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The multiple exostosis is a hereditary bone tumour. Generally, its complications are benign and are related to compressing surrounding structures such as nerves and vessels. This is the case of a 52-year-old woman with a family history of multiple exostosis, which was complicated by a pseudoaneurysm of the right superficial femoral artery. The delay in diagnosis was allowed to develop this pseudoaneurysm which caused nervous and deep venous compression., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Infection with hepatitis B virus has a major implication for transplant recipients due to the risk of reactivation under immunosuppression, progression to chronic liver disease, development of liver cirrhosis and hepatocellular carcinoma. We report two cases of renal transplantation patients who were hepatitis B surface antigen positive before transplantation and were treated by Lamivudine.

Aberrant right subclavian artery or arteria lusoria (AL) is the most frequent anomaly of the aortic arch, secondary to abnormal embryogenesis. It is usually asymptomatic and fortuitously discovered. It can compress neighboring structures and cause dysphagia or, more rarely, dyspnea. In symptomatic cases or in the presence of an aneurysm of the AL origin, it should be surgically treated. The case herein reported concerns a child presenting with respiratory symptomatology related to an AL that was surgically treated by right supraclavicular approach., (Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.)

The results provide new insights into the role of IL-2/IL-2R pathway in DC. We report that stimulation of human monocyte-derived DC with LPS strongly upregulated CD25 (α chain of the IL-2R) expression. In addition, by using a humanized monoclonal antibody against CD25, we demonstrated that the IL-2 signalling in DC upregulated both IL-12 and γIFN production but decreased IL-10 synthesis. Anti-CD25 treatment reduced the ability of LPS-DC to induce allogeneic CD4(+) T cell proliferation as compared to LPS-matured DC. In addition, LPS-matured DC treated with IL-2 had a higher allostimulatory capacity compared to LPS-DC. We also found that LPS-matured DC produced IL-2. Thus, IL-2 seems to contribute actively to DC activation through an autocrine pathway. Moreover, IL-2 pathway in DC is involved in T helper priming. These findings might be useful for protocols in cellular therapy and a valuable tool to understand graft rejection versus the acquisition of peripheral tolerance., (Copyright © 2009 Elsevier Masson SAS. All rights reserved.)

Leishmaniasis is an infection caused by a protozoan parasite belonging to the genus Leishmania and transmitted by the Phlebotomus sandfly. We report a case of visceral leishmaniasis in a 49-year-old male renal transplant recipient, a resident of the western part of Tunisia, which is an endemic zone for the disease. Just before and after the transplantation, the patient resided in Tunis, which is non-endemic for leishmaniasis. Visceral leishmaniasis occurred eight years after renal transplantation, and the clinical picture was characterized by fever and pancytopenia. Leishmaniae were detected by bone marrow aspiration. Pentavalent antimonal was used for 28 days and was substituted by allopurinol (20 mg/kg per day). One year after the infection, the patient remains totally asymptomatic. Our report suggests that visceral leishmaniasis may complicate the clinical course of organ transplantation and can be fatal, particularly when untreated. Relapses may occur after completion of the apparently effective treatment. Allopurinol could be a solution to avoid these relapses.

Renal transplant recipients are at higher risk of certain tumors such as lymphomas and skin cancers and than the general and dialysis populations. We retrospectively studied the prevalence of tumors in adult renal transplant recipients in four Tunisian centers of transplantation in Tunis, Monsatir and Sfax from January 1986 to January 2005. The study included 36 patients; 19 men and 17 women with a mean age of 34.6 years (range from 18-54 years). The mean time since dialysis to transplantation was 43 months (6-131months). Maintenance therapy was based on calcineurin inhibitors (CNI) in 86 % of cases, on antimetabolites and corticosteroids in 100 % of cases. Anti-thymoglobulin was administered in a mean course of 12.4 days in 78 % of the patients. Acute rejection occurred in 25 cases and was treated with polyclonal or monoclonal antibodies on 40 % of cases. Incidence of cancer among our population was 7 % and occurred after a mean period of 54 months of transplantation (range from 4-160 months). Eighty three percent of the tumors were solid, and the rest were in the skin. Kaposi sarcoma formed 41.6 % and non-Hodgkin or Hodgkin lymphoma 27.7 % of the solid tumors, while spinocellular carcinoma formed 83% and basocellular carcinoma 17% of the skin tumors. Switching CNI to sirolimus in 8.3% cases was associated with a favorable outcome. Mortality was the outcome in 33.3% of the patients with cancer, while partial or complete regression of cancers was observed in 55.5% cases after decreasing the doses of the immunosuppressive medications. We conclude that post renal transplant cancer is mainly characterized by the predominance of Kaposi sarcoma favored by solar exposure and rigorously induced and maintained immunosuppression. Careful follow-up may results in early intervention and decrease mortality.

Recently, attention has been focused on the role for dendritic cells (DCs) in the promotion of peripheral tolerance. It is currently believed that the maturation/activation state of DCs might be a control point for the induction of graft tolerance through modifications of the activation state of T cells. We have observed IL-2, and IL-2 receptor gene expression by reverse transcriptase-polymerase chain reaction (RT-PCR) in human DC lysates following bacterial stimulation. It has been demonstrated in the present study IL-2R alpha (CD25) expression on human DCs upon LPS activation. DCs differentiated from monocytes were exposed to anti CD25 during maturation, anti CD25 treatment affected the abilities of human DCs to induce CD4+ T cell proliferation in response to alloantigens, maintained endocytic capacity, Anti CD25 treated DCs produce low levels of IL-12 and IFN and high level of IL-10. All these characteristics suggest that DCs may be used in cellular therapy either to induce allograft tolerance (anti CD25 treated DCs) or to restore immunity against tumors (IL-2 treated DCs).

Surveillance of glomerular filtration rate (GFR) is essential for the management of kidney transplant recipients. We compared the performance of estimation equations with (99m)Technetium ((99m)Tc)-DTPA clearance (TcGFR) in 32 of our patients, using the Modification of Diet in Renal Diseases (MDRD), Nankivell (NK), and Cockcroft-Gault (CG) formulas. All patients were adequately hydrated before study. (99m)Tc-DTPA was injected intravenously (maximal dose = 37 MBq). A second syringe was prepared for an aliquot of the study ("standard"). Blood was sampled at 120 and 240 minutes in various sites. After centrifugation, 1.0 mL plasma was transferred into a counting vial. Both the samples and the "standard" were measured in a well counter. The mean time from transplantation to TcGFR was 47.9 months (range, 4-143 months). The mean serum creatinine level was 124 micromol/L (range, 70-371 micromol/L). The mean TcGFR was 58.6 mL/min/1.73 m(2) (range, 14-100 mL/min/1.73 m(2)). The MDRD equation showed a median difference of 1.4 mL/min/1.73 m(2) with 81.2% of estimated GFR within 20% of TcGFR. Median differences were 8.94 and 11.47 mL/min/1.73 m(2) for NK and CG formulas, respectively. The precision of the NK and CG was such that only 56.25% and 62.5% of estimations, respectively, fell within 20% of TcGFR. In this study, the MDRD equation demonstrated the best overall performance among the 3 tested methods. It should be sufficient for routine clinical practice in kidney transplantation.

The prevalence of obstructive arterial disease is between 3.5 and 12.1% in 60 aged populations. It's a current disease which has a pernicious influence in quality of life. Management of patients with peripheral arterial occlusive disease has to be planned in the context of natural history, epidemiology, and apparent risk factors that predict deterioration. The purpose of this review is to take stock of the consensus and the controversies about terminology, epidemiology, diagnosis and management of peripheral arterial occlusive disease.

Chronic contained rupture of abdominal aortic aneurysm is a rare event which can cause diagnostic difficulties. It can present as a chronic back pain and the delayed diagnosis and delayed surgical repair may compromise the final results. The outcome of urgent repair of a chronic contained leak is equivalent to that of elective aneurysm repair. We report a case of contained rupture of a small abdominal aortic aneurysm with delayed diagnosis, evaluated by computed tomography showing a beginning erosion of the lumbar vertebral body. The patient was operated on within 24 hours on admission with uneventful surgical outcome.

Primary hyperaldosteronism or Conn's syndrome is rare after renal transplantation. We present a case of a 34-year-old woman with end-stage renal disease, who had received a living renal transplant and showed persistent hypertension and hypokalemia. The common causes of hypertension after kidney transplantation were excluded and hypokalemia persisted despite potassium supplementation and angiotensin converting enzyme inhibitors. Biochemical findings revealed extremely elevated plasma aldosteron levels, suppressed plasma renin activity, and massive urinary potassium wasting. Abdominal computerized tomography scan showed a left 25-mm adrenal nodule. Her hypertension and hypokalemia was cured by the removal of the adenoma.

Objectives: To assess the effet of cryopreservation on the structural and functional properties of venous and arterial human allografts., Materials and Methods: Segments of arteries and veins harvested from multiorgan donors were divided into 3 groups: fresh-control tested for 24 hours after harvesting, frozen directly at -80 degrees C and frozen gradually (progressive freezing technique) and preserved in liquid nitrogen at -196 degrees C degree. The 2 cryopreserved groups of segments were allowed in two different cryoprotectant solutions (M1 and M2) containing both dimethyl sulphoxide (10%), RPMI 1640 for the first and M 199 for the second. Rapid thawing was done at regular intervals over 4 months and the allografts were processed for biomechanical, ultrastructural, morphological and immunohistochemical analysis., Results: Cell damage was less intense in the specimens conserved in M1 solution and by progressive freezing technique especially for smooth muscle cells and endothelial cells which remained preserved until 12 weeks., Conclusion: Cryopreservation in both the solutions employed induce changes in the morphology of arterial wall. Better results were obtained with RPMI 1640 associated with progressive freezing.

Arteritis is a local finding of a general disease: atherosclerosis. To define the risk factors of this disease in Tunisia, 531 patients were collected by a multicenter retrospective study between January 1998 and December 1999. Most of our patients were male with a mean age of 62 years. The most important risk factor was tobacco with an incidence of 90%. Lipids and diabetes were less common. The association of risk factors is particularly dangerous.

There has not been a peripheral vascular surgical procedure subject to as exquisite scruting as carotid endarterectomy. The last decade gave a new attitude after the analysis and conclusions of the North American Symptomatic Carotid Endarterectomy Symptomatic extracranial lesions were best managed with operative intervention rather than antiplatelet treatment alone. Now, in the first decade of the new millenium, we are embarking on yet another test of carotid endarterectmy--a comparison with percutaneous angioplasty and stenting, which is a most rigorous contest because endarterectomy must now withstand comparison with another "active treatment" rather than the more passive observational modality of antiplatelet therapy. The topic of the authors was to provide a panorama of the contemporay treatment of carotid disease at this pivotal point in the life cycle carotid endarterectomy.

Purpose: Results that were obtained from three patients and a literature review allow the authors to better define the place of medical and surgical treatments according to the different locations of arterial aneurysm occurring in the course of Behcet's disease., Methods: Retrospective report of five cases of arterial aneurysm that occurred during Behcet's disease in three patients., Results: Due to the unusual symptoms, diagnosis can be hampered. Though lesions may be observed in various areas, they were mostly aortic (two patients). Surgical revascularization was done in all three patients. It mainly involved prosthetic grafts. Two patients were subsequently treated by postoperative immunosuppressive drugs. The mean follow-up was 22 months. Relapsing aneurysm was observed in one patient, while in another patient aneurysm developed in a new location., Conclusion: These types of arterial lesions respond poorly to medical treatment when a combination of colchicine and intermittent intravenous bolus of cyclophosphamide is used. Surgical indications should be given great yet selected weight, using prosthetic rather than venous autologous grafts (due to the risk of spontaneous venous involvement). Since either complication or recurrence is possible, prolonged monitoring is required.

The authors report three new cases of ectopic pheochromocytoma: latero-aortic, bladder and near the kidney. From the review of the literature, they propose a diagnostic and therapeutic strategy for the management of ectopic localisation of pheochromocytoma.

Chronic post traumatic ischaemia is a specific late complication of vascular injuries. The authors report a four cases series, including three war vascular injuries. They emphasize the surgical management lines and point out the preeminence of vascular restoration on reconstructive bone and joint surgery.

A diabetic woman developed spontaneous gas gangrene of upper limb extending into trunk and due to clostridium septicum. Recovery was obtained after major surgery involving disarticulation of upper limb and excision of soft tissues of left hemithorax, and a difficult intensive care programme (hyperbaric oxygen therapy, assisted ventilation). The presence of this gas gangrene revealed a bipolar colon cancer treated in parallel. The conventional therapeutic hierarchy is discussed: surgery should be carried out as an extreme emergency and should not be delayed to allow transfer to a center equipped with a hyperbaric oxygen therapy apparatus.