Le dépistage ciblé de la pré-éclampsie au premier trimestre de la grossesse au CHU de Toulouse

GoalsPreeclampsia (PE) is a leading cause of maternal and neonatal morbidity and mortality. Early treatment by aspirin has been shown to significantly reduce PE risk before 37 weeks supporting the implementation of first-trimester screening.Subjects and methodsA targeted screening was recently implemented at Toulouse University Hospital for women in their first pregnancy or those with personal or familial history of PE. It uses Fetal Medicine Foundation (FMF) algorithm that combines maternal characteristics, clinical, biophysical and biochemical (PAPP-A, Pregnancy Associated Plasma Protein-A, and PlGF, Placental Growth Factor) data. We describe this first population of pregnant women and compare our results with those of a mini-test that excludes PlGF and biophysical data.ResultsBetween October 2016 and September 2017, 500 women have benefited from this screening. In such targeted population, we identified 3,6 % (n = 18) of women at high risk to develop PE before 34 weeks and 9,6 % (n = 48) of women at high risk to develop PE between 34 and 37 weeks. When we recalculated the risk using the mini-test, only 10 women (56 %) were identified at high risk of early PE.ConclusionFor the first time in France, we report the result of a targeted screening of PE during the first trimester using the FMF algorithm. We describe the screened population and show that it is more efficient than the mini-test.     

Contribution de la cytométrie de flux au diagnostic d’une allergie

For the laboratory investigation of allergic diseases, flow cytometric methods to detect leukocytes that have been activated by allergen in vitro have recently been developed. Cellular tests for the detection of in vitro-activated blood basophils are complementary to specific IgE determinations. After in vitro incubation with allergen, basophils are fixed and then labeled with anti-IgE antibodies, and activation is then identified with anti-CD63 or anti-CD203c monoclonal antibodies. Assays based on basophil activation complement the measurement of specific IgE. With some allergens, particularly in cases of drug-induced allergy, flow cytometry has greater sensitivity than specific IgE determination. However, high concentrations of drugs can induce cell toxicity, and this may be confused with basophil activation. Cytometry can also be used to explore allergies with a cell-mediated mechanism. The detection of cytokine synthesis in T cells and basophils incubated with allergen is now technically feasible, but the usefulness of this procedure in the diagnosis of allergy remains to be demonstrated. We believe that the application of flow cytometry to the investigation of allergy is likely to increase.     

Atteintes extrapancréatiques au cours de la pancréatite auto-immune: particularités et apport diagnostique

Autoimmune pancreatitis is a rare entity. It represents 2 to 5% of chronic pancreatitis. With clinical, biological, and radiological particularities, extra pancreatic features of autoimmune pancreatitis have a great value for diagnosis. Our study concerns 3 cases of autoimmune panreatitis. We will study the extrapancreatic features particularities and their diagnosic value. We report 3 cases (two men and a woman 55, 28 and 24 years-old) with autoimmune pancreatitis with jaundice or epigastrium pain, synchronous and metachronous extrapancreatic features. In 2 cases, these extra-pancreatic features included cholangitis with renal atrophy and retroperitoneal fibrosis in one case. In the last case, we found Crohn’s disease and Gougerot-Sjogren disease. IGG4 level was high in the three cases. The diagnosis was made radiologically (CT scan, MRI) in two cases and histologically after duodenopanreatectomy in one case. Corticoid therapy had constituted a diagnosis and therapeutic test in two cases and treatment for extra-pancreatic features in one case. The presence of synchronous or metachronous inflammatory lesions of the biliary tract, kidney, intestine or other during the auto-immune pancreatitis can guide the diagnosis of this rare and often misunderstood disease. Their knowledge can save the patient a surgical procedure allowing medical treatment with corticosteroids.