Interactions entre les virus de l’immunodéficience humaine et de l’hépatite C

Introduction. — Prevalence of hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)-infected subjects is around 9%, varying according to the mode of contamination. Reciprocal interactions between the two viruses have to be evaluated.Current knowledge and key points. — HCV infection is usually associated with chronic hepatitis and detectable viremia in HIV-infected Patients. HIV infection enhances HCV replication, leading to more severe liver lesions and to a more rapid occurrence of cirrhosis. This underlines the need for both early diagnosis and therapy in order to avoid severe evolution of the liver disease.Future prospects and projects. — Even though the rate of long-term responses to interferon α is low, improvement may be expected from combined therapies, especially with combination including ribavirin. The impact of both antiretroviral triple therapy and accompanying immune restoration on natural history and treatment of HCV infection has to be assessed, as the above mentioned consensual conclusions may be modified in a near future.     

Toux chronique de l’adulte et reflux gastro-œsophagien

Respiratory manifestations represent one of the most prevalent and difficult to manage extra-esophageal syndromes of GORD. However, the relationship between reflux and respiratory symptoms such as chronic cough is frequently difficult to establish with a high degree of certainty. The causality of reflux in cough can be supported by several different pieces of evidence, including (1) a significant epidemiological association between GORD and respiratory symptoms, (2) a temporal relationship between cough occurrence and reflux episodes (as shown by pH or pH-impedance monitoring). The diagnosis of GORD is easily made if the patient complains of typical symptoms, such as heartburn and regurgitation, or if endoscopy shows unequivocal signs of esophagitis (i.e. mucosal breaks). However, in the case of GORD-related cough, the typical digestive syndrome is frequently absent, a situation corresponding to the so-called “silent GORD”. Reflux can induce chronic cough through different mechanisms including micro-aspiration and both local and central reflexes. Cough and reflux may precipitate each other. A meta-analysis found no significant difference between placebo and Proton Pump Inhibitors (PPI) in the resolution of cough. Encouraging results have been reported, following antireflux surgery in patients selected on the basis of pH-impedance monitoring. Future trials should concentrate on patient selection and the control of efficacy using recently developed technologies, such as pH-impedance monitoring.     

Amylose ostéoarticulaire et dysglobulinémie: à propos de deux cas

Amyloidosis of bone and joint related to plasma cell dyscrasia.We report two cases of bone and joint amyloidosis involvement related to plasma cell dyscrasia. The radiographie appearances mimic numerous benign or malignant diseases. MR imaging shows a diffuse low signal in TI and an heterogenous low or mild low signal in T2 weighted spin-echo sequence.     

Dénervation rénale dans le traitement de l’hypertension artérielle résistante : expérience du CHU de Lyon

Aim

We report the first experience of Lyon's university hospital regarding renal denervation to treat patients with resistant essential hypertension.

Patients and methods

Over a one-year period, 17 patients were treated (12 men, 5 women) with renal denervation. Baseline characteristics were as follows: age 56.5 ± 11.5 years, BMI 33 ± 5 kg/m² and ambulatory blood pressure 157 ± 16/87 ± 13 mmHg with 4.2 ± 1.5 anti-hypertensive treatment.

Results

We did not observe per procedural and early complications. After a median follow-up of 3 months and with the same anti-hypertensive treatment, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) decrease respectively of 20 ± 15 (P < 0.001) and 10 ± 13 mmHg (P = 0.014) (n = 17). After six months of follow-up, ambulatory blood pressure (ABPM) decrease of 17.5 ± 14.9 mmHg (P = 0.027) for SBP and of 10.5 ± 9.6 mmHg (P = 0.029) for DBP (n = 6). Among these patients, five of them were controlled (ABPM inferior to 130/80 mmHg) and electrical left ventricular hypertrophy indexes decreased: R wave in aVL lead of 4 ± 3 mm (P = 0.031), Sokolow index of 3 ± 3 mm (P = 0.205), Cornell voltage criterion of 9 ± 7 mm (P = 0.027) and Cornell product of 1310 ± 1104 (P = 0.027).

Conclusion

Our results are in accordance with data from other centers. On average blood pressure decreases significantly but important inter individual variations are observed. The procedure seems safe.     

Pénétration de l’approche radiale dans le monde et apprentissage de la technique

The transradial approach has been used for the first non selective coronary angiographies but was quickly replaced by the femoral approach until a new birth in 1989 for coronary angiography in 1989 and coronary angioplasty in 1992. Transradial approach use is extremely heterogeneous in the world, dominated by some countries in Europe, Canada, and eastern Asia (India, Taiwan, China, Japan).Risk factors of failure have been well described, allowing two kinds of learning: systematic attempt in all kind of patients when working with a proctor; patient selection when beginning the technique alone in order to get a high and stable success rate from the beginning. Systematic radial approach for coronary angiography is a must to learn the technique.     

Dénutrition et infection par le VIH

Nutritional disorders in HIV infected patients. The wasting syndrome is well known in HIV infected patients. Predominant free fatty mass deletion is achieved. The weight loss results from decrease of food intake, from gut disorders due to HIV or opportunistic infections. Metabolic disorders are reported too. Breakdown of carbohydrats and proteins presents energy source. Raised free fatty acid turn over and hypertriglyceridemia are reported. Polyinsatured fatty acid level is raised inducing free radicals increase. Free radicals delete immune functions (apoptosis). Vitamin and trace element decrease worsen negative effects of free radicals.     

Insuffisance rénale aiguë et infarctus cérébral au décours d’un traitement par immunoglobulines intraveineuses à fortes doses

Introduction. — Side-effects of immunoglobulins administered via the intravenous route are usually minor. However, acute renal failure and more rarely thrombotic events, including ischemic stroke, have been reported in association with immunoglobulin infusion. To our knowledge, no case of both acute renal failure and stroke following immunoglobulin has been described until now.Exegesis. — Two days after immunoglobulin infusion (2 g/kg), a patient who presented with autoimmune thrombocytopenia suffered severe acute renal failure associated with an ischemic stroke in the right anterior choroid artery territory. Moreover, the stroke worsened immediately following a second infusion (1 g/kg). Clinical and neuroradiological examinations were conducted.Conclusion. — Results indicate the need for both close monitoring of serum creatinine and diuresis before starting immunoglobulin therapy, and limiting the total dose to prevent thrombotic events such as stroke.     

Induction de tolérance orale aux aliments chez l’enfant : aspects pratiques

Specific oral tolerance induction (SOTI) to food is a new topical-therapeutic approach of food allergy. When successful, it improves significantly the patients’ quality of life. SOTI’s practical aspects for child are discussed from our recent experience concerning cow milk, hen’s egg and wheat. Family’s motivation and education are crucial questions to achieve SOTI correctly. A detailed information of possible side effects is essential.     

Les troubles du rythme supraventriculaires chez le nourrisson et l’enfant. À propos de six cas

Supraventricular tachycardia in infants are variable. We try to summarize clinical, electrical and treatment particularities of supraventricular arrhythmia in infants. The majority of infants with supraventricular arrhythmia have a good clinical outcome and an excellent prognosis and may not require chronic antiarrhythmic therapy if they had precocious treatment.     

Virus de l’hépatite B, manifestations extrahépatiques immunologiques et risque de réactivation virale

Hepatitis B virus (HBV) infection is frequent with about 400 million individuals infected worldwide. Extrahepatic manifestations may be observed in up to 20% of patients infected with HBV, in both acute and chronic infections. The best-described manifestations are polyarteritis nodosa and glomerulonephritis. Besides manifestations related to HBV, patients presenting with primary autoimmune disorders and infected with HBV may exhibit reactivation of hepatitis B during immunosuppressive therapy that may be life-threatening. This article focuses on autoimmune manifestations related to HBV and its treatment, and on the risk of reactivation of HBV hepatitis in patients with primary autoimmune disorders treated with immunosuppressive agents.     

Artérite de Takayasu: explorations vasculaires et prise en charge thérapeutique. Expérience à propos de 16 patients

Purpose. -- There is no consensus in regard to vascular explorations and therapeutical management of Takayasu's arteritis. The objective of this study was therefore to establish the most appropriate vascular explorations and to analyze current treatments.Methods. -- Clinical, biological and morphological findings related to either diagnosis or treatment were retrospectively evaluated in sixteen patients diagnosed with Takayasu's arteritis according to the American College of Rheumatology criteria.Results. -- Median delay between the occurrence of the first symptoms and the diagnosis was 9 months. Aortic lesions and aortic valvular incompetence were more frequent. Statistical analysis showed the existence of a correlation between the lack of relapse and corticosteroid therapy (Fisher exact test, P = 0,021). Percutaneous transluminal angioplasty led to stabilization of vascular lesions. Surgical management led to satisfactory results, except for patients with aortic lesions, as survival was then less than 1 year.Conclusion. -- Early diagnosis is mandatory in patients with Takayasu's arteritis in order to propose appropriate therapy, particularly corticosteroid therapy. Surgery and angioplasty prove to be useful in occlusive forms. Late diagnosis is accompanied by severe aortic lesions and fatal outcome.

Résumé

Propos. -- Dans le cadre de l'artérite de Takayasu, il n'existe pas de consensus concernant les explorations vasculaires et la prise en charge thérapeutique. L'objectif de notre étude était d'analyser chez 16 malades souffrant d'artérite de Takayasu les méthodes d'exploration les plus adaptées et les traitements employés.Méthodes. -- Seize patients atteints d'artérite de Takayasu selon les critères de l'American College of Rheumatology ont été évalués de façon rétrospective de 1975 à 1997, cliniquement, biologiquement, morphologiquement, sur le plan diagnostic et thérapeutique.Résultats. -- Dans notre série, la médiane de retard diagnostique était de 9 mois. L'atteinte aortique et valvulaire aortique était plus fréquente. Les résultats ont montré l'existence d'une corrélation statistiquement significative entre l'absence de rechute et l'emploi des corticoïdes (test exact de Fisher, p = 0,021). L'utilisation de l'angioplastie a entraîné une stabilisation des lésions. La prise en charge chirurgicale s'est montrée satisfaisante, en dehors des patients ayant une atteinte aortique pour lesquels la survie était inférieure à 1 an.Conclusion. -- L'analyse de notre série montre la nécessité d'un diagnostic précoce afin de proposer une thérapeutique adéquate, en particulier la corticothérapie. La chirurgie et l'angioplastie sont des recours efficaces en cas de forme occlusive. Les formes diagnostiquées tardivement comportent une atteinte aortique sévère dont l'évolution est le plus souvent fatale.