La Gamma-globuline chez le nourrisson et le prémature

Sans résuméSéminaire sur les Gamma-Globulines, gehalten im Dezember 1954 im Centre International de l'Infant in Paris     

Nouveaux outils d’évaluation du contrôle de l’asthme : le NO expiré et le NO nasal

Nitric oxide (NO) is present in the upper and lower human airways. Nasal and exhaled levels of NO can be determined by non-invasive techniques using chemiluminescence analysers. NO levels in the upper airways are 10–100-fold higher than in the lower airways. International recommendations for standardized measurement of nasal and exhaled NO have been published recently. Exhaled NO is increased in patients with untreated asthma, and this elevation reflects, at least partially, bronchial inflammation. Measurement of exhaled NO may be useful when the diagnosis is doubtfull and for differentiation from other causes of chronic cough. Nasal NO is usually also increased in asthma but this is related to the frequency of allergic rhinitis in asthmatic patients. However, in patients with nasal polyps and asthma, nasal NO is decreased in proportion to the extent of sinusoidal involvement. Levels of exhaled NO decrease rapidly in asthmatic patients treated with anti-inflammatory drugs. Further studies are needed to establish more precisely the place of exhaled NO measurement in monitoring the control of asthma, especially in comparison with other non-invasive markers of bronchial inflammation.     

The homeostatic rôle of bronchoconstriction

This article argues in favour of the hypothesis that the homeostatic r?les of bronchoconstriction are to retract the airway tree during expiration, and to assist in the expulsion of mucus from peripheral airways by increasing the velocity of outgoing air. In asthma, this function may be dangerously exaggerated because of the presence of unusually viscous airway secretions and the remodelling of airway walls.     

Lésions caustiques digestives : apport de l’endoscopie dans le diagnostic et le traitement dans le centre d’endoscopie du CHU Aristide Le Dantec

Abstract

Caustic injury in the upper gastrointestinal tract is particularly frequent in number of countries. Their main complication is esophagus stricture.

Objective

To study the provision of endoscopy in diagnosis and treatment of upper gastrointestinal tract lesions secondary to caustic ingestion in the universitary hospital Aristide Le Dantec.

Patients and method

It was about a retrospective study in the digestive endoscopy center of the universitary hospital Aristide Le Dantec over the period from January, 2007 till May, 2009. All patients addressed for ingestion of caustic substances were included. The age, sex, the circumstances of happening, the nature of the caustic, lesions as well as the endoscopic treatment were studied.

Results

50 patients were included (1,7 % prevalence). The sex-ratio was 1,9 (33 men) and the mean age 8,4 years (extreme 10 months-47 years old). Caustic soda was at issue in 68% of cases. Ingestion was accidental domestic in 90% of cases. Endoscopy was performed for a mean delay of 4 days (extreme 12 hours-45 days). There were acute esophageal Lesions in 23 cases classified according Di Costanzo classification (table 1). Esophagitis was at stage IIa (6 cases), IIb (11 cases), IIIa (5 cases) and IIIb (1 case). This esophagitis was associated with 2 cases of gastritis. Chronic lesions were represented by esophageal stricture in 25 cases associated with gastric stricture in 1 case. Endoscopic dilatation was performed in 18 patients. The mean number of sessions was 2 (1 session-7 sessions).

Conclusion

The caustic digestive lesions in the universitary hospital Aristide Le Dantec of Dakar are often accidental. Endoscopy plays an important role in diagnosis and treatment of lesions.     

Contr?le du rythme sinusal ou contr?le de la fréquence ventriculaire ?

Rhythm control or rate control are the 2 therapeutic strategies for atrial fibrillation (AF) management. Despite strong physiological and epidemiological data to support a rhythm control strategy, the results of the prospective studies, especially AFFIRM and RACE trials, did not demonstrate any superiority of a rhythm control versus a rate control strategy. The AF-CHF trial conducted in heart failure patients led to the same conclusions. In clinical practice, the therapeutic management is only driven by the patient symptoms. For rhythm control, antiarrhythmic drugs are still the first step before considering, in selected patients, ablative techniques. Treatment algorithms proposed in 2006 by the European society of cardiology are the references for patient management, treatment being individually optimized.     

Réaction anaphylactoïde post-BCG : le rôle du dextran ?

The authors describe the case of a 16-year-old male without any medical history who developed anaphylactic shock a few minutes after the injection of the intradermal vaccine BCG Pasteur. Chronology of events, lack of any other drug intake and the dramatic increase of serum tryptase level account for the anaphylactic reaction consecutive to vaccine injection. A few weeks after the accident, the allergic data donˈt reveal much. At this time, serum anti dextran IgG are significantly high (8 mg/L), suggesting the involvement of dextran in this severe adverse reaction.     

Nouveaux outils d'évaluation pour le contrôle de l'asthme : apport de l'expectoration induite

Asthma is an inflammatory disease of the airways, as demonstrated by bronchoalveolar lavage and bronchial biopsy. The diagnosis and monitoring of asthma are usually based on the results of pulmonary function tests. It has been demonstrated that examination of induced sputum is a non-invasive, reliable technique for monitoring bronchial inflammation in patients with asthma. Induced sputum reveals aspects of inflammation that are distinct from those measured by functional assessment. In particular, enumeration of eosinophils in induced sputum provides useful information on the status of an asthmatic patient, independent of functional tests, and can be repeated in the long-term follow-up of patients. Recent studies suggest that induced sputum can be used as a guide to therapy, with the aim of preventing exacerbations of asthma. Nevertheless, additional studies are needed to determine in which asthmatic populations induced sputum monitoring could be useful.     

Actualités dans le syndrome de Susac

Susac syndrome is a rare disease affecting mainly young women, characterized by a microangiopathy limited to the cerebral, retinal, and cochlear vessels. Although the pathophysiology of Susac syndrome is not yet fully elucidated, recent advances favour a primitive vasculitis affecting the cerebral, retinal and cochlear small vessels. Susac syndrome must be recognized in the presence of the pathognomonic clinical triad associating: 1/subacute encephalopathy with unusual headache and pseudopsychiatric features associated with diffuse white matter, grey matter nuclei and specifically corpus callosum lesions on brain MRI; 2/eye involvement that may be pauci-symptomatic, with occlusions of the branches of the central artery of the retina at fundoscopy and arterial wall hyperfluorescence on fluorescein angiography; and 3/cochleo-vestibular damage with hearing loss predominating at low frequencies on the audiogram. Relapses are frequent during an active period lasting approximately 2 years. Eventually, the disease resolves but isolated retinal arterial wall hyperfluorescence without new occlusions may recur, which should not lead to treatment intensification. First-line treatment consists of a combination of anti-aggregants and high dose corticosteroids. In refractory patients or in case of relapse, immunomodulatory molecules such as intravenous immunoglobulins or immunosuppressive drugs such as mycophenolate mofetil, cyclophosphamide or rituximab should be started. Unfortunately, sequelae-mostly hearing loss- remain frequent in these young patients.