Pancréatite aiguë sous inhibiteur de l'enzyme de conversion (à propos d'un cas clinique, revue de la littérature)

Plus d'une vingtaine de médicaments sont actuellement reconnus comme responsables de pancréatite aiguë. La responsabilité des inhibiteurs de l'enzyme de conversion a été plusieurs fois décrite dans la littérature. Nous apportons ici le cas clinique original d'un patient ayant développé une pancréatite aiguë sous inhibiteur de l'enzyme de conversion et dont l'étiologie est indiscutable, car celui-ci a présenté une récurrence lors de la réintroduction accidentelle de ce même médicament. L'analyse de la littérature recouvre une cinquantaine de cas possibles de pancréatite aiguë sous inhibiteur de l'enzyme de conversion. Il s'agit le plus souvent du cas d'un homme âgé entre 50 et 70 ans, avec un terrain vasculaire (HTA - DNID -AVC). Le délai de survenue est de trente minutes à deux jours après la dernière prise d'inhibiteurs de l'enzyme de conversion. Il s'agit le plus souvent de pancréatite aiguë oedémateuse. Le diagnostic étiologique repose à la fois sur l'absence d'autres causes de pancréatite aiguë retrouvées et de récidive lors d'une réintroduction. Le mécanisme incriminé le plus probable semble résulter du rôle de l'enzyme de conversion sur la dégradation des bradykinines puissantes vasodilatatrices. Un traitement par inhibiteur de l'enzyme de conversion entraînerait une accumulation des bradykinines dans le sang et par conséquent augmenterait leurs effets (grands syndromes inflammatoires). Chez les patients traités par inhibiteur de l'enzyme de conversion, la survenue de manifestations digestives doit conduire au dosage des enzymes pancréatiques dans le sang, afin d'éliminer une pancréatite aiguë, compte tenu de la gravité de cette affection.PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Unexplained infertility: A French national survey of clinical practices

International audienceIntroductionThe aim of our study was to carry out a national survey of French practitioners to evaluate (i) their diagnostic criteria for making a diagnosis of unexplained infertility (UEI) and (ii) their management strategy when facing UEI.Materials and MethodAn online questionnaire comprising ten multiple-choice questions was sent by mail to French reproductive practitioners in 80 fertility centres.ResultsThe response rate was 59.6% (195/327). Post coital testing was always or often prescribed by 14.8% of respondents (n = 36). Chlamydia trachomatis testing was never prescribed by 31.7% (n = 59) of them, 30.2% prescribed a pelvic MRI in cases of UEI and 18.4% (n = 33) always or often performed laparoscopy. For 87.6% (n = 169), advanced maternal age was always or often an indication of first-line IVF, with an average threshold of 37.4 years. For 68.6% (n = 129), diminished AMH was an indication for first-line IVF, with an average AMH threshold of 1.2 ng/ml. With respect to the management of UEI, we did not observe a consensus between the strategies of 2 to 6 intrauterine insemination cycles before IVF or IVF as the first-line treatment.ConclusionThere is no consensus in France on what tests should or should not be carried out to conclude UEI, and there is also no consensus on the management of UEI. UEI is one of the top 10 priorities for future infertility research. The diagnostic criteria must be standardized to enable the comparison of studies on this topic as well as to improve the translation of research into clinical practice

Prise en charge de la grossesse au cours du diabète de type 1: Référentiel de la Société Francophone du Diabète (SFD) 2010

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

An overview of the North American residential radon and lung cancer case-control studies

Lung cancer has held the distinction as the most common cancer type worldwide since 1985 (Parkin et al., 1993). Recent estimates suggest that lung cancer accounted for 1.2 million deaths worldwide in 2002, which represents 17.6% of the global cancer deaths (Parkin et al., 2005). During 2002, the highest lung cancer rates for men worldwide reportedly occurred in North America and Eastern Europe, whereas the highest rates in females occurred in North America and Northern Europe (Parkin et al., 2005). While tobacco smoking is the leading risk factor for lung cancer, because of the magnitude of lung cancer mortality, even secondary causes of lung cancer present a major public health concern (Field, 2001). Extrapolations from epidemiologic studies of radon-exposed miners project that approximately 18,600 lung cancer deaths per year (range 3000 to 41,000) in the United States alone are attributable to residential radon progeny exposure (National Research Council, 1999). Because of differences between the mines and the home environment, as well as differences (such as breathing rates) between miners and the general public, there was a need to directly evaluate effects of radon in homes. Seven major residential case-control radon studies have been conducted in North America to directly examine the association between prolonged radon progeny (radon) exposure and lung cancer. Six of the studies were performed in the United States including studies in New Jersey, Missouri (two studies), Iowa, and the combined states study (Connecticut, Utah, and southern Idaho). The seventh study was performed in Winnipeg, Manitoba, Canada. The residential case-control studies performed in the United States were previously reviewed elsewhere (Field, 2001). The goal of this review is to provide additional details regarding the methodologies and findings for the individual studies. Radon concentration units presented in this review adhere to the types (pCi/L or Bq/m3) presented in the individual studies. One picocurie per liter is equivalent to 37 Bq/m3. Because the Iowa study calculated actual measures of exposure (concentration × time), its exposures estimates are presented in the form WLM5–19 (Field et al., 2000a). WLM5–19 represents the working level months for exposures that occurred 5–19 yr prior to diagnosis for cases or time of interview for control. Eleven WLM5–19 is approximately equivalent to an average residential radon exposure of 4 pCi/L for 15 yr, assuming a 70% home occupancy

A combined analysis of North American case-control studies of residential radon and lung cancer

Cohort studies have consistently shown underground miners exposed to high levels of radon to be at excess risk of lung cancer, and extrapolations based on those results indicate that residential radon may be responsible for nearly 10–15% of all lung cancer deaths per year in the United States. However, case-control studies of residential radon and lung cancer have provided ambiguous evidence of radon lung cancer risks. Regardless, alpha-particle emissions from the short-lived radioactive radon decay products can damage cellular DNA. The possibility that a demonstrated lung carcinogen may be present in large numbers of homes raises a serious public health concern. Thus, a systematic analysis of pooled data from all North American residential radon studies was undertaken to provide a more direct characterization of the public health risk posed by prolonged radon exposure. To evaluate the risk associated with prolonged residential radon exposure, a combined analysis of the primary data from seven large scale case-control studies of residential radon and lung cancer risk was conducted. The combined data set included a total of 4081 cases and 5281 controls, representing the largest aggregation of data on residential radon and lung cancer conducted to date. Residential radon concentrations were determined primarily by a-track detectors placed in the living areas of homes of the study subjects in order to obtain an integrated 1-yr average radon concentration in indoor air. Conditional likelihood regression was used to estimate the excess risk of lung cancer due to residential radon exposure, with adjustment for attained age, sex, study, smoking factors, residential mobility, and completeness of radon measurements. Although the main analyses were based on the combined data set as a whole, we also considered subsets of the data considered to have more accurate radon dosimetry. This included a subset of the data involving 3662 cases and 4966 controls with a-track radon measurements within the exposure time window (ETW) 5–30 yr prior to the index date considered previously by Krewski et al. (2005). Additional restrictions focused on subjects for which a greater proportion of the ETW was covered by measured rather than imputed radon concentrations, and on subjects who occupied at most two residences. The estimated odds ratio (OR) of lung cancer generally increased with radon concentration. The OR trend was consistent with linearity (p = .10), and the excess OR (EOR) was 0.10 per Bq/m3 with 95% confidence limits (-0.01, 0.26). For the subset of the data considered previously by Krewski et al. (2005), the EOR was 0.11 (0.00, 0.28). Further limiting subjects based on our criteria (residential stability and completeness of radon monitoring) expected to improve radon dosimetry led to increased estimates of the EOR. For example, for subjects who had resided in only one or two houses in the 5–30 ETW and who had a-track radon measurements for at least 20 yr of this 25-yr period, the EOR was 0.18 (0.02, 0.43) per 100 Bq/m3. Both estimates are compatible with the EOR of 0.12 (0.02, 0.25) per 100 Bq/m3 predicted by downward extrapolation of the miner data. Collectively, these results provide direct evidence of an association between residential radon and lung cancer risk, a finding predicted by extrapolation of results from occupational studies of radon-exposed underground miners

Defibrotide Interferes With Several Steps of the Coagulation-Inflammation Cycle and Exhibits Therapeutic Potential to Treat Severe Malaria

Objective-The coagulation-inflammation cycle has been implicated as a critical component in malaria pathogenesis. Defibrotide (DF), a mixture of DNA aptamers, displays anticoagulant, anti-inflammatory, and endothelial cell (EC)-protective activities and has been successfully used to treat comatose children with veno-occlusive disease. DF was investigated here as a drug to treat cerebral malaria. Methods and Results-DF blocks tissue factor expression by ECs incubated with parasitized red blood cells and attenuates prothrombinase activity, platelet aggregation, and complement activation. In contrast, it does not affect nitric oxide bioavailability. We also demonstrated that Plasmodium falciparum glycosylphosphatidylinositol (Pf-GPI) induces tissue factor expression in ECs and cytokine production by dendritic cells. Notably, dendritic cells, known to modulate coagulation and inflammation systemically, were identified as a novel target for DF. Accordingly, DF inhibits Toll-like receptor ligand-dependent dendritic cells activation by a mechanism that is blocked by adenosine receptor antagonist (8-p-sulfophenyltheophylline) but not reproduced by synthetic poly-A, -C, -T, and -G. These results imply that aptameric sequences and adenosine receptor mediate dendritic cells responses to the drug. DF also prevents rosetting formation, red blood cells invasion by P. falciparum and abolishes oocysts development in Anopheles gambiae. In a murine model of cerebral malaria, DF affected parasitemia, decreased IFN-gamma levels, and ameliorated clinical score (day 5) with a trend for increased survival. Conclusion-Therapeutic use of DF in malaria is proposed. (Arterioscler Thromb Vasc Biol. 2012; 32:786-798.)Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of HealthDivision of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of HealthDFG, Bonn, Germany [SCHW 296/18-2]DFG, Bonn, GermanyBrazilian Malaria Network [MCT/CNPq/MS/SCTIE/DECIT/PRONEX 555648/2009-5]Brazilian Malaria NetworkNational Academy of Sciences of the Czech RepublicNational Academy of Sciences of the Czech Republic [Z60220518