Human Listeriosis Caused by Listeria ivanovii

Two species of Listeria are pathogenic; L. monocytogenes infects humans and animals, and L. ivanovii has been considered to infect ruminants only. We report L. ivanovii–associated gastroenteritis and bacteremia in a man. This isolate was indistinguishable from prototypic ruminant strains. L. ivanovii is thus an enteric opportunistic human pathogen

Splenic Rupture and Malignant Mediterranean Spotted Fever

International audienc

Polykystose rénale autosomique dominante après transplantation rénale (étude d'une cohorte et analyse des données d'un registre)

La PKRAD est la plus fréquente des néphropathies héréditaires de l adulte. Nous avons cherché un éventuel impact de ses complications spécifiques sur les résultats de la transplantation. Après transplantation, les complications en rapport avec les kystes rénaux sont fréquentes mais peu sévères, ne justifiant pas de néphrectomie préalable. A l inverse, les infections des kystes hépatiques sont peu fréquentes mais sévères, susceptibles d engager le pronostic vital. Les ruptures d anévrysmes intracrâniens sont peu fréquentes mais souvent mortelles, indépendamment de la transplantation. La diverticulose colique se complique rarement et ne justifie pas d attitude particulière avant la transplantation. Quant au retentissement des autres anomalies associées, il est anecdotique. Malgré la fréquence particulièrement élevée de certains facteurs de risque pour la transplantation (hypertension artérielle, dyslipidémie et diabète), et un âge plus élevé au moment de la greffe, les résultats obtenus ne différent pas de ceux obtenus chez les autres patients transplantés non diabétiques. Si les complications tumorales constituent la principale cause de mortalité chez ces patients, le risque de développement des tumeurs n est pas supérieur à celui des autres transplantés. Les complications thromboemboliques sont plus fréquentes, ce qui justifie des mesures préventives adaptées dans les situations à risque. Ce type de complications n est pas liée à la polyglobulie, fréquente dans cette population et dont le retentissement apparaît limité. Finalement, la PKRAD ne nous apparaît pas comme un obstacle à la transplantation.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

[Living donors for kidney transplantation: ethical and legal challenges].

International audienceLiving donor kidney transplantation has developed very heterogeneously worldwide despite excellent results and without taking into account the context of global organ shortage. Such a heterogeneity highlights persistent ethical issues, whereas organ trafficking is emerging as an organized transplant tourism reinforcing the need for strong national legal frameworks. Despite its powerful regulation system, which ensures standardization, transparency and accountability of support for donation, France remains reluctant to enlarge the circle of legal donors, whereas it would be the first step to give a greater role to living organ donation

Représentations de la fin de vie pour les oncologues et les praticiens de soins palliatifs

International audienceContextIn Western countries, the care of patients at the end of their lives is guaranteed by law. Unlike death, the notion of “end of life”, though it is mentioned in some laws, has no legal nor medical definition and should guarantee adapted care for patients. Is the notion of end of life a consensual concept to delineate the boundary between curative care and refusal of unreasonable obstinacy? Our main hypothesis was that in oncology, the end of active drugs (antineoplastic) defined the start of the “end of life”.MethodologyThis was a prospective, multicentre, qualitative study, conducted through semi-directed interviews with oncologists and physicians working in palliative care units. The COREQ report guideline has been used.ResultsThe end of life could not be defined unanimously, and corresponded to two concepts framing the discontinuation of active drugs. The “objective” end of life was reaching a medical consensus while the “subjective” end of life, which is subject to multiple representations, was directly impacting the medical behaviour related to the cessation of active drugs.ConclusionDeath is experienced as a reality with a subjective component. The discontinuation of active therapies initiates discussions about medical possibilities for end-of-life management. The doctor then shifts from his function of “knowing” to confront himself with the expression of a patient's autonomy and the needs of the entourage.ContexteDans les pays occidentaux, les soins des patients en fin de vie sont encadrés par la loi, mais à la différence de la mort, la « fin de vie », évoquée dans l’intitulé des lois, n’a pas de définition légale ni médicale. La notion de fin de vie est-elle un concept consensuel permettant de délimiter la frontière entre le soin curatif et le refus d’une obstination déraisonnable ? Notre hypothèse principale était qu’en oncologie, l’arrêt des thérapeutiques actives (antinéoplasiques) définissait le début de la fin de vie.MéthodologieIl s’agissait d’une étude qualitative prospective multicentrique réalisée à l’aide d’entretiens semi-dirigés auprès de médecins oncologues et pratiquant les soins palliatifs. La directive de rapport COREQ a été utilisée.RésultatsLa fin de vie n’a pas pu être définie de façon unanime, mais deux concepts de « fin de vie » ont émergé. La fin de vie « objective » convergeait vers une définition consensuelle médicale et la fin de vie « subjective », sujette à de multiples représentations, impactait directement l’attitude médicale et l’arrêt des thérapeutiques actives.ConclusionLa mort est vécue comme une réalité ayant une composante subjective. L’arrêt des thérapeutiques actives initie les discussions relatives à la gestion médicale de la fin de vie. Le médecin se décentre alors de sa fonction de « sachant » et se confronte à l’expression de l’autonomie d’un patient et aux besoins de l’entourage

La transplantation rénale à partir de donneurs vivants

Malgré la pénurie d’organes et les excellents résultats des transplantations rénales réalisées à partir de donneurs vivants, cette pratique connaît un développement très hétérogène dans le monde. Cette hétérogénéité souligne la persistance de tensions éthiques, tandis que l’émergence d’un trafic d’organes sous la forme d’un véritable tourisme de transplantation organisé renforce la nécessité d’un encadrement réglementaire strict, garant du respect de la loi. La France, qui s’est dotée d’un tel dispositif, reste frileuse vis-à-vis de l’élargissement du cercle légalement autorisé des donneurs vivants, préalable indispensable à l’expansion de cette pratique

23andMe: a new two-sided data-banking market model

International audienceBackgroundSince 2006, the genetic testing company 23andMe has collected biological samples, self-reported information, and consent documents for biobanking and research from more than 1,000,000 individuals (90 % participating in research), through a direct-to-consumer (DTC) online genetic-testing service providing a genetic ancestry report and a genetic health report. However, on November 22, 2013, the Food and Drug Administration (FDA) halted the sale of genetic health testing, on the grounds that 23andMe was not acting in accordance with federal law, by selling tests of undemonstrated reliability as predictive tests for medical risk factors. Consumers could still obtain the genetic ancestry report, but they no longer had access to the genetic health report in the United States (US). However, this did not prevent the company from continuing its health research, with previously obtained and future samples, provided that consent had been obtained from the consumers concerned, or with health reports for individuals from other countries. Furthermore, 23andMe was granted FDA authorization on February 19, 2015, first to provide reports about Bloom syndrome carrier status, and, more recently, to provide consumers with “carrier status” information for 35 genes known (with high levels of confidence) to cause disease.DiscussionIn this Debate, we highlight the likelihood that the primary objective of the company was probably two-fold: promoting itself within the market for predictive testing for human genetic diseases and ancestry at a low cost to consumers, and establishing a high-value database/biobank for research (one of the largest biobanks of human deoxyribonucleic acid (DNA) and personal information).SummaryBy dint of this marketing approach, a two-sided market has been established between the consumer and the research laboratories, involving the establishment of a database/DNA biobank for scientific and financial gain. We describe here the profound ethical issues raised by this setup

Molecular Tumor Boards: Ethical Issues in the New Era of Data Medicine

International audienceThe practice and development of modern medicine requires large amounts of data, particularly in the domain of cancer. The future of personalized medicine lies neither with "genomic medicine" nor with "precision medicine", but with "data medicine" (DM) (big data, data mining). The establishment of this DM has required far-reaching changes, to establish four essential elements connecting patients and doctors biobanks, databases, bioinformatic platforms and genomic platforms. The "transformation" of scientific research areas, such as genetics, bioinformatics and biostatistics, into clinical specialties has generated a new vision of care. Molecular tumor boards (MTB) are one response to these changes and are now providing better access to next-generation sequencing (NGS) and new cancer treatments to patients with inoperable or metastatic cancers, and those for whom the usual treatment has failed. However, MTB face a crucial ethical challenge maintaining and improving the trust of patients, clinicians, researchers and industry in academic medical centers supported by private or public funding rather than providing genetic data directly to private companies. We believe that, in this era of DM, appropriate modern digital communication networks will be required to maintain this trust and to improve the organization and effectiveness of the system. There is, therefore, a need to reconsider the form and content of informed consent (IC) documents at all academic medical centers and to introduce dynamic and electronic informed consent (e-IC)

Evidence that graft-site candidiasis after kidney transplantation is acquired during organ recovery: a multicenter study in France.

International audienceBACKGROUND: Infections of renal grafts with Candida species can induce life-threatening complications in the recipient. METHODS: A 9-year retrospective study involving all of the transplant centers in France was designed to determine the incidence, origin, characteristics, and outcome of graft-site candidiasis that occurred after kidney transplantation. Yeasts cultured from preservation or drainage solutions and graft specimens were recorded. RESULTS: Among 18,617 kidney grafts, 18 recipients corresponding to 12 donors developed culture-confirmed graft-site candidiasis (incidence, 1 case per 1000 grafts) a median of 25 days after the graft procedure. Clinical presentations included 14 cases of renal arteritis (13 were complicated by aneurysm), 1 urinoma, 2 graft site abscesses, and 1 surgical site infection. Candida albicans was involved in 13 cases. A unique C. albicans genotype or a single rare Candida species was involved in each episode. Together with the clinical history, these findings demonstrate that organ contamination followed by transmission to the recipient occurred during recovery. Therapeutic management varied from simple monitoring in 1 case to a combination of surgery (nephrectomy in 9 cases and arterial bypass in 9 cases) and antifungal therapy (14 cases). Overall, 3 of 18 kidney transplant recipients died, and 9 had their graft surgically removed. CONCLUSION: Graft-transmitted candidiasis that ends most often in fungal arteritis is associated with high morbidity and mortality after kidney transplantation and is related to organ contamination during recovery in the donor