Thymic function is a major determinant of onset of antibody-mediated rejection in heart transplantation

Thymic function decreases progressively with age but may be boosted in certain circumstances. We questioned whether heart transplantation was such a situation and whether thymic function was related to the onset of rejection. Twenty-eight antithymocyte globulin-treated heart transplant recipients were included. Patients diagnosed for an antibody-mediated rejection on endomyocardial biopsy had a higher proportion of circulating recent thymic emigrant CD4+ T cells and T cell receptor excision circle levels than other transplanted subjects. Thymus volume and density, assessed by computed tomography in a subset of patients, was also higher in patients experiencing antibody-mediated rejection. We demonstrate that thymic function is a major determinant of onset of antibody-mediated rejection and question whether thymectomy could be a prophylactic strategy to prevent alloimmune humoral responses.

Surgical treatment of trans-sphincteric anal fistulas with the Fat GRAFT technique: a minimally invasive procedure

AIM

Anal fistulas are common pathologies with a significant social impact; however, their treatment is often complex and the recurrence rate can be significant. Some surgical treatments for fistula are also associated with the risk of sphincter injury. In this technical note, we aim to evaluate the feasibility and efficacy of the Fat GRAFT technique (Fat Grafting in Anal Fistula Treatment) in the treatment of recurrent anal fistulas.

METHOD

All patients presenting with recurrent trans-sphincteric anal fistulas over an 18-month period were included. After abdominal fat harvesting and fat preparation, fat grafting was performed in the track and peripheral area of the fistula. The internal and external openings of the fistula were closed to maximally preserve the retention of the adipocyte graft in the fistula.

RESULTS

Eleven patients underwent the Fat GRAFT procedure (seven men, four women). The average re-injected volume for each fistula was 21 ml (range 10-30 ml). The postoperative course was uneventful. At 6 months three patients developed recurrence (73% healed). There were no postoperative complications.

CONCLUSION

The Fat GRAFT technique appears to be a promising technique with a low risk of anal incontinence, in contrast to other techniques. This method was effective in > 70% of patients in a single session.

[Benefits of using the cutometer to evaluate the effectiveness of skin treatments in plastic and maxillofacial surgery]

INTRODUCTION

Evaluating skin properties is often too subjective. Using the cutometer allows one to take objective measures of certain mechanic properties of the skin such as visco-elasticity. The aim of this article is to evaluate through a review of existing literature the advantages and the limits of the cutometer and to propose an improvement.

MATERIAL AND METHODS

The selection of articles has been conducted with the PubMed database in order to identify all publications concerning the cutometer up until September 2013. The analysis criteria were: (1) quantitative distribution of articles from the first publication until today; (2) qualitative distribution over the various medical fields. The articles have been organized in 3 groups: medical, surgical and burns; (3) list of biases in the interpretation of results and limits of this measuring tool.

RESULTS

One hundred and twenty-nine publications have been included. The first article regarding the cutometer was published in 1994. We observe an increase in the number of publications after 2005. Most of the articles were published in medical journals of dermatology or cosmetology (83%), only 9% of articles have been published in burn study journals and 8% in surgical journals. The pressure applied by the experimenter constitutes the main measure bias.

DISCUSSION

The use of an external device maintaining the probe with an invariable pressure corresponding to its own weight enables more reliable results all the while limiting the inter- and intra-individual variability.