[Secondary megaureter: A rare complication of Deflux® endoscopic management of vesicoureteral reflux in children]

Endoscopic management is the gold standard for symptomatic low-grade vesicoureteral reflux (VUR) in children. Deflux^® (hyaluronic acid/dextranomer) injection is highly effective and has very few complications. We report on two cases of secondary megaureter after Deflux^® injections. In the first case, a boy presented with Grade 4 VUR. He received a bilateral Deflux^® injection with a total of three syringes. The postoperative ultrasound was normal. However, a check-up ultrasound 3 years later showed a significant ureteropyelocalyceal dilatation, with stasis and decreased renal function on scintigraphy, the reason why antireflux surgery (Cohen procedure) was performed. In the second case, a girl diagnosed with bilateral VUR at birth received bilateral injections with one syringe on each side at the age of 12 months. One month later, the ultrasound showed a dilation of the distal ureters (diameter of the right ureter, up to 10mm; left ureter, up to 6.7mm). The child underwent surgery 8 months later (Cohen procedure) because of iterative pyelonephritis and persistent ureter dilatation. Only one previous case has been described in the literature. In our experience, this complication has occurred only twice in 452 injections (4‰). In conclusion, endoscopic treatment with hyaluronic acid/dextranomer injection is a minimally invasive procedure that improves the situation in cases of VUR. It has few complications. Other than failure, there is a low risk of secondary expansion requiring, in our opinion, ultrasound verification over the long term.

[Recurrent distal ileal obstruction by a trichobezoar in a 5-year-old child]

The diagnosis of trichobezoar can be difficult, due to its low prevalence in the pediatric population, limited knowledge of behavioral disorders in children and their prevention, and the difficulty of the clinical diagnosis. We report a case of intestinal occlusion in a 5-year-old child, whose diagnosis was delayed and the trichobezoar, revealed intraoperatively, confined 15cm from the ileocecal valve. Diverging management strategies are proposed in the literature concerning the indication of CT for diagnostic and prognostic purposes, and fibroscopy, still considered as the diagnostic reference. Surgical exploration can lead to the final diagnosis. Bowel obstruction requires emergency surgery to avoid intestinal complications and must be followed by psychological therapy to limit recurrence.

Transcriptional profiles reveal a stepwise developmental program of memory CD8(+) T cell differentiation

The generation of CD8(+) T-cell memory is a major aim of vaccination. While distinct subsets of CD8(+) T-cells are generated following immunization that differ in their ability to confer long-term immunity against infection, the transcriptional profiles of these subsets within endogenous vaccine-induced CD8(+) T cell responses have not been resolved. Here, we measure global transcriptional profiles of endogenous effector (TEFF), effector memory (TEM) and central memory (TCM) CD8(+) T-cells arising from immunization with three distinct prime-boost vaccine regimens. While a proportion of transcripts were uniquely regulated within distinct CD8(+) T cell populations, we observed progressive up- or down-regulation in the expression of a majority of differentially expressed transcripts when subsets were compared in the order TN>TCM>TEM>TEFF. Strikingly, when we compared global differences in gene expression between TN, TCM, TEM and TEFF cells with known transcriptional changes that result when CD8(+) T cells repetitively encounter antigen, our analysis overwhelmingly favored a model whereby cumulative antigen stimulation drives differentiation specifically from TN>TCM>TEM>TEFF and this was common to all vaccines tested. These findings provide insight into the molecular basis of immunological memory and identify potential biomarkers for characterization of vaccine-induced responses and prediction of vaccine efficacy.