[News Skin lesions : a case report of fixed drug eruption]. / Apparition soudaine de lésions cutanées : à propos d'un cas d'érythème pigmenté fixe.

Fixed drug eruption is an erythematous eruption of one or more centimetric rounded or oval lesions well demarcated, recurrent at the same place and leaving a residual purple pigmentation. Diagnosis is clinical. Skin biopsy is not essential except in doubtful cases (eg bullous drug eruption can simulate Lyell Syndrome or mucosal reminiscent of erythema multiforme). The etiology is almost always drug-induced; rare cases of toxic or food issue were reported. Histopathology is immuno-allergic; recurrences correspond to re-exposure to allergen. There is no specific treatment except stopping the causing drug.

L'érythème pigmenté fixe est une éruption érythémateuse d'une ou plusieurs lésions arrondies ou ovalaires centimétriques bien délimitées, récidivant au même endroit et laissant une pigmentation violacée résiduelle. Le diagnostic est clinique. La biopsie cutanée n'est pas indispensable sauf dans les cas douteux (exemple : érythème pigmenté bulleux pouvant simuler un Syndrome de Lyell ou une atteinte des muqueuses faisant penser à un érythème polymorphe). L'étiologie est presque toujours d'origine médicamenteuse; des rares cas de cause alimentaire ou toxique ont été rapportés. L'histopathologie est donc immuno-allergique ; les récidives correspondent à la réexposition à l'allergène. Il n'existe pas de traitement spécifique hormis l'arrêt du médicament incriminé.

[Delirium in the elderly]. / Etat confusionnel aigu chez la personne âgée.

Delirium in the elderly is common but unfortunately underdiagnosed. The consequences could be significant such as an increase of the mortality in the hospital, loss of autonomy and increased risk to be institutionalized. The presentation of the delirium could be hyperactive, hypoactive or mixed. The predisposing and precipating factors are well known. The physiopathology is not yet well defined but the inflammation and the neuromediators are involved. It is important to develop primary and secondary prevention, but also to propose a follow in memory clinics for all elderly people who having suffered from delirium during hospitalization because a confusional state could be the first step towards future dementia.

Lung hyperpermeability and asthma prevalence in schoolchildren: unexpected associations with the attendance at indoor chlorinated swimming pools.

AIMS: To study whether exposure to nitrogen trichloride in indoor chlorinated pools may affect the respiratory epithelium of children and increase the risk of some lung diseases such as asthma. METHODS: In 226 healthy children, serum surfactant associated proteins A and B (SP-A and SP-B), 16 kDa Clara cell protein (CC16), and IgE were measured. Lung specific proteins were measured in the serum of 16 children and 13 adults before and after exposure to NCl(3) in an indoor chlorinated pool. Relations between pool attendance and asthma prevalence were studied in 1881 children. Asthma was screened with the exercise induced bronchoconstriction test (EIB). RESULTS: Pool attendance was the most consistent predictor of lung epithelium permeability. A positive dose-effect relation was found with cumulated pool attendance and serum SP-A and SP-B. Serum IgE was unrelated to pool attendance, but correlated positively with lung hyperpermeability as assessed by serum SP-B. Changes in serum levels of lung proteins were reproduced in children and adults attending an indoor pool. Serum SP-A and SP-B were already significantly increased after one hour on the pool side without swimming. Positive EIB and total asthma prevalence were significantly correlated with cumulated pool attendance indices. CONCLUSIONS: Regular attendance at chlorinated pools by young children is associated with an exposure dependent increase in lung epithelium permeability and increase in the risk of developing asthma, especially in association with other risk factors. We therefore postulate that the increasing exposure of children to chlorination products in indoor pools might be an important cause of the rising incidence of childhood asthma and allergic diseases in industrialised countries. Further epidemiological studies should be undertaken to test this hypothesis.