[Update of oral vitamin B12]. / Mise au point sur la vitamine B12 administrée par voie orale.

OBJECTIVE: The objective of this review is to evaluate the usefulness of oral cobalamin (vitamin B12) treatment. MATERIAL AND METHOD: PubMed was systematically searched for English and French articles published from January 1990 to January 2007. RESULTS: Prospective randomized studies (n = 3), a systematic review by the Cochrane group (n = 1) and prospective studies in well-determined population (n = 5) provide evidence that oral cyanocobalamin therapy may adequately treat cobalamin deficiency in elderly patients. However, the current literature may not suggest a strategy in terms of the form (hydroxy- or cyanocobalamin), frequency and duration of the treatment. CONCLUSION: This present review confirms the previously reported efficacy of oral cyanocobalamin treatment in elderly patients.

[Idiosyncratic drug-induced thrombocytopenia]. / Les thrombopénies médicamenteuses idiosyncrasiques.

Idiosyncratic drug-induced thrombocytopenia is a relatively rare and potentially serious side-effect in its moderate and profound forms (platelet count less than 100 x 10(9)L). It may be of central or peripheral mechanism, with consumption or immunological destruction. The main incriminated molecules are heparins, quinidine, sulfonamides and gold salts. Hemorrhagic manifestations are the rule and their severity is related to the level of thrombocytopenia and the involved molecule. Heparin-induced thrombocytopenia is more often associated with thrombotic events. Diagnosis relies on medical history and clinical criteria, which also establish the level of imputability. The role of serological tests is not yet clear but seems to be particularly interesting in difficult diagnostic situations and in heparin-induced thrombocytopenia. The treatment is based on the discontinuation of the incriminated drug and on supportive measures that depend on the severity of the clinical features.