C Lasseur

A simplified Cockcroft-Gault formula to improve the prediction of the glomerular filtration rate in diabetic patients

AIM The National Kidney Foundation recommends stratification of renal failure into moderate (Glomerular Filtration Rate: GFR = 30-60 mL/min/1.73 m2), severe (15-30) or terminal (<15) using the Cockcroft-Gault (CG) or the Modification of Diet in Renal Disease (MDRD) equations. We studied the biases in these methods in an attempt to improve the standard CG (MCG) and devise a strategy for stratification. METHODS GFR was measured by 51Cr-EDTA clearance in 200 diabetic patients: 100 (Group 1: study of concordance) before 2003 and 100 thereafter (Group 2: validation of MCG). The CG was modified by replacing body weight by its mean value: 76. RESULTS In group 1, the recommended equations only correctly stratified 50 patients. The CG, not the MDRD, underestimated GFR if BMI was normal, and overestimated it in obese patients. In group 2, the MCG was well correlated with GFR and not biased by weight. Over the whole population, the MCG and MDRD were more accurate for the diagnosis of moderate and severe renal failure. The MDRD showed the lowest differences with GFR, except if GFR > 60, where the MCG performed better. All formulae overestimated low GFR, the MDRD also underestimated high GFR. The best stratification (147/200) was obtained using the MCG if creatininemia < 120 micromol/l and the MDRD if creatininemia > or =120 micromol/l. CONCLUSION The CG is biased by weight, the MCG corrects this. The more accurate MDRD cannot be used in all patients as it underestimates high GFR. The best stratification was obtained using the MCG at low and the MDRD at high creatininemia.

Cinétique des lipides plasmatiques au cours des infections bactériennes aiguës

We have measured plasma lipids in 30 patients with 32 bacterial infections before (d0) and 3 (d3), 7 (d7) and 14 (d14) days after the beginning of therapy and 1 month after (d30). A decrease in IDL-cholesterol (p 0.01) occurred at d3. These abnormalities were negatively correlated to inflammatory parameters: HDL to CRP (p = 0.001) and fibrinogen (p = 0.001), and cholesterol to CRP (p = 0.01).

Polychondrite révélatrice de l'acutisation d'une leucémie myélomonocytaire chronique

The authors report a case of polychondritis preceding the acutisation of a myelomonocytic leukemia.

Atteintes cardiaques au cours des sclérodermies: étude en écho-cardiographie et doppler cardiaque chez 38 patients

A study of heart lesions has been conducted in 38 patients with systemic sclerosis using echocardiography, doppler and colour doppler. Abnormalities were found in 66% patients. Valvulopathies (mainly mitral regurgitation) were the most frequent lesions (45%). The presence of anti-SCL70 antibody was correlated to right cavities dilatation. Pulmonary hypertension was found in 6 patients.

Le purpura rhumatoïde de l'adulte. Étude rétrospective de 38 malades

The authors report retrospectively 38 cases of Schonlein-Henoch purpura (20 males, 18 females; median age, 26 years). Skin (37/38) and joint (21/38) manifestations are similar to those seen in children. Gastro intestinal (22/38) manifestations are less complicated. Long term outcome of the disease depends on kidneys involvement (32/38) and is severe: chronic renal failure in 31 %

Intérêt et limites de la biopsie endomyocardique au cours de l'infection par le VIH

The authors evaluated the interest of endomyocardial biopsy in 19 consecutively hospitalized patients with AIDS. Histopathological study dit not exhibit opportunistic infection but showed aspecific myocarditis in nine patients.

Une nouvelle menace: l'infection à Xanthomonas maltophilia. A propos de 50 observations

In an attempt to further characterize infections due to Xanthomonas maltophilia (XM), we reviewed 50 case reports observed in our institution. XM is emerging as an important nosocomial pathogen in immunocompromised patients, especially those receiving broad spectrum antimicrobial antibiotherapy. Distinction between colonisation and infection is often difficult. XM presents a therapeutic challenge because of its tendency to exhibit multiple resistance.

O8 La cystatine C améliore l’estimation de la fonction rénale chez les patients diabétiques

Introduction Il est recommande d’estimer le debit de filtration glomerulaire (DFG), pour diagnostiquer et stratifier (en 5 stades) l’atteinte renale chez les patients diabetiques. Peut-on ameliorer cette estimation en dosant la cystatine C (cysC) ? Patients et methodes Chez 124 patients diabetiques presentant un large eventail de DFG (8-164 mL/min/1.73m2) mesure par methode isotopique (51Cr-EDTA), nous avons estime ce DFG par : 1) les equations recommandees : Cockcroft & Gault (CG) et MDRD, 2) l’equation « Mayo Clinic Quadratic » (MCQ), 3) une estimation « Composite » recemment publiee et calculee a partir des taux seriques de creatinine et de cysC, 4) une approche simplifiee en divisant MDRD par cysC lorsque celle-ci etait Resultats Les meilleures performances pour le diagnostic d’insuffisance renale moderee (DFG Conclusion Donc les estimations recommandees du DFG a partir de la creatininemie ont des defauts. Mesurer la cystatine C et l’inclure dans les formules ameliore l’estimation, sans forcement beaucoup en augmenter la complexite.

Image en lâcher de ballons. Un piège diagnostique: le léiomyome bénin métastasiant

We report the case of an asymptomatic 65 year-old female who was evaluated for multiple pulmonary nodules. The radiologic aspect was similar to pulmonary metastasis. Pathologic specimens obtained by thoracotomy were consistent with benign metastasing leiomyoma. This exceptional disease is very interesting because of its histological benignity, hormonal dependency and favorable evolution.

Dermatopolymyosite révélatrice d'un myélome à IgM

We report the association of polymyositis with multiple myeloma secreting IgM lambda monoclonal paraprotein. Few observations describe coexisting polymyositis and benign monoclonal gammopathy but so far a similar association has never been mentioned.