Presse Med
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The standard immunosuppression protocol after liver transplantation (LT) is based on an anticalcineurin (ACN) (tacrolimus or cyclosporine microemulsion) combined with mycophenolate and corticosteroids. Corticosteroids are usually stopped between 6 and 12 months after LT, except for patients whose transplantations were necessitated by autoimmune disease. ACN and mycophenolate must be monitored to verify the dose, with a residual blood assay (for tacrolimus), at 2hours (for cyclosporine microemulsion), or by a simplified area under the curve (for mycophenolate). ⋯ The absence of any renal or vascular effect is interesting for patients with kidney failure, and the antiproliferative effect can be useful for patients transplanted because of cancer. The current objective of immunosuppression is to reduce the adverse effects (kidney failure, metabolic complications, cancer and infections, in particular, which reduce the survival of patients and grafts), and in the future, to promote the establishment of tolerance that ideally will allow the patient to stop prophylactic immunosuppressant treatment. New chemical agents, capable of acting on new and more specific pathways, are in phase II/III testing.
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Letter Case Reports
Pancreatic tuberculosis: a rare cause of pseudoneoplasic obstructive jaundice.
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To evaluate the effect of cosmetic surgery in patients with a minimal defect in appearance, with and without body dysmorphic disorder (BDD), 5 years after their request for plastic surgery. ⋯ This prospective study confirms that cosmetic surgery is not effective against BDD despite patients' reported satisfaction. Cosmetic surgery had no significant effects on BDD diagnosis, handicap or psychiatric comorbidity in BDD patients 5 years after surgery. Furthermore, BDD appeared at follow-up in some subjects not initially diagnosed. Patients' reported satisfaction with surgery may help explain why some plastic surgeons do not consider BDD a complete contraindication to cosmetic surgery.
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The peripartum cardiomyopathy is a rare form of dilated cardiomyopathy. Its etiology remains unclear and is likely multifactorial. The diagnosis is based on the association of clinical heart failure and systolic dysfunction assessed by echocardiography or magnetic resonance imaging. ⋯ Complete recovery of systolic function is observed in 50 % of the case. The mortality risk is low. Subsequent pregnancy should be discouraged, especially if systolic function did not recover.