Post-traumatic ulcers in the elderly subject

The occurrence of ulceration after minor traumatism in the older patient free from arterial disorders, can be explained by the decreased elasticity of the subcutaneous tissues, which thus provokes arterial rupture, which in turn brings on major bruising and the appearance of an area of necrosis whose surface is proportionately large or smaller according to the damage done to the arterioles. The treatment is straight forward, and usually leads to quick healing without scarring.     

Management of noninfectious mixed cryoglobulinemia vasculitis: data from 242 cases included in the CryoVas survey

Data on the clinical spectrum and therapeutic management of noninfectious mixed cryoglobulinemia vasculitis (CryoVas) in the era of hepatitis C virus screening are lacking. We analyzed data from 242 patients with noninfectious mixed CryoVas included in the French multicenter CryoVas survey. Baseline manifestations were purpura (75%), peripheral neuropathy (52%), arthralgia or arthritis (44%), glomerulonephritis (35%), cutaneous ulcers (16%), and cutaneous necrosis (14%). A connective tissue disease was diagnosed in 30% and B-cell non-Hodgkin lymphoma in 22%, whereas the CryoVas was considered to be essential in 48%. With the use of Cox-marginal structural models, rituximab plus corticosteroids showed the greater therapeutic efficacy compared with corticosteroids alone and alkylating agents plus corticosteroids to achieve complete clinical, renal, and immunologic responses and a prednisone dosage < 10 mg/d at 6 months. However, this regimen was also associated with severe infections, particularly when high doses of corticosteroids were used, whereas death rates did not differ between the therapeutic regimens. The role of each of these strategies remains to be defined in well-designed randomized controlled trials.     

Vaccination coverage among school children aged 14–15 years in the French department of Sarthe

Objectives

Vaccinations are the main pillar of primary prevention for infectious diseases. To guide and prioritize public health interventions, the Regional Health Agency has asked the Prevention, Vaccination, and Screening Center of the Sarthe department to assess vaccination coverage (VC) at the sub-departmental level. The main objective was to measure the VC among school children aged 14–15 years in Sarthe at the sub-departmental level.

Gadolinium in arteriography and interventional radiology: 39 patients

OBJECTIVE: To report the experience of using various Gadolinium chelates as contrast media in digital subtraction angiography in patients with relative or absolute contraindications for iodinated contrast agents. MATERIAL: and Methods. Forty-two arteriograms were performed in 39 consecutive patients using Gadolinium chelates (gadoteridol, gadodiamide, and gadopentetate dimeglumine). The vasculature of the brain, of the upper and lower limbs and the renal arteries were examined. Among these 39 patients, 17 were treated by various endovascular procedures. RESULTS: In 40 examinations out of 42, the angiographic result was satisfactory, allowing either a diagnostic evaluation or an endovascular therapeutic procedure. Clinical tolerance was excellent. In one case of renal failure that was reported after angiography, the patient had received both iodine and gadolinum-based contrast agents. CONCLUSION: Gadolinium appears to be an interesting alternative for arteriography in patients with absolute or relative contraindication to iodinated contrast agents, and also seems to demonstrate efficacy during endovascular therapeutic procedures.     

Improvement in HLA-DQB typing by PCR-RFLP: Introduction of a constant restriction site in one of the primers for digestion control

The PCR-RFLP method previously reported by Inoko is a powerful technique for HLA class II typing. The reliability of RFLP interpretation depends on complete digestion by restriction endonucleases using a modified primer with restriction sites as an internal digestion control. The use of restriction enzymes which recognize specific HLA DQB allelic variations makes HLA DQB genotyping possible.     

Psychostimulants and G tolerance in rhesus monkeys: effects of oral modafinil and injected caffeine

INTRODUCTION: Caffeine and modafinil are psychostimulants that may be taken by fighter aircraft pilots to reduce fatigue. Fighter pilots are subjected to high positive G loads that reduce cerebral blood flow and consequently may induce G-LOC. The aim of the experiment was to determine whether these drugs may reduce tolerance to G stress. METHODS: Seven adult male rhesus monkeys participated in the experiment. Five were equipped with ECoG and ECG wires and underwent two G tests (A and B). Each experiment consisted of five centrifuge runs. Before the runs, the monkeys received no drug (control) or were given either 7.5 mg x kg(-1) caffeine IM or 64 mg x kg(-1) modafinil PO or the corresponding vehicles. The runs were performed up to +13 Gz with an onset rate of 0.1 G x s(-1) (test A) or 3 G x s(-1) (test B). The run was ended when the electrical activity of one ECoG channel had disappeared (i.e., G-LOC). RESULTS: In experiment A, drug administration had no significant effect. In experiment B, the injection of the caffeine-free solvent caused a delay in G-LOC compared with the control condition (no administration). Caffeine solvent also induced an increase in plasma osmolality. DISCUSSION: Modafinil administration has no significant effect on the G tolerance of rhesus monkeys. Regarding caffeine, the drug seems to have caused the reverse effect compared with the solvent. CONCLUSIONS: Caffeine and modafinil administration had no significant effect on the G-tolerance of rhesus monkeys when compared with controls. This result needs to be confirmed in humans.     

Use of a biological glue in partial pulmonary excision surgery. Results of a controlled trial in 50 patients]

A controlled study concerning the surgical use of a fibrin glue was conducted in 50 patients undergoing partial pulmonary excision. In 25 of these patients, chosen at random, hemostasis and aerostasis of the fissural, and/or intersegmentary dissection planes were achieved by electrocoagulation, in the other 25 by the application of fibrin glue. The statistical study did not show any significant difference between the two groups in terms of the surgical indication, the type of excision and the associated surgical procedures (pleurectomy and parietectomy). No significant statistical difference was observed concerning the quality of aerostasis, the post-operative drainage, the persistance of residual collection or faulty reexpansion after removal of the latter, and the necessity for repeated drainage. The same applied to the length of post-operative hospital stay. This study seems to demonstrate that the surgical application of fibrin glue on the fissural and/or intersegmentary dissection planes is feasible but, as compared to electrocoagulation, does not significantly improve the quality of the surgical results for partial pulmonary excision; however its use could reduce the duration of post-operative drainage.     

ANCA-related crescentic glomerulonephritis in systemic sclerosis: revisiting the "normotensive scleroderma renal crisis"

The scleroderma renal crisis is characterized by acute onset of severe hypertension and by rapidly progressive hyperreninemic renal failure. There is, however, a very limited subset of patients with rapidly progressive renal failure who remain normotensive and develop ANCA-positive crescentic glomerulonephritis. We report a case of normotensive acute renal failure secondary to anti-MPO antibody-associated crescentic glomerulonephritis in a patient with diffuse systemic sclerosis. She was referred to our department with normal blood pressure and no extrarenal clinical manifestation ofvasculitis. She presented with rapidly progressive renal failure, microscopic hematuria and minimal proteinuria. P-ANCA were positive by immunofluorescence, with ELISA-confirmed specificity for myeloperoxidase. Renal biopsy revealed typical features of pauciimmune glomerulonephritis with crescent formation and fibrinoid necrosis. The patient was initially treated with i.v. cyclophosphamide only. Because of ongoing deteriorating renal function, additional treatment with intravenous pulses of methylprednisolone followed by oral prednisone was started and allowed renal function improvement. After 9 months, serum creatinine had almost returned to normal level with minimal proteinuria, no hematuria and negative ANCA testing. Control kidney biopsy only revealed scar lesions. The association of ANCA-positive crescentic glomerulonephritis and systemic sclerosis is a very rare event. Treatment with intravenous cyclophosphamide and corticosteroids allows rapid and long-term improvement of renal function. The onset of typical scleroderma renal crisis triggered by high-dose corticosteroids is unlikely but requires a close follow-up of patients with overlapping systemic sclerosis. Diagnosis and treatment are discussed and previously published cases are reviewed.