Dilatation kystique du cholédoque et maladie de von Recklinghausen

A choledochal cyst is rare, occurring mostly in childhood. Clinical symptoms are non-specific. CholangioMRI had proved her great values in the classification of the disease. The treatment is surgical. We report the rare case of a 45 year old woman with a choledochal cyst, associated with von Recklinghausen syndrome.     

L’allergie aux vaccins associés chez l’enfant. Une étude de 30 cas fondée sur les tests cutanés à lecture immédiate,semi-retardée et retardée,sur les dosages des anticorps spécifiques et sur les injections de rappel

Skin tests (prick and intradermal) were performed with vaccines containing diphtheria, pertussis, tetanus, polio and Haemophilus influenzae type b antigens (D.P.T.Pol.Hib), and with selected components of the vaccines in 30 children reporting reactions suggestive of allergy to these vaccines. Serum-specific IgE and IgG against components of the vaccines were also studied. Immediate responses in skin tests and specific IgE determinations strongly suggested the diagnosis of immediate-type hypersensitivity to tetanus or diphtheria toxoids in ten children (33.3%), including four of the six children with anaphylaxis, and six of the 16 children with urticaria and angioedema. In the other 20 children, immediate, semi-late and late responses in skin tests and specific IgE determinations were negative. Booster immunizations were given with monovalent or bivalent vaccines in 14 of these children, and were well tolerated. Our results suggest that most large local reactions and mild to moderately severe generalized skin reactions to multivalent vaccines are not allergic, but instead result from a nonspecific inflammatory reaction. However, our results show that toxoids may induce immediate-type hypersensitivity reactions in children, and suggest that skin tests with vaccines and vaccine components, and the determination of specific IgE against vaccine components, are of diagnostic value in children with anaphylaxis, and immediate and accelerated urticaria and angioedema induced by booster injections of multivalent vaccines.     

Évaluation de la tolérance et de l’acceptabilité de l’endoscopie digestive haute chez 350 patients

Objective

Evaluating upper gastrointestinal endoscopy’s tolerance and acceptability

Patients and methods

It’s a prospective study conducted from January to April, 2009. Upper gastrointestinal endoscopy was performed by 2 physicians in 3 endoscopy units. Premedication using 5 mg of diazepam by intravenous injection or 2.5 mg of clonazepam and lidocaïne gel by oral route was done. The procedure was discussed and explained to all the patients and their consent obtained before the examination. A questionnaire assessed patient’s tolerance and acceptability at the end or on the 24 hours following the examination.

Results

Three hundred and fifty patients were included, among whom 204 women (58.3%) with a sex-ratio at 1.4. The average age was 37.2 years (extreme ages: 18 and 79 years). In term of the educational level 55% of the patients got school education. More than half (51.1%) of the patients experiencing upper gastrointestinal endoscopy for the first time, had not have any preliminary information. The provided medical information by the prescribers was not good quality in nearly three cases out of four (72.2%). A sedation was effective for 98% of the patients and the examination lasted less than 5 minutes in 96.3% of the cases. The tolerance was good in the majority of case (84.6%). The unpleasant manifestations were: anxiety (79.4%), throat pain (40%), nauseas (79.4%) and feeling of suffocation (18.8%). The acceptability of a later upper gastrointestinal endoscopy was 96% (83.7% of the patients who would wish to repeat the examination under the same conditions against 12.3% who would prefer an anesthesia).