[Idiosyncratic drug-induced agranulocytosis: 7 year-analysis in a French university hospital]. / Agranulocytoses médicamenteuses idiosyncrasiques : analyse de 7 ans dans un hôpital universitaire français.

INTRODUCTION: Idiosyncratic drug-induced agranulocytosis is a rare but potentially serious haematological disorder. The pathophysiological mechanisms are complex and poorly understood. We aimed at investigating agranulocytosis drug related causes from the myelograms with "myeloid maturation arrest" performed in our university hospital over the last seven years. METHODS: A retrospective analysis of myelograms collected for agranulocytosis was performed from 1st January 2010 to 31th December 2016. We used the method of Bégaud et al. for drug causality assessment. RESULTS: Among the 104 myelograms analysed, 41 agranulocytosis were drug-induced, whose 28 were idiosyncratic. Among these 28 cases, 26 different drugs were involved. Agranulocytosis was a known adverse reaction in the summary of the product characteristics for 24 drugs, mainly associated with undetermined frequency (n=7). Mean onset latency was 38.1 days after starting the drug (calculated for n=23 cases) and granulocyte growth factors were used in 50% of cases without shortening the mean delay of blood count recovery. Bone marrow presented hypereosinophilia in 29% of cases. Pharmacovigilance reporting rate was 48%. CONCLUSION: A "maturation arrest" in the myelogram is not pathognomonic for idiosyncratic drug-induced agranulocytosis. This rare event require multidisciplinary care involving haematologists, biologists and pharmacovigilance experts. Agranulocytosis reporting rate was high compared with usual adverse drug reaction reporting rate (5 to 10%), probably related to the potential severity of this event.

[Berger's disease associated to an adalimumab-treated rheumatoid arthritis]. / Maladie de Berger au cours d'une Polyarthrite Rhumatoïde traitée par Adalimumab.

Berger's disease is characterized by deposits of immunoglobulin A in the glomerular mesangium. We report a case of a patient who was treated by adalimumab for a rheumatoid arthritis (RA). The patient is 45 years old and is treated for RA since 1996. Adalimumab was started after the failure of several treatments. Biological and clinical response to adalimumab were excellent. A nephrotic syndrome was diagnosed during the patient follow-up. Adalimumab was stopped since it was suspected to be responsible of these symptoms. Berger's disease was diagnosed thanks to a renal biopsy. The nephrotic syndrome was treated with corticosteroids, then tocilizumab was used to treat RA. TNF-alpha inhibitors are well known for inducing kidneys' adverse reactions (ADR). Usually, they appear shortly after the beginning of a treatment. Adalimumab has already been described in studies for inducing similar kidneys' adverse drug reactions. These ADR are often associated with systemic disease outbreak. It is difficult to assert that adalimumab or RA was responsible of the ADR that we noticed in our patient. It is usually admitted that these ADR are uncommon when the RA is controlled.

Associative history affects the associative change undergone by both presented and absent cues in human causal learning.

R. A. Rescorla (2000) noted that a number of influential theories of associative learning do not take the associative history of cues (i.e., the prior training that they have received) into account when calculating the associative change undergone by those cues. The authors tested this assumption in a human causal learning paradigm and found associative history to be an important determinant of the learning undergone by cues that are presented on a trial. Moreover, associative history was also found to influence the amount of retrospective revaluation undergone by absent cues. These findings conflict with models of causal learning in which the associative change undergone by an element of a cue compound is governed by a summed error term (e.g., R. A. Rescorla & A. R. Wagner, 1972).

Small bowel esophagoplasty with vascular microanastomoses in the neck for treatment of esophageal burns in childhood.

Replacement of the esophagus may become mandatory in esophageal burns if dilatation treatment is unsuccessful. Normally, the isoperistaltic transverse colon placed in the neck is used for this purpose. The use of the major curvature of the stomach, according to Gavriliu, may also be considered. In two of our patients, these techniques could not be applied, and we transplanted a portion of the small bowel into the neck, with the blood supply to the pedicule being provided by vascular microanastomosis in the cervical region. The functional results were very satisfying in both cases, despite of the bent appearance of the grafts. At long-term follow-up, there have been no major, particularly peptic, complications. The two cases and the technique applied are described.

[148 epiphysiodeses in the management of leg length inequality]. / Considérations sur 148 épiphysiodèses dans le traitement des inégalités de longuer des membres inférieurs.

The authors relate their experience in the treatment of unequal leg length, in children, by was of epiphysiodesis. They realized 54 Phemister's operations and 94 Blount's Among the latters, final sterilization of the epiphyseal cartilage has been noted after 1,5 year and the axis deviations (main complication of these operations) was clearly more frequent and graver. Besides, the estimates preliminary to the epiphysiodesis setted up for the treatment of small inequality proved to be little reliable and little accurate and this difficulty in making accurate prevision is an important snag to the method.