Recurrent pericarditis revealing a systemic sarcoidosis

Introduction

Sarcoidosis is a systemic granulomatous disorder of unknown cause, mainly involving the lung and the mediastinum. Involvement of the pericardium and peritoneum is rare, but can be the first manifestation of the disease.

Case report

A 55-year-old female patient was followed-up for a recurrent “idiopathic” pericarditis. Diagnostis was challenged when she secondarily presented with enlarged hilar and mediastinal lymph nodes associated with pulmonary “nodules”. Imaging with ¹⁸F-FDG positron emission tomography with computed tomography showed multiple hypermetabolic foci in the mediastinum and peritoneum, which suggested a malignant disorder. Finally, histopathological evaluation of the peritoneal nodules revealed a sarcoidosis. A corticosteroid therapy was initiated and disease course was favourable.

Conclusion

This case report highlights the importance of a unique explanation for a patient presenting with recurrent pericarditis associated with a systemic disease. Although rare, sarcoidosis should be discussed and diagnostic procedures should be performed to obtain histological confirmation.     

Check-list "Patient Safety" in the operating room: one year experience of 40,000 surgical procedures at the university hospital of Nice

Objectives

The implementation of the check-list “Safe surgery saves live” (CL) has proven effective to reduce morbidity and perioperative mortality. Since 1st January 2010 it is a requirement of the HAS as part of the process of certification of hospitals. The CL has been established on all the operating rooms of our hospital after the onset of a near accident.

Methods

The CL has been computerized to facilitate its adoption by professionals. An internal benchmarking was immediately implemented to allow each surgical specialty to benchmark themselves with other teams. We conducted an audit concerning the CL and periodic assessments in order to learn more precisely concerning the expectations and feelings of medical and nursing teams.

Results

Nearly 40 000 CL were collected in the patient record. The completeness of information of some items seems to reflect the difficulty for professionals to realize the difference between traceability and information sharing within the team on the implementation of a protocol. This audit has confirmed the difficulty in sharing information orally.

Conclusions

The CL is involved in developing a safety culture in the operating room and led to the establishment of a risk mapping in the operating room and the recovery room and participation in the program error prevention procedure and surgical site through international program “High 5s” whose purpose is to improve the safety of care.     

Epstein-Barr virus and multiple sclerosis

This review of the considerable evidence linking Epstein-Barr virus (EBV) infection to risk and disease progression in multiple sclerosis (MS) builds on the background to the virus and its interactions with the human host available in the online supplement (see supplement, available online only). The evidence for a similarity in the geographic patterns of occurrence of MS and EBV infection (with infectious mononucleosis or EBV specific serology used as surrogate markers), when reviewed critically, is very limited. There is strong evidence however that people with MS are more likely to report a past history of infectious mononucleosis (thought to represent initial EBV infection at an older age), and higher titres of EBV specific antibodies are associated with an increased risk of developing MS. Elevated levels of the latter are apparent many years before MS onset (compared with non-MS controls) and there is a dose-response relationship between MS risk and antibody titre, with antibodies to the EBV nuclear antigen-1 particularly important. The evidence in relation to EBV DNA load in blood or CSF is conflicting, as is that in relation to T cell responses to EBV. Several hypotheses that have been proposed to explain the links between EBV and MS risk are reviewed and gaps requiring further research are identified.     

Conservative management as an initial approach for post-operative voiding dysfunction

Objectives

The management of voiding dysfunction after tension-free vaginal tape (TVT) remains controversial. Timing of surgical intervention is debatable and the role of conservative management is not well researched. This study aims to determine whether self catheterisation is an effective first line management option for these patients.

Study design

389 women underwent a TVT operation over a five year period. Twenty-two (5.6%) developed post-operative voiding dysfunction. Twenty women commenced CISC and their progress was monitored by recording voided volumes and residual urine volumes in a voiding diary and uroflowmetry. Residual volumes of less than 100 ml s were considered normal.

Results

Voiding function returned to normal with self catheterisation in 72% of patients and of these, 85% were cured in less than 12 weeks.

Conclusion

CISC is a suitable and effective initial approach to managing the majority of cases of voiding dysfunction and avoids the risks associated with further surgery, including the recurrence of stress incontinence.     

Pregnancy after breast cancer: an update

Breast cancers account for one third of cancer patients of childbearing age. Given the trend for women to delay childbearing, many of them will not fulfill their parental project at diagnosis of a potential breast cancer. Thus, planning pregnancies in young patients with a history of breast cancer is increasingly becoming a common situation. In this difficult context, several issues have to be discussed with the patient, such as post-chemotherapy premature ovarian failure, fertility-sparing techniques, risk of cancer recurrence or optimal time between cancer and future pregnancy. Potential obstetrical complications, long-term teratogenicity of anti-cancer drugs or breast-feeding are another points that have to be discussed with the patient and her husband. The aim of this updated review of literature was to provide answers to the numerous questions that may be encountered in this type of highly difficult situation. Thus, planning a pregnancy in breast cancer patients seems to be possible with, in one hand, a multidisciplinary approach in order to answer different questions and to avoid side effects of chemotherapy. In the other hand, a close and specialized obstetrical monitoring should be proposed in order to anticipate potential obstetrical complications.     

Microbial exposure, interferon gamma gene demethylation in naïve T-cells, and the risk of allergic disease

The period of immune programming during early life presents a critical window of opportunity for the prevention of allergic diseases. There is mounting evidence that inappropriate immune programming may involve disruption of specific epigenetic modifications (switches) at immune-related genes. This novel area of research has great potential, as epigenetic changes are known to be sensitive to environmental factors and may therefore provide a mechanistic link for the observed association between specific environmental cues, faulty immune development, and the risk of allergic disease. In addition, the dynamic and potentially reversible nature of epigenetic modifications offers potentially novel targets for therapeutic and/or preventative interventions. We review the evidence that (1) failure to up-regulate the interferon gamma (IFNγ) response during infancy is an important determinant of the risk of allergic disease, (2) expression of the IFNγ gene in naïve T-cells is regulated by epigenetic mechanisms, and (3) failure to up-regulate IFNγ gene expression of naïve T-cells associated with low early life microbial exposure. Taken together, these lines of evidence suggest that low microbial exposure during early life increases the risk of allergic disease by reducing demethylation (activation) of the IFNγ gene of naive T-cells.     

Quantitative real-time PCR analysis and microarray-based RNA expression of HER2 in relation to outcome.

BACKGROUND: Our aim was to use quantitative real-time PCR (Q-PCR) and RNA expression profiles (RNA-EPs) to investigate HER2 status in relation to outcome. PATIENTS AND METHODS: Cut-off levels for Q-PCR and RNA-EP were established in relation to immunohistochemistry (IHC) validated by FISH in a test set of frozen tissue samples from 40 primary breast cancers. The HER2 status was subsequently studied in another validation set of 306 tumors, where Q-PCR and RNA-EP results were compared with previously carried out IHC that we had validated by chromogenic in situ hybridization (CISH). RESULTS: Q-PCR and RNA-EP offered similar sensitivity (90% versus 77%), specificity (93% versus 95%), and negative (99% versus 98%) and positive (63% versus 61%) predictive values for HER2 determinations. Analyses of relapse-free survival (RFS) and overall survival on the basis of 5 and 10 years of follow-up indicated equivalent hazard ratios for all three techniques. In contrast to IHC/CISH, both Q-PCR and RNA-EP analyses of HER2 also gave statistically significant results regarding RFS and breast cancer-corrected survival after 10 years of follow-up. CONCLUSION: The use of RNA-EP and Q-PCR to analyze HER2 in frozen and formalin-fixed breast cancer samples may be an alternate approach to IHC in combination with FISH/CISH.     

Peripartum cardiomyopathy in a patient with hyperprolactinaemia.

The clinical course of a patient with peripartum cardiomyopathy and hyperprolactinaemia is described. Hyperprolactinaemia may be a factor in this patient''s heart failure.