[Hospital readmission induced by adverse drug reaction: a pilot study in a post-emergency unit of a French university hospital]. / Réhospitalisations d'origine médicamenteuse : étude pilote dans un service de post-urgences médicales d'un hôpital universitaire français.

PURPOSE: Adverse Drug Reactions (ADRs) leading to hospital admission was estimated to 3.6 to 21.7%. Despite its importance in terms of patients care, readmission to hospital due to ADRs remains poorly documented. The aim of our study was to investigate the rate and main characteristics of readmission for ADRs. METHODS: We undertook a retrospective study during two years (2011-2012) in the post-emergency unit of Toulouse university hospital (south western, France). We selected all unplanned hospitalization for acute disease and included all cases of patients admitted twice fold or more for ADRs. Characteristics of drug-induced ADRs were assessed according to appropriate use or not. RESULTS: Out of the 197 readmitted patients, 71 was related to ADRs (3.6%) corresponding to 17.8‰ patients-year. Mean age was 82.3 years and 67% were women. The most frequent ADRs found were vascular (n=41, 18.4%), gastro-intestinal (n=28, 12.6%), cardiac (n=28, 12.6%), neurologic (n=26, 11.7%), metabolic (n=26, 10.3%) and psychiatric (n=24, 9.9%). The drugs mainly involved were psychoactive, cardiovascular, digestive or antithrombotic agents. The context of occurrence of ADRs was related to inappropriate drug prescription in 56% of cases. A total of 24 patients were admitted twice for the same ADR and 2 others three times. For 22 patients (30.9%), the same drugs were involved. CONCLUSION: Our data show hospital readmission was due to ADRs in 3.6% of cases. In 1.1% of cases, the same couple "drug-ADR" was involved. Furthermore, in 56% of cases, repeated admissions are related to an inappropriate drug prescription.

Heat-related illnesses during the 2003 heat wave in an emergency service.

INTRODUCTION: This study describes patients admitted to an urban emergency service in France during the 2003 heat wave. Patients with heat-related illnesses were studied and comparison was made between those who died and survivors. METHODS: A retrospective study of about 760 records concerning 726 patients aged over 65 years admitted during August 2003 to a French emergency department. RESULTS: After review of the medical records, 42 patients had heat-related illnesses. Heat-related illnesses were not diagnosed by the treating physician in any of the patients. The patients were more likely to live in institutional care and used more psychotropic medications. Hyperthermia and acute cognitive impairment were the main reasons for admission to the emergency department. The patients had a higher heart rate and body temperature and more dyspnoea and central nervous system dysfunction than those without heat-related illnesses. Twelve patients (28.6%) with heat-related illnesses died in the emergency unit or after admission to hospital. Temperature, heart rate and plasma creatinine levels were higher in those who died than in survivors with heat-related illnesses. CONCLUSION: Heat-related illnesses are a group of underestimated and underdiagnosed conditions with high morbidity and mortality rates.

[Preventability of adverse effects in a medical emergency service]. / Evitabilité des effets indésirables dans un service d'admissions médicales.

The aim of this prospective pharmacovigilance study was to assess the incidence and the preventability of adverse drug reactions (ADRs) leading to hospital admissions. All patients admitted to the Toulouse University Hospital through the medical admission ward during four non-consecutive weeks were included in the study. Characteristics of patients admitted for a suspected ADR (cases) were compared with those admitted for other reasons (controls). All cases were reviewed by both a pharmacologist and an emergency medicine specialist. Among a total of 671 admissions, 44 ADRs were identified. The incidence of hospital admissions for ADRs was 6.1 per 100 admissions [4.4-8.3]. Cases were exposed to a higher number of drugs (3.6 vs. 1.7; p < 0.001). Some classes of drugs were significantly associated with a higher risk of ADRs: antineoplastic, anti-infectious or musculoskeletal drugs. Haematological, metabolic and electrolytic, liver/gastrointestinal or cutaneous disorders were causes of admissions significantly more frequently related to ADRs. Using Imbs's preventability scale, 65 per cent of ADRs were categorized as 'definitely unpreventable', 26 per cent 'potentially preventable' and 9 per cent 'definitely preventable'. These results underline the frequency of ADRs leading to hospitalization, with 35 per cent which are more than likely preventable. Further studies are needed to validate this preventability scale in order to obtain an easier, more reliable and more reproducible tool.

[Pulmonary embolism in patients using estrogen-progestagen contraceptives]. / Embolies pulmonaires sous contraception estro-progestative.

OBJECTIVES: The risk of thromboembolism in patients taking estrogen-progestagen oral contraceptive drugs has apparently increased since the introduction of third-generation progestagens (desogestrel, gestodene). We examined the clinical features, risk factors and outcome of pulmonary embolism in this context. PATIENTS AND METHODS: We reviewed 11 cases of thromboembolism in patients on oral contraception and hospitalized in emergency situations in 1995 and 1996 for pulmonary embolism in order to determine the gravity of the thromboembolic event, risk factors and type of drug used. RESULTS: Early clinical signs had preceded the onset of embolism by 2 to 164 days. PaO2 was below 70 mmHg in 4 patients. Diagnosis was achieved with pulmonary scintigraphy (11 cases), spiral CT (3 cases) and angiopneumography (2 cases). Duplex Doppler visualized the phlebitis in 7 patients. Given heparin (with fibrinolysis in 3 cases) then anti-vitamin K, and after withdrawal of the oral contraceptive, outcome was favorable in all cases. There were no recurrences. The nature of the oral contraceptive varied. Five patients were taking third-generation progestagens. In two cases, embolism had occurred following a change from a second-generation to a third-generation progestagen. Family history of phlebitis and/or abnormal laboratory findings were observed in 6 patients: resistance to activated protein C (2 patients), protein C deficiency (2 patients), anticardiolipin (2 patients) and low-titre antinuclear antibodies (2 patients). CONCLUSION: Pulmonary embolism in patients on oral contraceptives persists despite changes in the hormone content of the drugs. Diagnosis is often delayed. Family history of thrombosis or biological risk factors are often found.

[Systemic manifestations of primary Gougerot-Sjögren syndrome. Nature and incidence apropos of 34 cases]. / Manifestations systémiques du syndrome de Gougerot-Sjögren primaire. Nature et fréquence à propos de 34 cas.

OBJECTIVES: Assess the systemic manifestations observed in patients with primary Sjörgen's syndrome and the correlation between clinical findings and paraclinical data. METHODS: This retrospective study included patients who met the preliminary European criteria established in 1993. RESULTS: Among the 34 patients with primary Sjögren's syndrome (32 women, 2 men, mean age 54.9 years), systemic manifestations were observed as the inaugural sign in 25 (73.5%) and 31 cases (91%) during a mean 43-month follow-up. Clinical signs in 23 patients were: neuropsychiatric disorders including depressive syndromes (n = 17) and peripheral neuropathies (n = 13), joint and muscle disorders (n = 16), Raynaud's phenomenon (n = 8), pulmonary disorders (n = 8), digestive disorders (n = 8) including two cases of chronic autoimmune hepatitis, skin disease (n = 7), and renal (n = 3) and thyroid (n = 8) disorders. Antinuclear antibodies were found in 20 cases and anti-SSA antibodies in 5 associated with anti-SSB in 4. Eight patients had hematologic disorders. There was a correlation between the number of systemic signs (at least 2) and positive Rose-Bengal test (p = 0.045). DISCUSSION: Different systemic manifestations were found at percentages comparable with data in the literature except for Raynaud's syndrome which was less frequent and neurological disorders which were more frequent.

[Course of interstitial lung diseases associated with inflammatory myopathies. Apropos of 5 cases]. / Evolution des pneumopathies interstitielles associées aux myopathies inflammatoires.

We describe five cases of polymyositis/dermatomyositis with interstitial lung disease, occurring in women, with a mean follow up of 28 months (15 to 51). One remained without respiratory symptoms, two had a chronic and relapsing course, and two an acute course, leading to death with respiratory failure in one. Anti-Jo1 antibody was found in two patients, without relation to the gravity of the respiratory illness. The two others with a severe course had anticardiolip antibodies, and one cutaneous necrosis of the fingers. Cancer-associated dermatopolymyositis was never seen at diagnosis, but a lymphoma of the brain was diagnosed after two years in one patient. Combination of corticosteroids with another immunomodulator treatment was necessary for all, because of frequent relapses. Methotrexate was effective in one case for the muscular and the respiratory signs, plasma exchanges with azathioprine in two cases, and intravenous immunoglobulin in one patient with acute lung injury.

[Specific respiratory manifestations associated with hemorrhagic rectocolitis. Analysis of a case and review of the literature]. / Manifestations respiratoires spécifiques associées à la rectocolite hémorragique. Analyse d'un cas et revue de la littérature.

Respiratory impairments occurring as systemic manifestations of ulcerative colitis are often misinterpreted. We report a case of chronic productive bronchitis associated with ulcerative colitis; symptoms appeared after colectomy. Clinical features distinguished it from common chronic bronchitis: it occurred in a woman without respiratory disease or smoking history, a chronic productive cough without bronchiectasis, negative infectious investigations, severe endoscopic and histologic lesions, and above all remarkable steroid efficacy. Systematic research and early treatment of these manifestations avoids aggravating pulmonary disease, especially secondary bronchiectasis. Though less frequent, other respiratory manifestations of ulcerative colitis have been described, such as asphyxiating tracheal stenosis, pneumonia or interstitial pulmonary diseases, pleurisy or pleuro-pericarditis.

[Kikuchi syndrome, Hashimoto thyroiditis and lupus serology. Apropos of a case]. / Syndrome de Kikuchi, thyroïdite de Hashimoto et sérologie lupique. A propos d'un cas.

Histiocytic necrotizing lymphadenitis (Kikuchi's disease) is an uncommon disease of the cervical lymph nodes occurring in young women, commonly associated with various auto-immune or infectious diseases. We describe the case of a 17 year-old girl who presented a Kikuchi's lymphadenitis occurring concomitantly with Hashimoto's thyroiditis and lupus serology as anti-nuclear, anti-DNA, anticardiolipid antibodies and hypocomplementemia. The patient was treated with prednisone and hydroxychloroquine. Thirty months after, she is doing well and hydroxychloroquine is continued.

Treatment of systemic vasculitis with cyclophosphamide and steroids: daily oral low-dose cyclophosphamide administration after failure of a pulse intravenous high-dose regimen in four patients.

The efficacy of cyclophosphamide (CY) in the treatment of severe systemic vasculitis has been demonstrated, but its optimal administration regimen remains to be defined. The four patients described participated in prospective therapeutic trials of polyarteritis nodosa (PAN) without hepatitis B infection markers, Churg-Strauss syndrome (CSS) and Wegener's granulomatosis (WG) and received daily oral low-dose CY after failure of a monthly pulse regimen. These patients were included in this study because of failure to induce clinical remission (two patients) and relapse during the course of treatment (two patients). The results were good with initial clinical remission in three patients and stabilization in one. One patient with WG relapsed 10 months after changing therapeutics. The advantages of the different administration protocols are discussed.

[Microscopic polyarteritis]. / La polyartérite microscopique.

Microscopic polyarteritis is an idiopathic necrotising vascularitis of the small vessels. Manifestations include diffuse alveolar haemorrhage, segmentary necrotising glomerulonephritis, and a cutaneous, articular, neurological or digestive vascularitis. The absence of a histological granulomas and medium calibre vessel involvement distinguishes Wegener's syndrome from polyarteritis nodulosa. The diagnosis is facilitated when anti-neutrophil cytoplasm antibodies are found in the serum. These auto-antibodies are suspected to be the cause based on clinical and experimental data, although this aetiology has not been confirmed. Corticosteroids, immunosuppressors and plasmapheresis can improve the prognosis of this severe and evolving affection which may be fatal.