L’insuffisance cardiaque à fraction d’éjection préservée : une maladie de système ?

When the syndrome of heart failure (HF) is due to left ventricular (LV) systolic dysfunction the clinical manifestations and natural history of the syndrome depend primarily on the severity of LV systolic dysfunction. In contrast, when the syndrome is attributed to LV diastolic dysfunction multiple comorbidities are responsible for the clinical manifestations and the natural history of the syndrome. The present review underscores the multifactorial pathogenesis of the syndrome of HF associated with LV diastolic dysfunction that nowadays is more properly referred to as HF with preserved LV ejection fraction (HFpEF) than to diastolic HF. The prognosis is similarly poor whether HF is due to systolic dysfunction or associated with diastolic dysfunction. The cause of death that is commonly non-cardiovascular in HFpEF supports the pathogenic importance of comorbidities in this condition. Hypertension, chronic kidney disease (CKD), diabetes, obesity and sleep disorder breathing are among the most frequent comorbidities in HFpEF. These comorbidities account for the multiple clinical presentations of the syndrome of HFpEF. Limited functional capacity is in HFpEF largely related to the downward spiral between CKD mediated fluid accumulation and LV stiffness as well as altered ventricular-vascular coupling. The diagnosis of HFpEF currently relies on 2D-Doppler echocardiography findings of impaired LV relaxation and increased LV stiffness and to a lesser extent on biomarkers. Owing to both lack of stringent inclusion and exclusion enrollment criteria and mistaken therapeutic target, placebo-controlled randomized therapeutic trials have been so far negative in HFpEF.     

Bronchiolite sévère à VRS et otite du nourrisson : premiers stigmates de la maladie allergique respiratoire ? À propos d'une observation

The observation of an infant having presented two severe respiratory syncytial virus (RSV) infections in the same winter with associated otitis media led us to consider virus-asthma relations in the child and middle ear place in the airway unit. Viruses (in particular RSV and rhinovirus) are indeed implied in 80% of asthma exacerbations in school-age children. Nevertheless, the role of viral respiratory infections in the genesis of asthma has not been clearly established. Severe RSV bronchiolitis requiring hospitalization seem associated with atopic asthma risk unlike less severe forms. RSV would be thus more revealing a particular susceptibility of the airways than a true etiologic factor. RSV cytopathic effect could indeed be facilitated by an epithelial susceptibility, primum movens of primary asthmatic remodeling. A new entity emerges within the airway unit: the middle ear. IgE sensitisation and wheezing recently seemed independent risk factors of otitis media with effusion. Epithelial infiltrate of the Eustachian tube and effusion located in the middle ear of the atopic patients, have Th2 profile. The "allergic oto-rhino-bronchitis" concept thus impose a total therapeutic approach of the airways of patients presenting with respiratory allergy, in particular otologic.     

Amyotrophie diabétique : intérêt de la corticothérapie ?

Diabetic amyotrophy or lombosacral radiculoplexus neuropathy is a rare complication associated with early-stage diabetes. Thigh pain, quadricipital amyotrophy, proximal weakness of lower limbs and weight loss are the main symptoms of the disease. As neurological damage is related to inflammatory microvasculitis, corticosteroid therapy may be considered as the first line therapy. We report a 54-year-old patient with type 2 diabetes affected with severe diabetic amyotrophy. Following intravenous corticosteroid therapy, the patient reported a rapid pain relief and gained muscle strength.     

Évaluation de l'influence des recommandations OMS–ARIA sur la prise en charge de la rhinite allergique en pratique de ville en France. Enquête ERNANI

Introduction

The WHO–ARIA allergic rhinitis recommendations are evidence-based.

Objectives

To determine the percentage of doctors who know and follow the WHO-ARIA guidelines and to evaluate their influence on medical practices.

Methods

A cross sectional analysis based on a questionnaire was performed between April and July 2005 on randomly chosen general practitioners (943) and ENT doctors (277).

Results

54.4% of the doctors claimed to know the WHO-ARIA guidelines. 4.7% knew but did not follow them. Patients whom doctors knew the guidelines benefitted more frequently (p < 0.0001) from an allergen search (42.2 vs 31.7%), a nasal endoscopy (38.3 vs 26.0%), a follow-up consultation (64.9 vs 52.6%) and written informations on rhinitis (30.7 vs 14.1%). There was no difference in terms of asthma search, first line treatment and duration of treatment.

Conclusions

When the WHO–ARIA guidelines are known by doctors (half), they seem to be followed. They favor: allergy testing, nose examination, repeat visit, written information but paradoxically do not influence search for asthma and first line treatment strategy and duration.     

Quoi de neuf en allergologie pédiatrique en 2005 ? Partie 2. Allergie respiratoire : épidémiologie (une revue de la littérature internationale d'octobre 2004 à octobre 2005)

Risk factors for asthma are genetic factors, parental history of atopy and asthma, conditions of pregnancy and delivery, maternal smoking and frequent use of paracetamol during pregnancy, personal history of atopy and infectious diseases of the respiratory tract, and in utero exposure to high levels of domestic pollutants. Farm children are less prone to develop asthma, except for children exposed to pigs during the first years of life. The impact of allergen exposure on asthma risk depends on allergens. As far as cat allergens are in concern, the risk of asthma is increased in children exposed to low to moderate levels, but decreased in heavily exposed children. However, this effect is highly variable from one child to another one. Allergic rhinitis is underdiagnosed and undertreated in asthmatic children, and increases the risk and the severity of asthma. Risks of asthma persistence and relapse are influenced by the timing, severity and persistence of early wheezing. A large number of young adults are in clinical remission but have persistent abnormalities of their respiratory functions, suggesting that these patients are at risk of subsequent relapse. Finally, several studies suggest the end of the asthma "epidemics" in most European countries. However, other studies show that, although declining in adolescents, the incidence of asthma is still increasing in young children.     

Fibrose rétropéritonéale et myélome multiple : association fortuite ?

We report a 59-year-old man presenting with retroperitoneal fibrosis (RF) associated with IgG lambda multiple myeloma. Recent clinical and immunohistochemical findings suggest that RF might be a particular expression of plasma cell/lymphoid dyscrasia, and that this association is not merely fortuitous. We review the pathophysiological evidence supporting this hypothesis.     

铭书;程安春;郭万柱;陈孝跃;四川农业大

物科技学院禽病防治研究中心,四川农业大学动物科技学院禽病防治研究中心,四川农业大学动物科技学院禽病防治研究中心 四川雅安625014,动物疫病和人类健康四川省重点