Quoi de neuf en allergologie pédiatrique en 2000 ?Revue de la littérature internationale dˈoctobre 1999 à octobre 2000

The relation between maternal and childhood atopy may result from an increased intrauterine Th2 environment and high levels of Th2 cytokines in the milk of atopic mothers. The value of in vitro tests for early prediction of atopy is low, but high levels of eosinophil-derived proteins in nasal secretions of neonates may predict respiratory allergy. The prevalence of respiratory allergy has decreased in children living in rural areas, especially on farms. This may be related to exposure to mycobacterias, but the development of allergic conditions is independent of tuberculin reactivity and history of tuberculosis infection; however, the prevalence of asthma is decreased in young adults infected by Mycobacterium tuberculosis during childhood. High levels of eosinophils in the blood of children with bronchiolitis predict the development of persistent wheezing and asthma. Inhaled, oral and intravenous corticosteroids do not prevent relapses of bronchiolitis and persistent wheezing, but early hyposensitization has long-term beneficial effects on asthmatic symptoms. Results of prick-tests and specific IgE determinations are correlated with the severity of food allergy, and several studies confirm the diagnostic value of patch-tests with foods in children with atopic dermatitis associated with food allergy. Interesting cases of unexpected food allergies are reported (carob-induced anaphylaxis, and exercise-induced anaphylaxis to snails). Finally, children with spina bifida demonstrate a progressive sensitization to latex, in spite of a latex-free environment after the first surgical procedure(s), and the gelatin included in vaccines is highly immunogenic and allergenic.     

Quoi de neuf dans les hypophysites ?

Hypophysitis is a rare disorder. As clinical manifestations and radiologic signs are non specific, the diagnosis is difficult. Pathogenesis of hypophysitis remains largely unknown but new histological and etiological variants have been recently reported. Primary hypophysitis is the main form. For the first time, hypophysitis in ANCA-associated vasculitides has been reported. An entity of IgG4 related plasmatic hypophysitis has been described and well-defined diagnostic criteria have been proposed. Monoclonal antibodies directed against the cytotoxic T-lymphocyte antigen-4 (CTLA-4), investigated in metastatic cancer, can induce hypophysitis. Several candidate pituitary auto-antigens have been described in the last decade, although none has proven to be useful as a diagnostic tool.     

Traumatismes de la rate dans le service de chirurgie générale du CHU Gabriel Touré

We have carried out a retrospective survey from January 1999 to December 2010, it has included all operated patients or not hospitalized for spleen traumatism at the general surgery service of training hospital Gabriel Toure. Our objectives were to determine the hospital frequency of spleen traumatism, describe the clinical and paraclinical signs and to analyze the treatment outcome. So, we have recorded 107 cases of splenic traumatisms, making 15.3% of abdominal traumatisms and 1.1% of abdominal emergencies, the average age was 23 year ±4–85, the sex ratio at 2.68. The etiology was dominated by road accidents with 80 (74.8%), followed by the fall off trees 12 (11.2%) The scuffles 10 (9.3%), the sport accidents 4 (3.7%) and one case from animal horns; the traumatism was closed 99% of cases, and located at left hypocondrium in 89.7% of cases. The average admission delay was 1.68 H, and the abdominal pain was diffuse in 80.3%. 86 (80.3%) patients were haemodynamically unstable, 44 (41.1%) had anemia. The splenic lesion was identified in 77.5%. According to Moore 58 (54.2%) were classified grade IV. The treatment was non-surgical in 21(19, 7%) of patients, the splenoraphy in 20 (18.6%) and the splenectomy in 63 patients (58.9%); the blood transfusion has been done in 44.9% of patients. We have noticed 4 (3.7%) parietal abscess. One evisceration, 5 (4.7%) fatalities. The average hospitalization duration was 8.7 days. Conclusion: spleen traumatisms are frequent in youth; the non-surgical treatment is the gold standard.     

Impact du risque coronarien et de l’hypertension sur le risque rénal en population générale

IntroductionAbnormal albuminuria (≥ 30 mg/g) and low estimated glomerular filtration rate (eGFR < 60 mL/min/1.73m²) not only are renal risk factors, but also cardiovascular and coronarian risk factors. Though, the relation between coronary risk and renal risk, and its interaction with insufficiently controlled brachial pressure (BP) is poorly described in the literature.Subjects and methodsWe realised a cross-sectional study on subjects 40 and older, having attended a medical exam in 11 IRSA centers between 2006 and 2010. Every subject filled a questionnaire, underwent biological analysis, and a clinical examination. eGFR and albuminuria were measured, and the 10-year risk of coronarian event was calculated (Laurier's equation)ResultsWe analysed 118 314 subjects, amongst whom 96 400 had no personal cardiovascular history. Amongst those, 9.1% had a 10-year coronary risk over 10%. There was a continuous relationship between coronary risk and renal risk: subjects with a risk above 15% had a significative risk of pathological albuminuria (OR: 6.87 [5.58–8.44]), and of low eGFR (2.26 [1.82–2.78]) compared to those with a risk under 5%. There was a continuous relationship between BP and renal risk, with a significative risk of pathological albuminuria (OR = 7.75 [6.69–8.96]) and of low eGFR (OR: 1.33 [1.09–1.60]) in subjects with BP greater than or equal to 180/110 mmHg, compared to those with normal BP.ConclusionIn the French population, 9.1% of subjects have a 10-year coronary risk above 10%. This risk is associated to abnormalities of the renal function. The relation between coronary risk and renal risk is continuous and dose-dependent, as is the relation between BP and renal risk.