[Low-dose methotrexate: Indications and side effects, particularly in cases of diffuse interstitial pneumonia]. / Méthotrexate à faible dose : indications et effets secondaires, en particulier en cas de pneumopathie interstitielle diffuse.

INTRODUCTION: Methotrexate (MTX) is a folate antagonist used as an immunosuppressant in a number of conditions, including rheumatoid arthritis (RA). Low-dose MTX (MTX-LD) is associated with a risk of haematological, hepatic, gastrointestinal and pulmonary toxicity, which may up until now have limited its use. STATE OF THE ART: In RA, data from retrospective cohorts have reported a possible excess risk of methotrexate toxicity in cases of underlying interstitial lung disease (ILD). However, recent prospective and retrospective multicentre studies have found no such increased risk, and have reassuringly concluded that MTX-LD can be prescribed in cases of RA-associated ILD (RA-ILD). PERSPECTIVES AND CONCLUSIONS: Current recommendations are not to delay the introduction of MTX in patients with RA at risk of developing ILD or in the presence of RA-ILD with mild to moderate respiratory impairment.

[Infectious pneumonia favored by paraneoplastic Cushing syndrome in a pulmonary carcinoid tumor]. / Pneumopathie infectieuse favorisée par un syndrome de Cushing paranéoplasique d'une tumeur carcinoïde pulmonaire.

INTRODUCTION: Ectopic Cushing's syndrome (CS) is a rare condition nevertheless well-known to endocrinologists. The pneumologist may be called upon to treat CS not only because bronchial carcinoid tumors are the most frequent source of ectopic ACTH secretion, but also due to the fact that the immunosuppression induced by hypercorticism favors lower respiratory tract infections. CASE REPORT: We report the case of a female patient presenting with acute respiratory failure secondary to Enterobacter cloacae pneumonia exacerbated by SC. Further investigations confirmed ectopic ACTH secretion and revealed a right upper lobe pulmonary nodule. After appropriate antibiotic therapy, the patient received preoperative adrenolytic treatment. Management by right upper lobectomy resulted in the extraction of a 12mm tumor. Pathological analysis was consistent with the diagnosis of a typical carcinoid tumor. Immunohistochemistry confirmed ACTH secretion by the tumor. Even though the postoperative course showed CS regression, the patient developed adrenal insufficiency. CONCLUSION: Ectopic CS induces immunosuppression, which aggravates lower respiratory tract infections. Search for a pulmonary neuroendocrine tumor should be systematic. Following control of the secretory syndrome by adrenolytic treatment, and if the diagnosis of carcinoid tumor is confirmed, surgical treatment is the preferred option.

[Face to a bilateral pneumothorax, just scratch your head!] / Devant un pneumothorax bilatéral, il faut bien se gratter la tête !

Head and neck skin angiosarcoma is a rare and aggressive tumor (1 % of head and neck tumors). Prognosis remains poor, with a 5-year survival rate ranging from 10 to 54%, depending on the initial stage. Metastatic disease markedly worsens the prognosis. Metastatic lung involvement is classic and can take on several forms. The cystic form is responsible for numerous complications, particularly pneumothorax. In this case, an 83-year-old patient was diagnosed with bilateral pneumothorax complicating cystic interstitial lung disease, which was revealed by hemoptoic sputum. Skin examination revealed two large necrotic lesions of the calvaria. Anatomo-pathological examination confirmed cutaneous angiosarcoma on both skin biopsy and lung resection. At a metastatic stage, only systemic treatment with paclitaxel can be proposed. The clinical course was unfavorable, leading to death before any specific treatment. This observation highlights the importance of a complete clinical skin examination in the assessment of pulmonary cystic lesions.

[Inhalation therapy: inhaled generics, inhaled antidotes, the future of anti-infectives and the indications of inhaled pentamidine. GAT aerosolstorming, Paris 2012]. / Aérosolthérapie : les génériques par voie inhalée, les antidotes en aérosol, le futur des anti-infectieux et les indications de la pentamidine en aérosol. Aérosolstorming du GAT, Paris 2012.

The working group on aerosol therapy (GAT) of the Société de pneumologie de langue française (SPLF) organized its third "Aerosolstorming" in 2012. During the course of one day, different aspects of inhaled therapy were discussed, and these will be treated separately in two articles, this one being the first. Inhaled products represent a large volume of prescriptions both in the community and in hospital settings and they involve various specialties particularly ENT and respiratory care. Technical aspects of the development of these products, their mode of administration and compliance with their indications are key elements for the effective therapeutic use of inhaled treatments. In this first article, we will review issues concerning generic inhaled products, the existence of inhaled antidotes, new anti-infective agents and indications for inhaled pentamidine.

[Inhalation therapy: inhaled corticosteroids in ENT, development and technical challenges of powder inhalers, nebulisers synchronized with breathing and aerosol size distribution. GAT aerosolstorming, Paris 2012]. / Aérosolthérapie : les corticoïdes inhalés en ORL, le développement et les défis techniques des inhalateurs de poudre, les nébuliseurs couplés à la respiration et la granulométrie d'un aérosol. Aerosolstorming du GAT, Paris 2012.

The working group on aerosol therapy (GAT) of the Société de Pneumologie de Langue Française (SPLF) has organized its third Aerosolstorming in 2012. During one single day, different aspects of inhaled therapies have been treated and are detailed in two articles, this one being the second. This text deals with the indications of inhaled corticosteroids in ENT, the development and technical challenges of powder inhalers, the advantages and disadvantages of each type of technologies to measure the particle sizes of inhaled treatments.

Staphylococcus simulans osteitis in a diabetic patient.

Staphylococcus simulans was identified as the aetiological agent of osteitis in a diabetic woman. Its identifying characteristics and antibiogram were confirmed. Diabetic foot frequently becomes infected and the spread of infection to bone is a major causal factor behind lower-limb amputation. Early diagnosis and appropriate treatment are essential in such cases.

[Renal and spleen infarction after massive consumption of cannabis and cocaine in a young man]. / Infarctus rénal et splénique après consommation massive de cannabis et cocaïne chez un homme jeune.

Cannabis is the most widely consumed drug in the world, particularly among young subjects. Cocaine is the third leading illicit drug. Cases of renal infarction associated with combined consumption of cannabis and cocaine have been reported in the literature. We describe the case of a 24-year-old man who presented renal and spleen infarction after massive consumption of cannabis and cocaine. Both vascular events arose on healthy arteries. Etiological tests were negative leading to the conclusion that the events resulted from a toxic cause related to cannabis and cocaine consumption. Different mechanisms, potentially including thrombosis, might explain the association of cannabis and cocaine with vascular events. We suggest that a systematic search for cannabis and cocaine consumption among young victims of vascular disease might be useful.

[Biological signifiance of 410 microcytosis]. / Signification biologique de 410 microcytoses de découverte fortuite chez des adultes jeunes.

We have detected 410 microcytosis among biological tests of military people. These microcytosis are principally coumpounded by haemoglobin's abnormalities (minor thalassemia, sickle cell diseases, E haemoglobin cases and cases of C haemoglobin) and cases of iron deficiency, usually among women.

[Acute rhabdomyolysis and primary human immunodeficiency virus type 1 infection: a new observation]. / Rhabdomyolyse aiguë associée à une primo-infection à VIH-1: une nouvelle observation.

INTRODUCTION: Acute human immunodeficiency virus type 1 infection is a clinical and biological misleading and often undiagnosed illness. Laboratory studies frequently demonstrate abnormalities. Acute rhabdomyolysis is rarely reported. EXEGESIS: Authors report the case of an African man who presented with acute fever, cough, diarrhea, conjunctivitis, thrombocytopenia, lymphopenia, and rhabdomyolysis without other possible cause. HIV test and detection of plasma p24 antigen were initially negative but were controlled positive and associated with high level of viral RNA. CONCLUSION: Symptomatic primary human immunodeficiency virus infection presenting with acute rhabdomyolysis was diagnosed. Diagnosis of primary HIV-1 infection must be considered in young people and patients at risk who present with acute rhabdomyolysis and fever.

[Streptococcus pyogenes: a rare etiology of non-gonococcal urethritis and balanitis in the adult]. / Streptococcus pyogenes: une cause exceptionnelle d'urétrite et de balanite non gonococcique de l'adulte.

Urethritis and balanitis due to S. pyogenes are very uncommon. The authors report the case of a 22 year-old male patient, presenting with this association, the first case reported in France. There was no associated STD.

[Asymptomatic forms of the Severe Acute Respiratory Syndrome (SARS)]. / Formes pauci-symptomatiques du Syndrome Respiratoire Aigu Sévère (SRAS).

INTRODUCTION: In November 2002 an epidemic of atypical pneumonia appeared in the Chinese region of Guandong. It was subsequently given the name "Severe Acute Respiratory Syndrome" (SARS) following the occurrence of further outbreaks in Hanoi and Hong Kong in February 2003. Five cases related to the same patient source have been reported in France. CASE REPORT: We report the case of a patient of 52 years who had direct contact with a probable case of SARS. On admission the patient presented with pyrexia associated with lymphopenia and liver cell necrosis but no respiratory symptoms. The chest x-ray was normal. The thoracic CT scan showed a sub pleural ground glass appearance. Early (36 hours) PCR studies of nasopharyngeal washings were negative for the coronavirus associated with SARS. The diagnosis was confirmed serologically. CONCLUSIONS: This observation demonstrates the existence of incomplete clinical presentations of SARS. The infectivity of this asymptomatic form is unknown. Serological analyses will allow better identification. The continuing danger of seasonal recurrence, particularly in the winter, cannot be ignored. In this context the recognition of probably infectious asymptomatic forms is essential.

Cytokeratin-like proteins in the sheep oocyte.

In immunoblotting analysis of fully grown oocyte proteins separated by sodium dodecyl sulfate polyacrylamide (SDS-PAGE) gel electrophoresis, four polypeptides reacted specifically with cytokeratin antibodies: Mr 66,000, IEP 5.6; Mr 64,000, IEP 5.4; Mr 59,000, IEP 5.3; Mr 55,00, IEP 5.2. These proteins remained insoluble after extraction in high salt buffer and Triton X-100. In oocytes isolated from small antral follicles, only two polypeptides of Mr 66,000 and Mr 55,000 were detected. Immunofluorescence microscopy revealed a bright granular staining throughout the oocyte with an accumulation of granules in the perinuclear and cortical regions. Using electron microscopy and immunogold staining after treatment with cytokeratin antibody, gold particles were found on discrete amorphous material distributed throughout the cell. In the subcortical region of the oocyte, dense aggregates, whose diameters ranged from 3 to 8 microns, were also covered with gold particles. From these results it appears that cytokeratin-like proteins are present in sheep oocytes in a non-fibrillar form.

Distribution and role of microfilaments during early events of sheep fertilization.

The distribution of actin was studied during early events of sheep fertilization by fluorescence microscopy after staining with 7-nitrobenz-2-oxal-1.3 diazole (NBD)-phallacidin and anti-actin antibody and by electron microscopy after heavy meromyosin labelling. unfertilized and fertilized eggs exhibited a continuous band of fluorescence with both NBD-phallacidin and anti-actin antibody. Unlike in mice, no high concentration of actin overlying the spindle was detected in ovulated sheep oocytes. At the site of sperm head incorporation, the fertilization cone developed above the decondensing male chromatin and was underlined by a submembranous area rich in microfilaments. A similar actin network was observed in the cortex of the second polar body. Cytochalasin D was used to investigate the role of actin during the fertilization process. This drug did not prevent sperm fusion and incorporation but inhibited polar body abstriction and fertilization cone development and retarded sperm tail incorporation. Moreover, in the presence of the drug, the anchorage of the metaphase II spindle at the surface of the egg was destroyed. The role of microfilaments in these early events is discussed.

Microtubule and centrosome distribution during sheep fertilization.

The distribution of microtubules and centrosomes was studied during sheep fertilization by electron and immunofluorescence microscopy. Tubulin and centrosomal material was identified with monoclonal anti-alpha-tubulin and MPM-2 antibodies, respectively. In ovulated eggs, microtubules were exclusively found in the meiotic spindle and centrosomal material at each of its poles. At fertilization, sperm centrosomes were incorporated into the egg and organized the sperm astral microtubules. During pronuclear development and migration, the sperm aster increased in size; microtubules of the sperm aster extended from the male pronucleus to the egg center and towards the female pronucleus. The position of the sperm aster during pronuclear migration suggests that it plays a role in this process. When the pronuclei were in apposition in the egg center, a dense array of microtubules and the centrosomal material were present between the two pronuclei. The proximal centriole of the sperm was identified by electron microscopy, between the apposed pronuclei. The centrosomal material extending around the centriole and the sperm neck and proximal mid-piece, apparently contained several foci from which microtubules radiated. These data suggest that in sheep unlike in mice, centrosomal material originating from the sperm is involved in the fertilization events.