[Interest of bone alkaline phosphatase in hemodialysis patients]. / Interet de la phosphatase alcaline osseuse chez les hemodialyses chroniques.

BACKGROUND: The renal osteodystrophy represent a major complication in hemodialysis. AIM: To evaluate the value of plasma bone-alkaline phosphatase (bAP) in the diagnosis of the type of renal osteodystrophy among hemodialysis patients and to seek a possible correlation between the bAP, total alkaline phosphatases (tAP) and the intact parathormone (iPTH). METHODS: We studied 67 chronic hemodialysis patients. Plasma bAP was determined by immunoenzymatic technic. iPTH (1-84) was measured by electrochimiluminescence. RESULTS: We found that bAP levels were normal (10-20 ng/ml) in 17 patients, low (< 10 ng/ml) in 4 and high (> 20 ng/ml) in the 46 other patients. There is a good positive correlation between the plasmatic rate of bAP and the following parameters: the period of dialysis (R = 0.316, p = 0.009), plasmatic rate of tAP (r = 0.781, p < 10(-3)) and the rate of iPTH (r = 0.650, p < 10(-3)). There is a good positive correlation between the plasmatic rate of bAP and the rates of the tAP and of iPTH, the correlation between bAP and the iPTH being more significant. A rate of bAP higher than 20 ng/ml had a sensitivity of 93.5%, specificity of 63.3% in favour of a rate of iPTH >400 pg/ml and consequently of the biological diagnosis of hyperparathyroidism. In addition, 4 patients have a bAP <10 ng/ml with iPTH < 150 pg/ml evoking an adynamic osteopathy. CONCLUSION: plasma bAP provides useful information about bone remodelling in hemodialysis patients.

[Allergic reactions to paracetamol]. / Réactions de type allergique au paracétamol.

BACKGROUND: Paracetamol is an extensively used analgesic and antipyretic. Allergy to this drug is occasionally reported and is usually moderate. MATERIALS AND METHODS: We led a retrospective study of 119 cases of allergic reactions to paracetamol notified to the Tunisian centre of pharmacovigilance, between September 1990 and September 2000. These cases were validated according to the method of imputability of Bégaud et al. RESULTS: Our population comprised 64 women and 55 men, aged 1 month to 70 years. Antecedents of allergy or atopy were found in many cases, including 10 cases of allergy to paracetamol and 6 to salicylates. Paracetamol was self-administered in 50% of cases and taken with other drugs in 68% of cases. The type of lesions varied, the most frequent being urticaria (34.4%), macular and pustular eruption (30.2%) and fixed drug eruption (12.6%). Some reactions were serious, such as Lyell syndrome or anaphylactic shock. Resolution was favourable in all cases and paracetamol was definitively contraindicated for patients with scores of high or mild imputability. CONCLUSION: Allergy to paracetamol seems to be rare but not exceptional. Several risk factors seem to be important in triggering this side effect, particularly antecedents of allergy to this drug or to aspirin.

[Recurrent bilateral shoulder hand syndrome induced by phenobarbital]. / Syndrome epaule-main bilateral recidivant gardenalique: a propos d'un cas.

Algodystrophy syndrome is characterized by pain, vasomotor disorders and/or trophic skin changes, without laboratory signs of inflammation. Among the etiological factors of this syndrome (trauma, cerebrovascular accident, diabetes mellitus...), iatrogenic ones including phenobarbital can be observed. We report a case of phenobarbital induced recurrent bilateral shoulder-hand syndrome in a 67 years old women with hypertension, diabetes, and history of epileptic crisis following ischemic cerebrovascular accidents. The patient recovered after barbiturate withdrawal and treatment with calcitonin. It's necessary to diagnose promptly shoulder-hand syndrome of iatrogenic cause in order to withdraw definitively the responsible drug, to start an effective therapy, at this stage, on pain and bone demineralization and to prevent severe sequels.