Chantal Lefebvre

Serum interleukin 10 titers in systemic lupus erythematosus reflect disease activity.

We investigated whether serum titers of interleukin 10 (IL-10), a cytokine known to shift lymphocyte responses towards humoral immunity, reflect disease activity in systemic lupus erythematosus (SLE). Sera from 72 SLE patients, 25 RA patients and 30 healthy controls were tested for IL-10 by ELISA. Low titers of IL-10 were detected in the serum of 37.5% of SLE patients and in 24% of RA patients but in only 3% of healthy controls. Interestingly, serum IL-10 titers in SLE patients were positively correlated with the SLE Disease Activity Index (SLEDAI) and with anti-DNA antibody titers, but negatively with complement fraction C3 levels. These results indicate that serum IL-10 values reflect SLE disease activity and suggest that overexpression of IL-10 might play a pathogenic role in severe lupus disease.

Polymorphic Transitions of Carbamazepine During Grinding and Compression

Carbamazepine is a potent anticonvulsivant, but, irregular plasma levels are noticed. The variability of therapeutic efficiency can be attributed to interindividual sensibility, chronobiologic effect, but also to rates of dissolution which can differ when polymorphs are induced by technologic operations.Several crystalline forms of Carbamazepine have been characterized. As for us, we have studied three crystalline modifications which can be found in commercialized galenic forms: the most usual beta form, the alpha form and the dihydrate.The aim of this work was to investigate:- the behaviour of these three crystalline forms during compression- the possibility of crystalline structural changes under grinding and tabletting conditions. Indeed, polymorphous transformations may occur during technologic operations such as grinding or compression owing to the increase of internal energy.Grinding was performed in a ball mill for 15 and 60 minutes. Compression was carried out using an instrumented single punch ma...

Relapses of lupus nephritis: incidence, risk factors, serology and impact on outcome.

We prospectivelyfollowed a cohort of 46 newly diagnosed cases of lupus nephritis (LN) over a mean period of five years in order to determine the renal relapse rate, to identify potential risk factors for relapses, to assess the value of serological tests during flares and to analyse their impact on global outcome. Of the patients 37% experienced at least one renal flare, the first episode occurring after a mean follow-up of 40 months, when most patients were still treated with low-dose glucocorticoidsand azathioprine. Baseline biochemical and pathological data did not differ between relapsing and nonrelapsing patients. Serological findings (low complement and high anti-DNA antibody) were less pronounced at relapse. Moreover, neither a decline in complement nor a rise in anti-DNA antibody titres were observed by the time of renal relapse, compared to immediate pre-flare values. Poor outcomes were observed only in relapsing patients. Taken together, renal relapses in LN patients are common, have a negative impact on outcome, but cannot be readily predicted. These results stress the importance of regular blood and urine examinations in LN patients, even years after the initial episode.

Side-effects of intravenous cyclophosphamide pulse therapy.

We reviewed the side-effects of intravenous (IV) cyclophosphamide (CPM) pulse therapy in a group of 75 patients suffering from various autoimmune disorders (mostly systemic lupus erythematosus and vasculitis) who received a total of 451 IV CPM pulses, given on a monthly basis (mean ± s.d. CPM dose per pulse: 764 ± 217 mg; mean ± s.d. follow-up period: 26.7 ± 22.1 mon). Infection was the most common side-effect (30 episodes in 21 patients; 28% of the patients) but rarely required in-patient treatment (8 episodes in 7 patients; 9% of the patients). No relationship could be found between the occurrence of infection and the dose of CPM or of glucocorticoids. Other side-effects were rare. Only one patient suffered from neutropenia. Haemorragic cystitis was never observed nor did premature ovarian failure in the 25 female patients at risk. Four patients developed neoplasia and three died suddenly a few days after receiving a CPM pulse but the causal relationship between CPM therapy and these poor outcomes is speculative. Taken together, our data confirm in a large group of patients that IV CPM pulse therapy is relatively safe. In particular, the rate of severe infection requiring in-patient treatment is rare (1.8% of 451 pulses).

Gamma globulin administration in relapsing Clostridium difficile-induced pseudomembranous colitis with a defective antibody response to toxin A.

A 53-year-old woman suffered six episodes of Clostridium difficile-pseudomembranous colitis. The serological follow-up demonstrated the absence of a rise in IgG and IgA to toxin A. Human pooled gamma globulin was administered during the fifth relapse and raised IgG levels to toxin A. Normal stools reappeared a week later. The role of the antibodies to toxin A and gamma globulin in C. difficile colitis are discussed.

Living Donor Liver Transplantation in Children: Surgical and Immunological Results in 250 Recipients at Université Catholique de Louvain.

Objectives: To evaluate the outcome of pediatric living donor liver transplantation (LDLT) regarding portal vein (PV) reconstruction, ABO compatibility, and impact of maternal donation on graft acceptance. Background: LDLT and ABO-mismatched transplantation constitute feasible options to alleviate organ shortage in children. Vascular complications of portal hypoplasia in biliary atresia (BA) and acute rejection (AR) are still major concerns in this field. Methods: Data from 250 pediatric LDLT recipients, performed at Cliniques Universitaires Saint-Luc between July 1993 and June 2012, were collected retrospectively. Results were analyzed according to ABO matching and PV complications. Uni- and multivariate analyses were performed to study the impact of immunosuppression, sex matching, and maternal donation on AR rate. Results: Overall, the 10-year patient survival rate was 93.2%. Neither patient or graft loss nor vascular rejection, nor hemolysis, was encountered in the ABO nonidentical patients (n = 58), provided pretransplant levels of relevant isoagglutinins were below 1/16. In BA recipients, the rate of PV complications was lower after portoplasty (4.6%) than after truncal PV anastomosis (9.8%) and to jump graft interposition (26.9%; P = 0.027). In parental donation, maternal grafts were associated with higher 1-year AR-free survival (55.2%) than paternal grafts (39.8%; P = 0.041), but only in BA patients. Conclusions: LDLT, including ABO-mismatched transplantation, constitutes a safe and efficient therapy for liver failure in children. In BA patients with PV hypoplasia, portoplasty seems to constitute the best technique for PV reconstruction. Maternal donation might be a protective factor for AR.

Hypocalcaemia and chronic alcohol intoxication: Transient hypoparathyroidism secondary to magnesium deficiency

SummaryThe authors report the observation of an alcoholic patient admitted for tetanic manifestations, in whom severe hypocalcaemia associated with hyperphosphatemia were suggestive of hypoparathyroidism. Administration of magnesium supplementation alone improved the clinical features and led to the correction of the calcium abnormalities. The mechanisms of hypomagnesemia in alcohol intoxication are reviewed as well as the links with hypocalcaemia.

Atteinte cérébrale au cours d’une maladie de Wegener

INTRODUCTION Wegeners granulomatosis (WG) is a systemic necrotizing vasculitis associated with c-ANCA antibodies. The involvement of the central nervous system in WG is uncommon and usually caused by in situ vasculitis, intracranial granuloma formation or contiguous invasion from extracranial sites. CASE REPORT Here, we report on a tumour-like expansion of a severe nasosinusal WG into the brain, which was confirmed by brain biopsy examination. CONCLUSION The positivity of positron emission tomography in our observation supports the potential role of such functional imaging in the staging, as well as in the follow-up of WG.

Acute cholestatic hepatitis with rash and hypereosinophilia associated with ranitidine treatment

We report a case of acute cholestatic hepatitis associated with rash and hypereosinophilia, in which the absence of transfusion, intercurrent viral infection, alcohol consumption or other hepatotoxic drugs are suggestive of ranitidine-induced hepatotoxicity. The pathogenesis of the disorder is unknown, but the lack of a dose-effect relationship, the rarity and unpredictability of the reaction, as well as the clinical signs suggest that hypersensitivity is involved. Physicians should be aware of this rare and idiosyncratic side-effect of ranitidine.

Solitary pancreas transplantation for life-threatening allergy to human insulin

We report on a 30‐year‐old man, with type 1 diabetes mellitus, who developed generalized allergy to insulin consisting of several bouts of tremor, tachycardia, breathlessness and syncope. Strong positive reactions to protamine and metacresol were demonstrated by skin‐prick testing. Symptoms persisted despite the use of antihistamine therapy, Actrapid HM Paraben® and Monotard® (insulin without protamine and metacresol) and immunosuppression (tacrolimus). He underwent a cadaver pancreas transplantation with portal‐enteric drainage in June 2003. Following the antithymocyte globulin induction, immunosuppression consisted in tacrolimus and sirolimus without steroids. The patient subsequently reported a complete resolution of his symptoms and excellent glycaemic control. Thirteen months after transplantation, the patient developed oral ulcerations and severe leucopoenia initially attributed to sirolimus, which was subsequently stopped. A hyperglycaemic episode following corticosteroid therapy for acute rejection therapy required the reintroduction of insulin. Allergic manifestations reappeared promptly. Currently, 2 years after transplantation, the patient is euglycaemic without insulin (glycated haemoglobin 5.8%) and he is free of allergic reactions.