Dysidrose : étude étiologique et apport des tests épicutanés

The etiology of pompholyx (dyshidrotic eczema) is a challenging diagnostic problem. The only established etiological link is between dyshidrosis and tinea pedis. Here, we report the results of a review of the causes of dyshidrosis in our patient population, focussing on allergic aspects. This was a prospective study carried out between June, 2003 and May, 2004. Epidemiological and clinical data were obtained for all the patients. They all had patch tests with the European patch test series. Sixty-two patients with pompholyx were included. Gender distribution was equal and the mean age of the patients was 31 years. Tinea pedis was reported in 35.5% of the patients. The patch tests were positive in 35.5% and relevant in 19% of the cases. The statistical analysis showed, on one hand, a significant relationship between gender and a positive patch test to nickel, and on the other hand, between work in a hot, wet environment and a positive patch test to chromium. These results revealed evidence of an increased frequency of tinea pedis and of sensitization to metals in patients with pompholyx compared to the general population. This suggests that in the development of pompholyx, sensitization to metals may be involved in a multifactorial process that includes both environmental and personal factors. However, we could not demonstrate a causal relationship between metal sensitization and pompholyx. Nevertheless, common factors might be involved in generating these two skin conditions.     

Une étude électrophysiologique complète reste nécessaire dans une cardiopathie évoluée symptomatique

Multiple mechanisms can explain a tachycardia associated or not with a heart disease. It is important to establish its origin, particularly if advanced heart disease is present, for the treatment. Complete electrophysiological study remains an important means of diagnosis. We report the case of a 39-year old man, who had a dilated cardiomyopathy since the age of 25 years and who complained of tachycardia. These symptoms were shown to be related to atrioventricular nodal re-entrant tachycardia at electrophysiological study and a specific treatment was indicated.     

Bronchite à éosinophiles

Eosinophilic airway inflammation may be encountered in asthma and in non asthmatic eosinophilic bronchitis, which is a recently identified and common cause of chronic cough. Non asthmatic eosinophilic bronchitis may be differentiated from asthma by the absence of airflow limitation and of bronchial hyperreactiveness (potentially reflecting the different localization of mast cells within the airway wall). Diagnosis is based on the confirmation of eosinophilic airway inflammation, usually by induced sputum, in the absence of other causes of chronic cough or of radiological and lung function abnormality. The cough is generally improved by inhaled corticosteroids. The long-term outcome is still not known; non asthmatic eosinophilic bronchitis may lead to the onset of fixed airway obstruction or asthma.     

Pollens et effets sanitaires : synthèse des études épidémiologiques

Allergic rhinitis grew up by threefold in French population in the last 25 years. In this context, we conduced a review on the relationships between pollens and health effects. Three fields are discussed: assessment of exposure in epidemiological studies, relationships between pollens and health effects, finally the results of the retained studies are presented. In epidemiological studies, population exposure to pollens is always done by outdoor stationary measurement. Relationships between aeroallergen concentrations and clinical effects are difficult to study because some factors as individual susceptibility, differences in the potential noxious effect of each allergen; lag between pollen and clinical effects, concentration limit that start up clinical effects and concentration limit for maximal effect; the successive productions and emissions of the different kinds of pollens; and multi-sensibility. Studying these relationship needs also to take into account several confounding factors such as: meteorological parameters, fungal aeroallergens concentrations; chemical air pollutants concentrations. Most of the epidemiological studies analyse the relationship between daily variations in pollen counts and daily variations in health effects quantified at individual levels in specific populations (panel study) or quantified at population levels (time-series). A review was already realised on studies published between 1978 and 1995 that examined the relationship between pollens and allergic rhinoconjunctivitis. Only 16 of the published studies had been retained (15 panels and one time-series). The conclusion of this work was that these studies showed associations between pollen counts and allergic rhinoconjunctivitis. But these associations could not be quantified and the dose-response curves could not be characterised because of inappropriate statistical methods and not taking into account confounding factors.In our review, nine studies that examined the short-term effect of pollen were retained for their good methodology (two of them are panels). Their results confirm associations between pollen counts and health effects and some of them succeed in quantifying the short-term effect of pollens on allergic rhinitis, allergic conjunctivitis and also asthma.     

Gastroentérite à éosinophiles

Purpose

Eosinophilic gastroenteritis is a rare and heterogeneous disorder characterized by eosinophilic infiltration of one or more layers of the gastrointestinal tract. Although it can involve any part of the gastrointestinal tract, the stomach and the proximal small bowel are the most common sites of involvement. Clinical features depend on which layer and site are involved. We report eight cases of eosinophilic gastroenteritis.

Methods

We conducted a retrospective review of consecutive adult cases diagnosed with eosinophilic gastroenteritis from 1990 to 2010. The diagnosis was established by histologic examination of endoscopic biopsy or operative specimen or by the presence of eosinophilic ascites.

Results

Eight patients (three men, five women) were diagnosed with eosinophilic gastroenteritis during the study period. Three out of the eight patients had a history of allergy. All patients had gastrointestinal symptoms. The most common symptoms were abdominal pain, vomiting, weight loss and ascites. Seven patients (87.5%) had hypereosinophilia. Seven patients had involvement of the subserosa and one of the mucosa. Four patients were treated with oral prednisolone. The symptoms in all the patients subsided within one month. The remaining four patients improved spontaneously. Four of our patients were followed-up for at least 2 months (11 to 68 months). A single patient presented a relapse.

Conclusion

Eosinophilic gastroenteritis should be suspected in patients having gastrointestinal discomfort along with peripheral eosinophilia. Definitive diagnosis requires histological demonstrations of eosinophilic infiltration of the gastrointestinal wall or high eosinophilic count in ascites fluid.