges were associated on a routine basis. The two groups were comparable apart from initially more severe renal impairment in group 1 (p less than 0.05). Initial control of the disease was obtained in 11 patients (7 from group 1, 4 from group 2) including the patients with oligoanuria. Six patients recovered, 3 had recurrence requiring chronic hemodialysis and 5 patients died from group 1 (p less than 0.05). These preliminary findings suggest that plasma exchange can contribute to control of polyarteritis nodosa with renal complications.

Nineteen double-filtration plasma exchanges were performed in 8 patients selected according to the presence or absence of disease-related and/or patient-related risk factors. The haemofiltration system consists of 2 filters with different pore sizes. The first filter, called plasma separator (Asahi plasmaflo HI-05), separates plasma from whole blood; the second filter, called plasma filter (Asahi XK-60; Kuraray Eval 2A or 4A), separates high molecular weight components from plasma. The filtrate from the second filter is returned to the patient mixed with blood cells and either a 4% albumin solution or Plasmion to replace the plasma discarded (about 0.5-0.8 I for a 1-1.5 plasma mass treated). The system (a) modulates venous pressure and transmembrane pressure in each of the two filters by means of pump velocity variations; (b) recirculates and concentrates the plasma extracted, and (c) provides information on the plasma mass extracted by the second filter. In our study, antihistaminics were always infused before each plasma exchange session, and blood pressure and electrocardiogram were monitored throughout the session. The selectivity of the second filter is relatively good for low and high molecular weight components (e.g. albumin and IgM respectively), but needs to be improved for those of intermediate molecular weight, such as IgG and immune complexes. The amounts of plasma substitute utilized are about 6 times less than with conventional methods; however, transmembrane pressure in the second filter is imperfectly controlled, and this too calls for improvement. A study is in progress to evaluate the ideal plasma mass to be extracted. Clinically, and taking into account the biological results obtained, diseases with high molecular weight mediators should benefit from the double-filtration technique, but this technique needs to be perfected for the treatment of IgG-mediated diseases.

Zidovudine (AZT) is a new anti retroviral agent widely used in the treatment of AIDS and related diseases. It has a short elimination half-life (1 h) in patients with normal hepatic and renal functions, and it is extensively metabolized to a glucuronide derivative (GAZT). In patients with end stage renal disease, the AZT elimination half-life is slightly increased (1.9 h) while for GAZT the very important increase of this parameter results in a major risk of accumulation. A 4-h hemodialysis is more efficient in removing GAZT than AZT. In these patients not only AZT but also GAZT plasma levels should be closely monitored.

The aliphatic polyamines (putrescine, spermidine, spermine) are associated with the phenomena of normal and neoplastic cellular growth. Two third of cancers generally show elevated urinary excretion of polyamines. The urinary levels of polyamines are significantly higher in cancer in evolution than in cancer in remission. The variable association of polyamines with different localisations is reviewed. The potential interest of polyamines analysis in the diagnosis and prognosis of cancer is discussed. The more exciting application of this test remains in the possibility of a short term appreciation of the oncostatic treatment efficiency.

Benign recurrent intrahepatic cholestasis (BRIC) or Summerskill's disease is a rare affection characterized by recurrent episodes of cholestasis of no apparent cause, separated by totally asymptomatic remissions. No specific treatment exists for the disease, and plasma exchange (PE) was proposed for disabling episodes affecting the general condition of two patients: one by two sessions of 4 and 13 exchanges during two episodes respectively (mass exchanged 14 and 35.5 l) and the other by 3 exchanges (total exchanged 4.5 l) during one episode. Improvement in clinical symptomatology and shortening of duration of two cholestatic episodes was noted when PE was carried out at an early stage. Bile acids were purified satisfactorily (42 to 52%), 0.15 to 1.17 mmole being extracted at each acute attack. Although difficult to assess in a rare affection such as this, PE appears to contribute to the symptomatic treatment of BRIC acute episodes if performed early enough, shortening their duration by the probable purification of circulating factors that are cholestatogenic as in primary biliary cirrhosis.

A monocentric, retrospective, comparative long term study based essentially on functional criteria was performed on 27 patients presenting Guillain-Barré syndrome, 14 treated with plasma exchange (PE), 13 with conventional therapy during the same period. Severity of the disease was similar in both groups. Functional improvement of PE treated patients was significant and mean duration of hospital stay significantly shortened (mean 79 days). These findings confirm those in the literature and suggest that treatment with PE be applied to every case of severe recent Guillain-Barre syndrome.