Cessation of oral anticoagulants in antiphospholipid syndrome.

Objective To study the outcome of patients with antiphospholipid syndrome (APS) after oral anticoagulant treatment cessation. Methods We performed a retrospective study of patients with APS experiencing cessation of oral anticoagulant and enrolled in a French multicentre observational cohort between January 2014 and January 2016. The main outcome was the occurrence of recurrent thrombotic event after oral anticoagulation cessation. Results Forty four APS patients interrupted oral anticoagulation. The median age was 43 (27-56) years. The median duration of anticoagulation was 21 (9-118) months. Main causes of oral anticoagulant treatment cessation were switch from vitamin K antagonists to aspirin in 15 patients, prolonged disappearance of antiphospholipid antibodies in ten, bleeding complications in nine and a poor therapeutic adherence in six. Eleven (25%) patients developed a recurrent thrombotic event after oral anticoagulation cessation, including three catastrophic APS and one death due to lower limb ischemia. Antihypertensive treatment required at time of oral anticoagulants cessation seems to be an important factor associated with recurrent thrombosis after oral anticoagulant cessation (15.2% in patients with no relapse versus 45.5% in patients with recurrent thrombosis, p = 0.038). Oral anticoagulant treatment was re-started in 18 (40.9%) patients. Conclusion The risk of a new thrombotic event in APS patients who stopped their anticoagulation is high, even in those who showed a long lasting disappearance of antiphospholipid antibodies. Except for the presence of treated hypertension, this study did not find a particular clinical or biological phenotype for APS patients who relapsed after anticoagulation cessation. Any stopping of anticoagulant in such patients should be done with caution.

Characterisation of 16 polymorphic markers in the NF2 gene: application to hemizygosity detection.

Neurofibromatosis type 2 (NF2) is an autosomal dominant disorder that predisposes to nervous system tumors. Point mutations are evidenced in about 50% of the NF2 patients and large genomic deletions account for approximately 33% of the NF2 gene alterations. To facilitate the deletion screening, 16 polymorphic markers were identified in the NF2 genomic sequence enabling an hemizygosity test in familial studies.

[Treatment with clarithromycin of 173 HIV+ patients with disseminated Mycobacterium avium intracellulare infection]. / Traitement de 173 malades VIH+ atteints d'infection disséminée à M. avium intracellulare par une association incluant la clarithromycine.

No treatment was established for disseminated M. avium intracellulare (MAC) infection, a common disease of end stage of AIDS. An open study was conducted to assess in 173 AIDS patients, the activity of clarithromycin. Initial bacteriologic eradication from blood was observed in 136/147 evaluable patients (93%). Acquired resistance to clarithromycin associated with relapse appeared to develop after 2 to 7 months of drug treatment in 31/136 patients with initial success. Early bacteriological relapse was associated with clinical deterioration. Side effects of drug treatment were elevated liver enzymes (26%) and impaired hearing (4%). Side effects conducted to stop treatment in 14 cases (8%) to modified treatment in 8 cases (5%). Our study gave new argues for activity of clarithromycin in disseminated MAC infection.

Recent methods for the determination of volatile and non-volatile organic compounds in natural and purified drinking water.

Four analytical protocols for the extraction and preconcentration of organic residues in natural or purified drinking water were investigated and compared: closed loop stripping analysis; simultaneous extraction-distillation; purge and trap analysis; continuous liquid-liquid extraction. Organic extracts were submitted to a variety of separation and identification techniques. Volatiles were determined by conventional capillary column gas chromatography with tandem mass spectrometry, using triple-stage quadrupole instruments. Non-volatile and thermally labile molecules were investigated by several different techniques (high-temperature gas chromatography, capillary column supercritical fluid chromatography, pyrolysis gas chromatography-mass spectrometry, thermospray liquid chromatography with tandem mass spectrometry and conventional fast-atom bombardment with tandem mass spectrometry). Several samples recently examined in the laboratory provide examples of this multitechnique approach for a more complete knowledge of the organic carbon distribution in water-dissolved organic matter, taking into account organic substances with widely different volatilities, polarities and thermal stabilities.

[Thrombo-embolic disease with antiphospholipid-type serum auto-antibodies]. / Maladie thrombo-embolique avec auto-anticorps sériques de type antiphospholipide.

We report a case of thrombo-embolic disease in which we were able to detect the presence of serum antiphospholipid auto-antibodies. The existence of antiphospholipid auto-antibodies has already been described in cases of recurrent thrombo-embolism. The thrombogenic role is only partially explained, but would for the greater part be linked to an action on the fibrolytic activity of the vascular parietal wall. Amongst these antibodies one can find amongst others VDRL, antiprothrombinase and anticardiolipin. The association of other stigmata of auto immunity is not rare, especially disseminated lupus erythematosus (LED). When phospholipids are found in an isolated fashion in cases of recurrent thrombo-embolism they produce the syndrome of antiphospholipids. The long term prognosis of this syndrome has not yet been established but the risk of a secondary systemic disease developing justifies a clinical follow up and regular blood checks.

[Is thoracic actinomycosis underestimated? Reflections on 7 cases]. / L'actinomycose thoracique est-elle sous-estimée? Réflexions à propos de 7 cas.

An analysis of 7 cases of thoracic actinomycoses were recorded over 25 years enabling a better appreciation of the radiological and clinical criteria: a low grade pneumonia with haemoptysis and an alteration in the general physical state, with pseudo-tuberculous radiological images or "pseudo-tumoral" with bronchograms and parietal wall disease. This clinical picture calls for endoscopic biopsies or biopsies under CT scanning for a study combining both histological and bacteriological diagnosis on appropriate culture media, enabling an exploratory thoracotomy to be avoided, the latter the classic method of diagnosis. This approach should reduce the number of pneumonias which are not confirmed bacteriologically which are sensitive to the usual antibiotics and determine better the true frequency of actinomycoses.

[Correlation between the IgG oligoclonal pattern and the benign nature of monoclonal abnormalities in the aged subject]. / Corrélation entre profil oligoclonal des IgG et caractère bénin ou malin d'une anomalie monoclonale chez le sujet âgé.

The presence of an IgG oligoclonal pattern was investigated by isoelectric focusing and immuno detection in 151 individuals over 60 years of age. One hundred are individuals with no detectable monoclonal anomaly and among them, 22 exhibit an oligoclonal pattern. The others are 27 patients with a benign and 24 with a malign monoclonal dysglobulinemia, including respectively 9 and 2 oligoclonal patterns. In all groups the oligoclonal pattern is always found among the oldest individuals. The small association found between this special distribution of the IgG and the benign monoclonal dysglobulinemia seems to be most probably in favour of aging. The IgG oligoclonal distribution associated to a monoclonal component would not be a discriminating argument for malignant or benign monoclonal proliferation diagnosis.

[Sarcoidosis and autoimmunity. Apropos of 2 cases]. / Sarcoïdose et auto-immunité. A propos de 2 observations.

Several immunologic abnormalities exist in patients with active sarcoidosis. Impairment of in vivo and in vitro cellular immunity is well known. Humoral immunity disorders are characterized by increase in polyclonal serum immunoglobulin, existence of circulating immune complexes and auto-antibodies. In the serum, these abnormalities are nearly the same than disorders observed during auto-immune diseases. We report 2 cases of patients where active sarcoidosis was associated with auto-immune disease. Then we discuss the relationship which could exist between the 2 types of diseases. The first patient was a woman (aged 66 years). She presented an active sarcoidosis and clinical symptoms of sclerodermia. The second patient, a man (aged 24 years), presented active sarcoidosis diagnosed 4 years ago. He had never received any treatment. Thrombopenic purpura occurred suddenly and needed steroid therapy. Antibodies to platelets were found in the serum. These associations raise some questions: 1) are they only fortuitous? such cases are rare but their frequency is perhaps underestimated; 2) could any common abnormalities of the immune response explain the emergence of the 2 diseases? 3) could one of the diseases favour emergence of the other? This hypothesis seems possible only if sarcoidosis is the initial disease. Eventually these associations also raise difficult therapeutic problems and must incite to explore precisely the immunity of patients with active sarcoidosis.

Alveolar macrophage dysfunction in malignant lung tumours.

Alveolar macrophage chemotaxis was measured in 129 individuals--13 normal volunteers, 15 tumour free patients with recent bronchopulmonary infections, 10 patients with chronic bronchitis, 29 patients with endothoracic sarcoidosis, 48 patients with primary bronchial carcinoma and 14 patients with pulmonary metastases from various origins. Chemotaxis was tested in the presence of either zymosan activated autologous serum, N-formyl-methionine-leucyl-phenylalanine (F-Met-Leu-Phe), or zymosan activated human AB serum. Alveolar macrophage chemotaxis was significantly less in patients with bronchial carcinoma than in healthy volunteers (p less than 0.01). Chemotaxis was significantly more depressed in samples obtained from the neighbourhood of the tumour than in samples from the opposite lung. Defective chemotaxis was also found in patients with sarcoidosis. In contrast, the presence of lung metastases did not affect chemotaxis. A recent bronchopulmonary infection was associated with significantly increased (p less than 0.02) chemotaxis in tumour free patients but not in patients with a primary lung tumour. The findings suggest that an intrinsic functional defect of alveolar macrophages might favour the development of bronchogenic carcinoma.

[A syndrome of hyper-IgE and recurrent infections. Developmental variants? A familial study]. / Syndrome hyper-IgE et infections récidivantes. Variantes évolutives? Etude familiale.

The first patient suffered from a very severe atopic dermatitis with intense pruritus and thickened skin. He had also recurrent infections, particularly related to Staphylococcus coagulase +, and axillary and inguinal lymphodermopathy. The use of tetracosactide given intramuscularly allowed controlling the evolution of his atopic dermatitis. After several months of treatment, the skin became less infiltrated, lymphodermopathy disappeared and no severe infection had happened. The second patient had a less severe atopic dermatitis and recurrent infections without any particular severity. Topical corticosteroids allowed to control the atopic dermatitis. These two patients had high levels of circulating IgE and an important deficiency of polymorphonuclear chemotaxis which was evaluated by migration through boyden room. Study of the family showed atopic manifestations in several members, but with lower levels of IgE. The most characteristic abnormality of this syndrome is the according to considerable increase of IgE. The deficit in polymorphonuclear chemotaxis may vary according to time and even become normal. The prognosis over long periods remains to be determined.