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retrouve d’autres cas d’atteinte des ongles dans la creche de l’enfant et la survenue quelques semaines auparavant d’un syndrome mains-pieds-bouche chez plusieurs de ces enfants. Une interne presente lors de la consultation signale qu’un de ses enfants a eu egalement une onychomadese, ainsi que trois autres enfants de la creche ou il est garde, environ trois semaines apres une epidemie de syndrome mains-pieds-bouche. Ulterieurement un avis est demande par Internet a l’un d’entre nous sur une dystrophie ungueale d’un enfant avec des lignes de Bau et une chute de quelques ongles. Le pediatre nous demande s’il s’agit d’une mycose : on lui conseille de rechercher des antecedents de syndrome mains-pieds-bouche : effectivement, il y a bien eu une epidemie de syndromes mains-pieds-bouche a la creche quelques semaines auparavant. Discussion.— Le syndrome mains-pieds-bouche est une infection liee a un enterovirus pouvant s’accompagner de manifestations cliniques tres variees allant de quelques micro pustules ovalaires sur les paumes des mains, les plantes des pieds avec quelques lesions dans la bouche a des eruptions vesiculobulleuses parfois impressionnantes. Il existe souvent un erytheme peri-ungueal assez marque. La survenue de cas d’onychomadese dans les suites d’une telle infection a ete rapportee (JDP 2011, au cours de deux formations medicales continues sur les infections de l’enfant et sur les pathologies ungueales). Cependant la litterature est pauvre sur ce point, et les publications sont principalement retrouvees dans des revues de pediatrie. Il semble que les enterovirus aient un tropisme particulier pour les ongles chez le nourrisson et le petit enfant expliquant cette evolution particuliere. Conclusion.— Les infections a enterovirus ont des manifestations cliniques tres variables. Parmi celles-ci, les onychomadeses avec chute de certains ongles chez le nourrisson et le petit enfant doivent etre connues. Leur connaissance permet de rassurer les parents de ces enfants en raison de leur evolution ulterieurement favorable. Declaration d’interets.— Aucun.

This study investigated the effects of a drastic weight reduction on insulin secretion rate (ISR), insulin metabolic clearance rate (MCRI) and insulin sensitivity (SI) in severely obese subjects. A frequently sampled intravenous glucose tolerance test (FSIVGTT, 0.3 g/kg) was performed before and 8 +/- 1 months after a vertical ring gastroplasty in 12 overnight-fasted obese non-diabetic subjects; the results were compared to those obtained in 12 lean controls matched for age and sex. ISR was derived by deconvolution of plasma C-peptide levels; MCRI was obtained by dividing the area under the curve (AUC180 min) of ISR by the corresponding AUC of plasma insulin levels (IRI); the SI and the glucose effectiveness index (SG) were calculated by Bergman's minimal model. Before gastroplasty, obese subjects showed significantly higher ISR (P0.02), lower MCRI (P0.001), lower SI (P0.001) but similar SG when compared to lean controls. After gastroplasty (reduction of body weight from 104.8 +/- 3.8 to 73.4 +/- 3.6 kg and of BMI from 37.9 +/- 0.8 to 26.5 +/- 0.9 kg/m2; P0.001), ISR only decreased from 53,125 +/- 7968 to 42,302 +/- 3716 pmol/180 min (not significant) while AUC-IRI dramatically fell from 53,626 +/- 6378 to 21,111 +/- 2584 pmol.min/l; P0.001); consequently, MCRI markedly increased from 526 +/- 96 to 1257 +/- 150 ml/min/m2; P0.01). SI significantly rose from 3.12 +/- 0.45 to 7.10 +/- 1.20 x 10(-4) l/mU/min (P0.005) while SG remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Three cases of behavioral disorders in children previously treated for a diencephalic tumor are reported. In such cases, classical psychiatric evaluation is difficult because reference data on childhood psycho-organic syndromes are lacking. Another complicating feature is that multiple factors contribute to the impairment of social interactions, including maladaptive reactions to disease-related stress, sensory deficits, and cognitive disorders. A structured evaluation should be performed in order to assess the child's behavior, the psychological and educational environment, and impairment of neuropsychological and neurophysiological function.

Gérard Alain B. L. La notion d'élite. In: Horizons Maghrébins - Le droit à la mémoire, N°20-21, 1993. Élites maghrébines de France. Politiques, associatives, religieuses, scientifiques, artistiques. pp. 208-212.

Neuromuscular blocking drugs (NMB) are involved in most of the anaphylactic reactions occurring during anaesthesia. Patients are evaluated usually 6 weeks after the reaction, by skin testing. In order to obtain an earlier diagnosis, we have measured plasma concentrations of histamine, tryptase and NMB-specific IgE antibodies in 14 patients after an anaphylactoid reaction. We have compared the results with those of skin tests and specific IgE obtained 8 weeks later. Good agreement was observed in all subjects between the results of skin tests and the values for histamine and tryptase, provided that both markers were measured simultaneously. Furthermore, there was no significant difference between the concentrations of NMB-specific IgE antibodies observed at the time of the reaction and 8 weeks later. Thus anaphylaxis to neuromuscular blocking drugs can be demonstrated at the time of the reaction by measuring plasma concentrations of histamine, tryptase and specific IgE. In the event of the patient's death, such measurements may be useful in identifying the likely cause.

This study assessed the cardiovascular stability of intraoperative normovolaemic haemodilution carried out with 6% Elohes during the exchange, the intraoperative, recovery and postoperative periods, as well as its effects on coagulation and renal function. Ten patients, ranked ASA 1, were included. Patients were premedicated with 100 mg of hydroxyzine, and anaesthesia was induced with 2 mg.kg-1 propofol, 3 micrograms.kg-1 fentanyl, and 0.5 mg.kg-1 atracurium. Maintenance was obtained with propofol, fentanyl and 50% nitrous oxide in oxygen. Haemodilution, carried out with a peripheral venous catheter, size 14 G, consisted in the removal of 15 ml.kg-1 of blood and its simultaneous replacement with Elohes 6%. Heart rate, systolic, diastolic and mean blood pressures were recorded before anaesthetic induction, every 5 min during the haemodilution, and thereafter during surgery, recovery and postoperative periods, up to the third postoperative day. Blood haemoglobin, fibrinogen, prothrombin, sodium, potassium, urea and creatinine concentrations, haematocrit, platelet count, and bleeding and activated cephalin times were assessed before and immediately after haemodilution, and on postoperative days 1 and 3. A mean of 1,295 +/- 68 ml of blood were removed during a 32 +/- 2 min period, and replaced by 1,315 +/- 64 ml of Elohes. Haematocrit decreased from 44 +/- 1.1% to 29.7 +/- 0.8%. There were no significant alterations in other parameters, except for an increase in heart rate at the time of extubation. Cardiovascular parameters, as well as the haemodilution, were stable up to the end of the study period. It is concluded that replacing blood with Elohes for intentional haemodilution affords convenient cardiovascular stability.(ABSTRACT TRUNCATED AT 250 WORDS)

Three markers of in vivo histamine release, i.e. plasma histamine and tryptase, and urinary methylhistamine, were assessed using sensitive radioimmunoassays in 18 patients who had experienced an adverse reaction to an anaesthetic agent. Controls were obtained from 35 patients following a general anaesthetic, which included a muscle relaxant, and who remained free from any adverse reaction. A first blood sample was obtained from all 18 patients a mean 25 +/- 26 min after the reaction, and a second one in thirteen a mean 120 +/- 65 min after the reaction. Ten patients had had a life-threatening reaction. Plasma histamine levels were increased in all these cases, and tryptase concentrations in 9 out of 10. Urinary methylhistamine rarely reached pathological levels (4 out of 10). Skin tests were positive in the four tested patients. Plasma histamine concentration was still high in 8 cases thirty minutes after the reaction, and remained increased for more than 2 h in two patients. Among the other eight patients with a moderate reaction, 3 had high histamine levels, with normal or weakly increased tryptase concentrations, and normal urinary methylhistamine. Two of these patients had positive skin tests. There were no abnormal findings in any of the investigations carried out in the other five patients, except for a slightly positive skin test to atracurium in one patient. Plasma histamine had a higher sensitivity than tryptase levels. Methylhistamine concentrations were only rarely of interest. There were no false positives with the three investigated markers.(ABSTRACT TRUNCATED AT 250 WORDS)

Introduction Le traitement de 1re intention du cancer epidermoide de l’anus (CEA) repose sur la radio-chimiotherapie (RCT). A l’ere des traitements antiretroviraux efficaces (HAART), le resultat de la RCT chez les patients infectes ou non par le VIH est controverse. Le but de cette etude etait de comparer les resultats du traitement du CEA par RCT dans ces deux populations. Patients et methods Etude retrospective de 20 patients VIH+ (âge moyen 48 ans, 19 hommes) et 26 patients VIH- (âge moyen 63 ans, 20 femmes) pris en charge pour un CEA entre 2001 et 2006. La RCT prevue associait 60 Gy au 5FU-Cisplatine. La chirurgie n’intervenait qu’en eventuelle 2e ligne. L’echec de la RCT etait defini par la persistance d’un reliquat tumoral ( 1an). Resultats Parmi les patients VIH+, 19 etaient traites par HAART; la mediane des CD4 etait de 305/mm3 (118-621) et 17 avaient un ARN VIH Le suivi moyen etait de 34 ± 20 mois. La RCT etait en echec chez 10 patients VIH+ (50 %) et 6 VIH- (23 %). La survie sans echec de RCT tendait a etre plus courte pour les patients VIH+ (37 % vs 75 % a 5 ans, p = 0,06, Kaplan-Meier). Onze patients VIH+ (55 %) et 8 patients VIH- (31 %) ont ete operes. Sept patients VIH+ (35 %) et 3 patients VIH- (12 %) sont decedes. La survie etait plus courte chez les patients VIH+ (39 % vs 84 % a 5 ans, p = 0,02, Kaplan-Meier). Conclusion Chez les patients VIH+, meme sous HAART, les resultats de la RCT semblent moins bons que chez les patients VIH- en termes de controle local, avec une diminution significative de la survie.

We have studied the effect of surgery under general anaesthesia on whole blood histamine (WBH) and on basophil morphology in patients operated on without adverse reaction. In 10 patients administered a muscle relaxant and other anaesthetic drugs, WBH decreased significantly the day after surgery and returned to normal within 5 days. Basophils were examined after Percoll gradient concentration: after surgery, the granules were paler and located at the periphery of the cell in a great number of cell. Twentyfour hours later, the number of basophils was reduced and they often did not stain. The morphology returned to normal within 5 days. The variations of WBH were significantly related to the variations of the staining intensity and inversely related to the percent of basophils with peripheral granules. These findings indicate that surgery and/or general anaesthesia leads to a progressive release of mediators by basophils.

A 41 year old man was admitted to hospital for acute alcoholic rhabdomyolysis and renal failure. Calcium deposits in the damaged muscles of the inferior limbs were detected by technetium-99 m methylene diphosphonate. Repeat bone imaging studies showed a decrease in the deposits with time. The mechanisms responsible for the rhabdomyolysis and the characteristic disturbances in serum calcium and phosphorus concentrations during such renal failure are recalled. The interest of 99mTc-MDP is reviewed. Early dialysis is advocated, in particular in case of extensive muscular damage.

Two cases of pulmonary emboli are reported: a thrombus was detected by echocardiography in the right atrium in the first case and in the right ventricle in the second. Following a review of the 28 cases published to date, criteria are given for distinguishing between those thrombi embolizing from the peripheral veins and those arising in the right cavities of the heart. Therapeutic recommendations are also given.

A prospective, randomized study was carried out to evaluate two antibiotic prophylactic regimens for patients undergoing cardiac surgery with cardiopulmonary bypass. Each patient of the first group (cefazolin) received four intravenous injections of 1 g cefazolin during 12 hours, patients of second (cefamandole), four doses of 750 mg. 155 patients scheduled for cardiac operation were included in the study. (May 1983 to April 1984). Patients were not admitted to the study in case of emergency, if their weight was less than 20 kg, if they had received antibiotics during the week before surgery or if they had a history of anaphylactic reactions to cephalosporins. There were no differences between the two groups on age, weight, height, sex, previous history of infectious disease, surgery and intensive care. There were no significant differences between the two groups in minor infections. The rate of urinary tract infection by streptococci was significatively higher (p less than 0.02) in the cefamandole group (38.3%) than in the cefazolin group (17.6%). There were no major infections (septicemia, mediastinitis, endocarditis). Patients temperature was the same during the first four postoperative days. Hospital stay was the similar in the two groups. The two antibiotics are similarly effective to prevent major infections in cardiac surgery. However cefazolin was preferred for antibiotic prophylaxis in cardiac surgery because of the higher rate of streptococcal urinary infections in patients given cefamandole.

A 41 year old man was admitted to hospital for acute alcoholic rhabdomyolysis and renal failure. Calcium deposits in the damaged muscles of the inferior limbs were detected by technetium-99 m methylene diphosphonate. Repeat bone imaging studies showed a decrease in the deposits with time. The mechanisms responsible for the rhabdomyolysis and the characteristic disturbances in serum calcium and phosphorus concentrations during such renal failure are recalled. The interest of 99mTc-MDP is reviewed. Early dialysis is advocated, in particular in case of extensive muscular damage.

A prospective randomized study was carried out to assess two protocols of antibiotic prophylaxis in patients undergoing cardiac surgery with cardiopulmonary by-pass. Each patient of the first group received four intravenous injections of 1 g cefazolin over a period of 12 h, whilst in the second group each one received twelve doses over a period of 36 h. Between May 1983 and April 1984, 159 patients scheduled for cardiac surgery entered the study. Those who underwent emergency surgery, or weighed less than 20 kg, or received antibiotics in the week before surgery, or had a previous history of anaphylaxis to cephalosporins were not included in the study. Both groups were similar in their distribution of age, weight, height, sex, past history of infectious disease, surgery and iatrogenic factors. There were no significant differences between the two groups in the number of minor infections and bacterial floral changes. There were no major infections either (septicaemia, mediastinitis, endocarditis). Temperature charts were the same on the first four days. The length of stay at hospital was the same in both groups. Since the efficacy of the two protocols in preventing major infections was the same, the authors recommend the short prophylaxis with cephazolin for cardiac surgery patients.

The action of cimetidine on gastric acid secretion being perfectly known, the authors sought to confirm the possible efficacy of a single injection of cimetidine, by the intramuscular route, combined with the premedication, on the reduction in gastric secretion during the operative period. Fifty patients undergoing routine surgery were divided into two groups at random. One group was used as a control. The patients of the other group received 200 mg of cimetidine by intramuscular injection one hour before surgery. In all patients, gastric pH was measured by a colorimetric technique at the time of induction, one hour after induction and two hours after induction. The number of samples with a pH of less than 2.5 was very significantly decreased (p less than 0.01) at the time of the induction of anaesthesia. The authors suggest the administration of cimetidine as pre-anaesthetic premedication in all cases where a Mendelson's syndrome is particularly feared.