LES PANCREATITES MEDICAMENTEUSES DIFFICULTES DIAGNOSTIQUES ET THERAPEUTIQUES

Les pancréatites médicamenteuses sont rares mais potentiellement graves. Plusieurs médicaments sont incriminés. Le diagnostic positif repose sur l’établissement d’un lien entre le médicament et la pancréatite aiguë et sur la consultation des centres de pharmacovigilance et des revues de la littérature. Le but de notre travail est de rappeler les différentes étapes du diagnostic et d’insister sur l’importance de la pharmacovigilance. La difficulté diagnostique réside dans le fait que les manifestations cliniques des pancréatites médicamenteuses sont peu spécifiques. De plus, le lien entre un médicament et la survenue d’une pancréatite médicamenteuse peut être difficile à établir. Il repose sur plusieurs critères : sémiologiques, chronologiques et bibliographiques.Une liste de médicaments de plus en plus étendue est mise en cause. Cette liste ne saurait être exhaustive car chaque jour, de nouvelles molécules sont signalées aux centres de pharmacovigilance. La prise en charge des pancréatites médicamenteuses comprend un volet symptomatique mais aussi un volet étiologique qui consiste en un arrêt immédiat du médicament en cause.The drug-induced pancreatitis are rare but potentially serious. Several drugs are accused. The positive diagnosis rests on: - Establishment of a bond between the drug and the acute pancreatitis. -Consultation of centers of pharmacovigilance and reviews of literature. The aim of our work is to point out the various stages of the diagnosis and to insist on the importance of the pharmacovigilance. The diagnostic difficulty lies in the fact that the clinical demonstrations of the drug-induced pancreatitis are not very specific. Moreover, the bond between a drug and occurred of a drug-induced pancreatitis can be difficult to establish.  It rests on several criteria: semiological, chronological and bibliographical. Un increasingly wide list of drugs is blamed. This list could not be exhaustive because each day, of new molecules are announced to the centers of pharmacovigilance. The assumption of responsibility of the drug-induced pancreatitis comprises a symptomatic aspect but also a shutter etiologic which consists of a dead halt of the drug in question

Cirrhose sur stéato-hépatite, Un diagnostic qu’il ne faut pas oublier.

La stéatose non alcoolique ou NAFLD (Non Alcoholic Fatty Liver Disease) est la première cause d’hépatopathie chronique. Elle se présente comme un spectre d’entités histologiques allant de la stéatose isolée souvent bénigne, à la stéatohépatite ou non alcoholic steato hepatitis (NASH) associant des signes d’inflammation et de souffrance hépatocytaire. Elle est susceptible d’évoluer vers la fibrose, la cirrhose et ses complications et vers le carcinome hépatocellulaire (CHC) après plusieurs années d’évolution. Elle se présente, le plus souvent dans un contexte d’obésité ; de diabète avec syndrome d’insulino-résistance et de dyslipidémie

On recognizing and formulating mathematical problems

When mathematics is used to help people cope with real-life situations, a three-stage intellectual process is involved. First, a person becomes aware of a problem-situation which stimulates him to generate a problem-statement, a verbal story-problem. This may be in writing, expressed orally, or merely thought and evidenced by other behavior. Second, he transforms the verbal problem-statement into a mathematical formulation. Third, he analyzes this mathematically stated problem into subproblems to which the solution is more immediate.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43864/1/11251_2004_Article_BF00052419.pd

Embodied Emotion Modulates Neural Signature of Performance Monitoring

BACKGROUND:Recent research on the "embodiment of emotion" implies that experiencing an emotion may involve perceptual, somatovisceral, and motor feedback aspects. For example, manipulations of facial expression and posture appear to induce emotional states and influence how affective information is processed. The present study investigates whether performance monitoring, a cognitive process known to be under heavy control of the dopaminergic system, is modulated by induced facial expressions. In particular, we focused on the error-related negativity, an electrophysiological correlate of performance monitoring. METHODS/PRINCIPAL FINDINGS:During a choice reaction task, participants held a Chinese chop stick either horizontally between the teeth ("smile" condition) or, in different runs, vertically ("no smile") with the upper lip. In a third control condition, no chop stick was used ("no stick"). It could be shown on a separate sample that the facial feedback procedure is feasible to induce mild changes in positive affect. In the ERP sample, the smile condition, hypothesized to lead to an increase in dopaminergic activity, was associated with a decrease of ERN amplitude relative to "no smile" and "no stick" conditions. CONCLUSION:Embodying emotions by induced facial expressions leads to a changes in the neural correlates of error detection. We suggest that this is due to the joint influence of the dopaminergic system on positive affect and performance monitoring

ERP evidence suggests executive dysfunction in ecstasy polydrug users

Background: Deficits in executive functions such as access to semantic/long-term memory have been shown in ecstasy users in previous research. Equally, there have been many reports of equivocal findings in this area. The current study sought to further investigate behavioural and electro-physiological measures of this executive function in ecstasy users. Method: Twenty ecstasy–polydrug users, 20 non-ecstasy–polydrug users and 20 drug-naïve controls were recruited. Participants completed background questionnaires about their drug use, sleep quality, fluid intelligence and mood state. Each individual also completed a semantic retrieval task whilst 64 channel Electroencephalography (EEG) measures were recorded. Results: Analysis of Variance (ANOVA) revealed no between-group differences in behavioural performance on the task. Mixed ANOVA on event-related potential (ERP) components P2, N2 and P3 revealed significant between-group differences in the N2 component. Subsequent exploratory univariate ANOVAs on the N2 component revealed marginally significant between-group differences, generally showing greater negativity at occipito-parietal electrodes in ecstasy users compared to drug-naïve controls. Despite absence of behavioural differences, differences in N2 magnitude are evidence of abnormal executive functioning in ecstasy–polydrug users

The mind's eye, looking inward? In search of executive control in internal attention shifting

In studies of mental counting, participants are faster to increment a count that was just incremented (no-switch trial) than to increment a different count (switch trial). Investigators have attributed the effect to a shift in the internal focus of attention on switch trials. Here we report evidence for other bottom-up and top-down contributions. Two stimuli were mapped to each of two counts. The no-switch facilitation was greater when stimuli repeated than when they were different. Event-related potential (ERP) activity associated with repetitions was anterior to that associated with switching. Runs of no-switch trials elicited faster responses and frontal ERP activity. Runs of switches and large counts both elicited slow responses and reduced P300 amplitudes. Bottom-up processes may include priming on no-switch trials and conflict on switch trials. Top-down processes may control conflict, subvocal rehearsal, and the contents of working memory.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73572/1/1469-8986.00059.pd

Imbalanced decision hierarchy in addicts emerging from drug-hijacked dopamine spiraling circuit

Despite explicitly wanting to quit, long-term addicts find themselves powerless to resist drugs, despite knowing that drug-taking may be a harmful course of action. Such inconsistency between the explicit knowledge of negative consequences and the compulsive behavioral patterns represents a cognitive/behavioral conflict that is a central characteristic of addiction. Neurobiologically, differential cue-induced activity in distinct striatal subregions, as well as the dopamine connectivity spiraling from ventral striatal regions to the dorsal regions, play critical roles in compulsive drug seeking. However, the functional mechanism that integrates these neuropharmacological observations with the above-mentioned cognitive/behavioral conflict is unknown. Here we provide a formal computational explanation for the drug-induced cognitive inconsistency that is apparent in the addicts' “self-described mistake”. We show that addictive drugs gradually produce a motivational bias toward drug-seeking at low-level habitual decision processes, despite the low abstract cognitive valuation of this behavior. This pathology emerges within the hierarchical reinforcement learning framework when chronic exposure to the drug pharmacologically produces pathologicaly persistent phasic dopamine signals. Thereby the drug hijacks the dopaminergic spirals that cascade the reinforcement signals down the ventro-dorsal cortico-striatal hierarchy. Neurobiologically, our theory accounts for rapid development of drug cue-elicited dopamine efflux in the ventral striatum and a delayed response in the dorsal striatum. Our theory also shows how this response pattern depends critically on the dopamine spiraling circuitry. Behaviorally, our framework explains gradual insensitivity of drug-seeking to drug-associated punishments, the blocking phenomenon for drug outcomes, and the persistent preference for drugs over natural rewards by addicts. The model suggests testable predictions and beyond that, sets the stage for a view of addiction as a pathology of hierarchical decision-making processes. This view is complementary to the traditional interpretation of addiction as interaction between habitual and goal-directed decision systems

HEMANGIOME DU GRELE (A PROPOS D’UN CAS)

The small bowel hemangioma is a rare vascular tumour, can be revealed by a digestive hemorrhage. The authors report a 46 years old patient presenting a jejunal hemangioma discovered by a secondary severe anemia with repeated episodes of moelena. Endoscopic and radiological explorations were not evocative. The diagnosis was retained by the peroperative enteroscopy. The surgical operation consisted of an ileal exeresis with a termino-terminal anastomosis. The histologic study showed a diffuse intestinal hemangiomatosis. The postoperative continuations were marked by the bleeding repetition. The diffuse hemangiomas raise two difficulties: on the one hand, a problem of positive diagnosis, and on the other hand, a problem of therapeutic management, which obscures their prognosis.L’hémangiome du grêle est une tumeur vasculaire rare, peut être révélée par une hémorragie digestive. Les auteurs rapportent le cas d’un hémangiome du jéjunum chez un patient âgé de 46 ans, découvert par une anémie sévère secondaire à des épisodes répétés de moelena. Les explorations endoscopiques et radiologiques n’étaient pas évocatrices. Le diagnostic a été retenu par l’entéroscopie peropératoire. L’intervention chirurgicale a consisté en une résection iléale avec une anastomose termino-terminale. L’étude anatomopathologique a conclu à une hémangiomatose intestinale diffuse. Les suites postopératoires étaient marquées par la récidive du saignement. Les hémangiomes diffus posent deux difficultés : d’une part, un problème de diagnostic positif, et d’autre part, un problème de prise en charge thérapeutique, ce qui assombrit leur pronostic

The Impact of Second Language Learning on Semantic and Nonsemantic First Language Reading

The relationship between orthography (spelling) and phonology (speech sounds) varies across alphabetic languages. Consequently, learning to read a second alphabetic language, that uses the same letters as the first, increases the phonological associations that can be linked to the same orthographic units. In subjects with English as their first language, previous functional imaging studies have reported increased left ventral prefrontal activation for reading words with spellings that are inconsistent with their orthographic neighbors (e.g., PINT) compared with words that are consistent with their orthographic neighbors (e.g., SHIP). Here, using functional magnetic resonance imaging (fMRI) in 17 Italian–English and 13 English–Italian bilinguals, we demonstrate that left ventral prefrontal activation for first language reading increases with second language vocabulary knowledge. This suggests that learning a second alphabetic language changes the way that words are read in the first alphabetic language. Specifically, first language reading is more reliant on both lexical/semantic and nonlexical processing when new orthographic to phonological mappings are introduced by second language learning. Our observations were in a context that required participants to switch between languages. They motivate future fMRI studies to test whether first language reading is also altered in contexts when the second language is not in use

Comparison of Zotarolimus-Eluting and Sirolimus-Eluting Stents in Patients With Native Coronary Artery Disease A Randomized Controlled Trial

ObjectivesThis trial examined the relative clinical efficacy, angiographic outcomes, and safety of zotarolimus-eluting coronary stents (ZES) with a phosphorylcholine polymer versus sirolimus-eluting stents (SES).BackgroundWhether a cobalt-based alloy stent coated with the novel antiproliferative agent, zotarolimus, and a phosphorylcholine polymer may provide similar angiographic and clinical benefit compared with SES is undetermined.MethodsA prospective, multicenter, 3:1 randomized trial was conducted to evaluate the safety and efficacy of ZES (n = 323) relative to SES (n = 113) in 436 patients undergoing elective percutaneous revascularization of de novo native coronary lesions with reference vessel diameters between 2.5 mm and 3.5 mm and lesion length ≥14 mm and ≤27 mm. The primary end point was 8-month angiographic in-segment late lumen loss.ResultsAngiographic in-segment late lumen loss was significantly higher among patients treated with ZES compared with SES (0.34 ± 0.44 mm vs. 0.13 ± 0.32 mm, respectively; p < 0.001). In-hospital major adverse cardiac events were significantly lower among patients treated with ZES (0.6% vs. 3.5%, p = 0.04). In-segment binary angiographic restenosis was also higher in the ZES cohort (11.7% vs. 4.3%, p = 0.04). Total (clinically and non-clinically driven) target lesion revascularization rates at 9 months were 9.8% and 3.5% for the ZES and SES groups, respectively (p = 0.04). However, neither clinically driven target lesion revascularization (6.3% zotarolimus vs. 3.5% sirolimus, p = 0.34) nor target vessel failure (12.0% zotarolimus vs. 11.5% sirolimus, p = 1.0) differed significantly.ConclusionsCompared with SES, treatment with a phosphorylcholine polymer-based ZES is associated with significantly higher late lumen loss and binary restenosis at 8-month angiographic follow-up.(The Endeavor III CR; http://clinicaltrials.gov/ct/show/NCT00265668?order=1?