Utilisation des ballons actifs dans l’angioplastie coronaire : indications actuelles et perspectives

The paclitaxel-eluting balloon is an emerging percutaneous coronary angioplasty tool which aim is to prevent restenosis by delivering a high intravessel paclitaxel dose during balloon inflation. It has been already approved in the treatment of bare metal stent restenosis and is being investigated in drug-eluting stent restenosis. For the treatment of de novo lesions, it could be used alone or in combination with bare metal stent implantation. Most interesting results were obtained by a drug-eluting balloon alone strategy in small vessels angioplasty. Current and upcoming results of this evolving technology are reviewed.     

Purpura rhumatoïde de l’adulte

Henoch-Schönlein purpura is a systemic vasculitis of the small vessels characterized by perivascular leucocyte infiltrates. It is an immunoglobulin A-related immune complex-mediated disease involving the skin, the joints and the gastrointestinal system. Renal disease may sometimes be associated to these clinical manifestations. Prevalence of the nephritis is highly variable, depending on the series. More rarely, other organs such as the lungs, the heart or the nervous system may be involved. The clinical diagnosis is confirmed by histopathology of the skin (leukocytoclastic vasculitis) and kidney (endo-capillary proliferative glomerulonephritis), showing IgA deposits in these tissues. Short-term prognosis depends on the severity of digestive involvement, but long-term prognosis depends on the renal disease. Recent publications of pediatric and adult series show that the chronic renal failure may progress, sometimes more than ten years after the initial flare. Treatment is usually supportive. The benefit of more specific treatments (corticosteroids or immunosuppressive drugs) in severe visceral forms (usually abdominal or kidney) has not yet been established.     

Spontaneous rupture of uterine vessels during pregnancy, about three cases

Spontaneous rupture of uterine vessels during pregnancy is an exceptional event which remains little known by the gynecologists. Being given its important morbi-mortality, we wanted to make a reminder of this pathology through three cases arisen in the CHU of Grenoble. All patients experienced acute abdominal pain. In two cases out of three, birth followed vaginal delivery. No maternal death was deplored. Fetal prognosis remains poor, as one is dead among our three cases. Clinical signs are sensible but not specific. Early management requires efficient resuscitation then surgical haemostasis, and has to be teatched in order to improve its prognosis.     

Angiographie par résonance magnétique avec produit de contraste

L'utilisation de produits de contraste paramagnétiques en angiographie par résonance magnétique a donné à cette technique la possibilité de s'opposer comme substitut à l'angiographie conventionnelle ou numérique. Cependant, en dé[it d'améliorations angiographiques spectaculaires, l'obtention de ces images nécessite une technique d'acquisition rigoureuse. Une concentration homogène et suffisante de produit de contraste est indispensable pendant l'acquisition des lignes centrales du plan de Fourier pour obtenir un rehaussement vasculaire de bonne qualité. De ce fait, la dose et le débit d'injection de produit de contraste doivent être sougneusement adaptés à l'acquisition pour produire des angiographies suffisamment concentrées par rapport aux tissus stationnaires avoisinants. La synchronisation de l'acquisition à l'injection est essentielle et plusieurs solutions ont été proposées, comme la détermination du temps d'arrivée du produit de contraste par bolus préalable, ou l'utilisation de séquences ultrarapides permettant de s'affranchir de cette information. Ces séquences ultrarapides, obtenues en six secondes environ et répétées plusieurs fois dans le temps, permettent de capter le produit de contraste lors de son premier passage, de même que la synchronisation automatisée de l'acquisition au-delà d'un certain seuil de signal dans le vaisseau, ce qui rapproche la technique d'angiographie par résonance magnétique de celle de la tomodensitométrie spiralée.     

Splenic artery aneurysm rupture in late pregnancy: a case report and review of the literature

Haemorrhages during pregnancy may have a non-obstetrical origin, the pregnancy itself favoring some specific aetiologies because of pregnancy-related physiological modifications. These non-obstetrical haemorrhages are rare but are associated with a high maternal and foetal mortality. The prognosis depends on an early diagnosis and a multidisciplinary approach. We report the case of a patient who had a caesarean section for suspicion of acute foetal distress during which was found a large intraperitoneal bleeding due to rupture of an unknown splenic artery aneurysm. We discuss the principal causes of non-obstetrical intra-abdominal bleeding, including subcapsular liver haematoma, rupture of uterine vessels and rupture of splenic artery aneurysm, with a specific focus on this last aetiology.     

Bases anatomiques pour la chirurgie vertébrale de la jonction thoraco-lombaire

Résumé Les deux premières vertèbres lombaires et les trois dernières vertèbres dorsales forment une région anatomo-chirurgicale caractérisée par des rapports antérieurs diaphragmatiques qui nécessitent une phrénotomie pour un abord antérieur. C'est pourquoi l'étude des gros vaisseaux prévertébraux à mobiliser, des vaisseaux collatéraux à ligaturer, des vaisseaux intrarachidiens à éviter méritait d'être exposée. La zone d'élection des ligatures se situe sur les flancs de l'aorte et les zones dangereuses pour la vascularisation médullaire sont représentées par l'espace compris entre les trous de conjugaison et les apophyses transverses.     

Strategies for improved stability of Peste des Petits Ruminants Vaccine

The main focus of this work was the improvement of the stability of the current PPRV vaccine. First, new formulations based on the Tris buffer were tested, with and without the addition of sucrose and trehalose and compared with the formulation normally used to stabilize the vaccine, the Weybridge medium. The results show a virus half-life of 21 h at 37 °C and 1 month at 4 °C for the Tris/trehalose liquid formulation and, in the lyophilized form, the formulation was able to maintain the viral titer above the 1 × 10⁴ TCID₅₀/mL (>10 doses/mL) for at least 21 months at 4 °C (0.6 log lost), 144 h at 37 °C (0.6 log lost) and 120 h at 45 °C (1 log lost).Secondly, a strategy based on culture medium composition manipulation aiming at improving the intrinsic PPRV vaccine stability was also evaluated. The addition of 25 mM fructose resulted in a higher virus production (1 log increase) with higher stability (2.6-fold increase compared to glucose 25 mM) at 37 °C. Increased concentrations of NaCl, improved virus release, reducing the cell-associated fraction of the virus produced. Moreover this harvesting strategy is scalable and more suitable for a larger scale production than the freeze/thaw cycles normally used.The information gathered in this work showed that it is possible for the PPRV vaccine to have adequate short-term stability at non-freezing temperatures to support manufacturing, short-term shipping and storage. The identification of a more stable formulation should significantly enhance the utility of the vaccine in the control of a PPRV outbreak.