Infectious endocarditis complicated by an ischemic stroke and revealing Marfan syndrome

Marfan syndrome is a systematic genetic disease of the connective tissue. The cardiac affection would predict the prognosis and ischemic stroke might complicate it. The purpose of this work is to discuss the mechanisms of the ischemic stroke in Marfan syndrome which have to be considered in all young patients of ischemic strokes. We report the case of a 17-year-old male patient who presented with right hemiparesis with brachio-facial dominance, hemihypoesthesia and Broca's aphasia; these symptoms were followed by partial right somato-motor epileptic seizure. The cerebral computed tomographic (CT) scan demonstrated early signs of ischemic stroke in the left Sylvian artery. Cardiovascular examination revealed a systolic murmur in the mitral site. Marfan syndrome with infectious endocarditis complicated by ischemic stroke was diagnosed. However, the family pathological history was negative. The Marfan syndrome diagnosis was approved considering the following criteria: Ligamentous hyperlaxity, crystalline ectopia and mitral valve prolapsus with mitral insufficiency. The patient benefited of antibiotherapy for 4 weeks. The patient underwent sessions of motor physical therapy and orthophonic rehabilitation. Then, cardiac surgery was carried out and valvuloplasty was performed. The surgical treatment confirmed the presence of mitral insufficiency and prolapsus of the big mitral valve and multiple friable anterior-posterior vegetations with broken cordage of the small mitral valve. Replacement of the mitral valve was achieved, and the post-surgery follow-ups were simple. The diagnosis of Marfan syndrome was based on well-defined criteria. The evolution of the patient was marked by a complete improvement of the cardiac and motor deficits, and disappearance of the Broca's aphasia. A fibroelastic disease such Marfan syndrome has to be considered in unexplained ischemic stroke in all young patients. Hence, the diagnosis of Marfan syndrome involves an anticipation of the neurovascular complications by early cardiovascular care

Regulation of matrix Gla protein by parathyroid hormone in MC3T3-E1 osteoblast-like cells involves protein kinase A and extracellular signal-regulated kinase pathways

Inhibition of osteoblast-mediated mineralization is one of the major catabolic effects of parathyroid hormone (PTH) on bone. Previously, we showed that PTH induces matrix Γ-carboxyglutamic acid (Gla) protein (MGP) expression and established that this induction is critical for PTH-mediated inhibition of osteoblast mineralization. In the present study, we focus on the mechanism through which PTH regulates MGP expression in osteoblastic MC3T3-E1 cells. Following transient transfection of these cells with a −748 bp murine MGP promoter-luciferase construct (pMGP-luc), PTH (10 −7 M) induced promoter activity in a time-dependent manner with a maximal four- to six fold induction seen 6 h after PTH treatment. Both H-89 (PKA inhibitor) and U0126 (MEK inhibitor), suppressed PTH induction of MGP promoter activity as well as the MGP mRNA level. In addition, forskolin (PKA activator) stimulated MGP promoter activity and mRNA levels confirming that PKA is one of the signaling molecules required for regulation of MGP by PTH. Co-transfection of MC3T3-E1 cells with pMGP-luc and MEK(SP), a plasmid encoding the constitutively active form of MEK, led to a dose-dependent increase in MGP promoter activity. Both MGP promoter activity and MGP mRNA level were not affected by the protein kinase C (PKC) inhibitor, GF109203X. However, phorbol 12-myristate 13-acetate (PMA), a selective PKC activator induced MGP mRNA expression through activation of extracellular signal-regulated kinase (ERK). Taken together, these results indicate that PTH regulates MGP via both PKA- and ERK-dependent pathways. J. Cell. Biochem. 102: 496–505, 2007. © 2007 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/57362/1/21314_ftp.pd

Evaluation de la prise en charge de la bronchiolite aigüe par des médecins libéraux (étude des prescriptions pré-hospitalières de 118 nourrissons vus en deuxième intention aux urgences pédiatriques d'Ambroise Paré)

En 2000 la conférence de consensus sur la prise en charge ambulatoire de la bronchiolite recommande des DRP fréquentes associées à de la kinésithérapie respiratoire systématique. Des antipyrétiques si besoin et une antibiothérapie en cas de signes de surinfection bactérienne sont préconisés. Tout autre traitement n est pas recommandé.Sept ans après la conférence de consensus, cette étude analyse les prescriptions thérapeutiques de 118 patients vus en première intention par un médecin de ville pour des symptômes de bronchiolite aigüe, ces prescriptions étant recueillies lors de leur passage aux urgences pédiatriques lors de l hiver 2007/2008. On retrouve une bonne application des recommandations concernant la kinésithérapie respiratoire systématique, la prescription d antibiotique et la non prescription de mucolytique. Cependant la prescription d antitussif reste significative et la prescription de bronchodilatateurs et de corticoïdes concerne encore un patient sur deux. Les faibles taux de prescription de DRP et d antipyrétiques retrouvés témoignent du peu de crédit accordés par les parents à ces traitements.PARIS6-Bibl. St Antoine CHU (751122104) / SudocSudocFranceF

Les pleuro-pneumopathies de l'enfant en 2004 (prise en charge en pédiatrie générale)

PARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Maladies chroniques: S'appuyer sur les enjeux de l'adolescence pour une transition réussie vers les services pour adultes

International audienceTransition from pediatric to adult care is a process that needs to be addressed very early in the follow-up of a child with a chronic disease. It must take in account the rhythm of each of the parties involved: the practitioner, the adolescent and his/her family. The interaction between the upheavals of adolescence and the transition process too often leads to a break in follow-up, with its consequences in terms of morbidity and mortality. In recent years, guidelines and dedicated structures have been put in place to facilitate a smooth transition to adult care structures

Syndrome de non oxygénation (état des lieux des connaissances des médecins généralistes et modalités de la prévention)

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF