La maladie thrombo-embolique veineuse au cours du purpura thrombotique thrombocytopénique autoimmun est associée à un traitement prolongé par échanges plasmatiques

IntroductionThrombotic thrombocytopenic purpura (TTP) is a devastating disease characterized by disseminated microvascular thrombosis. Despite pro-thrombotic predisposing conditions, the prevalence of macrovascular venous thrombosis event (VTE) in immune-mediated TTP (iTTP) has rarely been assessed.MethodsWe reviewed data of all iTTP patients of the French reference Center for thrombotic microangiopathies registry prospectively enrolled through a 10-year period, between 2008 and 2018. Venous thrombosis included either thrombosis of central venous catheter, symptomatic deep venous thrombosis of the limbs or pulmonary embolism.ResultsForty-eight (12.7%) VTE were diagnosed. VTE was diagnosed after a median time of 7 [IQR, 3–16] days following the first therapeutic plasma exchange (TPE) and consisted mainly in catheter-related thrombosis (73%), and to a lesser extend symptomatic deep venous thrombosis (16%), proximal pulmonary embolism (8%) and splanchnic vein thrombosis (2%). Cases with VTE (VTE + cases), required more TPE to achieve remission (P < 0.01), and the total volume of plasma required to achieve remission was larger (P < 0.01) than for VTE- cases. There was also a trend for more rituximab use in the VTE + cases as compared to the VTE- cases (47% vs 33%; respectively; P = 0.07). Curative anticoagulation was started in 38 cases (79%), while 6 VTE cases did not receive any antithrombotic agents, and catheter was systematically removed when catheter-related thrombosis was diagnosed. VTE + cases had a higher number of inserted central venous catheters than VTE- cases (P < 0.05).ConclusionVTE is a frequent condition occurring during iTTP management and is observed when patients require a prolonged treatment with daily TPE and multiple catheter insertions. Therapeutic strategies aimed at reducing the duration of TPE treatment in iTTP should substantially reduce this complication.     

Pollution atmosphérique et troubles du rythme cardiaque : une étude rétrospective

IntroductionAccording to many studies, exposure to air pollution increases cardiovascular morbidity and mortality. It has also been shown that the frequency of heart rhythm disorders in Region wallonne is very high.ObjectivesThe objective of this study is to test the hypothesis of a link between rhythm disorders measured by cardiac holters and data from devices measuring the concentration of air pollutants present in ambient air.MethodologyThe health data were obtained via the Erasme hospital's cardiology center. This is a retrospective data collection over the last 2 to 5 years. The environmental data are: PM2.5, PM10, NO2, O3 and temperature. The statistical models were based on “cross-case” analyses.ResultsAn association between PM10 and the number of ESAs was observed. An increase of 10 μg/m³ of PM10 increases the number of ESAs by 20% (P = 0.040). The number of ESAs increases with age (63% more ESAs when age increases by 10 years). A history of intervention also decreases the number of ESAs (−35%), the same phenomenon is observed for pacemaker wearers (−66%). The strongest association observed between NO2 and ESA with an OR of 1.37 (P = 0.027) in the final model. No significant association was observed between the effects of air pollution and VPCs.ConclusionOur analyses resume the effects of the different pollutants on rhythm disorders, the effects adjusted for treatment and co-morbidities. They open the door to other more refined studies based on individual measurements.     

Les maladies digestives dans un service de médecine à Madagascar: étude rétrospective

Aim

To list digestive diseases encountered at the Department of Gastroenterology, University Hospital of Antananarivo in aim to assess morbidity and mortality rate.

Materials and methods

A retrospective study of patient??s files including digestive diseases was conducted between the 1^st January 2007 and 30^th June 2009.

Results

Digestive diseases have represented 16,03% of all admissions. Three hundred twenty eight cases of digestive diseases were recorded corresponding to 276 patients. Men were more frequent between 30 and 70 years old (n = 139; 42,37%). Cirrhosis was the main pathology (n = 110; 33,54%) followed by duodenal ulcers (n = 9; 9,76 %). Cirrhosis was responsible of the highest mortality rate (n = 25; 22,73%).

Conclusion

Digestive diseases are frequent in a department of medicine in Madagascar. Amongst digestive diseases, cirrhosis is the most frequent and is responsible of high mortality rate.     

Méningo-encéphalites : étude rétrospective sur 4 ans au CHRU Bretonneau de Tours

Introduction

Meningoencephalitis (ME) are central nervous system inflammations with many etiologies. The etiology remains unknown in nearly half of the cases. The last French study was performed in 2007. Besides some rare or emerging causes, such as limbic ME, which are curable, infectious ME are the most frequent. Long term ME outcome remains partly known. The study objectives were to assess etiologies and outcome of ME in a University hospital between 01/01/2011 and 31/12/2014.

Cytopénies auto-immunes associées au lymphome de Hodgkin : étude rétrospective monocentrique

IntroductionHodgkin's lymphoma (HL) is less common than non-Hodgkin lymphoma and is rarely associated with autoimmune cytopenia.MethodWe report a consecutive, monocentric and retrospective series of HL patients diagnosed with concomitant or subsequent autoimmune cytopenia over a period of 8 years.ResultsWe report 4 out of 84 HL patients (4.8%) diagnosed with autoimmune cytopenia (4 immune thrombocytopenia including 2 Evans’ syndromes). They were 4 males (average age 24 years for the 3 youngest, and one over 60 years old). Autoimmune cytopenia revealed lymphoma in 2 patients and occurred after HL treatment in the two other patients (5 and 36 months from the end of chemotherapy) without HL relapse. All cytopenias were resistant to conventional treatments (glucocorticoids, intravenous immune globulin, rituximab) and sensitive to chemotherapy when indicated for HL treatment.ConclusionIn our series, the predominance of males, a higher frequency of immune thrombocytopenia than autoimmune hemolytic anemia, the resistance to usual treatments and the efficacy of specific chemotherapy were consistent with the literature. Unexpectedly, patients were young and with nodular sclerosis morphology (vs. mixed cellularity) in 3 of 4 cases.