Stress et auto-immunité

The etiology of auto-immune disorders is multifactorial. Stress is probably a participating factor. Indeed, a high proportion of patients with auto-immune diseases report uncommon stress before disease onset or disease flare. The biological consequences of stress are increasingly well understood. Glucocorticoids and catecholamines released by hypothalamic-pituitary-adrenal axis during stress will alter the balance Th1/Th2 and the balance Th17/Treg. Stress impairs cellular immunity, decreases immune tolerance and stimulates humoral immunity exposing individuals to autoimmune disease among others. The treatment for autoimmune disease should include stress management.     

Axe I,Axe II ou Troubles mentaux et Troubles de la personnalité

Objectives

Since the publication of the third edition of the American classification the Diagnostic and Statistical Manual of mental disorders (DSM-III), psychiatric clinical syndromes and personality disorders appear in two distinct axes, axis I and II. In the fifth revision of the manual (DSM-5), published in May 2013, this distinction no longer exists and personality disorders now appear among other mental disorders. The aim of this paper is to try to pinpoint the clinical and epistemological stakes therein.

Method

The particular interest of this distinction was to attract the attention of the practitioners on the personality of the patients, independently of their psychiatric diagnoses. However today, its scientific justification appears insufficient. Numerous arguments are in favour of a continuity between the two axes and the nosographical reorganisation of anxiety, depression and personality disorders. This clarification summarises the principle tendencies that have emerged over the past ten years regarding the classification of personality disorders, with increasing dissatisfaction with the traditional categorical model and a growing interest in a dimensional perspective. These tendencies are illustrated by the recommendations drawn up by the DSM-5 task force on personality and personality disorders.

Results

The criticisms of the scientific world regarding theses recommendations have been strong. This article summarises the main arguments developed here and there, and the evolution of the task force's reflections up to the final decisions that were published in December 2012. No real consensus exists on the best dimensional model to be retained; even if the system most studied is, without doubt, the five-factor model, known as the ‘Big Five’.

Discussion

This system was studied above all in psychology, and its applicability to psychopathology, which could obviously be envisaged, requires adjustments and further validation studies before being finally adopted.

Conclusion

The return to a single axis perspective for personality disorders also justifies in depth reflection on the limits of normality and on the general definition of a mental disorder that has never been the subject of a true consensus in our profession.     

Modulation de l’axe hypothalamo-hypophyso-surrénalien par l’utilisation des agents hypnotiques dans le contexte chirurgical

During stress, the relationship between the central nervous system and the immune system is essential to maintain homeostasis. The main neuroendocrine system involved in this interaction is the hypothalamic-pituitary-adrenal axis (HPA), which via the synthesis of glucocorticoids will modulate the intensity of the inflammatory response. Anaesthetic agents could be interacting with the HPA axis during surgery. Although etomidate currently remains in the center of the discussions, it seems, at least experimentally, that most hypnotics have the capacity to modulate the synthesis of adrenal steroids. Nevertheless, with the large literature on this subject, etomidate seems to be the most deleterious hypnotic agent on the HPA axis function. Its use should be limited when HPA axis is already altered.     

La réalité virtuelle : retombées thérapeutiques sur l’ajustement de l’axe corporel chez les enfants infirmes moteurs cérébraux

Through the practical physiotherapy rehabilitation activities at the cerebral palsy children, the physiotherapists are opposed to major problems which represent the rectification the body spine with all the complications related (orthopaedic deformities, problem of equipment's installation, respiratory complications). This work is a result of a case study made at the end of the master's degree II in Sciences of the motricity was carried out at the laboratory of neurophysiology and biomechanics of the movement at the ULB.

Life threatening chop injuries to the head: Optimising injury interpretation using three dimensional computerised tomography (3DCT) reconstruction of pre-treatment imaging

Computerised tomography (CT) is being increasingly advocated to support post mortem investigation of death but the value of using CT data already captured during emergency imaging, prior to treatment of life threatening injuries, remains under recognised and inadequately explored. We demonstrate the value of three dimensional computerised tomography (3D CT) reconstructions of such data, in interpreting the injuries sustained by a male who survived after being subjected to an assault with an axe and whose surface injuries had been debrided and sutured, before any photography was undertaken. The 3D CT images captured most of the scalp, face and skull vault trauma prior to the surgical intervention. Taken with other evidence, this indicated that the victim had received at least four separate blows to the face and head with a sharp chopping weapon; evidence which proved to be centrally important in the subsequent criminal court proceedings. This case also illustrated the effectiveness of joint interpretation of 3D CT reconstructed images in medico-legal casework, by experienced consultants in forensic pathology and radiology and the potential value of reviewing emergency pre-treatment CT imaging in any serious head injury allegedly sustained in an assault. This is likely to be particularly valuable when sharp or blunt weapon damage to bone is suspected.