The first simultaneous kidney-adrenal gland-pancreas transplantation: outcome at 1 year

Adrenal insufficiency is a rare but life-threatening disease. Replacement therapy sometimes fails to prevent an acute adrenal crisis and most often does not lead to restoration of well-being. We report here the 1-year outcome of the first simultaneous kidney-adrenal gland-pancreas transplantation in a 33-year-old patient with type 1 diabetes and concomitant autoimmune adrenal insufficiency. En bloc left adrenal gland and kidney grafts were anastomosed on the left iliac vessels in normal vascular conditions and the pancreas graft was anastomosed on the right iliac vessels. The immunosuppressive regimen was not modified by the addition of the adrenal gland. We observed no additional morbidity due to the adrenal gland transplantation, as there were no surgical complications. One-year kidney and pancreas graft functions were satisfactory (estimated glomerular filtration rate: 55 mL/min/1.73 m(2) and HbA1c: 4.8%). The adrenal graft functioned well at 12 months with a normalization of cortisol and aldosterone baseline levels. Functional imaging at 3 months showed good uptake of [(123) I]-metaiodobenzylguanidine by the adrenal graft. Transplantation of the adrenal gland en bloc with the left kidney appears to be a good therapeutic option in patients with adrenal insufficiency awaiting kidney or kidney-pancreas transplantation.

Newcastle disease virus F glycoprotein expressed from a recombinant vaccinia virus vector protects chickens against live-virus challenge

Chickens were immunised using a vaccinia recombinant virus (vaccinia-Italien-F), expressing the F protein of Newcastle disease virus (NDV). Immunisation was successful using either TK" cells infected with the vaccinia-Italien-F virus, the recombinant virus grown in TK7 cells and inoculated intracerebrally in one-day-old chickens or the recombinant virus given by wing-web to adult chickens after adaptation by alternate passage in chick embryo fibroblasts and chickens. The use of recombinant viruses expressing the F protein of NDV as vaccines would allow joint application of vaccination and eradication programmes for NDV. Therefore, recombinant viruses obtained in chickens virus vectors are needed.

[Prescription of bone remodeling markers in hospitals]

Biochemical markers of bone turnover have for several years been considered as valuable parameters in research clinical studies, but their use in individual patients is still debated. Recently several position papers have proposed guidelines for their use in clinical practice in patients with post menopausal osteoporosis. In the present article, we report the results of a survey which aims at comparing the actual modalities of prescription of French physicians with the above-mentioned recommendations. We contacted by phone clinical chemists from 158 different hospitals and asked them to transmit to the concerned physicians of their hospital a detailed questionnaire for assessing which bone marker(s) is (are) prescribed and for which purpose (s), and if not prescribed, the reason of non prescription. We were able to analyze 309 questionnaires from 89 hospitals including 5 specialties, rheumatology (35.9%), endocrinology (18.1%), gynecology (11.0%), internal medicine (22.0%) and geriatry (12.9%). The results showed large discrepancies between the mode of prescription of a subset of physicians and the guidelines. The most often evoked reason for non prescription was a lack of information about bone markers suggesting a need for teaching courses. This survey has also shown that many physicians do not know exactly which parameters are effectively measured in their hospital and which are addressed to specialized laboratories underlining the importance of the dialogue between clinicians and clinical chemists. We propose that in a given hospital, the present article may serve as a basis for a discussion between clinicians and biologists about the development and/or the optimization of the measurements of these markers of bone turnover.

[Biochemical markers of bone remodeling: pre-analytical variations and guidelines for their use. SFBC (Société Française de Biologie Clinique) Work Group. Biochemical markers of bone remodeling]

Biochemical markers of bone turnover have been developed over the past 20 years that are more specific for bone tissue than conventional ones such as total alkaline phosphatase and urinary hydroxyproline. They have been widely used in clinical research and in clinical trials of new therapies as secondary end points of treatment efficacy. Most of the interest has been devoted to their use in postmenopausal osteoporosis, a condition characterized by subtle modifications of bone metabolism that cannot be detected readily by conventional markers of bone turnover. Although several recent studies have suggested that biochemical markers may be used for the management of the individual patient in routine clinical practice, this has not been clearly defined and is a matter of debate. Because of the crucial importance to clarify this issue, the Société Francaise de Biologie Clinique prompted an expert committee to summarize the available data and to make recommendations. The following paper includes a review on the biochemical and analytical aspects of the markers of bone formation and resorption and on the sources of variability such as sex, age, menstrual cycle, pregnancy and lactation, physical activity, seasonal variation and effects of diseases and treatments. We will also describe the effects of pre-analytical factors on the measurements of the different markers. Finally based on that review, we will make practical recommendations for the use of these markers in order to minimize the variability of the measurements and improve the clinical interpretation of the data.

Serum levels of YKL-40 and C reactive protein in patients with hip osteoarthritis and healthy subjects: a cross sectional study

BACKGROUND

YKL-40 is a 40 kDa glycoprotein secreted by chondrocytes and synoviocytes. It has been suggested that it is a surrogate marker of synovial inflammation and joint destruction in rheumatoid arthritis (RA) and osteoarthritis (OA) and related to C reactive protein (CRP) serum levels in RA.

OBJECTIVE

To study serum levels of YKL-40 in patients with hip OA and its relation with CRP.

METHODS

YKL-40 and CRP were assayed in serum samples from 45 patients (24 women, 21 men, mean age 65) with symptomatic OA of the hip and 33 healthy controls. YKL-40 was assayed by immunoassay and CRP by ultrasensitive immunonephelometry. OA severity was assessed by the measurement of joint space width with a computer analysis system of digitised hip radiographs. Statistical analysis was performed to determine correlations between serum markers and radiological joint space width.

RESULTS

The mean (standard error) YKL-40 level was 90.3 (8.2) ng/ml in patients with hip OA and 66.9 (8.2) ng/ml in controls (p=0.03). The mean CRP level was 2.93 (3.03) mg/l in OA and 1.40 (1.61) mg/l in controls (p=0.006). The serum levels of YKL-40 and CRP increased with age and were significantly correlated (Spearman test: r(s)=0.42, p=0.005) in patients but not in controls. Neither YKL-40 nor CRP correlated with radiographic joint space width.

CONCLUSIONS

Serum YKL-40 was significantly increased in patients with hip OA. The correlation between YKL-40 and CRP suggests that YKL-40 may be a marker of joint inflammation in OA. Longitudinal studies are required to assess the usefulness of YKL-40 in the monitoring of patients with hip OA.

Organ procurement in children--surgical, anaesthetic and logistic aspects

To cover the need in paediatric organ transplantation, every potential donor should be considered as a multi-organ donor. Successful transplantation may be performed with kidneys retrieved from very young infants, even anencephalic neonates if the en-bloc technique using both kidneys is used. Regarding the liver, paediatric donors can be accepted from one month of age while livers harvested from older children and even young adults can be transplanted into small children after ex-vivo reduction of the size of the graft. Multi-organ procurement from the same donor provides valuable organs if the anaesthetic management of the donor is appropriate. Active transplant programs needs international cooperation which is made possible by the organ exchange organizations.

Comparison of hemagglutination-inhibition, agar gel precipitin, and enzyme-linked immunosorbent assay for measuring antibodies against influenza viruses in chickens

Individual variations in serological response to avian influenza virus infection were demonstrated after experimental infection of specific-pathogen-free chickens with H6N2 influenza virus. Homologous antibodies were detected from the 6th to the 157th day after infection using hemagglutination-inhibition or enzyme-linked immunosorbent assay and from the 11th to the 157th day by agar gel precipitation test.

Evaluation of the use of monoclonal antibodies to hemagglutinin and fusion glycoproteins of Newcastle disease virus for virus identification and strain differentiation purposes

Monoclonal antibodies detect evident antigenic variations in NDV HN and F protein. However, the A/PMV-1 viruses can be identified by HI test using a preparation made of the combination of two different monoclonals. A primary evaluation of the pathogenicity of the isolated viruses can be made by HI test using monoclonal antibodies but needs always confirmation using conventional pathogenicity tests.

Antigenic and biological characterization of avian paramyxovirus type 1 isolates from pigeons

21 A/PMV-1 viruses were isolated from pigeons and characterized using polyclonal and monoclonal antisera in hemagglutination inhibition, seroneutralization and immunoprecipitation studies. Polyclonal and monoclonal antibodies directed against the HN and F proteins of Italien virus reacted with all pigeon isolates showing a close relationship between chicken velogenic and pigeon viruses. Differences in the M.W. of F0, P and M proteins were however observed between pigeon and chicken Italien virus. Marked differences in virulence were recorded among pigeon isolates; these were reflected by great variation in the IVPI of the different strains.