Strategies for preventing late-onset cytomegalovirus disease in organ transplant recipients.

Objective: The incidence of late-onset cytomegalovirus disease (i.e. disease appearing after discontinuation of antiviral prophylaxis) in solid-organ transplant recipients remains excessively high. This review will focus on describing the several strategies that could potentially reduce the incidence of late-onset cytomegalovirus disease. Methods: We reviewed the literature and presented our own clinical experience in the field. Results: The incidence of late-onset cytomegalovirus disease in recent trials can be as high as 36% in high-risk patients (donor positive/recipient negative for cytomegalovirus). The extension of antiviral prophylaxis to six months has recently proven in a prospective randomized controlled trial to be effective for reducing late-onset cytomegalovirus disease. The monitoring of cytomegalovirus viral load by PCR after the discontinuation of prophylaxis seems to be of moderate usefulness in low/intermediate-risk patients. The use of low-dose valganciclovir could reduce drug toxicity and costs while maintaining similar efficacy, but further studies are needed. A potentially interesting approach to predict the individual risk for development of cytomegalovirus disease appears to be the assessment of specific cell-mediated immune response. If cell-mediated immunity assays become widely available in transplant centers in the future, these assays may possibly be used to tailor the cytomegalovirus preventive strategy on an individual basis. Finally, recent prospective trials have evaluated novel cytomegalovirus vaccines that merit further evaluation in the transplant setting, although currently there is no cytomegalovirus vaccine that has been approved for routine clinical use. Conclusions: Several studies have recently evaluated novel strategies to reduce the incidence of late-onset cytomegalovirus disease. It is therefore expected that this improvement in preventive strategies will allow to further reduce the negative effects of cytomegalovirus disease after transplantation.

Athletic injuries of the extensor carpi ulnaris subsheath: MRI findings and utility of gadolinium-enhanced fat-saturated T1-weighted sequences with wrist pronation and supination.

OBJECTIVE: To report the magnetic resonance imaging (MRI) findings in athletic injuries of the extensor carpi ulnaris (ECU) subsheath, assessing the utility of gadolinium-enhanced (Gd) fat-saturated (FS) T1-weighted sequences with wrist pronation and supination. METHODS: Sixteen patients (13 male, three female; mean age 30.3 years) with athletic injuries of the ECU subsheath sustained between January 2003 and June 2009 were included in this retrospective study. Initial and follow-up 1.5-T wrist MRIs were performed with transverse T1-weighted and STIR sequences in pronation, and Gd FS T1-weighted sequences with wrist pronation and supination. Two radiologists assessed the type of injury (A to C), ECU tendon stability, associated lesions and rated pulse sequences using a three-point scale: 1=poor, 2=good and 3=excellent. RESULTS: Gd-enhanced FS T1-weighted transverse sequences in supination (2.63) and pronation (2.56) were most valuable, compared with STIR (2.19) and T1-weighted (1.94). Nine type A, one type B and six type C injuries were found. There were trends towards diminution in size, signal intensity and enhancement of associated pouches on follow-up MRI and tendon stabilisation within the ulnar groove. CONCLUSION: Gd-enhanced FS T1-weighted sequences with wrist pronation and supination are most valuable in assessing and follow-up athletic injuries of the ECU subsheath on 1.5-T MRI.

Hygiène de la chevelure et affections du cuir chevelu / par A. Izard,...

Collection : Bibliothèque des femmes