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Objectif Video detaillant la prise en charge chirurgicale d’un patient de 30 ans, presentant une stenose de 5 cm du bas uretere lombaire droit, refractaire aux traitements endoscopiques. Methodes Indication d’une prise en charge par uretero-appendicoplastie. Elle sera realisee par cœlioscopie robot-assistee. Resultats Description de la technique chirurgicale et des differents temps operatoires : – decollement colon droit ; – dissection de l’uretere droit ; – section de l’uretere d’amont puis d’aval a la stenose ; – dissection appendiculaire ; – spatulation appendiculaire en proximal et en distal ; – realisation de l’anastomose uretero-appendiculaire proximale ; – realisation de l’anastomose appendico-ureterale ; – mise en place de la sonde JJ. Conclusion Presentation des suites postoperatoires, et du scanner de controle a 3 mois, apres ablation de la sonde JJ.

Resume But Faire le point sur les pratiques de prescription dans l’inhibition de la lactation avec les molecules ayant (bromocriptine et lisuride) ou n’ayant pas (dihydroergocryptine et cabergoline) une autorisation de mise sur le marche (AMM), en France, pour cette indication. Patientes et methodes Analyse d’un questionnaire diffuse en 2009 aux 618 services de maternite repertories, en France, et exploitation des donnees de remboursement de l’assurance-maladie de la region Rhone-Alpes portant sur la nature des medicaments prescrits dans l’inhibition de lactation chez des femmes sortant d’un sejour en service de maternite. Resultats Le taux de reponse au questionnaire est de 43 %. La pratique de reference des repondeurs est la bromocriptine (89 %). L’alternative principale est la dihydroergocryptine (39 %), puis la cabergoline (24 %). Le lisuride, l’homeopathie et la phytotherapie sont rarement cites. Les donnees de l’assurance-maladie en Rhone-Alpes montrent une augmentation des remboursements de dihydroergocryptine entre 2008 et 2009 (de 37 a 46 %) aux depens de la bromocriptine, surtout chez des patientes ayant de probables facteurs de risque cardiovasculaires ou neuropsychiatriques. Conclusion Notre etude confirme l’interet croissant porte a l’utilisation de la dihydroergocryptine et de la cabergoline comme alternative a la bromocriptine dans l’inhibition de la lactation, malgre l’absence d’AMM pour ces deux medicaments en France.

Introduction La meningite aseptique est une inflammation meningee non infectieuse, parfois d’origine medicamenteuse. Alors que moins de 10 cas de DIAM a l’amoxicilline sont publies, nous rapportons deux cas pour lesquels les tests immunobiologiques ont contribue a confirmer une hypersensibilite retardee specifique contre ce medicament. Resultats Nos deux cas etaient des femmes de 62 et 32 ans, sans antecedent. Elles presentaient des syndromes meninges stereotypes quelques heures apres chaque prise d’amoxicilline. L’analyse du liquide cephalorachidien confirmait la meningite aseptique. L’imagerie cerebrale etait sans anomalie et les symptomes etaient rapidement resolutifs a l’arret de l’amoxicilline. Le diagnostic de DIAM a l’amoxicilline a ete retenu avec un score de probabilite de Naranjo > 9. Les patch-tests et IDR a lecture retardee a l’amoxicilline etaient negatifs. Des tests immunobiologiques ont ete effectues. Dans un cas, un test ELISPOT etait positif avec une importante secretion d’interferon gamma et de granzyme B par les cellules mononuclees sanguines en presence d’amoxicilline, alors qu’il etait negatif avec la ceftriaxone et un temoin negatif. Dans l’autre cas, un test de transformation lymphocytaire (TTL) etait positif pour l’amoxicilline avec un index de stimulation > 2, negatif pour la ceftriaxone et le temoin negatif. L’amoxicilline a ete contre-indiquee chez les 2 patientes. La ceftriaxone a ete reintroduite sous surveillance medicale sans incident. Discussion Le mecanisme immunopathologique du DIAM et la nature des cellules impliquees demeurent inconnus. La reaction inflammatoire serait limitee aux meninges, pouvant expliquer l’absence de cellules effectrices specifiques au niveau cutane et par consequent la negativite des tests cutanes. Une reaction de type hypersensibilite retardee due a des lymphocytes T a ete suspectee lors d’un DIAM a un complexe vitaminique B, avec un TTL positif. Conclusion Nos resultats tendent a confirmer cette hypothese avec un ELISPOT et un TTL positifs dans deux cas de DIAM a l’amoxicilline.

Resume Introduction Les sources actuelles inhabituelles d’exposition au plomb d’origine environnementale comprennent principalement les medecines traditionnelles, ayurvediques ou autres, les cosmetiques traditionnels (khol, surma), et l’utilisation culinaire de vaisselle artisanale, pour le stockage ou la cuisson. Observations Nous rapportons deux observations de saturnisme chez l’adulte, decouverts soit a l’occasion du bilan etiologique de douleurs abdominales paroxystiques, soit a l’occasion du bilan etiologique d’une anemie. Dans les deux cas, l’enquete environnementale conduira a l’identification d’une source principale d’exposition au plomb : une cruche artisanale vernissee dans laquelle macerait une boisson consommee par le patient, le « kefir de fruit » dans un cas, le the « kombucha » dans l’autre cas. Conclusion Il faut savoir rechercher une intoxication par le plomb chez un patient presentant une anemie inexpliquee. Les sources environnementales de plomb peuvent etre multiples ; elles doivent etre hierarchisees au sein de l’enquete environnementale, et parmi elles, les poteries artisanales doivent etre retenues comme une source d’exposition significative lorsque les boissons y sont stockees et peuvent ainsi macerer.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 36 - N° 1 - p. 62-67

Archives des Maladies Professionnelles et de l'Environnement - Vol. 65 - N° 7-8 - p. 605-608

To determine the optimal evaluation and management of renal injuries by review of the world's English-language literature on the subject.

Three months after infection with Echinococcus multilocularis, Mongolian gerbils were given either the dipeptide methyl ester (Phe-Phe-OMe) or a combination of Phe-Phe-OMe plus albendazole to treat alveolar echinococcosis. Each drug was given orally at the daily dose of 50 mg/kg of body weight following various administration regimens. Histologic and ultrastructural studies of parasites recovered from infected gerbil tissues showed that the dipeptide methyl ester increases the effect of albendazole.

Contact dermatitis is a cutaneous inflammatory reaction mediated by hapten-specific T cells. We used a murine model to investigate the contact sensitivity reaction elicited by different concentrations (optimal and suboptimal) of the haptens DNFB and oxazolone applied singly or in combination. The simultaneous application of DNFB and oxazolone at optimal concentrations (0.2% and 0.4% respectively) did not significantly increase the ear swelling response induced by each of the allergens when applied singly. No contact sensitivity response was observed when the haptens were tested individually at subthreshold concentrations (0.05% and 0.1% respectively). However, mixing the 2 molecules at the same concentrations gave rise to a clinical contact sensitivity reaction. The simultaneous application of the haptens at a 2 x higher, but still suboptimal concentrations (0.1% and 0.2% respectively), elicited an inflammatory response that was significantly greater than the responses elicited by either of the haptens when applied separately. These results suggest that a "false-positive" reaction to a mix may reveal a genuine sensitization to the constituents.

The immune-mediated side effects of pharmaceuticals include lymphomas and infectious complications related to immunosuppression and immunodepression; flu-like reactions, exacerbation of allergy to unrelated allergens, and de novo induction of autoimmunity, associated with immunoenhancement; drug-induced hypersensitivity (allergic) reactions; and finally, organ-specific or systemic autoimmune diseases. A number of pharmaceuticals have been reported to induce one or several of these immune-mediated side-effects. Even though few guidelines have been published, every effort should be paid to predicting these side effects as part of the preclinical safety assessment of new pharmaceuticals. Although they are relatively infrequent they are sometimes severe, or even life-threatening. Unexpected immunosuppression, and possibly immunoenhancement, can be best addressed by tiered protocols in rodents. Contact sensitization assays or systemic anaphylaxis models can be instrumental in several instances. Autoimmunity is...

Objectives and Methods: To describe cases of fusidic acid-associated sideroblastic anaemia from the French Pharmacovigilance database. Results: Six cases of sideroblastic anaemia associated with oral fusidic acid treatment were retrieved. Four females and two males (mean age 65.3 yr) developed severe anaemia (mean haemoglobin level: 6.9 g/dL) within 32–190 d (mean: 81 d) of treatment. Bone marrow aspirates showed dyserythropoiesis and ringed sideroblasts in all patients. Four patients required repeated blood transfusions. After fusidic acid discontinuation in five patients, complete recovery was obtained. In one patient, rechallenge with fusidic acid resulted in recurrence of anaemia that resolved after definitive discontinuation of the drug. Conclusion: Our data indicate that fusidic acid should be added to the list of drugs that can cause sideroblastic anaemia.

Objectifs L’uretroplastie avec excision et anastomose termino-terminale est le traitement standard des stenoses courtes de l’uretre bulbo-membraneux. La non-transecting uretroplasty est une technique alternative moins morbide et ayant pour but des resultats fonctionnels similaires. Methodes Patient de 55 ans, ayant pour principal antecedent une hemophilie A. Le patient a ete opere d’une vaporisation de prostate green light en 2014. Dans les suites apparition progressive d’une dysurie majeure. Il a ete pris en charge a deux reprises par uretrotomie interne pour une stenose courte de l’uretre bulbaire, avec recidive precoce de la stenose. L’uretrographie realisee trouve une stenose courte de l’uretre bulbaire Il a ete indique chez ce patient une non-transecting uretroplasty . Resultats Patient en position de la taille. Incision perineale mediane, dissection de l’uretre bulbaire et dissection bulbo-caverneuse afin de faire le tour de l’uretre. Poursuite de la dissection de l’uretre a sa face caverneuse en direction du sphincter. Reperage de la stenose bulbaire. Incisons centimetrique longitudinale au niveau de la stenose. Fermeture horizontale par des points separes de PDS 5.0. Mise en place d’une SAD ch 16 fermeture. L’intervention a dure 124 minutes, pertes sanguines 100 cc. Le patient est sorti a j5. La sonde a ete enlevee a j12 avec un UCRM de controle satisfaisant. Conclusion La non-transecting uretroplasty est une avancee majeure dans la chirurgie des stenoses courtes de l’uretre bulbo-membraneux. Le recul est assez court, mais les premieres publications montrent des resultats fonctionnels equivalents a la chirurgie avec transsection de l’uretre beaucoup plus morbide.

Objective To report the follow-up of continuing pregnancies after first-trimester exposure to mifepristone. Design Observational prospective study. Setting France. Sample Patients exposed to mifepristone during the first 12 weeks of pregnancy. Methods Women were included in the study when they or their doctors asked a French pharmacovigilance centre or the Paris Teratogen Information Service about the risk of mifepristone exposure in early pregnancy. Exclusion criteria were requests received after 22 weeks of gestation or subsequent elective termination of pregnancy without a pathological examination of the fetus. Data on maternal history and drug exposure were collected on first contact, and pregnancy outcomes were documented at follow-up. Main outcome measures Rate of major congenital malformations. Results A total of 105 pregnancies were included, with 46 exposed to mifepristone alone, and 59 exposed to both mifepristone and misoprostol. There were 94 live births (90.4%) and 10 (9.6%) miscarriages (including one with major malformation). Elective termination of pregnancy was performed after the subsequent diagnosis of trisomy 21 in one case. The overall rate of major congenital malformations was 4.2% (95% CI 1.2–10.4%), with two cases among 38 patients exposed to mifepristone alone, and two cases among 57 patients exposed to both mifepristone and misoprostol. Conclusions This first prospective study found that the rate of major malformations after first-trimester exposure to mifepristone is only slightly higher than the expected 2–3% rate in the general population. Such findings provide reassuring data for risk evaluation for continuation of pregnancy after mifepristone exposure.

Resume Observation. – Au cours d'une hospitalisation, un nouveau-ne de dix jours a ete traite par ceftriaxone (Rocephine® intraveineuse, 390 mg/j) pour une infection sur catheter ombilical. Quelques minutes apres la fin de la cinquieme injection, le nouveau-ne a presente une cyanose, d'abord localisee au trajet de la perfusion puis generalisee, une tachycardie puis une insuffisance circulatoire majeure avec une hypotension arterielle a 37/19 mmHg puis une defaillance multiviscerale avec troubles de la coagulation, rein et foie de choc. Le nouveau-ne a beneficie de mesures classiques de reanimation et a recupere sans sequelle (recul de deux mois). Les donnees chronologiques etaient tres en faveur de l'imputabilite de la ceftriaxone. Le mecanisme de cette reaction pouvait etre discute. Une sensibilisation post-natale au cours des quatre injections precedant la reaction etait possible, mais le delai de survenue des reactions d'hypersensibilite immediate apres un premier contact sensibilisant est habituellement plus long. Une sensibilisation in utero ou via l'allaitement maternel etait a ecarter du fait de l'absence d'exposition maternelle a la ceftriaxone. L'absence d'urticaire et de bronchospasme, et la presence d'une cyanose initialement localisee au site d'injection n'etaient pas evocateurs d'une reaction allergique classique. Une autre cause, toxique ou infectieuse, n'a pu etre formellement ecartee. Des tests allergologiques, realisables ulterieurement chez cet enfant, permettraient eventuellement de conclure.

Severe but regressive toxic liver damage was observed in a 30-week pregnant woman due to acetaminophen poisoning. A cesarean section was performed 1 week later for suspected chorioamniotitis and the patient gave birth to an infant who only experienced complications of preterm birth. The lack of fetal liver damage following acute maternal paracetamol poisoning seems to be the rule, as shown by a review of the literature.

To provide an overview of ergot derivatives prescription for lactation inhibition in France, either label (bromocriptine 2.5mg and lisuride 0.2mg) or off-label prescription (dihydroergocryptine and cabergoline).Analysis based on a questionnaire sent to all 618 French maternity wards in 2009, and prescription modalities from social security reimbursement data in the Rhône-Alpes region.The mean response rate to the questionnaire was 43% and main characteristics of respondents in this sample were very close to those found at the national level. The use of bromocriptine (89%) was the most frequently proposed. Dihydroergocryptine and cabergoline were mentioned as first or second alternatives in 39 and 24% of cases, respectively. Lisuride, homeopathy and phytotherapy were very rarely mentioned. The analysis of social security reimbursement data in the Rhône-Alpes region between 2008 and 2009 evidenced an increase in the rate of dihydroergocryptine prescriptions (from 37 to 46%), which were more frequent in women also treated with cardiovascular or psychotropic drugs, while that of bromocriptine decreased.This study shows that, in France, the main alternative to bromocriptine for lactation inhibition is the off-label use of dihydroergocryptine followed by cabergoline, which seems to be safer.

One case of analytical interference between cannabis and niflumic acid resulting in a false-positive screening in a 3-year-old girl is described.The child was hospitalized because of behavioral disturbances of unknown origin. The only noteworthy finding in her medical history was a drug treatment including suppositories of niflumic acid, started 5 days before. The initial urinary toxicological screening was positive for cannabinoids, but the child's parents strongly denied the exposure. Another analysis was performed by the same laboratory on the same urine sample using chromatography and confirmed the absence of any cannabinoids, while clearly identifying the presence of niflumic acid.Immunoanalysis for toxicological analysis has various limitations that must be known. False-positive results of the urinary screening for cannabis in patients treated with niflumic acid are well recognized although seldom reported. All usual screening tests are not concerned by this ill-explained interference with niflumic acid and all formulations can be involved except transcutaneous formulations. Because of the wide use of this nonsteroidal anti-inflammatory drug, particularly in pediatric patients, it is important to know that this type of interference can occur with various screening tests for cannabis so that misleading conclusions can be avoided.

We describe an accidental ecstasy poisoning in a 10-month-old girl.A 10-month-old infant suddenly exhibited behavior disorders with restlessness, hypertonia, and repetitive movements. She was immediately taken to the Emergency Department. Cardiovascular (tachycardia and hypertension) and neurological disorders (major agitation, mydriasis, and nystagmus) were the predominating clinical features. The most common differential diagnoses including febrile convulsion, cranial trauma, or encephalitis were progressively ruled out. The urinary toxicological screen was positive for methamphetamine. MDMA, its main metabolite, and caffeine were subsequently detected in the infant's urine using gas chromatography/mass spectrometry. The child had completely recovered the next morning.Pediatric poisoning with ecstasy remains uncommon. To date, about 10 cases have been reported. All were due to accidental ingestion. Today, the use of ecstasy is no longer restricted to recreational purposes (rave parties, etc.) and it seems to be developing in private parties and in the home. The intrusion of this amphetamine-like drug into the domestic environment may expose young children to the accidental ingestion of ecstasy tablets.

Current unusual environmental sources of lead exposure mainly include traditional medicines, either ayurvedic remedies or others, traditional cosmetics (kohl, surma), and the use of traditional earthenware, for storage or cooking.We report two cases of lead poisoning in adults initially identified by paroxysmal abdominal pain or anemia. In both cases, the environmental investigation evidenced one main source of lead exposure, namely a lead-glazed earthenware jug in which a drink was stored, "kefir" in the first case, and "kombucha" tea in the second one.It is recommended to search for lead intoxication in patients with unexplained anemia. Environmental sources of lead can be multiple. Their relative importance has to be ranked during the environmental investigation and among these, lead-glazed earthenware must be considered as a source of high lead exposure when drinks are stored inside and thus can soak.

En depit de progres spectaculaires depuis l’introduction de la « methode danoise », le traitement des intoxications aigues reste perfectible. Une approche originale reside dans l’utilisation d’anticorps specifiques capables de neutraliser les effets du toxique contre lequel ils sont diriges. Les venins de serpents en ont ete le premier exemple (Calmette, 1891). Longtemps, on s’est limite a montrer que l’immunisation active d’un animal, c’est-a-dire l’injection repetee d’un toxique couple a une proteine porteuse, exercait un effet protecteur lors de l’administration d’une dose souvent mortelle d’aspirine, ajmaline ou morphine, mais pas d’amanitine, paraquat ou dioxine. Plus pertinentes sont les etudes ou des animaux « naifs » recoivent a titre preventif et surtout curatif des anticorps ou du serum issus d’animaux sensibilises. Les resultats positifs sont nombreux : adriamycine, ajmaline, arsenic, aspirine, paraoxon, ricine, strychnine… Plusieurs immunotherapies specifiques sont disponibles en clinique. On a estime a 5 millions le nombre d’envenimations par serpents ou scorpions dans le monde, responsables de 50 a 100 000 deces par an. Les anticorps poly- ou monoclonaux, ou les fragments d’anticorps constituent un element essentiel du traitement de ces envenimations (y compris les viperes francaises). Les intoxications digitaliques sont l’autre exemple d’immunotherapie. Les annees 1970 ont permis de fabriquer assez de fragments Fab ou F(ab′) 2 dont les effets neutralisants ont ete demontres dans des modeles d’intoxication par la digoxine. Le premier cas d’utilisation humaine a ete rapporte en 1976, succes confirme par de nombreuses publications. L’immunotherapie des intoxications par antidepresseurs tricycliques suivait la meme voie : malgre des donnees experimentales positives et les resultats prometteurs d’un essai de phase II avec un anticorps specifique (TriTab°), le developpement en a ete arrete pour des raisons apparemment commerciales. L’immunotherapie des intoxications par colchicine a, jusqu’ici, suivi un chemin comparable : donnees experimentales convaincantes, resultats prometteurs chez une patiente gravement intoxiquee, puis plus rien depuis 1995. Le concept d’immunotherapie specifique des intoxications est bien vivant. Il n’est pas limite aux intoxications aigues, comme en temoigne le developpement d’un vaccin contre la cocainomanie. Les progres technologiques de ces dernieres annees n’ont pas atteint ce domaine, sans doute trop restreint, peu attractif pour des raisons commerciales. En cela, l’immunotherapie specifique des intoxications s’apparente trop bien aux antidotes classiques.

Resume Introduction Les aerosols impermeabilisants pour le cuir ne sont que rarement a l'origine d'accidents serieux. Toutefois, dans certaines circonstances, leur toxicite pulmonaire peut s'averer importante comme le montrent deux observations et une revue de la litterature. Exegese Deux cas d'alveolite aigue survenus chez des sujets jeunes sans pathologie respiratoire preexistante apres utilisation d'un aerosol impermeabilisant pour le cuir sont rapportes. Les manifestations observees comprenaient des signes pseudogrippaux (malaise, fievre, frissons) associes a une dyspnee, et dans un cas a une hemoptysie. Les examens complementaires ont objective un œdeme interstitiel lesionnel d'evolution rapidement favorable sous traitement symptomatique. Le mecanisme toxicologique de ces atteintes est discute : les donnees tant experimentales que cliniques permettent d'incriminer les resines fluorees, matieres actives de ces sprays, nouvellement employees par les fabricants. Conclusion Les aerosols impermeabilisants pour le cuir peuvent etre responsables d'une pathologie respiratoire severe en cas d'inhalation massive en milieu confine ; la prise en charge est symptomatique.

After consumption of mushrooms containing amatoxins (Amanita, Lepiota, and Galerina species), symptoms usually develop after a long delay (6 h). Initial symptoms start as severe gastroenteritis, progressing to liver failure and possibly death as a result of hepatic coma. Since the survival rate of poisoned patients is claimed to depend on the time of beginning of efficient treatment, fast and reliable assays for amatoxins in biological fluids are essential. Described analytical methods for amatoxins include high performance liquid chromatography and radioimmunoassay (RIA). Recently, a new enzyme-linked immunosorbent assay (Bühlmann Amanitin ELISA kit) has been introduced as an alternative method to RIA. This ELISA-based assay offers several advantages: no complex extraction procedure is required (vs. HPLC) and no safety precautions concerning radioactivity have to be taken (vs. RIA). From August 2004 to October 2005, a pilot study was performed to test the practicability and the clinical utility of this method in emergency situations.ten urines, 9 serums and 1 faeces from 10 patients suffering from acute gastroenteritis after mushroom ingestions (7 contaminated meals) were analyzed. Definitive diagnosis of amatoxin poisoning was made in 4 cases (3 contaminated meals) on the basis of the anamnesis, laboratory results, and clinical course. A patient developed a severe amatoxin poisoning with urinary amanitins level1.5 microg/L (urines were collected more than 72 h after mushroom ingestion). Two patients were paucisymptomatic with urinary amanitins levels10 microg/L (urines were collected before the 36th hour).Urine is the sample of choice for the determination of amatoxins. The most critical factor to invalidate the usefulness of this analysis is time. After 36 h, the sensitivity is unreliable.

Glycol ethers (GE) belong to two main series: series E, which include ethylene glycol ethers (EGE) and series P which include propylene glycol ethers (PGE). GE are widely used as solvents in a large number of industrial, household and cosmetic applications. EGE can be found in water paints, varnishes, inks, household products. Severe adverse effects have been noted with pharmaceutical formulations containing diethylene glycol monoethyl-ethers and this led to withdrawal from the French market. The toxicity of GE depends on the molecular weight and the metabolites generated. It can manifest following acute or chronic exposure by disorders of the nervous system, bone marrow, immune system, kidneys as well as fertility, reproduction and embryofetal development. Several EGE are mutagenic. The carcinogenic risk is not known. The most toxic derivatives EGME, EGMEA, EGEE and EGEEA alter male and female fertility, and induce malformations. Taking these toxic effects into consideration, what is the place of GE as absorption promoting agents? An example is DEGEE, which facilitates estradiol penetration when used as a gel in the treatment of estrogen deficiency. This review is intended to address this issue.

To determine the optimal evaluation and management of renal injuries by review of the world's English-language literature on the subject.A consensus conference convened by the World Health Organization and the Societé Internationale d'Urologie met to critically review reports of the diagnosis and treatment of renal trauma. The English-language literature about renal trauma was identified using Medline, and additional cited works not detected in the initial search obtained. Evidence-based recommendations for the diagnosis and management of renal trauma were made with reference to a five-point scale.There were many Level 3 and 4 citations, few Level 2, and one Level 1 which supported clinical practice patterns. Findings of nearly 200 reviewed citations are summarized.Published reports on renal trauma still rely heavily on expert opinion and single-institution retrospective case series. Prospective trials of the most significant issues, when possible, might improve the quality of evidence that dictates the behaviour of practitioners.

Viral inactivation is a critical step during the manufacture of factor VIII formulations for use in humans. Indeed, viral inactivation procedures may alter the three-dimensional structure of factor VIII resulting in the formation of new epitopes which, in turn, may lead to the synthesis of inhibiting antibodies, and hence to a decreased therapeutic activity. A rabbit model was used to compare the immunogenicity of a solvent/detergent (SD)-inactivated formulation with a double-inactivated (SD plus heating in solution, SDP) formulation of factor VIII. Two groups of five rabbits were immunized by six s.c. injections of each formulation. The serum of each animal was incubated with various amounts of the competing antigens, e.g. factor VIII SD or factor VIII SDP. The remaining free polyclonal antibodies were assayed by ELISA. Curves obtained with both antigens were compared for each serum. Both factor VIII SD and factor VIII SDP decreased the amount of antibodies raised to either formulation in a dose-dependent manner without observable differences. These results suggest that no new epitopes were present on factor VIII SDP as compared with factor VIII SDP as compared with factor VIII SD and that no epitope deletions occurred, supporting the view that the double-inactivation procedure does not change the immunogenicity of factor VIII SD. This model is proposed as a tool to detect changes in the immunogenicity of proteins which may be modified.

It is now accepted that serotonin can either initiate or aggravate myocardial ischaemia through a vasoconstrictor action and platelet activation. It is therefore possible that substances likely to neutralize the effects of serotonin could be used, without any danger, in humans with ischaemic heart disease. This type of action may therefore be exerted by 5-HT2 antagonists, such as naftidrofuryl. A recent double-blind clinical study has in fact shown that administration of naftidrofuryl versus placebo leads to better exercise tolerance, with an increase in the maximum level and delay in ST segment shift (increase in the threshold of onset of ischaemia). The purpose of this study was therefore to evaluate, in an animal model (pig) of acute myocardial ischaemia (occlusion of the proximal section of the left anterior descending coronary artery), the action of serotonin, naftidrofuryl and a combination of both substances on the following parameters: 1) electrophysiological (sinus heart rate, ST segment shift, T-wave amplitude, duration of monophasic action potentials, intraventricular conduction time); 2) haemodynamic (systolic, diastolic and mean blood pressure, first derivative of rate of increase of left ventricular pressure with time: LV dP/dt max); and 3) biochemical (malonedialdehyde concentration as an index, cell peroxidation index, creatine phosphate and adenosine triphosphate). It was found that co-infusion of serotonin aggravated the myocardial ischemia and that naftidrofuryl exerted beneficial effects on the serotonin-mediated aggravation of myocardial ischaemia.

During an hospitalization, a ten-day-old newborn infant was treated with ceftriaxone (Rocephine i.v., 390 mg/day) for an infection secondary to the presence of an umbilical catheter. A few minutes after the end of the fifth injection, the infant presented with cyanosis, initially localized at the perfusion site, then generalized, a tachycardia followed by acute circulatory failure with arterial hypotension and finally a multiple organe failure with coagulation, kidney and liver dysfunction. The infant received classical resuscitation treatment and recovered without short term sequelae. The time of onset was in favour of drug-induced accident. A postnatal sensitization during previous injections might have occurred, although the latency of immediate hypersensitivity reactions after a first sensitizing contact is usually longer. A sensitization in utero or via breast feeding was ruled out due to the absence of maternal exposure to ceftriaxone. The absence of urticaria and bronchospasm, and the initial localization of cyanosis were not in favour of a classic allergic disease. An other cause, toxic or infectious cannot be ruled out.

A case of severe ocular burns in an amateur speleologist is reported. The explosion of his acetylene lamp caused the projection of calcium carbide particles, which induced burning of the cornea and conjunctiva in both eyes. He slowly recovered in several months. The pathophysiology of the burns, linked to the in situ production of lime, and their management are discussed.

Many women of childbearing age are occupationally exposed to chemicals and concerned with the ensuing risk when pregnant.To describe the principles of individual risk assessment to be applied in pregnant women or women wishing to become pregnant that are exposed to chemicals at the workplace.Each request for risk assessment is based on a comprehensive review of the hazards of the handled products together with a thorough evaluation of the actual exposure at the workplace. A toxicological advice is then written to the gynecologist or the general practitioner in charge of the patient. When the exposure is estimated to be hazardous for the pregnancy, either total withdrawal, avoidance of certain activities or improvements of individual protective devices are recommended. The outcome of the pregnancy is systematically followed-up.An objective assessment of toxic risks in pregnant women exposed to chemicals at the workplace can be done. Thus, patients who must be withdrawn or benefit from improvements of their workstation can be selected.

Many women of childbearing age are occupationally exposed to chemicals and concerned with the ensuing risk when pregnant.To present the results of a prospective follow-up study of 100 pregnant women and to discuss them after a brief overview of the published data on this topic.Since January 1996 the Lyon Poison Center has been conducting a prospective follow-up of all request concerning pregnant women occupationally exposed to chemicals. A thorough evaluation of the hazards of the handled products and of the actual exposure at the workplace is done for each patient. A toxicological advice is given and the outcome of the pregnancy is followed-up.One hundred pregnant women were included between January 1996 and December 2000. Based on the nature of the handled products, two groups have been identified: the first included 73 women exposed to organic solvents and the second 27 women exposed to miscellaneous. When the exposure was considered potentially hazardous for the pregnancy, either withdrawal from the workstation (19 cases), avoidance of certain activities (9 cases) or improvement of individual protective measures (29 cases) was recommended. In 43% of the cases, the occupational exposure was not considered hazardous to the outcome of the pregnancy. No increase of adverse outcome was identified: 4 miscarriages and 96 living births were observed, with 2 major malformations and 1 minor malformation.Occupational exposure to chemicals was not found to affect adversely the outcome of these 100 pregnancies.