[Contribution of CSF/serum immunofixation to the diagnosis of inflammatory diseases of the central nervous system]. / Intérêt de l'immunofixation du couple LCR/sérum dans le diagnostic des maladies inflammatoires du système nerveux central.

INTRODUCTION: Multiple sclerosis and other inflammatory diseases of the central nervous system produce various and nonspecific symptoms. The diagnosis of these diseases is ultimately a clinical decision, although examination of cerebrospinal fluid (CSF) and other complementary tests such magnetic resonance imaging (MRI) and evoked potentials can be contributive. One important aspect of these diseases is intrathecal synthesis of immunoglobulins. PATIENTS AND METHODS: In order to determine the contribution of CSF/serum immunofixation to the diagnosis of inflammatory diseases of the central nervous system, we conducted a retrospective study in the biochemistry laboratory of the military instruction hospital Mohammed V. 363 CSF/serum samples were collected over a period of four years. RESULTS: Immunofixation was less sensitive than MRI for the diagnosis of inflammatory neurological disease (44% vs 87%), but was much more specific than MRI (97% for immunofixation vs 38%). The positive predictive value was higher that for MRI (85% vs 40%). The negative predictive value (80%) was close to that of MRI (86%). The bivariate analysis showed that immunofixation results could be predicted from clinical findings and complementary test results such as the index of Link, syphilis serology in CSF, and MRI. CONCLUSIONS/DISCUSSION: Semi-automatic Hydrasys immunofixation of CSF IgG is a technique exhibiting excellent diagnostic and analytical performance for the diagnosis of inflammatory neurological diseases.

Intérêt des marqueurs tumoraux sériques dans les cancers digestifs

Les marqueurs tumoraux sont des composés produits par les cellules cancéreuses ou leur environnement se retrouvant en quantité suffisante dans le sang, les urines et les liquides d'effusion. Les marqueurs les plus utilisés en pathologie digestive sont l'antigène carcino-embryonnaire (ACE), l'alpha foetoproteine (_FP) et le CA19-19. Le but de notre travail est de discuter l'intérêt de ces trois marqueurs dans le dépistage, le suivi et le pronostic des cancers gastriques, pancréatiques, colorectaux et hépatiques.La faible sensibilité et l'existence de faux positifs rendent parfois ces marqueurs impropres à une stratégie de dépistage. Par contre, seul l'_FP a une valeur diagnostique dans les hépato carcinomes pour les populations à haut risque. L'ACE et le CA19-9 ont une bonne sensibilité et une spécificité relative qui leur permettent de suivre l'évolution des cancers digestifs en particulier les cancers colorectaux. Ils constituent les meilleurs marqueurs pour évaluer le pronostic, l'efficacité thérapeutique et pour dépister les récidives de façon précoce. Leur association est justifiée et permet d'atteindre 91% de spécificité et 76% de sensibilité.Devant la place occupée par la biologie dans le diagnostic, le pronostic et le suivi des cancers digestifs par le dosage des marqueurs tumoraux, nous nous devons que de reconnaître tant leurs performances que leurs limites

[A critical study of the screening practices of gestational diabetes of a service of gynecology and obstetrics]. / Etude critique des pratiques de dépistage du diabète gestationnel d'un service de gynécologie obstétrique.

Our study has for aim to describe the practices of screening of the gestational diabetes mellitus. Screening test was realised at 61% of the women included in the study. The HGPO in 50 g was prescribed in 47% of the cases, a single fasting blood glucose in 28% of the cases; 13,4% of the detected women had a glycaemia included between 1,30 and 2 g/L one hour after a load of 50 g of glucose. Among these patients, 52,63% did not realize test HGPO in 100 g. Gestational diabetes mellitus complicates about 7,7% of pregnancies in our study. In statistical analysis united varied, are considered as risk factors: the age, the family history of diabetes and the histories of macrocosmic during previous pregnancy.

[Biological profile of type I allergies at Mohamed V Hospital (Rabat- Morocco)]. / Profil biologique des allergies de type I chez les consultants de l'hôpital Mohamed V de Rabat.

Allergic diseases are ranked fourth considering the world health organization classification of diseases. The consequences linked to these ailments are huge for public health economics and the diagnosis is awkward due to clinical polymorphism and multifactorial aetiologies. The allergologic diagnosis is the result of weighing in clinical and biological findings. The biological assessment is made of qualitative specific and multiple-allergen serum IgE test, which once positive drives to skin test and each allergen-specific IgE level determination to conclude. Our study aims at displaying biological analysis results of incoming patients with clinical allergy conditions. We carried out a nine months retrospective study, from June 2007 to March 2008, with 200 outwards patients involved. Blood samples were collected using dry tubes and as recommended we first did screening tests for respiratory (Pharmacia Phadiatop) and food (fx 5) allergens, then for positive samples we proceeded to serum specific IgE assay (UniCap, Phadia). We also realized the total IgE assay on 46 patients using Roche Elecsys 2010 technology. 49% of patients enrolled in the study were positive to aerollergens, d1 Dermatophagoides pteronyssinus being the most incriminated (96.4%), and 2.5% to food allergens. On 13% of patients, we noticed a double sensitization to d1 and g6 (pollen of grasses). Concerning the total IgE dosage, we found 50% of patients tested with normal values, 28% of whom having a positive allergologic screening test. Further studies matching clinical data, skin tests to serum IgE assay are necessary to draw the profile of respiratory and dermatological allergies for our patients.

[Kidney vasculitis connected to cryoglobulinemia IIA and hepatitis B]. / Vascularite rénale dans le cadre d'une cryoglobulinémie mixte associée au virus de l'hépatite B.

We report the case of a 70 years old patient hospitalized for renal insufficiency and deterioration of the general state. The electrophoresis of serum proteins on freezing of agarose reveals the presence of a discrete peak of monoclonal pace on the level of the gammaglobulines identified by serum immunofixation like IgM of the kappa type. The research of the cryoglobulinemia carried out in a laboratory of city was made positive and typified like a monoclonal cryoglobulinemia IgM kappa, thus directing the diagnosis towards a disease of Waldenström. However, the result of the biopsy medullary made exclude any lymphoprolifératif syndrome. The positivity of the serology of hepatitis B justified a second request for study of the cryoglobulinemia, carried out within our laboratory. The cryoglobuline was typified like mixed (IgM kappa monoclonal and IgG polyclonales). This result associated with the immunological assessment and the renal biopsy made retain for our patient the diagnosis of a kidney vasculitis connected to an infection chronicle by the virus of hepatitis B. This observation points out the interest of the preanalytic, analytic and post analytic phases in the study of the cryoglobulinemias. A good technical control is today the only guarantee of the quality of the result of this examination which has large importance in internal medicine in the etiologic assistance with the diagnosis of certain clinical demonstrations.

[Non-secreting myeloma associated with nephrotic syndrome]. / Myélome non excrétant révélé par un syndrome néphrotique.

The non-secreting myeloma is a rare form of myeloma. Its association with a nephrotic syndrome is exceptional. The observation which we report below described the history of a 66 years old patient who presents a non-secreting myeloma revealed by a nephrotic syndrome. Various assumptions on the mechanism of no excretion were put forth. Nevertheless, several points are to be elucidated as for the pathogenesis of the association non-secreting myeloma and nephrotic syndrome.