[ myeloproliferative syndromes]

There are chronic malignant haemopathy resulting from the attack of a hematopoietic original cell and resulting in monoclonal proliferation, without blocking of cellular maturation, concerning at least one of the three lineages myeloid [granulous, erythroblastic, thrombocytic]. These syndromes gather four affections: chronic myeloid leukaemia, the polycythemia vera, the essential thrombocytaemia and the primitive myelofibrosis. It is about a retrospective study carried out over 6 years period from 2002 to 2007. The data were collected from the registers of the laboratory. The diagnosis of these various myeloproliferative syndromes is based on the data of the complete blood count, the blood smear, and is supplemented when it is necessary by the study of the myelogram and the cytogenetic study of the myeloid cells as it is the case for the Chronic myeloid leukaemia. This work interested 50 cases of myeloproliferative syndromes, distributed as: 44 cases of chronic myeloid leukemia, four cases of polycythemia vera and two cases of primitive myelofibrosis. The means of age were respectively of 42 +/- 15 years, 56 +/- 14 years and of 43 +/- 5 years. There was a clear male prevalence. It was not noted a case of essential thrombocytaemy. The epidemiologic aspect and the clinical signs and biological parameters in the diagnosis of these various myeloprliferative syndromes were evoked and discussed during this work. There are rare chronic malignant haemopathy. There is few data on epidemiology of these affections; their incidence is estimated in the Western counties at 5 to 10 new cases per million inhabitants, each year, according to the type. The diagnosis rests on the clinical and hematological data. There are rare affections, requiring the multidisciplinary collaboration [clinician and hematologist], for best dealt with diagnostic and therapeutic. Their evolution, often pejorative is revealed by clinical signs and above all by disturbances with the complete blood count different from those noted at the time of the initial presentation

[Critical analysis of the prescription of the assay of troponine Ic]

The roponine Ic is a good tool diagnosis and forecast in the assumption of responsibility of cardiac ischemic pathologies. Its requirement in the mergency department often exceeds the framework of the international recommendations. Our objective of this work is to evaluate the practices concerning the regulation of the proportioning of TnIc. This is a study that was conducted over a period of one month from 01/04/ 2009 to 30/04/2009. Sixty-six patient who benificie of a regulation of the proportioning of the TnIc. On the whole, 130 proportionings were carried out, with the method of the first proportioning to the admission, then a second 6 to 9 hours after, in the event of negativity of the first. The reasons for admission having led to the regulation of proportioning are: thoracic pain [63%], dyspnea [18,4%], disorders of conscience [7.8%], epigastric pains [6.8%], dysarythmy [4%]. The number of pathological results of TnIc according to the symptoms of calls is of 20 cases for the thoracic pains, 3 for dyspnea, 4 for the disorders of conscience. The number of pathologicalresults of TnIc according to diagnosed pathology is of 17 per 27 cases of SCA,6 per 15 case of cardiac failure, 2 per 7 cases of ischemic heart disease, 1 per 18 cases of atypical thoracic pains and 1 per 9 cases of acute edema of the lungs. This study confirms that the proportioning of TnIc is required ill-advisedly in a large number of cases considering the percentage of pathological results [20,8%]. This proportioning as that of any biological marker is only one help with the diagnosis. These results suggests that a better control of the use of TnIc, is essential on the part of the prescribers

[Current concept of the coagulation]

Coagulation is the whole of enzymatic reactions leading in transforming plasma into a gel primarily made up of fibrin to consolidate the clot formed during primary hemostasis. Fibrin derived from the enzymatic cleavage of fibrinogen by thrombin, a key enzyme of coagulation. The classic design of coagulation describes two different pathways: intrinsic and extrinsic. In fact these two ways are overlapping since passages exist between them. In this work we are interested in the current concept of coagulation physiology by underlining the place of the cellular reactions in this phenomenon. The phenomena of coagulation take place either in circulation, or on a cellular surface. The effectiveness of the enzymes implied in coagulation is much larger on a cellular surface than in plasma, bringing to conceive coagulation like a cellular phenomenon. Recently, this cellular conception of coagulation resulted in proposing a new sight of coagulation which would proceed in three phases: initiation, amplification, propagation

New resistance mechanism of escherichia coli to beta-lactamins

Escherichia coli is the germ most frequently isolated in espicially urinary infections. The perpetual change of its sensitivity profile to beta-lactamins is [due to several evolution factors. Some strains have acquiered resistance by gene mutation or by acquisition of movable genetic material. Also phenomenon as impermeability, excretion by efflux system or modifying penicillin liaison proteins could be seen but the production of beta-lactamases remains the most frequent mechanism of resistance that has been describe until now. The authors report, through this observation, a case of a particular strain of Escherichia coli that has been isoleted from urine of an hospitalized patiente. This strain presented an hyperproduction of cefalosporinases, which is a recently discovered mechanism of resistance. In one hand, specific bacteriologic tests as synergy test, antagonism test and the use of cloxacillin added antibiogramme on Mueller-Hinton medium were carried out and have allowed to display the phenotypic aspect of this mechanism. In the other hand, its genetic aspect was mentionned through a new literature data. The authors have also underlined the importance of the antibiogramme prior to any prescription of antibiotics which could put pressure on the germ leading to a selection of individual resistant, to this kind of difficul not controlled resistance and many potential complications ensue from it