Syndrome de Nicolau après infiltration de corticoïdes

We report three cases of Nicolau’s syndrome induced by intraarticular glucocorticoid injections. Nicolau’s syndrome is defined as livedo-like dermatitis secondary to acute arterial thrombosis occurring immediately after intravascular injection of an insoluble drug substance. The cases described by Nicolau occurred in association with injections of oily bismuth suspensions. In the 1970s and 1980s, cases occurred with delayed-action penicillin suspensions injected intramuscularly. Typically, the injection is followed immediately by excruciating pain in the buttock, sometimes with syncope. Cyanotic patches and a livedoid pattern develop. Rapid resolution of the pain and slower clearing of the skin changes occur in most patients. We report three typical cases with both severe pain and skin changes. In addition, two other patients had incomplete variants without skin abnormalities. Each of these five patients had received an injection in or about a joint of a glucocorticoid in a crystalline suspension. The pathophysiology of this syndrome probably involves acute vascular spasm related to penetration of microcrystals into a blood vessel.     

La posture de l’entre-deux des professionnels des secteurs médico-social et sanitaire et la coordination des parcours des jeunes en situation de handicap

In France, social and medico-social workers were impelled by the 2002 law to reconsider their work relationships with the parents of children with disabilities, as parents are now the core decision-makers in the disabled child's educational project. This paper aims to shed new light on the evolution of the professionals’ attitudes and roles as they were compelled to cooperate to a greater or lesser extent in the different stages of children's lives. This research aims to redefine the concept of ‘go-between’ position as it studies the medico-social coordination of the different kinds of support given to disabled children (0–6 years) and the follow-up of their academic and medical life trajectories. Two short videos were shot and screened during 7 table-round discussions to collect the opinions of 67 educational, health and social workers on the coordination of life trajectories. Our results focus on the main effects of the coconstruction: finding the right in-between position and attitude by paying attention to the sensitive points that can hinder the confluence, paying particular attention to thresholds and ways to crossing them, paying attention to how expectations in terms of reasoned involvement are expressed so as to work in an intermediary position without being intrusive and establish a relation of mutual trust.     

Les résidus de fabrication des hémodialyseurs diminuent la phosphorylation oxydative des mitochondries isolées de rat

IntroductionThe persistence of manufacturing waste in hemodialysers is a neglected aspect of lack of hemodialysis biocompatibility. The effect of waste was tested on mitochondria isolated from rat liver.Material and methodsAfter throwing the first two liters of the rinse solution of hemodialysers, the third liter is lyophilized. The waste is placed in the presence of mitochondria. The parameter V3 is the synthesis of ATP, the respiratory control (RC) is the ability to activate phosphorylation in the presence of ADP, ADP/O is the ratio of ADP used on oxygen consumption. The study was conducted on two hemodialyzers sterilized with gamma rays (Tricea and APS) and one hemodialyzer sterilized with flowing steam (FX60).ResultsThe respiratory parameters in the presence of waste are expressed as percentage of values obtained in the presence of control (sterile water). The respective values with Tricea, APS and the FX are for V3: 67 ± 14, 79 ± 10, and 81 ± 8% (T vs A p = 0.02; T vs F p = 0.01; A vs F p = 0.68) ; for CR : 44 ± 6, 63 ± 7, and 74 ± 9% (T vs A p < 0.001; T vs X p < 0.001; A vs F p = 0.004) ; for ADP/O : 75 ± 11, 90 ± 19, 91 ± 11% (T vs A p = 0.16; T vs F p = 0.01; A vs F p = 0.68). The dose-response curves confirm the differences concerning V3 and RC but not concerning ADP/O.ConclusionThe hemodialyzers contain waste which has toxic effects on isolated mitochondria. This waste impairs the oxidative phosphorylation. The fact that this waste is still present in the dialyzers despite rinsing with two liters should alert users about the importance of extensive rinsing and manufacturers about the importance of effective procedures in order to eliminate manufacturing waste.