[Neuropsychiatric lupus and autoantibodies against ionotropic glutamate receptor (NMDAR)]. / Lupus neuropsychiatrique et auto anticorps dirigés contre le récepteur ionotrope activé par le glutamate (R-NMDA).

Almost half of lupus patients will experience neuropsychiatric symptoms during the course of their disease. The etiology of the neuronal damages is still uncertain and probably multiple. Autoantibodies reactive with brain have been postulated to play a role. The observation of pathogenic autoantibodies binding the NR2A and NR2B subunits of the ionotropic glutamate receptor (NMDAR) illustrates this hypothesis. First studies showed that 40% of lupus patients possess serum titers of anti-NR2A/B antibody, but the presence of these autoantibodies is not always associated with the occurrence of neuronal damages or neuropsychiatric symptoms. Nevertheless, their presence is observed in the cerebrospinal fluid (CSF) of one half of the patients suffering from neurolupus. The presence in the serum of these autoantibodies anti-NR2A/B of the NMDAR is preliminary to their presence in the CSF where their deleterious effect is observable. Their entry into the brain is dependent on a breach of the blood brain barrier (BBB). In conclusion, the serum titer of autoantibodies against NR2A/B subunits is an indication of the potential for neuropsychiatric manifestations during the course of the disease.

[Pain assessment and interventional spine radiology]. / Evaluation de la douleur en radiologie interventionnelle du rachis.

Due to advances in interventional spine procedures, the radiologist can now participate in the clinical evaluation of patients. The purpose of this article is to review the main tools available to evaluate spine related pain and promote their use to demonstrate the efficacy of different interventional spine procedures.

Hormonal regulation of B-cell function and systemic lupus erythematosus.

The prevalence of systemic lupus erythematosus (SLE) is far higher in females than in males and numerous investigations to understand this gender bias have been performed, which propose as casual actors genetic predispositions and sex hormones effects. We will describe in this review how the sex hormones estrogen and prolactin influence B cell maturation and selection, permitting B cells to mature to immunocompetence in a mouse model of lupus. Finally, we will discuss the relevance and implications of these results for human disease.

Sex hormones and SLE: influencing the fate of autoreactive B cells.

The prevalence of systemic lupus erythematosus (SLE) is far higher in females than in males and numerous investigations to understand this gender bias have been conducted. While it is plausible that some sex-linked genes may contribute to the genetic predisposition for the disease, other likely culprits are the sex hormones estrogen and prolactin. In this chapter we review studies that have addressed the influence of sex hormones in SLE activity and discuss the recent data established in a BALB/c mouse transgenic for the heavy chain of an anti-DNA antibody. These mice are prone to develop lupus following exposure to exogenous sex hormones. We describe how estrogen and prolactin influence B cell maturation and selection, permitting B cells to mature to immunocompetence. Finally, we discuss the relevance and implications of these data for human disease.

Correlation of serum B lymphocyte stimulator and beta2 microglobulin with autoantibody secretion and systemic involvement in primary Sjogren's syndrome.

BACKGROUND: In primary Sjögren's syndrome (pSS), extraglandular involvement might result from more intense stimulation of autoreactive B cells. Thus markers of B cell activation could be useful in the clinical assessment of this disease. OBJECTIVE: To investigate the association of serum B lymphocyte stimulator (BLyS) and beta2 microglobulin with autoantibody production and extraglandular involvement in pSS. METHODS: Serum concentrations of BLyS and beta2 microglobulin were analysed in 177 patients with pSS according to the American-European consensus group criteria. Serum beta2 microglobulin was determined serially in 25 patients. RESULTS: Autoantibody secretion (presence of anti-SSA antibody alone or of both anti-SSA and anti-SSB) was associated with increased serum BLyS and beta2 microglobulin. No correlation was found between BLyS and beta2 microglobulin levels (p = 0.36). Serum concentrations of beta2 microglobulin and C reactive protein and positive anti-SSB antibody results were associated with extraglandular involvement on univariate analysis (p<10(-4), p = 0.003, and p = 0.004, respectively). Serum beta2 microglobulin was also significantly increased in patients with extraglandular involvement without autoantibodies (mean (SD): 1.75 (0.7) v 1.39 (0.5) mg/l, p = 0.039). Multivariate analysis showed that extraglandular involvement was associated only with increased serum beta2 microglobulin (p = 0.035, odds ratio = 2.78 (95% confidence interval, 1.07 to 7.22)). Among the 25 patients who had serial determinations of serum beta2 microglobulin, the concentrations were increased in all those with disease flare and decreased in three following treatment. Serum BLyS, gamma globulin, IgG, and rheumatoid factor levels were not associated with features of systemic involvement. CONCLUSIONS: Serum beta2 microglobulin and BLyS reflect B cell activation in different ways in pSS. Serum beta2 microglobulin assessment could be helpful as an activity marker in pSS.

Prevalence of anti-cyclic citrullinated peptide and anti-keratin antibodies in patients with primary Sjögren's syndrome.

OBJECTIVE: To investigate the prevalence of anti-cyclic citrullinated peptide (anti-CCP) and anti-keratin antibodies (AKA) in patients with primary Sjögren's syndrome. METHODS: 149 patients with a diagnosis of primary Sjögren's syndrome according to the European/American consensus criteria were recruited from three French medical centres. The presence of anti-CCP was determined by enzyme linked immunosorbent assay and of AKA antibodies by indirect immunofluorescence. Radiographs of hands and feet were evaluated at the time of anti-CCP analysis. RESULTS: Six patients with radiological erosions and nine patients with non-erosive arthritis fulfilling ACR criteria for rheumatoid arthritis were thought to have rheumatoid arthritis and secondary Sjögren's syndrome, while 134 were considered to have primary Sjögren's syndrome (mean (SD) disease duration, 11.1 (6.6) years). Of these, 80 tested positive for IgM rheumatoid factor (RF) (59%), 10 (7.5%) for anti-CCP, 7 (5.2%) for AKA, and 5 (3.7%) for both anti-CCP and AKA. There was no difference in clinical and biological features, including prevalence of RF, between anti-CCP positive and negative patients. The nine Sjögren patients with non-erosive arthritis, fulfilling ACR criteria for rheumatoid arthritis, were all CCP positive. Their response to disease modifying antirheumatic drugs could be different from classical rheumatoid patients. CONCLUSIONS: Most patients with primary Sjögren's syndrome are negative for AKA and anti-CCP, but positive test results should not rule out this diagnosis. Anti-CCP positive patients, who may be prone to developing rheumatoid arthritis, require cautious clinical and radiographic follow up.

[Volvulus of the mobile spleen. Conservative laparoscopic treatment]. / Volvulus de la rate mobile. Traitement conservateur coelioscopique.

BACKGROUND: Volvulus of the mobile spleen is a rare condition generally manifested by acute sudden onset abdominal pain localized in the left flank. Ultrasound or computed tomographic imaging generally provides the diagnosis. CASE REPORT: An 18-year-old patient was hospitalized for acute pain of the left flank that had begun 48 hours earlier. The abdominal scan visualized a volvulus of a mobile spleen. Laparoscopic distortion was successful, allowing normal recoloration of the spleen. DISCUSSION: Rapid intervention is crucial for conservative treatment. Laparoscopic treatment allows distortion manoeuvres and splenopexia using a mesh. This is the first reported case of successful conservative laparoscopic treatment of volvulus of a mobile spleen.

[Cystic dystrophy of an aberrant pancreas. Surgery after failure of medical therapy]. / Dystrophie kystique sur pancréas aberrant. Chirurgie après échec d'un traitement médical.

BACKGROUND: Cystic dystrophy of aberrant pancreas, characterized by cystic formations in ectopic pancreatic tissue, produces variable signs. Treatment is difficult. CASE REPORT: Our patient presented signs of acute pancreatitis and angiocholitis due to cystic dystrophy of an aberrant pancreas situated in the duodenal wall associated with chronic alcoholic pancreatitis. Prolonged medical treatment was unsuccessful. Duodenopancreatectomy with preservation of the tail led to complete regression of the clinical signs. DISCUSSION: Signs of cystic dystrophy of an aberrant pancreas vary greatly. Diagnosis is generally established on the basis of echoendoscopic findings. After failure of medical treatment, duodenopancreatectomy with preservation of the tail could be the most appropriate surgical treatment, hypothesizing that the disorders result from obstruction of the Wirsung and the lower main bile ducts.

[Acute arterial mesenteric ischemia]. / Ischémie aiguë artérielle mésentérique.

The authors report the experience of their surgical department, in the treatment of acute arterial mesenteric ischemia. They insist on the diagnostic, and sometimes therapeutic, interest of mesenteric arteriography. Arterial revascularisation must be the surgical aim. In spite of this attitude, the prognosis of acute mesenteric ischemia remains very severe.

[Learning and coping]. / Apprendre et faire face.

In the course of the last few years, the development of what can be called "modern-day diseases" has revealed the limits of medicine and a system which is primarily curative in nature. The recognition of these limits has launched the search for a new, therapeutic approach to health which is characterized by the modification of the target from the individual to a collectivity and by taking into consideration a true association of the different actors who are legitimate and indispensable partners in health promotion activities. Although this new approach is currently being applied in various ways throughout the world, there are still some unanswered questions: is the scientific foundation adequate? Is the objective of changing lifestyles legitimate? And particularly, are the methods and techniques effective? The answers to these questions inevitably depend on the projected objectives: are we trying to change current lifestyles or do we want to contribute to the process of social change? Evaluating the efficacity of the former does not really pose a problem. In evaluating the efficacity of the latter, on the other hand, it appears difficult to isolate certain environmental factors and identify the resistances which are due to the processes of socialization. It might, in fact, be wise to investigate the extent of necessary changes prior to evaluating the effectiveness of the methods used. At any rate, precipitous judgement should be avoided. A slow pace of change can be used as a gauge of depth and durability, and can avoid the extremism of moving from a splintered view of the individual to one that becomes oversocialized.

[Vaginal evisceration. Apropos of a case]. / L'éviscération vaginale. A propos d'une observation.

The authors report one observation of vaginal evisceration of the small intestine which occurred one year after vaginal hysterectomy for uterine prolapse. A review of the literature shows the rarity of these cases. The treatment is surgery.

[Sclerosing cholangitis following the surgical treatment of hydatid cyst of the liver]. / Cholangite sclérosante survenue après traitement chirurgical d'un kyste hydatique du foie.

The authors report a case of sclerosing cholangitis following surgical treatment of a hydatid cyst of the liver. The review of the literature demonstrates the rarity of this serious complication. The authors speculate on the mechanism of this disease: postoperative infection of the common bile duct, or chemical trauma associated with a cysto-biliary fistula. No single hypothesis seems to be able to account for all of the signs of this condition.