[Torsade de pointes: a severe and unknown adverse effect in a patient taking methadone]. / Torsade de pointe: un effet secondaire grave et méconnu chez le toxicomane sous méthadone.

We present here the case of a young drug-addicted patient, who showed a cardio-respiratory arrest attributed to a torsade de pointe-type ventricular arrhythmia. After excluding the usual causes of such arrhythmia, we concluded that it was consecutive to high-dose methadone intake. Methadone can induce torsade de pointe through two mechanisms: a QT interval prolongation secondary to a bradycardia or a prolongation of the myocardial action potential. When prescribing methadone, one should avoid association with other CYP3A4 inhibiting drugs and, if higher doses are necessary, perform regular EKG screening.

[Salami and extrinsic allergic alveolitis: a new occupational disease in Switzerland]. / Salami et alvéolite allergique extrinsèque: une nouvelle pathologie professionnelle en Suisse.

The authors report a case of extrinsic allergic alveolitis in a patient working in an industrial butchery where she is involved in the preparation of dry sausages. The molds proliferating at the surface of these sausages, molds from the Penicillium family, are responsible for the disease. The respective value of laboratory tests such as the presence of precipitating antibodies and the analysis of the cellularity of the bronchoalveolar lavage are discussed. Whenever a patient presents with clinical symptoms suggestive of extrinsic allergic alveolitis a detailed search for any type of exposure linked to the professional milieu is required, so as to propose adequate modifications in work conditions or work place.

[Pulmonary lymphangiomyomatosis and renal angiomyolipoma. Apropos of 2 cases]. / Lymphangiomyomatose pulmonaire et angiomyolipomes rénaux. A propos de 2 cas.

Pulmonary lymphangiomyomatosis (LAM) is a rare and serious disease in women of reproductive age, in which hamartomatous smooth muscle proliferation occurs in lymphatics. The most frequent presenting symptoms or complications are dyspnea, chylothorax and pneumothorax. Chest X-ray reveals a diffuse interstitial infiltrate associated, curiously, with airflow obstruction, air trapping and even hyperinflation. In more than a third of cases, pulmonary LAM coexists with a rare renal tumor, angiomyolipoma. Two new cases additional to the hundred published are reported. The first patient died undiagnosed after a typical seven years' evolution including removal of a renal angiomyolipoma late in the disease. In the second case a renal angiomyolipoma was excised several years before the first respiratory symptoms; at the time of diagnosis there was already severe airflow obstruction now stable under treatment with progesterone. Early hormonal therapy with medroxyprogesterone seems to be the only treatment likely to improve this disease, whose prognosis is usually fatal. Previous attempts to treat LAM are also discussed.

[Changes in the hemodynamics of the lung and the right ventricle during rest and exertion in 2 groups of patients with chronic broncho-obstructive syndrome of different severity]. / Modifications de l'hémodynamique pulmonaire et ventriculaire droite au repos et à l'effort dans deux collectifs de patients avec syndrome broncho-obstructif chronique de gravité fonctionnelle différente.

Forty patients with chronic obstructive pulmonary disease (COPD) underwent right heart and central catheterization at rest and during exercise when not in a state of acute exacerbation. They were divided into 2 groups of different functional gravity: group I: FEV1 less than or equal to 1250 ml, RV/TLC greater than or equal to 55% (24 patients); group II: FEV1 > 1250 ml, RV/TLC < 55% (16 patients). At rest, group I had mean pulmonary artery pressure, pulmonary arteriolar resistance, and arterial PCO2 significantly higher, and arterial PO2 significantly lower, than group II. There was no difference in cardiac index, mean atrial pressure and pulmonary wedge pressure between the two groups. During exercise, mean right atrial and pulmonary wedge pressure increased markedly in group I and showed a significant difference from the values of group II. For pooled data of groups I and II, there was a correlation between FEV1 and mean right atrial pressure under exercise and between arterial PO2 and right atrial pressure under exercise. It is concluded that (1) subdividing patients with COPD, as reported here, determines two different blood gases and pulmonary hemodynamic subsets when taken at rest; (2) during exercise, group I patients have "abnormal" right and left ventricular function; (3) FEV1 and arterial PO2 on physical exertion serves to predict mean right atrial pressure under exercise.

[25-hydroxy vitamin D deficiency with reduction of intestinal calcium absorption and bone density in chronic alcoholism]. / Carence en 25-hydroxyvitamine D avec diminution de l'absorption intestinale de calcium et de la densité osseuse dans l'alcoolisme chronique.

Plasma levels of 25-hydroxycalciferol (25-OH-D), 47-calcium intestinal absorption, bone mineral content and the biologic parameters of phospho-calcium metabolism were studied in 30 chronic alcoholics, 15 with Laennec's cirrhosis (group A) and 15 without (group B). These patients were compared with 27 normal subjects. In group A, the mean 25-OH-D plasma level was 23.7 +/- SD 18.5 microgram/l and in group B 35.2 +/- SD 21.8 microgram/l. These mean levels were lower than those of the control group, which were 57.2 +/- SD 22.5 microgram/l (p less than 0.001). The mean value of the 47Ca intestinal absorption, measured as the percentage of the ingested dose per litre of plasma and multiplied by the body weight, was also significantly lower in group A, which was 140 +/- SD 47 (p less than 0.01), and in group B, which was 145 +/- SD 69 (p less than 0.05), compared with the normal subjects whose average was 182 +/- SD 45.6. Similarly, the total plasma calcium was low: 1.99 +/- SD 0.24 mmol/l in all the alcoholics, while that of the control group was 2.22 +/- SD 0.18 mmol/l (p less than 0.001). For the 30 chronic alcoholics there was a positive correlation between 25-OH-D and 47Ca intestinal absorption, (r = 0.484; p less than 0.004). This suggests that in chronic alcoholism the deficiency of 25-OH-D induces a diminution of the intestinal absorption of calcium which, in the long term, can result in bone demineralization evidenced in the patients studied by a bone mineral content lower than normal (p less than 0.001).

[Decrease of intestinal absorption of 47-calcium in chronic alcoholism]. / Diminution de l'absorption intestinale de 47-calcium dans l'alcoolisme chronique.

Intestinal 47-calcium absorption has been studied in 34 chronic alcoholics, 17 of whom were cirrhotics (group A) and 17 non-cirrhotics (group B). These patients were compared with 44 normal subjects (group C). In group C, the 47Ca 2 h plasma % of the dose showed a significant negative correlation to the total body weight (p less than 0.001) and a positive correlation with the serum albumin (p less than 0.05). The mean intestinal absorption of 47Ca expressed as 2 h plasma % of the dose multiplied by total body weight was 131 +/- SD 52 in group A and 136 +/- SD 71 in group B. These two means are significantly low (p less than 0.001 and p less than 0.002 respectively) in relation to that found in group C (168 +/- SD 32). These results suggest that intestinal calcium absorption is diminished in chronic alcoholism even in the absence of hepatic cirrhosis.