Wegener’s granulomatosis presenting as multiple bilateral renal masses: case report and literature review

Wegener's granulomatosis (WG) is a disease of unknown etiology characterized by necrotizing granulomatous vascularitis. The upper and lower respiratory tract and kidney involvements are very common; however, its presentation as bilateral renal masses is unusual. We report a case of a 59-year-old female patient who presented with multiple bilateral renal masses. The patient presented with sinusal and ocular symptoms suggestive of WG, and positive antineutrophil cytoplasmic antibodies (c-ANCA) with an anti-PR3 pattern. Histopathologic examination of the renal biopsy specimen revealed granulomatous inflammation with vasculitis and fibrinoid necrosis. The patient management, including prednisone and cyclophosphamid, induced a marked improvement of the renal masses. This case illustrates that WG should be considered in the differential diagnosis of renal masses.     

Bevacizumab 5 or 7.5 mg/kg in Metastatic Colorectal Cancer Can Be Infused Safely Over 10 Minutes

Background  

Bevacizumab is a humanized monoclonal antibody that blocks vascular endothelial factor. It demonstrated an efficacy in many cancer types. The standard recommendation of administration is the 90-, 60-, and 30-min infusion sequence for all doses. We evaluated in this study the possibility of reducing infusion time to 10 min for bevacizumab given at 5 or 7.5 mg/kg in metastatic colorectal cancer (MCRC).     

Renal infiltrate by a plasmocytoïd chronic B lymphocytic leukaemia and renal failure: a rare occurrence in nephropathology. A case report and review of the literature

We report the case of a 55-year-old male with renal failure as the initial manifestation of interstitial and focal infiltration of the kidneys by a small B-cell lymphoma. Since three years, this patient had a history of CLL with plasmocytic differentiation and was left untreated owing to stade A Binet classification. After chemotherapy, the lymphocytosis and the adenopathies disappear and the renal function improve. Infiltration of the kidneys by non-Hodgkin small B-cell lymphoma, including chronic lymphocytic leukaemia (CLL), is usually asymptomatic, fortuitously discovered at the time of an X-ray examination or at autopsy. Association with renal failure is extremely rare. We review the reported cases of renal failure associated with lymphomatous infiltration (13 cases of CLL and five cases of lymphoplasmocytic lymphoma kappa or lambda IgM), with the following conclusions: in most cases, renal insufficiency appears in a few months and significantly disappears after chemotherapy; the renal infiltrate is usually focal in lymphoplasmocytic lymphoma and rather massive and diffuse in CLL; the neoplastic feature of a small B-cell lympho?d infiltrate may be difficult to determine: a poorly limited, monomorphous, CD20+ CD5+ lymphoid infiltrate is lymphomatous. In case of plasmocytic differentiation, it must be looked for kappa or lambda monotypy; the type of the lymphomatous infiltrate according to the WHO 2008 classification may be difficult to determine in a small sampling of renal tissue: the renal infiltrate must be compared, if possible, with a lymph node infiltrate. Owing to its bad prognosis, mantle cell lymphoma must be distinguished from other small B-cell lymphoma like CLL/small lymphocytic lymphoma, marginal zone lymphoma and lymphoplasmocytic lymphoma.     

La NLPC en d��cubitus dorsal modifi�� : notre exp��rience

Purpose:

Percutaneous nephrolithotomy (PCNL) is conventionally performed with the patient in the prone position. In this study, we assess the safety and efficacy of PCNL in the supine position.

Methods:

Between November 2004 and January 2010, we performed 159 percutaneous nephrolithotomies. The patient is placed in a supine modified position with an air bag underneath the operating flank. If necessary, a modified lithotomy position allowing the simultaneous antegrade and retrograde endourological access was used. The access has been realized with progressive Alken dilators or with the one-shot technique. Operative times, mean stay in hospital, complications and success rates were analyzed.

Results:

The mean age was 47 ± 13.1 years (range: 22–70). Twenty-one patients had previous kidney surgery. Twenty-one had solitary kidneys and 3 patients had congenital renal abnormalities. The mean stone size was 3.4 ± 1.9 cm (range: 1.3–5.4). Twenty patients (29.5%) had complete staghorn stones. Ten patients (11.4%) also had ureteral stones and underwent concomitant ureteroscopy. The mean operative time was 60 ± 29 min, including patient positioning. In 2 patients it was necessary to suspend the procedure due to of bleeding. Postoperative complications included prolonged fever in 3 patients, nephrocutaneous fistula requiring double pigtail stent placement. Arterial embolization was never required. The colon was never damaged and we had no cases of hydrothorax or kidney loss. A second early treatment using the same percutaneous access during the same hospital stay was needed in 8 patients. The stone-free rate was 91.8%.

Conclusions:

Percutaneous nephrolithotripsy with the patient in a modified supine position is effective and safe. It offers obvious advantages from the point of view of the patient’s comfort and use of anesthetic. There is no risk of vitiated positions or traumatisms due to the change of bed-position and no thoracic compression occurs, which makes the procedure safe in patients with associated cardiorespiratory pathologies or obese patients. Also, the risk of colon perforation is reduced, which allowed for allows access to the entire urinary collecting system.     

Improvements in quality of life associated with insulin analogue therapies in people with type 2 diabetes: results from the A1chieve observational study

Aims

To determine the effects on quality of life after starting insulin with, or switching to, insulin analogue therapies in the 24-week, prospective, non-interventional, observational A₁chieve study conducted across four continents in people with type 2 diabetes.

Methods

Health-related quality of life (HRQoL) was assessed at baseline and at 24 weeks by the validated EQ-5D questionnaire (visual analogue score [VAS] and five dimensions) in 66,726 people who had started using basal insulin detemir, mealtime insulin aspart (with or without a basal insulin) or biphasic insulin aspart 30.

Results

For the overall cohort, reported HRQoL increased significantly by 13.8 points from 63.4 points at baseline to 77.2 points at 24 weeks (p < 0.001) (scale 1-100, 100 = best health imaginable). Beginning or changing insulin was associated with a significant increase in HRQoL score (+15.0 points and +11.1 points, respectively), resulting in a similar score at 24 weeks in the two populations (77.8 and 75.9 points). Reported HRQoL also increased statistically significantly in people administering any insulin analogue regimen and across all regions, although there were some marked regional differences in reported HRQoL at baseline.

Conclusion

Compared with baseline scores, beginning insulin with, or switching to, insulin analogue therapies are associated with increased HRQoL.     

Snake venom serine proteinases: sequence homology vs. substrate specificity, a paradox to be solved

Snake venom glands synthesize a variety of serine proteinases capable of affecting the haemostatic system. They act on macromolecular substrates of the coagulation, fibrinolytic, and kallikrein–kinin systems, and on platelets to cause an imbalance of the haemostatic system of the prey. In this review we describe their biochemical/biophysical characteristics, biological activities as well as aspects of their evolution and structure-activity relationship.