[Mycosis fungoides in a heart transplant recipient]

BACKGROUND

Skin cancer occurs frequently in organ transplant patients as a result of induced immunosuppression. Most cases involve carcinomas or B-cell lymphomas induced by the Epstein Barr virus (EBV). Cutaneous T-cell lymphomas remain rare. We report a case of cutaneous T-cell lymphoma of the mycosis fungoides type in a heart transplant recipient.

PATIENTS AND METHODS

A 68-year-old man who had received a heart transplant 21years earlier and was being treated with tacrolimus, mycophenolate mofetil and prednisolone had been presenting a psoriasiform rash on his trunk, limbs and head for 4years. The rash was resistant to both PUVA therapy and topical corticosteroids. Histopathological examination suggested epidermotropic cutaneous T-cell lymphoma. There was no impairment of the patient's general state of health nor any adenopathy. Molecular biology revealed TCR rearrangement in both blood and skin. Screening for circulating Sézary cells was negative, and PET scan revealed no signs of extracutaneous localization. Mechlorethamine showed little efficacy, bexarotene was complicated by dysthyroidism, hypertriglyceridemia was ineffective, methotrexate was contraindicated because of calcineurin inhibitor-related chronic kidney failure, and interferon could not be given due to the context of heart transplantation. Finally, we treated our patient with gemcitabine, which initially proved effective but was later complicated by septic shock that resulted in the patient's death.

CONCLUSION

The particularities of our observation are the onset of cutaneous T-cell lymphoma of the mycosis fungoides type in a heart transplant patient, and the therapeutic difficulties encountered in a setting of transplantation with immunodepression.

[Annular lipoatrophy of the ankles treated by fat grafting: Case report and review of the literature]

INTRODUCTION

Annular lipoatrophy of the ankles is a rare disease. Eleven cases are described in the literature.

CASE REPORT

We report the case of a 10-year-old girl having an annular lipoatrophy of the ankles. The clinical history begins with the appearance of inflammatory infiltrated nodules at the two legs, which have evolved in a few months to a circumferential lipoatrophy of the ankles. Laboratory studies showed a very high antistreptolysin O titer, concluding streptococcal origin of this hypodermitis. After two years of stable lesions, the patient received two sessions of fat injection.

RESULT/DISCUSSION

A satisfactory outcome of the adipocyte graft was observed with reconstitution of shapely legs, stable over time. Eleven cases described in the literature are found. It is a pediatric pathology seen predominantly in female children. The evolution towards lipoatrophy is systematic with or without treatment initiated at the inflammatory phase. We first discuss the management of aesthetic sequelae of this disease.

CONCLUSION

Fat grafting appears to be a good indication for the treatment of the cosmetic sequelae seen in annular lipoatrophy of the ankles.

[Chronic tropical pancreatitis: a case report]

The purpose of this report is to describe a case of tropical calcific pancreatitis (TCP). This disease is specific to tropical regions and constitutes the main cause of chronic pancreatitis in children worldwide. It can also be observed in young adults (2nd and 3rd decade). Shortage of dietary lipids during childhood has been implicated in the development of TCP and mutation of the SPINK1 gene has been cited as a predisposing genetic factor. The underlying pathophysiology of TCP is the same as chronic calcific pancreatitis (CCP) due to alcohol abuse. The main features are a sex ratio of 1, absence of alcohol consumption, occurrence of childhood diabetes in one third of cases, low incidence of acidoketosis, and presence of macro-calcifications especially in ducts. In 10% of cases TCP is complicated by pancreatic carcinoma occurring at an early age, located mainly in the body and tail of the pancreas, and having a less favorable prognosis than primary cancer. Treatment of patients with TCP is the same as for patients with CCP due to alcohol abuse. Prevention depends on improvement of nutritional status of the population.

[Acute infectious diarrhea: current treatment and perspectives]

Acute infectious diarrhea is a worldwide public health problem. In developing countries it remains a major cause infant mortality despite therapeutic progress, especially with regard to the efficacy of oral rehydration, during the last two decades. Mortality in industrialized countries is much lower and generally stable. In most cases, acute diarrhea is a self-limiting illness that resolves with or without symptomatic treatment in a few days. In view of the high frequency and generally benign course of diarrheal diseases, management must emphasize a cost-effective approach with selective use of available diagnostic methods. The initial approach should be based on the patient's history, physical examination, and risk factors to identify infections that require more specific measures. The purpose of this report is to review currently available drug therapies and to describe treatment guidelines for adolescents and adults with uncompromised immune systems. Early rehydration is still the mainstay of treatment. Use of "etiological" treatment using antimicrobial or antiparasitic agents depends on the severity of disease and risk factors.

[Hepatitis C in tropical areas]

The tropical features of hepatitis C have not yet been fully elucidated due to the scarcity of data. However it has been estimated that two-thirds of the infected population lives in tropics. The most heavily affected regions are Africa, China, and southeast Asia with prevalence rates of 5.3, 3.0, and 2.4 p. 100 respectively. In several countries mostly in Africa, prevalence rates range from 5 to 10 p. 100 or higher. Age is a major risk factor for infection. The classic transmission modes, i.e., blood transfusion and intravenous drug use, do not account for these high prevalence rates. Another mechanism could be parenteral injection under unsafe conditions. The most widespread genotypes in tropical areas are genotypes 1, 2, and 3. Other genotypes can be encountered locally including genotype 4 in black Africa and Egypt, genotype 6 in southeast Asia, and genotypes 1 and 3 in India. The association of hepatitis C with chronic liver disease has been the focus of several studies, mainly in Africa. The seroprevalence of virus C ranges from 2 to 55 p. 100 in cases of chronic hepatitis or cirrhosis and from 0 to 47 p. 100 in cases of hepatocellular cancer. Hepatitis C could be the underlying cause of 33 to 50 p. 100 of chronic liver diseases not linked to virus B. It is observed more often in patients with chronic hepatitis or cirrhosis than cancer in which virus B is dominant. Infection by both virus is rare without liver disease but is more frequent in patients with cancer than chronic non-tumoral liver disease.

[Eosinophilic gastroenteritis: an example of gastrointestinal toxicity of eosinophils]

Toxicity of polynuclear eosinophils in the digestive tract results from a cascade of immune responses involving various mediators including mastocytes and T-lymphocyte helpers. Polynuclear eosinophils may be implicated in many digestive disorders. This involvement is well established in eosinophilic gastroenteritis which has become the model for study of eosinophil toxicity on the digestive tract. Considered to be of uncertain etiology up until 1998, this mechanism is well illustrated by the case described in this report involving infiltration of all layers of the small intestinal mucosa in a 23-year-old patients who responded well to corticosteroid treatment. This case provides the opportunity to update physiopathologic and therapeutic data concerning this unpredictable syndrome. Current evidence of transition forms from idiopathic hypereosinophilic syndrome casts doubt on the conventional classification of eosinophilic gastroenteritis and underlines the need for careful diagnostic work-up and prolonged follow-up.

[Colonic angiodysplasia. Rare cause of low digestive hemorrhage in young patients]

We report the following observation of a diffuse kind of colic angiodysplasia in a young subject. Usually to be find in old subjects and regarded as been degenerative origine, angiodysplasiae have been reported in young subjects and we are led to ponder over their nature. The contribution of diagnostic and therapeutic means and their respected place have been specified. In particular the significance of vascular radiology and the angiographic signs of this arterioveinous malformation have been developed.

[Rotor's syndrome. Apropos of a case]

Rotor's syndrome is a rare hereditary non hemolytic hyperbilirubinemia. The authors report a new case of a 22-year-old man, with chronic asymptomatic fluctuating jaundice. Liver function tests such as alkaline phosphatase, gammaglutamyl transferase and aminotransferase were normal, the same applying to globulin levels. The diagnosis was confirmed by a typical bromsulphalein clearance test, oral cholecystography, and increased total urinary coproporphyrin as well as coproporphyrin isomer I.

Axis establishment and microtubule-mediated waves prior to first cleavage in Beroe ovata

The single axis (oral-aboral) and two planes of symmetry of the ctenophore Beroe ovata become established with respect to the position of zygote nucleus formation and the orientation of first cleavage. Bisection of Beroe eggs at different times revealed that differences in egg organisation are established in relation to the presumptive oral-aboral axis before first cleavage. Lateral fragments produced after but not before the time of first mitosis developed into larvae lacking comb-plates on one side. Time-lapse video demonstrated that waves of cytoplasmic reorganisation spread through the layer of peripheral cytoplasm (ectoplasm) of the egg during the 80 minute period between pronuclear fusion and first cleavage, along the future oral-aboral axis. These waves are manifest as the progressive displacement and dispersal of plaques of accumulated organelles around supernumerary sperm nuclei, and a series of surface movements. Their timing and direction of propagation suggest they may be involved in establishing cytoplasmic differences with respect to the embryonic axis. Inhibitor experiments suggested that the observed cytoplasmic reorganisation involves microtubules. Nocodazole and taxol, which prevent microtubule turnover, blocked plaque dispersal and reduced surface movements. The microfilament-disrupting drug cytochalasin B did not prevent plaque dispersal but induced abnormal surface contractions. We examined changes in microtubule organisation using immunofluorescence on eggs fixed at different times and in live eggs following injection of rhodamine-tubulin. Giant microtubule asters become associated with each male pronucleus after the end of meiosis. Following pronuclear fusion they disappear successively, those nearest the zygote nucleus shrinking first, to establish gradients of aster size within single eggs. Regional differences in microtubule behaviour around the time of mitosis were revealed by brief taxol treatment, which induced the formation of small microtubule asters in the region of the nucleus or spindle during both first and second cell cycles. The observed wave of change may thus reflect the local appearance and spreading of mitotic activity as the zygote nucleus approaches mitosis.

DNA polymerase, DNA ligase, and thymidine kinase activity in chicken lens, related to DNA X-ray lesion repair

The activity of DNA polymerases alpha, beta, and gamma; DNA ligases I and II; and thymidine kinase in chicken lenses is determined. These enzymes are present in embryonic intact lenses freshly isolated at 6 days and 11 days of development and in lenses isolated at 11 days of development and cultured for three days. They are also found in both epithelium and fibers when separated at 10 days of embryonic development and in the epithelium of 141/2-month-old hen lenses. In the anucleate mature hen lens fibers, the only detected enzyme is thymidine kinase. Previous results showed that repair of X-ray irradiated DNA was total in 11-day-old embryonic lenses while repair was not detected at six days. On the other hand, repair was very much impaired when the 11-day-old lenses were cultured for three days. Enzymic analyses suggest that the defect in DNA repair and the spontaneous DNA degradation observed in chick lenses at certain embryonic stages, are not due to the absence of any of the above enzymic activities. Alternative explanations are discussed.