[Antenatal corticosteroids: benefits and risks]. / Corticothérapie anténatale: bénéfices et risques.

A favorable benefit-to-risk ratio is well established for a single dose of antenatal corticosteroids in women at risk of preterm delivery. The efficacy is real with an important decrease of mortality and morbidity. No adverse effects were described after one course. Possible beneficial effects of repeated courses include lower rates of RDS and a decrease in oxygen use, whereas an increasing body of evidence raises the concern of multiple short and long term adverse consequences, principally neurological. It seems rational to prescribe one course of corticosteroids. The indication for a second course should be discussed but multiples courses of this treatment should not be prescribed. We prefer betamethasone over dexamethasone because of the better side profile. Further work is needed to understand the long-term effects of this treatment.

[Bilateral jugular thrombosis in Lemierre syndrome]. / Un cas de syndrome de Lemierre avec thrombose veineuse jugulaire bilatérale.

An adolescent presented with a rhinosinusitis complicated with bilateral jugular veins and left superior ophthalmic vein thrombosis and respiratory distress with pulmonary hypertension. Blood culture was positive for Haemophilus influenzae and sinus puncture for Streptococcus constellatus. Evolution was under control after 1 week of appropriate antibiotherapy, antithrombotic and anti-inflammatory treatment. He had no neurologic, respiratory or ophthalmologic sequelae 6 months later. Despite lack of pharyngitis or isolation of anaerobic species on blood cultures, the picture was considered compatible with Lemierre syndrome. The risk for such a complication should be considered in cases of severe otorhinolaryngologic infection in young adults.

Human umbilical vein endothelial cell culture on heparin-like microcarriers.

Biospecific functional polymers, i.e., polymers randomly substituted with specific chemical functional groups, were designed to interact with living systems. Interactions between polystyrene sodium sulfonate (PSSO3Na) and insulin secreting RINm5F cells have been previously described. For the sake of comparison, interactions of PSSO3Na with human umbilical vein endothelial cells (HUVEC) were studied. In this case, the interaction is indirect, i.e., mediated by a binding protein, fibronectin (Fn). This was evidenced by HUVEC culture on Fn precoated PSSO3Na microcarriers. The interactions between PSSO3Na and HUVEC result in a biologically normal proliferation of cells and synthesis and secretion of Von Willebrand Factor (VWF). These results show that different biospecific interactions may occur between cells in culture, binding proteins and polymers randomly substituted with suitable functional groups. HUVEC, when cultured on heparin-like microcarriers, behave differently from other cells like RINm5F, whose interaction with the same polymers is not mediated by binding proteins.

Pulmonary hypertension complicating portal hypertension: prevalence and relation to splanchnic hemodynamics.

The prevalence of pulmonary hypertension in 507 patients hospitalized with portal hypertension but without known pulmonary hypertension who underwent cardiac catheterization was prospectively studied. Ten (2%) of these patients, 6 of whom were clinically asymptomatic, had primary pulmonary hypertension. Second, 26 patients with symptomatic pulmonary hypertension complicating portal hypertension were reviewed. Pulmonary hypertension occurred later after diagnosis of portal hypertension in patients with a surgical shunt (10 patients) than in those without a shunt (147 +/- 49 vs. 44 +/- 27 months; P less than 0.0001). Cardiac index correlated inversely with pulmonary arterial pressure (r = -0.45; P less than 0.01) and was lower in the 5 patients who died of pulmonary hypertension than in the 5 who died of liver failure (1.52 +/- 0.14 vs. 3.69 +/- 1.88 L/min.m2; P less than 0.05). Third, systemic and splanchnic hemodynamics were compared in 285 patients with alcoholic cirrhosis and 29 controls. No significant relation was found between elevated pulmonary vascular resistance and increased portal pressure, zzygos blood flow, or cardiac index. Pulmonary hypertension is considerably more frequent than was previously estimated in patients with portal hypertension. The risk of developing pulmonary hypertension could increase with the duration of portal hypertension without any clear relation to the degree of portal hypertension, hepatic failure, or amount of blood shunted.