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Resume Propos Nous rapportons une serie de patients explores en medecine interne pour une inflammation orbitaire et decrivons la forme idiopathique appelee syndrome d’inflammation orbitaire idiopathique (SIOI). Patients et methodes Quarante patients etaient adresses consecutivement par un centre specialise ou une biopsie orbitaire etait realisee en cas de lesion accessible. Onze patients avaient ete exclus en cas de dossiers incomplets ou en raison de lymphome non hodgkinien, de xanthogranulomatose periorbitaire ou de maladie de Basedow. Etaient inclus les patients ayant une maladie systemique ou auto-immune (MS/AI) validant les criteres internationaux, ou un SIOI en l’absence d’etiologie. Les caracteristiques anatomocliniques et immunologiques des patients ayant un SIOI, leur traitement et leurs profils evolutifs sont rapportes selon les formes histologiques decrites par Mombaerts. Resultats Parmi les 29 patients inclus, huit avaient une dacryoadenite revelatrice de MS/AI, principalement une vascularite necrosante chez cinq patients, sept avaient un SIOI presume et 14 un SIOI histologiquement documente. La presentation du SIOI etait dominee par une atteinte diffuse de l’orbite. Le SIOI beneficiait d’une corticotherapie seule ou recevait en plus un immunosuppresseur dans 57 et 24 % des cas, respectivement. L’incidence de la rechute/resistance etait superieure a celle de la remission et en particulier, en cas de SIOI presume ou de sa forme classique. Les patients ayant un stade III-IV de Chisholm etaient tous en rechute ou resistants. Conclusion Une dacryoadenite peut reveler certaines MS/AI. La forme sclerosante du SIOI n’est peut-etre pas un facteur de rechute ou de resistance, contrairement a la sialadenite severe.

The registry is a prospective, European, multicentric, longitudinal study, which follows a cohort of children born to mothers with antiphospholipid syndrome (APS). It was started in 2003. In this report, we update the results obtained from the study of 110 mothers and 112 children (two twin births). Eighty per cent of the mothers ( n = 86) had primary APS. Purely obstetrical, thrombotic and mixed (obstetrical and thrombotic) APS represent 65.5 %, 21.8 % and 12.7 % of the whole cohort respectively. Isolated antiphospholipid antibodies and isolated anticardiolipin antibodies positivity were present in 50 of 109 (46%) and in 34 of 109 (31%) of the pregnant women, respectively. In the babies, in spite of a high rate of prematurity (14.3%) with four (3.6%) of the premature babies born before 33 weeks of gestation and an increased number of newborns small for gestational age (17%), the large majority of the neonates were healthy. Thirty-one infants are now older than 24 months. Among them, three displayed behavioural abnormalities before 3 years of age. After completing data, there will be the possibility to evaluate the newborn status in relation to the mothers’ diseases, treatments and antibodies and to follow the neuropsychological development and immunological evolution of the babies during the next 5 years.

Background/Aims: Oxidative stress is involved in sepsis-related endothelium dysfunction. Selenoprotein-P (Sel-P), the main plasma selenoprotein, may have high antioxidant potential, and binds to endothelium. We hypothesize that, in septic shock, and similar syndromes such as systemic inflammatory response syndrome (SIRS), Sel-P binds massively to endothelium, causing a drop in Sel-P plasma concentration. Methods: Plasma Se, Sel-P and albumin concentrations, and glutathione peroxidase (GPx) activity were measured in patients with septic shock and SIRS with organ failure (S group, n = 7 and n = 3, respectively) admitted to the intensive care unit (ICU) and compared to non-SIRS patients (NS group, n = 11) and healthy volunteers (HV group, n = 7). Results: On ICU admission, plasma Sel-P concentrations were 70% lower in the S group than in the other groups [15 (10–26) vs. 44 (29–71) and 50 (45–53) nmol/l] and were lower in nonsurviving septic-shock patients. GPx activity did not differ between groups. Sel-P was significantly lower before ICU death in the 3 deceased patients of the S group (septic shock) than in the 3 patients of the non-SIRS group. Conclusions: Early decrease in Sel-P plasma concentrations was specifically observed in septic shock and was similar in SIRS patients whereas GPx activity remained unchanged. Further studies are needed to determine whether Sel-P can be an early marker of septic shock linked to microvascular injury.

Resume Cette etude exploratoire porte sur une comparaison entre les tentatives de suicide des adolescents d’origine maghrebine et celles des adolescents de parents non migrants. Nous posons ainsi la question d’une eventuelle specificite des tentatives de suicide chez les jeunes d’origine maghrebine. Le recueil des donnees s’est appuye sur les dossiers de 339 jeunes âges de 15 a 25 ans, recus aux urgences de l’hopital Avicenne a la suite d’une tentative de suicide. Les analyses statistiques montrent que les deux groupes de patients se differencient selon leur devenir apres leur passage aux urgences et l’evenement declenchant la tentative de suicide. Les conflits intergenerationnels sont plus frequemment rapportes comme etant a l’origine des tentatives de suicide par les jeunes d’origine maghrebine. Ces resultats sont discutes en tenant compte du contexte de vie transculturel de ces adolescents.

Resume Objectifs. – Comparaison de deux protocoles de sedation, remifentanil-midazolam vs sufentanil-midazolam pour la sedation prolongee en reanimation. Type d'etude. – Prospective, randomisee en double insu. Patients et methodes. – Patients necessitant une ventilation invasive de plus de 48 heures. Posologie initiale : remifentanil : 10 μg/kg par heure ou sufentanil : 0,125 μg/kg par heure et midazolam : 0,1 mg/kg par heure. Un reajustement de 50 % des posologies etait realise pour atteindre l'objectif de sedation. Un score de Ramsay de 2 a 4 pour les patients en ventilation assistee et superieur a 4 pour les patients presentant un syndrome de detresse respiratoire aigue etait requis. Les criteres principaux etaient la duree du sevrage ventilatoire et la survenue d'une tachyphylaxie definie par une augmentation ≥ 5 fois la posologie initiale de la sedation. Resultats exprimes en moyenne ± DS ou mediane [interquartile 25–75]. Resultats. – L'etude a ete interrompue lors de l'analyse intermediaire apres l'inclusion de 41 patients. Les deux groupes etaient comparables en termes d'IGS II : 56 ± 22 vs 64 ± 26 et de duree de sedation, six jours (4–19 jours) vs six jours (3–16 jours). Compares au groupe sufentanil, les patients recevant du remifentanil presentaient une duree de sevrage ventilatoire plus courte, 22 heures (4–112 heures) vs 96 heures (6–150 heures), p Conclusions. – Compare a l'association sufentanil-midazolam, le protocole remifentanil-midazolam raccourcit la duree du sevrage ventilatoire.

Background/Aims: N-acetylneuraminidine (NeuNAc), N-acetylglutamine (GIcNAc) and acetate are metabolites present in normal urine. In patients treated with aminoglycosides and/or glycopeptides, elevation of these metabolites in urine suggests renal tubular injury. NeuNAc, GIcNAc and acetate are easily detected by magnetic resonance spectroscopy (MRS), in contrast to other bioanalytical methods. In the present study, these urinary metabolites were detected using MRS and compared with standard biochemical markers of renal injury in intensive care unit patients treated with aminoglycosides and/or glycopeptides. Methods: 16 patients with clinical and biochemical signs of renal dysfunction were included in the study. Proton magnetic resonance spectra were obtained from 134 urine samples. The resonance intensity of NeuNAc, GIcNAc and acetate were reported relative to the resonance intensity of creatinine (ct). These ratios were compared with classical parameters of renal dysfunction, such as plasma creatinine and urea concentration, and 24-hour urine volume, by logistic regression and general linear models. Results: Statistical analysis showed that changes in plasma creatinine and urea concentration were reliably reflected in changes in the NeuNAc/ct ratio, and that plasma urea concentration changes also correlated with the acetate/ct ratio; however, the GIcNAc/ct ratio was not related to these measures of overall renal function. Conclusions: NeuNAc/ct may be a useful marker of renal dysfunction in patients treated with aminoglycosides and glycopeptides; by MRS it can be both straightforward and informative to follow the renal function of patients treated with these antibiotics.

Resume Introduction : Les detecteurs portables de monoxyde de carbone (CO) sont largement utilises par les equipes de secours. Ils donnent l’alerte en presence d’une atmosphere riche en CO et permettent le dosage de CO dans l’air expire. Aucune etude n’a valide l’utilisation de ces appareils. Objectif : Evaluer l’interet du dosage du CO dans l’air expire au cours de la prise en charge prehospitaliere des intoxications oxycarbonees. Type d’etude : Etude retrospective sur l'annee 1998 par inclusion de tous les patients pris en charge pour intoxication oxycarbonee. Patients et methodes : Les signes cliniques ont ete regroupes en quatre categories : patients asymptomatiques, signes cliniques mineurs, de gravite intermediaire et d'intoxication severe. Les dosages du CO ont ete realises dans l'air expire sur site de l'intoxication (HbCOe) dans le sang (HbCOs) et a l'hopital (HbCOh). Une analyse de variance et une recherche de correlation ont ete realisees. Resultats : Vingt appels ont donne lieu a la prise en charge 262 victimes. Les 144 patients (55 %) asymptomatiques avaient des valeurs d'HbCOe de 11,6 ± 7,5 % (moyenne ± SD) et d'HbCOh de 4,9 ± 3,3 %. Les 91 patients (35 %) avec symptomes mineurs avaient des valeurs d'HbCOe de 16,4 ± 7,9 et d'HbCOh de 7,1 ± 4,5 %. Les 21 patients (8 %) avec des symptomes d'intoxication severe et intermediaire avaient des valeurs d'HbCOe de 26,4 ± 17,7 % et d'HbCOh de 12,8 ± 9,3 %. Les dosages du CO dans l’air expire et a l’arrivee a l’hopital etaient correles a la gravite des symptomes ( p Conclusion : Le dosage du CO dans l’air expire est une technique simple, facilement disponible et dont les resultats sont correles a la gravite des symptomes.

To describe a case series of patients investigated in internal medicine for an inflammation of the orbit and to clarify the clinical and pathological features of patients with idiopathic orbital inflammatory syndrome (IOIS).Forty patients were consecutively referred by a specialized center where an orbital biopsy was performed in case of accessible lesion. Eleven patients were excluded because of missing data or diagnosis of lymphomas, periorbital xanthogranulomas, or Graves' disease. Patients with systemic disease (SD) or auto-immune disorder (AID) that validated the international criteria, or those having an IOIS in the absence of local or systemic etiology, were included. The clinicopathologic and immunologic characteristics of IOIS patients, their treatment and their evolutionary profiles are reported according to the histological types described by Mombaerts.Of the 29 patients enrolled, eight had a dacryoadenitis revealing a SD/AID, mainly a necrotizing vasculitis, seven patients had a presumed IOIS and 14 an IOIS histologically documented. The presentation of IOIS was dominated by a diffuse involvement of the orbit. Corticosteroids were administered alone or with an immunosuppressant in 57 and 24% of IOIS patients, respectively. The incidence of relapse/resistance was higher than that of remission, particularly in case of presumed IOIS or in its classical form. All four patients with a stage III-IV of Chisholm were relapsing or resistant.A dacryoadenitis may reveal some types of SD/AID. Unlike the severe sialadenitis, the form of sclerosing IOIS may not be a factor associated with relapse or resistance.

Behcet disease (BD) is a chronic systemic auto-inflammatory immune disorder with generalised vasculitis of the arteries and veins. It was originally described as orogenital aphthous ulcerations and uveitis but the disease can affect any organ or system. BD is characterised by recurrent crises of variable duration and intervals. The skin pathergy reaction (SPR),1 which explores hypersensitivity to minor trauma (needle prick), is considered as one of the main criteria for BD diagnosis, by both the International Study Group (ISG) of BD and the Behcet Disease Japanese Committee.2 In spite of its high specificity, SPR has a variable sensitivity and inconstant reproducibility, which limit its use. Although the aetiology of the disease is still unknown, …

Microsatelite instability (MSI) is the consequence of the inactivation of a mismatch repair gene and is observed in approximately 15% of colon cancer cases. Patients with MSI colon cancer do not benefit from 5-fluorouracil (5-FU)-based chemotherapy. A current treatment of reference for colon cancer is a combination of 5-FU and oxaliplatin (FOLFOX). The aim of this study was to determine the efficiency of the FOLFOX treatment in patients with metastatic MSI colon cancer.Tumour specimens were collected from patients with metastatic colon cancer treated with FOLFOX 4 modified or FOLFOX 6; these two regimens are based on 85 mg/m2 and 100 mg/m2 oxaliplatin, respectively. The MSI status was assessed by measuring the length of five monomorphic mononucleotide markers. The FOLFOX regimen was evaluated as a first-line treatment according to WHO criteria.Forty patients (22 men, 18 women), median age 63.5 years (27-83 years) were treated with FOLFOX 4 or 6. Nine patients had tumours exhibiting high MSI (MSI group) and 31 patients had tumours exhibiting microsatellite stability (MSS group). In the MSS group, 11 partial responses (36%) were observed, while there were only two in the MSI group (22%) (no significant difference). The two patients who were responders in the MSI group were treated with FOLFOX 6. The overall survival was not significantly different for MSI and MSS patients.No significant differences in the overall response rate or overall survival between the two groups of patients were observed. However, these results suggest that patients with MSI colon cancer are more sensitive to a higher dose of FOLFOX.

This prospective multicentric register was initiated by the European Forum of Antiphospholipid Antibodies (APL) in 2003 after approval by local ethic committees. This register allows the investigation of infants after written informed parental consent. It collects mothers’ clinical pattern of antiphospholipid syndrome (APS), course and outcome of pregnancy, treatment and immunological status. For the babies, clinical and immunological examinations are performed at birth; neuro-developmental conditions followed up to five years. A re-evaluation of lupus anticoagulant (LA), anticardiolipin (ACL) or other antibodies will be done if they are positive at birth to follow their kinetics. A descriptive and a case control study of babies with versus without APL at birth will be possible after the inclusion of 300 cases.

Remifentanil has a unique metabolic pathway that holds potential benefits for long-term sedation. We compared remifentanil-midazolam to sufentanil-midazolam in 41 critically ill adults requiring mechanical ventilation.Randomized double-blind trial.Infusion rates were titrated every 4 hours to achieve the desired Ramsay score. Five fold increases in dose requirement was considered as the development of tolerance. Drugs requirement, development of tolerance and weaning time of ventilation were compared.The study was stopped after an interim analysis. The remifentanil and sufentanil groups were comparable regarding IGS II: 56+/-22 vs 64+/-26, mean+/-SD, ICU length of stay: 26 (8-45) vs 19 (11-34) days, and sedation duration: 6 (4-19) vs 6 (3-16)days, median [interquartile range, IQR]). There was a shorter weaning time in the remifentanil group as compared to sufentanil group: 22 h (12-53) vs 96 (47-142) h, median [IQR], p=0.04). The daily opioid infusion rate needed to be decreased over time only in sufentanil group, p0.001. Tolerance occurred in 6 (30%; CI(95), 10 to 40%) remifentanil and no sufentanil patients (P=0.02).Sufentanil infusion needed to be reduced over time and prolonged the weaning time when compared to remifentanil.

Background: Environmental carbon dioxide (CO) detectors used as an early warning method have been adapted to measure CO concentration in expired breath. This technique has been validated in smokers with relatively low CO concentrations, but its applicability to poisoning has not been demonstrated. Objective: To compare the reliability of toxicologically significant CO measurements performed using a portable CO detector with those obtained using infrared spectrometry, the standard method for blood CO concentration determination. Design: Experimental study with a CO detector and infrared spectrometer. A balloon simulated respiratory movements and an expired breath. Balloon gas mixtures contained CO, in one of 21 different concentrations from 100 to 600 parts per million (ppm) in air. CO concentration was measured directly with the portable CO detector and two gas samples obtained at the beginning and end of the simulated expired breath were diluted, with validation, for spectrometric measures. Main outcome measures: Portable CO detector concentrations were compared with the mean value of the reference method. Simple linear regression was performed using ANOVA to evaluate the parallel between the model with the reference method. Results: Portable CO detector concentration measurements were perfectly linear ( R 2 =0.989, P −3 ) over a concentration range of 46–645ppm. The difference from the reference plot was significant ( P Conclusion: Given the linearity of the measurements, the underestimation by the portable CO detector at higher concentrations can be corrected mathematically. A portable CO detector should measure CO in expired breath efficiently and reliably.

Whereas patients most often select their surgeon, they don't usually select their anesthesiologist. Further, anesthesia frequently involves different physicians at different stages perioperatively. This inability to choose and the multiplicity of interveners may reduce patient satisfaction. Our study examined patients' willingness to choose their anesthesiologist for the operation, as well as their opinion on the way anesthesia is practiced presently.Nine hundred and twelve patients (mean age 51 +/- 16 yr, 58% moles) were requested, immediately after the preoperative visit, to choose their anesthesiologist for the operation. The request was formuled by a nurse, in the absence of the anesthesiologist, in order to avoid a courteous response. After surgery, prior to leaving the hospital, patients were invited to give their opinion on the anesthesia core received and to name the anesthesiologist(s) and surgeon involved.Women chose an anesthesiologist more frequently than men, but only 34% of patients overall elected to do so. Eighty percent of patients were cared for by an anesthesiologist other than the one seen at the preoperative visit. Four percent of patients regretted the change. Patients recalled the surgeon's name more frequently (60%) than the attending anesthesiologist's (4%).In France, the preoperative visit is required by law and must precede the operation by at least 48 hr. Despite this preoperative interview, patients were unwilling to choose the anesthesiologist responsible for surgery, did not object to multiple interveners and seldom remembered their anesthesiologist's name. Efforts to improve the image of the profession are required.

Carbon monoxide detectors are currently used by the French prehospital medical teams. These detectors can also be used to measure expired breath carbon monoxide concentration. The interest of this measurement has never been studied.To evaluate interest of expired breath carbon monoxide concentration measurement in the management of prehospital carbon monoxide intoxication.Patients with carbon monoxide poisoning were included during 1998.Four levels of clinical severity: no symptom, minor, medium or severe intoxication were defined. Carbon monoxide concentration were measured in the expired breath (COHbe) at the place of the intoxication and in blood samples collected at the place of the intoxication (COHbs) and at the hospital (COHbh).209 patients were included, 144 had no symptom (55%), the value of COHbe was 11.6 +/- 7.5% (mean +/- DS) and the value of COHbh was 4.9 +/- 3.3%. 91 patients had minor intoxication (35%), the value of COHbe was 16.4 +/- 7.9% and the value of COHbh was 7.1 +/- 4.5%, 21 patients had sever or medium intoxication (8%) the value of COHbe was 26.4 +/- 17.7% and the the value of COHbh was 12.8 +/- 9.3%. Results for COHbh were obtained for only three patients. Relationship between symptoms and expired breath carbon monoxide and relationship between symptoms and carbon monoxide blood concentration on arrival at the hospital were significant (p0.05).Measurement of expired carbon monoxide concentration, easy and quick to perform is correlated with clinical severity in carbon monoxide poisoning.

The control of hypertension in diabetic hypertensive patients prevents micro and macroangiopathy complications. Our prospective study was designed to evaluate the level of treatment of hypertension in type II diabetic patients at the time of referral to our endocrinology unit and after a mean follow-up of 9.2 months. Five hundred and sixty four patients (sex ratio: 1.15, mean age of 56 +/- 13, mean BMI of 28 +/- 15, mean duration of diabetes of 11.3 +/- 9.9) were referred to our unit. Among these, 42% had an antihypertensive drug (58% under monotherapy, 42% under combinations) and 92% had a documented history of CHD. Glycemic and blood pressure controls were stable during follow-up. HbA1c remained unchanged (8.95% at admission, 8.8% at 9 months) BP decreased from 143/84 +/- 26/13 mmHg to 142/82 +/- 23/13 mmHg. Fifty six percent reached a BP goal of 140/90 mmHg whereas 42% achieved a BP goal of 130/85 mmHg at 9 months compared to respectively 56% and 39% at admission. A multivariate logistic regression analysis showed that initial value of SBP (p0.0001), age (p0.0001), BMI (p = 0.006), HbA1c (p = 0.018) were independent factors of non control of hypertension. In conclusion, follow-up of hypertension diabetic patients would be focussed on identified and modifiable factors.