Syndrome d’antidiurèse inappropriée (sécrétion inappropriée d’hormone antidiurétique)

The syndrome of inappropriate antidiuresis (SIAD; formerly the syndrome of inappropriate secretion of antidiuretic hormone) is the most frequent cause of hyponatremia. A strong association exists between mortality and hyponatremia, which reflects the severity of the underlying disease. In SIAD, hyponatremia is associated with normovolaemia but the assessment of extracellular volume can be difficult. Clinical features are mainly neurological and can lead to death but mechanisms of adaptation can limit cerebral oedema. The notion of mild asymptomatic hyponatremia was questioned by the observation of subclinical neurocognitive impairment, a greater risk of falls and fractures. Aetiologies are classified into six groups: neurologic disorders, infections mainly cerebral, meningeal and pulmonary, drugs in particular antidepressants, tumors, genetic causes, and idiopathic. Symptomatic acute hyponatremia is a therapeutic emergency that is not specific of SIAD. When hyponatremia is asymptomatic, fluid restriction with salt intake is generally sufficient but urea can be an alternative. In chronic SIAD, there is currently no recommendation. Fluid restriction is not always feasible; urea has proved its efficacy, its good tolerance and its long-term harmlessness. Vaptans have demonstrated their good tolerance and their efficacy on the correction of hyponatremia from SIAD in studies subgroups, for moderate hyponatremia and asymptomatic patients. In the only study having compared vaptans and urea, efficacy and tolerance were similar. Because of the cost difference between vaptans and urea and while waiting for follow-up studies, urea appears at present as the first-line treatment of hyponatremia in SIAD.     

Intérêt du gemtuzumab ozogamicin dans les leucémies aiguës myéloïdes

Gemtuzumab ozogamicin (GO) is a humanized monoclonal antibody anti-CD33 conjugated with calicheamicin and was indicated for acute myeloid leukemia (AML) patients. It was initially approved in 2000 by FDA thank to promising results from a phase II trial including elderly relapsing AML patients. Numerous studies evaluated this treatment as salvage and frontline therapy in various regimens including associations with intensive chemotherapy. Based on the results from a randomized phase III trial, this agent was withdrawal because of no evidence for its benefit in terms of survival associated with excessive toxicity. Other phase III trials were then reported and show potentially better efficacy/toxicity profile. We review here the results of main trials interesting this agent, which is so far only available in a compassionate ATU program in France for the treatment of relapsing CD33+ AML patients.     

Evaluation of simple laboratory investigations to predict fatal outcome in infants with severe malnutrition presenting in an urban diarrhoea treatment centre in Bangladesh

Objective To evaluate rapid and simple laboratory investigations to predict fatal outcome in infants presenting with diarrhoea and severe malnutrition. Method Retrospective chart analysis of infants with severe malnutrition and diarrhoea with (cases) and without fatal outcome (controls) admitted to the Special Care Ward in Dhaka Hospital at ICDDR,B between May 2005 and April 2006. All infants (n = 61) who underwent bedside blood glucose, full peripheral blood count, serum C‐reactive protein (CRP), and serum electrolyte tests were included. Results In logistic regression analyses, after adjusting for all available potential confounders (abnormal WBC count, higher CRP level, hyponatraemia, hypokalaemia, hypocalcaemia, and hypomagnesaemia), cases (n = 10) were significantly associated only with hypoglycaemia (measured using a portable bedside finger blood glucose test) (odds ratio 5.0, CI 1.1–23.0, P = 0.039) on admission. Conclusion A simple rapid bedside glucose test may be used to predict the outcome of diarrhoeal infants presenting with severe malnutrition.     

Extracorporeal membrane oxygenation in adults for severe acute respiratory failure

The purpose of this review is to examine the indications of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS). This technique of oxygenation has significantly increased worldwide with the H1N1 flu pandemic. The goal of ECMO is to maintain a safe level of oxygenation and controlled respiratory acidosis under protective ventilation. The enthusiasm for ECMO should not obscure the consideration for potential associated complications. Before widespread diffusion of ECMO, new trials should test the efficacy of early initiation or CO₂ removal in addition to, or even as an alternative to mechanical ventilation for severe ARDS.     

Assistance ventilatoire par ECMO veino-veineuse pour résection d’aspergillome pulmonaire

Respiratory support using extra corporeal membrane oxygenation (ECMO) is rarely used in the setting of adult lung surgery, with the exception of lung transplantation. We report the case of a patient with pulmonary aspergilloma, for whom selective bronchial intubation was required to facilitate surgery. Intolerance to unilateral ventilation was anticipated due to poor underlying lung function. Intra-operatively, an attempt to lung exclusion was responsible for severe hypoxemia. The use of veno-venous ECMO allowed to improve oxygenation and lung resection was carried out successfully at the expense of major intra-operative bleeding.