The diagnostic yield of transjugular renal biopsy. Experience in 200 cases

Renal histology remains the keystone of diagnosis in most parenchymal renal diseases and especially in glomerulopathies [1–3]. Sampling of renal tissue by percutaneous needle biopsy was described by Iversen and Brun in 1951 [4]. This procedure is usually safe, provided contraindications are respected [5–10]. Such contraindications include uncontrolled hypertension and/or bleeding disorders, which can favor severe perirenal hematoma. Even when these contraindications are heeded, systematic computerized tomography (CT) showed that the incidence of perirenal hematoma discovered by CT scan (irrespective of its clinical manifestation) is 57 to 85% [11, 12].In the absence of contraindications, there are patients in whom the slightest possibility of a complication necessitating lombotomy for hemostasis would be ethically incompatible with renal biopsy. This is the case, for instance, in patients with morbid obesity or with chronic respiratory insufficiency, in whom general anesthesia might represent a considerable hazard. Finally, there are cases where the size or the anatomical location of the kidney makes renal tissue sampling difficult or impossible. Ultrasound or CT scan-guided biopsy [13–15] does not always obviate such pitfalls. Other, more invasive methods have been proposed to sample kidney tissue, for instance by means of a short lombotomy [16–21], but this approach, which in addition necessitates the use of an operating room and several days of hospitalization, is similarly inapplicable in a patient with severe bleeding disorder or morbid obesity.We have described a novel technique of renal biopsy using the transjugular route, inspired from that used for liver biopsy in patients with clotting disorders in whom the percutaneous route would similarly be precluded [22–24]. This new technique was published in abstract form [25], and we reported our preliminary results on 50 cases [26]. The goal of this Technical Note is to analyze our present experience on 200 procedures carried out in 195 patients

Dimorphisme dans la sequence d'adressage mitochondrial de la MnSOD (répartition, influence sur le pronostic vital et le risque de survenue du carcinome hépato-cellulaire dans une population de cirrhotiques alcooliques)

PARIS5-BU Méd.Cochin (751142101) / SudocPARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Transient elastography in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is a relevant issue in public health owing to its epidemiological burden. It represents the most common chronic liver disease in the general population and is expected to increase in future as a result of an ageing population. Liver biopsy is still considered the “gold standard” for distinguishing the broad range of NAFLD. However, liver biopsy is often not recommended in the NAFLD patients, because of its cost, the potential risk of bleeding and the absence of consensus regarding the histopathological criteria that firmly differentiate between the NAFLD entities. Due to the remarkable increase in the prevalence of NAFLD and the concomitant efforts in developing novel therapies, a non-invasive, simple and reproducible technique is needed in the clinical practice. Transient elastography is a non-invasive technique for liver stiffness measurement (LSM) as a function of the extent of hepatic fibrosis. This review focuses on practical issues in the use of LSM in the NAFLD patients and suggests areas for further research and development

Severe hepatitis induced by cyproterone acetate: role of corticosteroids. A case report

Cyproterone acetate (CPA) is an oral anti-androgen commonly used to treat advanced prostate cancer. A variety of hepatotoxic reactions has been reported with CPA. Here we describe a case of a male patient who developed severe drug-induced hepatotoxicity during the treatment with CPA. The case, presenting sub-acute hepatitis, was characterized by a rapid evolution of cirrhosis and a protracted activity during the period of a few months despite the treatment withdrawal and an apparent benefits of corticosteroids, suggesting their indication in life threatening cases

In Situ Tensile Testing under High-Speed Optical Recording to Determine Hierarchical Damage Kinetics in Polymer Layers of Flax Fibre Elements

International audienceThis study aims at better understanding the damage and fracture kinetics in flax fibre elements at both the unitary and bundle scales, using an experimental setup allowing optical observation at high recording rate in the course of tensile loading. Defects and issues from flax unitary fibre extraction are quantitated using polarized light microscopy. Tensile loading is conducted according to a particular setup, adapted to fibres of 10 to 20 µm in diameter and 10 mm in length. Optical recording using a high-speed camera is performed during loading up to the failure at acquisition, with speed ranging from 108,000 to 270,000 frames per second. Crack initiation in polymer layers of fibre elements, propagation as well as damage mechanisms are captured. The results show different failure scenarios depending on the fibre element’s nature. In particular, fractured fibres underline either a fully transverse failure propagation or a combination of transverse and longitudinal cracking with different balances. Image recordings with high time resolution of down to 3.7 μs suggest an unstable system and transverse crack speed higher than 4 m/s and a slower propagation for longitudinal crack deviation. Failure propagation monitoring and fracture mechanism studies in individual natural fibre or bundles, using tensile load with optical observation, showed contrasted behaviour and the importance of the structural scale exanimated. This study can help in tailoring the eco-design of flax-based composites, in terms of toughness and mechanical performances, for both replacement of synthetic fibre materials and innovative composites with advanced properties