Hépatite alcoolique aiguë sévère

Tout patient consommateur chronique et excessif d’alcool avec un ictère récent doit être évalué par le score de Maddrey à la recherche d’une hépatite alcoolique aiguë sévère. Les corticostéroïdes représentent le traitement de première ligne, associés à un soutien nutritionnel adapté et à une abstinence alcoolique. La combinaison corticostéroïdes plus N-acétylcystéine (perfusée pendant les cinq premiers jours) améliore la survie à court terme par rapport aux corticostéroïdes seuls, constituant une option thérapeutique de première ligne. La réponse au traitement est évaluée au septième jour par le modèle de Lille inférieur ou égal à 0,45. Le pronostic des patients non répondeurs aux corticostéroïdes avec un modèle de Lille supérieur à 0,45 est sombre avec une survie de 23 % à six mois. Pour des patients non répondeurs aux corticostéroïdes et sélectionnés, la transplantation hépatique précoce améliore significativement la survie à six mois et à long terme.

Perfusion magnetic resonance imaging in pediatric brain tumors

PURPOSE

The use of DSC-MR imaging in pediatric neuroradiology is gradually growing. However, the number of studies listed in the literature remains limited. We propose to assess the perfusion and permeability parameters in pediatric brain tumor grading.

METHODS

Thirty children with a brain tumor having benefited from a DSC-MR perfusion sequence have been retrospectively explored. Relative CBF and CBV were computed on the ROI with the largest lesion coverage. Assessment of the lesion's permeability was also performed through the semi-quantitative PSR parameter and the K2 model-based parameter on the whole-lesion ROI and a reduced ROI drawn on the permeability maps. A statistical comparison of high- and low-grade groups (HG, LG) as well as a ROC analysis was performed on the histogram-based parameters.

RESULTS

Our results showed a statistically significant difference between LG and HG groups for mean rCBV (p < 10^-3), rCBF (p < 10^-3), and for PSR (p = 0.03) but not for the K2 factor (p = 0.5). However, the ratio K2/PSR was shown to be a strong discriminating factor between the two groups of lesions (p < 10^-3). For rCBV and rCBF indicators, high values of ROC AUC were obtained (> 0.9) and mean value thresholds were observed at 1.07 and 1.03, respectively. For K2/PSR in the reduced area, AUC was also superior to 0.9.

CONCLUSIONS

The implementation of a dynamic T2* perfusion sequence provided reliable results using an objective whole-lesion ROI. Perfusion parameters as well as a new permeability indicator could efficiently discriminate high-grade from low-grade lesions in the pediatric population.

[Atypical intradermal smooth-muscle neoplasm]

BACKGROUND

We report herein a case of atypical intradermal smooth-muscle neoplasm.

PATIENT AND METHODS

A 58-year-old man presented with a painless pinkish-white chest nodule ongoing for two years. Histopathology revealed a proliferation of intradermal smooth-muscle cells. Some atypia and 5 mitoses were seen in the most mitotic fields. The histopathologist suggested a diagnosis of "atypical intradermal smooth-muscle neoplasm".

DISCUSSION

Atypical intradermal smooth-muscle neoplasm is part of a spectrum extending from skin leiomyoma to leiomyosarcoma. The prognosis consists chiefly in risk of local recurrence. The terminology is not currently accepted by WHO but nevertheless offers an alternative to inappropriate diagnosis of sarcoma, which carries psychological and social impact.

Vascular expression of annexin A2 in lupus nephritis

AIMS

To evaluate vascular expression of annexin A2 (ANXA2) and its subunit S100A10 in lupus nephritis (LN).

METHODS

The present histological study included 14 patients with LN and 11 controls (patients with non-lupus kidney diseases). Kidney biopsies from patients with lupus were scored for lupus glomerulonephritis (according to the International Society of Nephrology/Renal Pathology Society 2003 classification) and vascular lesions (such as microthrombi and antiphospholipid syndrome nephropathy (APSN)). ANXA2 and S100A10 expression in glomerular and peritubular capillaries was evaluated by immunohistochemistry on tissue sections. The staining intensity score ranged from 0 (no expression) to 4 (intense expression).

RESULTS

In patients with LN, the median age (range) at first kidney biopsy was 36 (18-49). Vascular lesions were observed in six patients (including two with APSN). We observed intense expression of ANXA2 in glomerular and peritubular capillaries while expression of S100A10 was weaker. However, one of the patients with APSN showed strong S100A10 expression. Patients with LN and controls differed significantly in terms of S100A10 expression in peritubular capillaries. We also observed a statistical difference between patients who had LN with renal vascular lesions and those without renal vascular lesions in terms of ANXA2 expression in peritubular capillaries.

CONCLUSIONS

The presence of vascular lesions in LN appears to be associated with significant differences in the vascular expression of ANXA2. Vascular expression of ANXA2 was somewhat higher in LN. Vascular expression of S100A10 was somewhat lower in LN (except one of the two patients with APSN). Further studies of ANXA2's putative value as a biomarker of active LN or of vascular lesions in LN are required.