Corticothérapie dans le cancer de la prostate résistant à la castration

IntroductionCorticosteroids are commonly used in the treatment of prostate cancer resistant to castration (PCRC), partly due to the inhibitory effects on adrenal androgen production acting as a pituitary suppressant.MethodsA literature search was conducted in PubMed/MEDLINE database using the following key words: prostate cancer; castration resistance; metastasis; corticotherapy.ResultsCorticosteroids exert direct anti-tumoral activities mediated by the glucocorticoids receptor and involving cellular/tissue functions as growth, apoptosis, inflammation, metastasis, differentiation and angiogenesis. As a pain relieving agents, corticosteroids significantly relieve PCRC clinical symptoms, especially those due to bone metastasis. In the comparative arm of phase II-III trials, corticosteroids administered daily produce a PSA decline. Among the adverse effects due to corticosteroids, bone loss and cardiovascular risk should be carefully monitored. In association with abiraterone acetate, corticosteroids increase overall survival in PCRC patients, and reduce the mineralocorticoid side effects of abiraterone.ConclusionCorticosteroids in monotherapy for PCRC have a limited efficacy. In association with abiraterone acetate it reduces the mineralocorticoid toxicity and enhances the androgenic suppression.     

Actualités dans la physiopathologie de la sclérodermie systémique : vers de nouvelles opportunités thérapeutiques

Systemic sclerosis is a rare connective tissue disease characterized by skin and several internal organ fibrosis, systemic vasculopathy and immune abnormalities. Even if fibroblasts and endothelial cells dysfunction, as well as lymphocytes and other immune cells implication are now well described, the exact origin and chronology of the disease pathogenesis remain unclear. Oxidative stress, influenced by genetic and environmental factors, seems to play a key role. Indeed, it seems to be implicated in the early phases of fibrosis development, vasculopathy and in immune tolerance abnormalities shared by all patients, although disease expression is heterogeneous. To date, no curative treatment is available. Even if immunosuppressive treatment or drugs acting on vascular system are proposed for some patients, overall, treatment efficiency remains modest. Only autologous hematopoietic stem cells transplantation, reserved for patients with severe or rapidly progressive fibrosis, has recently demonstrated efficiency, with lasting regression of fibrosis. Nevertheless, this treatment can expose to important, life-threatening toxicity. In the last decade, new mechanisms implicated in the pathogenesis of systemic sclerosis have been unraveled, bringing new therapeutic opportunities. In this review, we offer to focus on recent insights in the knowledge of systemic sclerosis pathogenesis and its implication in current and future medical care.     

Une complication exceptionnelle de la maladie ulcéreuse: la fistule gastrojéjunocolique

Since the recent advances in medical therapy and the eradication of Helicobacter pylori, gastrojejunocolic fistula has become an exceptional complication of anastomotic peptic ulceration. We report two cases of postoperative gastrojejunocolic fistulas (after duodenal ulcer surgery), who both initially presented with diarrhea, malabsorption syndrome and an impaired general condition. Both patients underwent one-stage en bloc resection, and their postoperative course was uneventful.     

Impact de la maladie parodontale sur la pression artérielle des souris diabétiques

Diabetes-driven cardiovascular diseases represent a high challenge for developed countries. Periodontal disease is strictly linked to the aforementioned diseases, due to its Gram negative–driven inflammation. Thus, we investigated the effects of periodontal disease on arterial pressure during the development of diabetes in mice. To this aim, C57BL/6 female mice were colonized with pathogens of periodontal tissue (Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum) for 1 month, whereas another group of mice did not undergo the colonization. Subsequently, all mice were fed a high-fat carbohydrate-free diet for 3 months. Then, arterial pressure was measured in vivo and a tomodensitometric analysis of mandibles was realized as well. Our results show increased mandibular bone-loss induced by colonization with periopathogens. In addition, periodontal infection augmented glucose-intolerance and systolic and diastolic arterial pressure, parameters already known to be affected by a fat-diet. In conclusion, we show here that periodontal disease amplifies metabolic troubles and deregulates arterial pressure, emerging as a new axis of metabolic investigation.     

La pancréatite aiguë au cours de la rectocolite ulcérohémorragique : complication rare de la mésalazine

Acute pancreatitis secondary to mesalazine is rare. Thirty-nine cases were described. We report a new case of pancreatitis during treatment of distal ulcerative colitis (UC) with mesalazine in a 38-year-old woman, without alcohol consumption. Treatment with enema and oral mesalazine was started. One week later, the patient was admitted for pancreatic epigastric pain; lipasemia was raised to threefold the upper normal limit. Ultrasound and abdominal CT scan showed an enlarged heterogeneous pancreatic head without Wirsung or biliary ducts abnormalities; treatment was stopped with regression of symptomatology as well as normalization of lipasemia after 10 days. Acute pancreatitis secondary to mezalasine is a rare side effect in the treatment of chronic inflammatory bowel diseases. This diagnosis must be evoked in any patient receiving mesalazine and presents pancreatic epigastric pain after excluding other causes of pancreatitis, particularly autoimmune etiology.