Presse Med
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VIROLOGICAL ASPECTS: Human polyomaviruses (BK virus and JC virus), together with simian polyomaviruses (SV40 virus) share 75% of genomic homology. Their in vivo and in vitro genomes vary. Molecular analyses have identified several genotypes, some of which appear related to the development of viral diseases. Genomic modifications of the regulation area might provide the BKv with a pathogenic aspect thus enhancing the induction of tubulo-interstitial nephropathies in renal transplant recipients.
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TWO PREREQUISITES: In order to avoid the emergence of bacterial resistance, the treatment of nosocomial infections must avoid unnecessary multiplication of antibiotics. Treatment must also be given early for these life-threatening infections. The presence of resistant and/or multiresistant strains is a common cause of antibiotic failure.
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Review Comparative Study
[What pre-operative explorations should be performed in a cardiac patient scheduled for non cardiological surgery?].
In general, preoperative assessment of cardiac patients undergoing non-cardiac surgery relies on thorough clinical evaluation and rest EKG associated if necessary with further examination. In the case of coronary failure, coronary artery disease is the pathology most frequently encountered and is worrying because of the severe complications it provokes. Modern care of such patients requires a thorough study of clinical risk factors as well as pre-test probability of post-operative complications. ⋯ If the latter reveals severe coronary stenosis, bypass grafting or percutaneous angioplasty is required if its risk does not exceed the patient's present post-operative complication rate for the scheduled surgery. For the other cardiac pathologies, echocardiography is the leading exam to assess left ventricular failure or valvular pathologies. New York Heart Association and Duke University classifications help in the risk stratification of such patients.
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THE CONTEXT: Type II cryoglobulinemia, composed of a monoclonal IgM rheumatoid factor directed against polyclonal IgG, is associated in most cases with chronic hepatitis C viral infection. THE CHARACTERISTICS OF RENAL DAMAGE: Frequent, the renal damage usually occurs after the onset of various systemic manifestations and is expressed by moderate renal failure, microscopic haematuria, proteinuria lower than 3 g/d and hypertension difficult to control. ⋯ A renal biopsy confirms the diagnosis by revealing a membranoproliferative glomerulonephritis, characterized by the intensity of the monocyte infiltration and glomerular deposits, often arranged in curved microtubules under electronic microscopy and often associated with vasculitis lesions. Progression towards terminal renal failure is rare.