[Benralizumab in cases of eosinophilic granulomatosis with polyangiitis]. / Diagnostic d'une granulomatose éosinophilique avec polyangéite sous benralizumab.

INTRODUCTION: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare necrotizing vasculitis affecting small vessels and associated with severe asthma and eosinophilia. Monoclonal antibodies blocking the IL-5 signaling pathway, one example being benralizumab, decrease the proliferation of eosinophils and represent an effective treatment in severe eosinophilic asthma. They are a therapeutic option currently studied for EGPA. We report the paradoxical clinical case of EGPA appearing following the initiation of treatment with benralizumab (anti-IL-5R monoclonal antibody). CASE REPORT: We describe the case of a 66-year-old female patient with severe asthma. Following the initiation of benralizumab, she showed deterioration of her general condition, associated with severe peripheral neuropathy of the lower limbs. At the same time, she developed massive hypereosinophilia. After an extensive workup, the patient was eventually diagnosed with an EGPA with multisystem involvement. Benralizumab was stopped and a course of high dose corticosteroids and immunosuppressants was initiated, enabling slow clinical recovery. CONCLUSION: Anti-IL5 monoclonal antibodies, including benralizumab, are being investigated for new therapeutic indications, including EGPA. Paradoxically, a few rare cases of EGPA associated with these molecules have been reported in the literature. The causal link of this association remains hypothetical. Close monitoring of patients on benralizumab consequently seems indispensable.

[Pulmonary embolism and inferior vena cava agenesis: An unusual association]. / Embolie pulmonaire et agénésie de veine cave inférieure : une association inhabituelle.

INTRODUCTION: Inferior vena cava agenesis is a rare congenital anomaly, generally associated with thrombophilic conditions, and a predisposing factor for deep venous thrombosis (DVT), rarely complicated by pulmonary embolism, in a young population with atypical clinical features and frequent absence of risk factors. CASE REPORT: We report the case of a 30-year-old woman who developed a right iliac DVT, initially presenting as a low back pain and complicated by a pulmonary embolism, 8 months after a sleeve gastrectomy. Chest CT angiography revealed abnormalities that led to the diagnosis of inferior vena cava agenesis. Thrombophilic screening showed a heterozygous prothrombin gene mutation G20210A and hyperhomocysteinemia. The patient was treated with rivaroxaban with good results after 2 years of follow-up. CONCLUSIONS: In young patients without risk factors developing a deep venous thrombosis, an inferior vena cava anomaly should be considered. Although no therapeutic consensus has been currently established, inferior vena cava agenesis seems to be associated with a high prevalence of thrombophilic disorders. Screening could be useful, particularly in patients with a thrombotic family history.

[Platypnea, orthodeoxia A report of two cases]. / Platypnée, orthodéoxie À propos de deux cas.

The plathypnea orthodeoxia syndrome is a rare condition that is characterized by dyspnea and hypoxia that occurs in the upright position and improves with recumbency. The diagnostic is often made tardively and requires the combination of two components: a mechanical one (for example a patent foramen ovale) and a kinetic one (for example COPD). This combination contributes to the blood flow through the communication. The treatment consists of closing the veno-arterial communication (in the case of a patent foramen ovale, the closing of the inter-atrial septum) (Knapper et al, 2014). In the present article, we describe two severe hypoxemic patients suffering from this syndrome. Both cases were associated with an acute pulmonary disease. A review of the literature is performed.

The sound exposure of the audience at a music festival.

During the Paleo Festival in Nyon, Switzerland, which took place from 24th to 29th July 2001, ten volunteers were equipped each evening with small sound level meters which continuously monitored their sound exposure as they circulated among the various festival events. Sound levels at the mixing console and at the place where people are most heavily exposed (in front of the speakers) were measured simultaneously. In addition, a sample of 601 people from the audience were interviewed over the six days of the festival and asked their opinion of sound level and quality, as well as provide details of where in the arena they preferred to listen to the concerts, whether they used ear plugs, if they had experienced any tinnitus, and if so how long it had persisted. The individual sound exposure during a typical evening was on average 95 dB(A) although 8% of the volunteers were exposed to sound levels higher then 100 dB(A). Only 5% of the audience wore ear plugs throughout the concert while 34% used them occasionally. While some 36% of the people interviewed reported that they had experienced tinnitus after listening to loud music, the majority found both the music quality and the sound level good. The sound level limit of 100 dB(A) at the place where the people are most heavily exposed seems to be a good compromise between the public heath issue, the demands of artists and organisers, and the expectations of the public. However, considering the average sound levels to which the public are exposed during a single evening, it is recommended that ear plugs be used by concert-goers who attend more than one day of the festival.

Evidence for recombination in natural populations of dengue virus type 1 based on the analysis of complete genome sequences.

Recombination events are known to occur in non-segmented RNA viruses like polioviruses or alphaviruses. Analysis of the subgenomic sequences of dengue virus type 1 (DENV-1) structural genes has recently allowed the identification of possible recombination breakpoints. Because DENV is a major human pathogen, this discovery might have important implications for virus pathogenicity, vaccine safety and efficiency, or diagnosis and, therefore, requires clear confirmation. We report the complete sequence determination of one Asian and two African strains of DENV-1 isolated from human patients. Rigorous sequence analysis provided strong evidence for the occurrence of intragenomic recombination events between DENV-1 strains belonging to different lineages. Singapore S275/90 strain appears to be the evolutionary product of a recombination event between viruses belonging to two distinct lineages: one lineage includes an African strain isolated in Abidjan (Ivory Coast) and the other includes isolates from Djibouti and Cambodia. The 'Recombination Detection Program', bootscanning and analysis of diversity plots provided congruent results concerning the existence of a two-switch recombination event and the localization of recombination breakpoints. Thus, the 5' and 3' genomic ends of the Singapore S275/90 strain were inherited from a Djibouti/Cambodia lineage ancestor and an internal fragment located in the envelope/NS1 region originated from an Abidjan lineage ancestor.

Complete genomic sequence of a dengue type 2 virus from the French West Indies.

Severe forms of dengue fever, dengue haemorrhagic fever, and dengue shock syndrome, were not prominent in the Americas until the epidemic of Cuba in 1981. Since that time, they have spread to other countries in Central and South America, correlating with the spread of dengue type 2 viruses related to Southeast Asian strains. We report here the complete genomic sequence of a dengue type 2 virus isolated during the epidemic in La Martinique in 1998. This constitutes the first complete genetic characterization of a dengue virus strain from French West Indies, and also the first molecular identification in this region of a dengue 2 strain phylogenetically related to the emerging American type 2 dengue viruses.

[Aorto-iliac aneurysms rupturing into the vena cava. A retrospective multicenter study]. / Anévrysmes aorto-iliaques rompus dans la veine cave. Etude rétrospective multicentrique portant sur 15 ans.

Eleven of the 28 centers participating in the French inter-university association for surgical research (AURC) collected retrospective data on abdominal aortic aneurysms ruptured into the vena cava. Thirty-nine cases were observed between 1979 and 1989. The signs and symptoms reported varied greatly. The pathognomonic triad associating aneurysm, abdominal pain and continuous abdominal murmur was found in one-third of the cases: 25.6% of the patients had signs of global heart failure. The diagnosis was preoperative in 74.4% of the cases. Mean delay of symptomatology before diagnosis was 7 +/- 12 hours. The analysis of operative procedures included 37 patients as 2 patients died before vascular repair could be attempted. Venous repair was done by direct suture in 76% of the cases. Peroperative blood loss was 4 600 +/- 3 500 ml. Perioperative mortality was 11 cases (28.2%). Cardiac and respiratory disorders were the cause of death in 54.4% of the fatal cases.

Complete nucleotide sequence and phylogeny of an American strain of yellow fever virus, TRINID79A.

Yellow fever was presumably imported to the Americas from West-Africa from the 16th to the 19th century. American and African genotypes of the virus are distinguishable, indicating separate evolution in different vector/host cycles. The complete nucleotide sequence of the yellow fever virus strain TRINID79A, isolated in Trinidad in 1979, has been established. It exhibits extensive homology with those of current West-African strains and attenuated strain FNV. However, a unique deletion of the 3' non-coding region (NCR) of the viral RNA has been identified. It indicates that RYF1 and RYF2 repeated sequences of the 3' NCR are not necessary to the replication of the virus.

The light-induced increase of carbohydrate metabolism in glial cells of the honeybee retina is not mediated by K+ movement nor by cAMP.

The retina of the honeybee drone is a nervous tissue in which glial cells and photoreceptor neurons constitute two distinct metabolic compartments. The phosphorylation of glucose and its subsequent incorporation into glycogen occur essentially in glia, whereas O2 consumption occurs in the photoreceptors. After [3H] glucose loading of superfused retinal slices, light stimulation induced a significant rise in [3H] glycogen turnover in the glia. This occurs without a concomitant covalent modification of glycogen enzymes. Probably only an increase or a decrease of the availability of [3H] glycosyls that are incorporated into glycogen is necessary. As only photoreceptors are directly excitable by light, we searched for a signal that stimulates glycogen metabolism in the glia. Although K+ in extracellular space and glia increases after repetitive light stimulation, increasing bath K+ in the dark did not mimic the metabolic effects of light, despite an equivalent increase of K+ in the extracellular space and glia. We subsequently explored the role of cAMP, a universal intracellular second messenger. Exposure of retinal slices to the adenylate-cyclase activator forskolin induced an expected increase in the rate of formation of cAMP, but only partially mimicked the metabolic effects of light. Furthermore, light stimulation failed to induce a rise in the rate of formation of cAMP. We conclude that in this nervous system, without synapses, neither K+ nor cAMP mediates the effect of light stimulation on intraglial glucose metabolism.

[Efficacy of an extract of Ginkgo biloba in the treatment of chronic obliterating arteriopathies of the lower limbs in stage III of Fontaine's classification]. / Efficacité de l'extrait de Ginkgo biloba dans le traitement des artériopathies oblitérantes chroniques des membres inférieurs au stade III de la classification de Fontaine.

UNLABELLED: A controlled trial of Ginkgo biloba extract in injectable form (Tanakan 50 mg, a lyophilizate for parenteral use) was carried out versus a placebo as a preoperative medical treatment of stage III (Fontaine classification) chronic occlusive arterial disease of the lower limbs (with pain in decubitus). The 64 men and women patients in this multicenter study (32 in each group) were over 18 years of age and had a cultural and intellectual level as well as a physical condition allowing them to play an active role in the experiment (self-evaluation of pain). During 8 days they received two daily infusions of 500 cc of normal saline solution containing either 100 mg of Ginkgo biloba extract or a placebo of identical appearance. During this period, anticoagulants were authorized; hemodilution, vasoactive drugs and platelet anti-aggregates were forbidden; pentazocine (Fortal, 50-mg tablets) was allowed at the patient's request. Pain was rated according to a visual scale, with each patient marking a point between two extremes ("maximum imaginable pain" and "total absence of pain") 100 mm apart. A questionnaire based on that of Melzack (McGill Pain Questionnaire) completed this qualitative as well as quantitative self-evaluation of pain. The results of these questionnaires were assessed on the basis of 4 scores, each determined by the patient's choice among 3 evaluation figures. The chi square, Student and Wilcoxon tests were used for statistical analysis. RESULTS: The two randomly-composed groups with Ginkgo biloba extract and a placebo were comparable (Table I). Analysis was based on 55 observations (26 in the extract group and 29 in the placebo group).(ABSTRACT TRUNCATED AT 250 WORDS)

Postnephrectomy arteriovenous fistula of the renal pedicle treated with detachable balloons: a case report.

A case of postnephrectomy arteriovenous fistula of the right renal pedicle is reported here. The diagnosis was confirmed by angiography, and successful treatment was achieved using detachable balloon.

Honeybee retinal glial cells transform glucose and supply the neurons with metabolic substrate.

The retina of the honeybee drone is a nervous tissue in which glial cells and photoreceptor cells (sensory neurons) constitute two distinct metabolic compartments. Retinal slices incubated with 2-deoxy[3H]glucose convert this glucose analogue to 2-deoxy[3H]glucose 6-phosphate, but this conversion is made only in the glial cells. Hence, glycolysis occurs only in glial cells. In contrast, the neurons consume O2 and this consumption is sustained by the hydrolysis of glycogen, which is contained in large amounts in the glia. During photostimulation the increased oxidative metabolism of the neurons is sustained by a higher supply of carbohydrates from the glia. This clear case of metabolic interaction between neurons and glial cells supports Golgi's original hypothesis, proposed nearly 100 years ago, about the nutritive function of glial cells in the nervous system.

Local fibrinolytic therapy in ischemic carotid pathology.

Sixteen patients underwent local fibrinolytic therapy for thrombosis or embolism of the main trunk or intracranial branches of the internal carotid artery. There were eight cases of complete thrombosis of the internal carotid artery, five proximal stenoses of the internal carotid artery with extensive thrombus, one thrombus of the carotid siphon and two middle cerebral artery emboli. Indications for treatment included transient ischemic attacks in 11 cases, cerebral ischemia after carotid arteriography in two cases, and after surgery for atheromatous lesions of the carotid bifurcation in three cases. The fibrinolytic therapy was initiated during carotid surgery in three cases, where extended thrombosis of the internal carotid artery was discovered, which was inaccessible to a Fogarty catheter. The other 13 cases were treated during arteriography procedures. Lysis of the clot was always obtained. One patient died of hematoma of the frontal lobe. All other patients survived and showed neurologic improvement. The neurologic outcome was dependent on the duration and the degree of initial ischemia. Fibrinolytic therapy appears to be beneficial therapy for certain cases of cerebral ischemia.

Post-radiotherapeutic left main coronary ostial stenosis: clinical and histological study.

Pericardial abnormalities remain the most common manifestation of radiation-induced cardiac disease, but coronary artery lesions are not rare. In this report we describe a left coronary ostial stenosis which appeared five years after mediastinal irradiation for breast carcinoma in a 50-year-old woman. The patient underwent coronary angiography. A pressure drop was observed as the left catheter tip engaged the left coronary ostium; so, only nonselective coronary opacifications were performed showing an isolated, marked narrowing of the left coronary ostia. During surgery, a circumferential aortotomy allowed the examination of the left coronary ostium which appeared severely stenosed. The coronary tree was otherwise normal. A termino-terminal saphenous vein graft was anastomosed on the left stem and its proximal part was implanted on the ascending aorta. The coronary ostium and the proximal part of the left main stem were excised and the macroscopic examination of the proximal part of the left coronary artery confirmed the diagnosis of severe ostial stenosis. Microscopic examination of the coronary ostium showed a severe intimal thickening without any evident lesion of the media. This intimal thickening consisted of fibrous tissue without extracellular lipid deposit. Microscopic examination of the aorta near the coronary ostium also demonstrated an intimal thickening without any lesion of the media. Coronary ostial stenosis appears to be a rare lesion; its incidence has varied between 0.13 and 2.7% in angiographic studies and there is co-existing disease in multiple coronary vessels in the majority of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Thin-layer chromatography of amine antioxidants and antiozonants used in elastomers.

Fifty-four amines used as antioxidants and/or antiozonants for elastomers were separated on silica gel thin-layer plates with benzene and benzene-ethyl acetate-acetone (100:5:1) as developing solvents and N-chloro-2,6-dichloro-p-benzoquinone monoimine in buffered alkaline medium as spray reagent. Benzene-n-hexane (50:50) was used to separate diheptyl- and dioctyldiphenylamines. The active agents of several imprecisely defined products were identified and the relationships between some mixtures were elucidated. The method highlights the numerous minor components of these very impure industrial compounds. Some theoretical correlations between the chemical structures, the RF values and the colours of the spots were also established.

Rupture of abdominal aortic aneurysm into the inferior vena cava: a study of seven cases.

The authors report seven cases of abdominal aortic aneurysm rupturing into the inferior vena cava system. Symptoms were protean, but included local clinical manifestations and general findings due to the high-flow arteriovenous fistula. In spite of different types of clinical presentation, the correct preoperative diagnosis was made when a continuous bruit with systolic accentuation was heard over the abdomen. Venous repair consisted of simple closure of the fistula from within the aneurysm in six cases. In one case, treatment required ligation of the right common iliac vein. There were two cases of paraplegia, one before and one after the operation. Two of the seven patients died.

[Acute pancreatitis caused by lithiasis in a dilated ampulla of Vater]. / Pancréatite aiguë par lithiase dans un papillocèle vatérien.

Unusual features in a case of dilatation of ampulla of Vater were in the existence of biliary calculi in the diverticulum and lithiasis complicated by a revealing acute pancreatitis. Diagnosis was suggested from barium meal followed through images and confirmed by perioperative cholangiography. Surgical treatment of such cases is simple, allows recovery without sequelae and avoids risks of recurrence.