Syndrome des antiphospholipides « séronégatif » : mythe ou réalité ?

The antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by thrombosis and/or obstetrical manifestations and the persistent presence, at least 12 weeks apart, of antiphospholipid antibodies (aPL) such as lupus anticoagulant (LA) and/or anticardiolipin antibodies (ACL) and/or anti-β2 glycoprotein I antibodies (aβ2GPI). The finding of patients with clinical profile highly suggestive of APS but who are negative for conventional biological criteria has led to the concept of seronegative APS. In the last few years, new antigen targets and methodological approaches have been employed to more clearly identify this syndrome in patients with thrombosis or obstetrical complications without conventional aPL. Although seronegative APS is still controversial, there is increasing recognition of the existence of this subgroup. However, clinical relevance of non conventional aPL need to be confirmed by efforts toward standardizing new biological tools and longitudinal studies involving large cohort of patients.     

Agressivité du cancer gastrique chez le sujet jeune : mythe ou réalité ?

Introduction

Although gastric cancer (GC) is considered as a disease of middle-aged and elderly, 2%?C15% of patients with CG are younger than 45 years and especially among women. Until now, many epidemiological and clinicopathological characteristics of gastric cancer, including risk factors, were conducted in the elderly. However, in young, only a few studies with small samples have been conducted. Within each study the results of these studies were highly variable, which may be due to low statistical power.

Study purpose

We propose through this study a review of epidemiological, clinical and pathological characteristics of gastric cancer in young adults.

Materials and methods

It is a retrospective study including all patients sent to the hepato gastroenterology department of the University Hospital Hassan II for management of gastric adenocarcinoma gastric tumor between April 2001 and June 2010.We first described the demographic, clinical, endoscopic, histopathological, radiological treatments and also the outcome of gastric cancer in young patients and secondary we make a comparison with the characteristics of those over 45 years.

Results

Two hundred and three patients were included during this period. Patients aged under 45 accounted for 25% (n=50). There was a female predominance in this group of patients (p=0.05), familial forms were not more frequent (p=0.1). The location of the tumor does not differ between the 2 age groups (p=0.07). On the histological side Linitic form was more frequent in young adult (40%, p=0.01), they had more metastatasis at diagnosis (p=0.0001), mostly of peritoneal carcinomatosis (p=0.04).

Conclusion

In our study, gastric cancer remains uncommon in younger patients (25% of all gastric cancers). This frequency is certainly not explained by familial forms (only 1.5%). Linitic forms seem to be more frequent in younger patients, and carcinomatosis is much more common at diagnosis.     

Pleuroscopie virtuelle de la plèvre diaphragmatique: mythe ou réalité ?

PURPOSE: Evaluate the feasibility of the virtual pleuroscopy (VP) in the detection of the pleural plaques. METHOD AND MATERIALS: Twenty consecutive patients, having asbestos exposure, explored by unenhanced multidetector CT-scan (Siemens, Sensation 16). The imaging parameters were as follows: beam width, 12 mm; beam pitch, 1; and reconstruction thickness, 1mm every 0.8mm at 120 kV and 180 mA. The image display used a surface-rendering algorithm and produced perspective red-scale images with a matrix of 512 x 512. Each VP image simulated a coned-down view, with a variable cone angle to explore the diaphragmatic pleura. The camera was placed 1 to 2 cm above the diaphragmatic dome. Four views are studied by diaphragm: craniocaudal, lateral tangential, anterior and posterior. The observed virtual pleura aspect was classified in 5 groups (gr): gr 1: Rib band, gr 2: lobulated pleural thickening, gr 3: spicular, gr 4: plaques and gr 5: nodules. The results were compared to the other MDCT images using multiplanar reformatting. RESULTS: The visualization of each diaphragm was optimal (35/40; 87.5%), limited (3/40; round atelectasis and asbestosis) or impossible (2/40; asbestosis). The classifications of the studied 38 diaphragmatic pleura were: gr 1 (n=15), gr 2 (n=5), gr 3 (n=11), gr 4 (n=7), gr 5 (n=0). The MDCT analysis showed normal pleura for both gr 1 and gr 2, a confirmed or beginning of fibrosis for gr 3 and confirmed the presence of pleural plaques on the diaphragmatic pleura in all cases of gr 4. CONCLUSION: The virtual pleuroscopy is a reality. It is a feasible technique. Other studies are necessary to confirm these preliminary results.