Release of nonesterified fatty acids during cerulein-induced pancreatitis in rats

During acute pancreatitis, data obtainedin vitro suggest that pancreatic lipase, acting on circulating or tissular triglycerides, might generate nonesterified fatty acids (NEFA) that could promote pancreatic and fat tissue necrosis. This work determined whether NEFA were actually producedin vivo in pancreatic tissue and in blood during cerulein-induced pancreatitis in rats. Intraperitoneal injections of cerulein induced pancreatitis. To promote the possible NEFA release by pancreatic lipase, a venous infusion of human very low density lipoprotein (VLDL) was used to cause hypertriglyceridemia. NEFA were measured in portal and aortic blood and in tissue extracts prepared from pancreas homogenates. NEFA did not increase either in peripheral or in portal blood. In pancreatic tissue, NEFA levels did not differ from controls. The major hypertriglyceridemia produced by human VLDL intravenous infusion neither altered the course of the disease nor promoted plasma NEFA release. The role commonly attributed to NEFA in acute pancreatitis seems questionable.Dr. Paye was the recipient of a scholarship from the Fondation pour la Recherche Médicale (Paris). Partial financial support of the work was provided by the Conseil Scientifique of Faculté X. Bichat and by Association Charles Debray.     

Angiotensin‐converting enzyme inhibitors‐induced angioedema treated by C1 esterase inhibitor concentrate (Berinert®): about one case and review of the therapeutic arsenal

C1 esterase inhibitor (Berinert^®) is generally used to treat severe attack of hereditary angioedema. We describe here the case of a patient who presented with a severe angioedema induced by angiotensin‐converting enzyme inhibitors (ACEIs) endangering her life. It could be successfully treated with that medicine.     

Temporomandibular joint model: anatomic and radiologic comparison between rat and human

Purpose

The temporomandibular joint (TMJ) is a complex anatomic structure with various pathologies as fractures, ankylosis or degenerative diseases. Few animal models already exist and the current study aims at demonstrating that rats’ TMJ could be considered as a model, using anatomic dissection and radiology.

Methods

Five adult Wistar rats were dissected to explore the soft and bone anatomy of the TMJ. Five more adult Wistar rats underwent a CT scan to measure size and angles of the condyle.

Results

The angles between the condyle and the mandible corpus were observed to be different both in the sagittal plane (150° vs. 125° in human) and the transversal plane (140° vs. 180°). The condyle axis is sagittal and drop-shaped and there is no anterior eminence in rats’ temporal fossa. However, the other anatomic structures proved to be quite similar.

Conclusions

The temporomandibular joints in human and rat are close and only few anatomic differences have been reported. Rats thus appear as an interesting and cheap alternative to model TMJ.     

Intérêt de l’échocardiographie trans-œsophagienne dans l’optimisation de la stratégie thérapeutique après un accident vasculaire cérébral ischémique

Aim of the study

In the setting of ischemic stroke, the place of transesophageal echocardiography (TEE) is still matter of debate. The aim of the study is to evaluate the therapeutic impact provided by TEE and to characterize patients in whom TEE is warranted.

Patients and method

Three hundred and fifty-nine consecutive patients were included in the study. “Decisive TEE” (DTEE) was defined by echographic findings resulting in a change of treatment, whereas “informative TEE” (ITEE) was defined by TEE revealing a potential cardiac or aortic source of embolism.

Results

Three hundred and forty-one patients underwent TEE. Twenty-eight patients (8.2%) had DTEE and 184 (53.9%) had ITEE. DTEE were as follows: thrombus in the left atrial appendage in 6 patients, complex aortic plaques in 10 patients, patent foramen ovale (PFO) associated with atrial septal aneurism (ASA) and an important right to left shunt (3 patients), FOP associated with ASA and lower limb phlebitis (1 patient), 4 cases of endocarditis and 4 patients with intense spontaneous echo contrast in the left atrium. In most cases of DTEE (67.8%), the patient was given anticoagulation drugs. Left atrial dilatation (P = 0.005) and multivessel territory stroke (P = 0.018) were statistically predictive of DTEE.

Conclusions

In the setting of ischemic stroke, TEE provides important additional informations, but modifies therapeutic strategy in less than 10% of cases. Multivessel territory stroke, and left atrial dilatation were predictive of DTEE.     

Clinical analysis and prognostic significance of haemophagocytic lymphohistiocytosis‐associated anaplastic large cell lymphoma in children

Haemophagocytic lymphohistiocytosis (HLH) has been rarely described in children treated for an anaplastic large‐cell lymphoma (ALCL). We evaluated the incidence, the clinical and histological characteristics and the prognosis of HLH associated‐ALCL. The medical, biological, cytological and histological data of patients treated for ALK‐positive ALCL in the paediatric department of a single institution between 1975 and 2008 were analysed and assessed for HLH according to diagnosis criteria of the Histiocyte Society. Data concerning a series of 50 consecutive children with ALCL were reviewed. HLH‐associated ALCL was observed in 12% of the patients. Lung involvement was significantly more frequent in HLH‐associated ALCL patients than in the group without HLH (P = 0·004), as well as central nervous system (CNS) and bone marrow involvement (P = 0·001 and P = 0·007 respectively). The histological subtype in children with HLH‐associated ALCL did not differ from that of the group without HLH. There was no significant difference between the two groups in 5‐year EFS and OS (P = 0·91 and P > 0·99 respectively). In conclusion, HLH is not rare in paediatric ALCL. Despite a high incidence of visceral, CNS and bone marrow involvement, HLH does not seem to exert a significant impact on outcome in children treated for ALCL.