Biomedical subjects
Publications and source records attributed to E Renoult.
Infection of the sternoclavicular joint due to Staphylococcus aureus occurred in 2 hemodialysis patients. Good results were achieved in both cases by applying appropriate antibiotic therapy. Sternoclavicular joint sepsis is rare. However, it is often associated with underlying conditions, and hemodialysis must be recalled as one of the possible predisposing factors.
Renal artery stenosis is frequent after transplantation. The systematic pre-operative search for arterial injuries by angioscopy allows a reduction in their incidence. The authors report a series of 60 transplantations with pre-operative angioscopy, which revealed benign injuries and two major injuries which were successfully treated surgically. This prevention allows a reduction in the incidence of stenosis from 12 to 6.6% according to a previous series of 210 transplantations without angioscopy.
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We report an exceptional case of cardiac pheochromocytoma which raised problems of localization. A 30-year old man who for several years had been hypertensive was admitted for attacks of paroxysmal hypertension. Very high levels of urinary catecholamines suggested a diagnosis of pheochromocytoma, but no tumour was found at computerized tomography (CT) and metaiodobenzylguanidine (MIBG) scintigraphy. However, regional venous samplings detected two para-carotid phaeochromocytomas which were surgically removed. Thereafter, the symptoms persisted and investigations were resumed. As new regional venous samplings persisted and investigations were resumed. As new regional venous samplings showed high levels of catecholamines in the right atrium, a mediastinal and, chiefly, cardiac phaeochromocytomas was suspected. No tumour was visible at CT or ultrasonography and another MIBG scintigraphy proved negative. Coronary angiography showed a very large tumour behind the left atrium, well supplied by the circumflex artery and by a branch of the right coronary artery. The patient was operated upon and is now totally asymptomatic after a 9-month follow-up. This case emphasizes the value of invasive methods (i.e. regional venous sampling and coronary angiography) in the localization of this ectopic tumour. In most cases, however, phaeochromocytomas can be localized by MIBG scintigraphy.
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Primary IgA mesangial nephropathy was first described in adults by Berger, and has been increasingly recognized in children. IgA nephropathy is a frequent type of glomerulonephritis in 3 to 15 year-old children in France. Clinical features and outcome have been defined and the progression to renal failure is possible. The pathogeny of IgA nephropathy remains unclear and is under multifactorial control and, at present, no satisfactory specific treatment is available.
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A long-term hemodialysis male patient was known to have systemic iron overload due to regular blood transfusions. As he was suspected to have aluminum overload, he received a single intravenous administration of desferrioxamine (that supported the hypothesis). Four days later, he became highly febrile with no focus of infection on physical examination. All blood cultures yielded Yersinia enterocolitica. The aim of this case report is to recall the potential risk of Yersinia sepsis in iron overload patients treated with desferrioxamine, even for a short time. The diagnosis should be suspected even in the absence of digestive symptoms, leading to immediate desferrioxamine withdrawal and antibiotic therapy.
A CASE REPORT: Different abnormalities suggesting a "Charge" association were recognized in a 23-year-old man, as an end-stage renal disease was discovered. Though its undetermined cause(s), this association needs to be evoked in order to detect and to manage occult visceral anomalies and to evaluate for a familial form.
Tolerance and efficacy of single i. v. injections of PK 10169 (1 mg/kg) during installation were evaluated in 10 patients with stable chronic renal insufficiency treated with 3 sessions of hemodialysis weekly (sessions of 4 and 5 hours). Tolerance was good in all cases. Efficacy was globally satisfactory (no complete coagulation) but by the 4th hour in 7 out of 30 sessions coagulation was apparent in the bubble trap with elevation of residual blood volume, recurring in the same patient but not affecting result of dialysis. In these cases anti-Xa activity was reduced from the 2nd hour and at end of dialysis, with a markedly elevated FPA level. For most patients it is possible to envisage 5-hour sessions, but in those few susceptible to develop coagulation repeated clinical surveillance of all circuit elements is necessary.
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The prognosis of hemolytic uremic syndrome was studied in 37 children hospitalized between January 1980 and January 1985. 75% of affected children were less than 3 years of age. Twenty-two (60%) presented with anuria or oliguria (mean duration of anuria: 10.7 days). In this last group, severe extrarenal manifestations occurred: 12 cases of neurological involvement (6 involving hypervolemia), gastrointestinal involvement in 5 cases, including a case of ileal necrosis; pancreatic involvement in another. Three children died during the first month of the disease (overall death-rate: 8%). Thirty-two children were followed with a mean 24 months follow-up (6 months to 60 months). Six (19%) presented with sequellae, of which 3 were severe: one severe arterial hypertension and two with chronic renal failure of which one terminal with severe neurologic sequellae. The existence of extrarenal manifestations implies a poor prognosis. Among the 22 children with anuria or oliguria, 8 had no extra-renal manifestations. All of these recovered. Three of 11 children with one extrarenal manifestation had an unfavorable outcome. The course was unfavorable in the 3 cases with multiple extrarenal involvement.
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