Functional defects of peripheral regulatory T lymphocytes in patients with progressive vitiligo.

Auto-reactive cytotoxic T lymphocytes play a key role in the progressive loss or destruction of melanocytes in vitiligo but the mechanism underlying the loss of self-tolerance is unknown. A deregulation of regulatory T-cell biology has recently been suggested. The analysis of the suppressive effects of peripheral T regulatory cells in vitiligo patients revealed a functional defect in seven of 15 cases. This defect was strongly correlated with disease activity. The evaluation of the percentage of peripheral regulatory T lymphocytes did not reveal any intrinsic quantitative defect. Yet, a decrease in the percentage of such cells was noted in patients with progressive forms, suggesting a recruitment of regulatory T cells from the peripheral blood to the site of injury. This was further corroborated by the significant increase of Forkhead box P3 expression in the vitiliginous skin of patients. Our data support the involvement of a functional defect of peripheral regulatory T cells in the pathogenesis of vitiligo and open new possibilities to advance therapeutic approaches.

[Esophageal perforation during nasogastric tube insertion in a patient with right-sided aortic arch and thoracic aorta. Pathophysiology and surgical implications]. / Perforation oesophagienne par sonde nasogastrique avec arc aortique droit et aorte descendante à droite. Physiopathologie et particularités chirurgicales.

Esophageal perforation during nasogastric tube insertion is a very unusual occurrence. In this case report, radiologic images revealed a right-sided aortic arch with a right-sided thoracic aorta. This anatomical anomaly probably contributed to the complication and necessitated a modified approach to the surgical repair.

[Esophageal perforation during nasogastric tube insertion in a patient with right-sided aortic arch and thoracic aorta. Pathophysiology and surgical implications]. / Perforation oesophagienne par sonde nasogastrique avec arc aortique droit et aorte descendante à droite. Physiopathologie et particularités chirurgicales.

Esophageal perforation during nasogastric tube insertion is a very unusual occurrence. In this case report, radiologic images revealed a right-sided aortic arch with a right-sided thoracic aorta. This anatomical anomaly probably contributed to the complication and necessitated a modified approach to the surgical repair.

[Reactive haemophagocytic syndrome and multiple organ failure in intensive care unit patients]. / Syndrome d'activation macrophagique réactionnel: une cause sous-estimée de défaillance multiviscérale en réanimation?

The incidence of the haemophagocytic syndrome in the ICU patients with multiple organ failure seems to be high. The haemophagocytic syndrome can be considered as the consequence of the initial aggression leading to multiple organ failure. On the contrary the haemophagocytic syndrome could be the cause of multiple organ failure. A case of haemophagocytic syndrome is presented which led to rapidly fatal multiple organ failure.

[Experience with Ramipril (Triatec(R)) in the treatment of glaucomatous neuropathy]. / Traitement de la neuropathie glaucomateuse par le Ramipril (Triatec(R)).

PURPOSE: The main purpose of this study was to assess the improvement in visual function in patients with glaucomatous neuropathy treated with Ramipril (angiotensin-converting enzyme inhibitor); we were thus able to link ischemia and visual deterioration in glaucoma. Ramipril increases endothelium-dependent relaxation and vasodilatation to bradykinin via B2 receptors linked to the formation of nitric oxide (NO). On the other hand, Ramipril could have an influence on retinal neurotransmission modulation. MATERIALS AND METHODS: Ramipril was administered to 22 patients suffering from chronic glaucoma in whom intraocular pressure (IOP) was controlled by classic treatment, combining Ramipril with this treatment. It was given orally (1.25mg daily) for 3 months in order to improve visual function. In addition to the standard follow-up (visual acuity, intraocular pressure, automatic perimetry, optic disk), this study focused on the systemic tolerance to Ramipril. RESULTS: Thirty eyes in 22 patients were evaluated. Mean intraocular pressure did not change, but the mean visual acuity improved from 0.53 to 0.74. After 3 months of treatment, the perimetric test (Octopus) showed an improvement in the mean defect (MD) (48%) and the corrected loss variance (CLV) (54%). No complications in terms of arterial pressure were observed. CONCLUSION: This study has shown that Ramipril was an effective agent in glaucomatous neuropathy. It improved visual function without changing IOP and had a satisfactory general tolerance in all patients. This could be explained in part by a higher production of NO by endothelial cells. This gas is a powerful vasodilator. It is formed from L-arginine by constitutive nitric oxide synthetase. This would provide an improvement in local blood flow autoregulation altered in glaucoma by an endothelial dysfunction.

[Occlusion of the central retinal vein in a 6-month pregnant woman]. / Occlusion du tronc de la veine centrale de la rétine chez une femme enceinte au 6e mois.

The authors report the case of 27-year old woman who was 6 months pregnant (second pregnancy, first parity) and presented an occlusion of the central retinal vein. The etiological investigation revealed impaired fibrinolysis after venous stasis. The clinical course including evolution and therapy was stressed. The role of pregnancy as a supplementary risk factor by haemorrheological mechanism was suggested.