Propensity-based study of aminoglycoside nephrotoxicity in patients with severe sepsis or septic shock.

To assess the risk of acute kidney injury (AKI) attributable to aminoglycosides (AGs) in patients with severe sepsis or septic shock, we performed a retrospective cohort study in one medical intensive care unit (ICU) in France. Patients admitted for severe sepsis/septic shock between November 2008 and January 2010 were eligible. A propensity score for AG administration was built using day 1 demographic and clinical characteristics. Patients still on the ICU on day 3 were included. Patients with renal failure before day 3 or endocarditis were excluded. The time window for assessment of renal risk was day 3 to day 15, defined according to the RIFLE (risk, injury, failure, loss, and end-stage renal disease) classification. The AKI risk was assessed by means of a propensity-adjusted Cox proportional hazards regression analysis. Of 317 consecutive patients, 198 received AGs. The SAPS II (simplified acute physiology score II) score and nosocomial origin of infection favored the use of AGs, whereas a preexisting renal insufficiency and the neurological site of infection decreased the propensity for AG treatment. One hundred three patients with renal failure before day 3 were excluded. AGs were given once daily over 2.6 ± 1.1 days. AKI occurred in 16.3% of patients in a median time of 6 (interquartile range, 5 to 10) days. After adjustment to the clinical course and exposure to other nephrotoxic agents between day 1 and day 3, a propensity-adjusted Cox proportional hazards regression analysis showed no increased risk of AKI in patients receiving AGs (adjusted relative risk = 0.75 [0.32 to 1.76]). In conclusion, in critically septic patients presenting without early renal failure, aminoglycoside therapy for less than 3 days was not associated with an increased risk of AKI.

[Changes in inspiratory capacity during acute respiratory failure in COPD patients]. / Evolution de la capacité inspiratoire au cours de la BPCO décompensée.

INTRODUCTION: Inspiratory Capacity (IC), which reflects dynamic pulmonary hyperinflation, correlates with outcome in moderate exacerbation of COPD. Whether this is also true in COPD with acute respiratory failure (ARF) has not been studied. METHODS: A prospective multicenter assessment of IC measurement feasibility, reliability, time-course and relationship to outcome in COPD with ARF was conducted. Dyspnea (visual analogue scale) and IC were repeatedly measured. Outcome was classified as not favourable (death or intubation or non invasive ventilation increased or patient referred to ICU from respiratory ward) or favourable (none of the above criteria). RESULTS: Fifty patients were included and 48 analysed. IC measurement was possible in all but one patient and its coefficient of variation was 9+/-8%. Between inclusion into the study and discharge, IC increased from 39.9+/-15.5 to 50.2+/-14.5% pred (p<0.001) and dyspnea declined from 48+/-23 to 33+/-22 mm (p<0.001). Inclusion IC was not different on average between patients with or without favourable outcome. CONCLUSION: In COPD patients with ARF, IC measurement at bedside was feasible and reproducible. IC was low at entry and increased over time from inclusion to discharge tending to correlate with patient outcome.

Microclimate influence on mineral and metabolic profiles of grape berries.

The grape berry microclimate is known to influence berry quality. The effects of the light exposure of grape berry clusters on the composition of berry tissues were studied on the "Merlot" variety grown in a vineyard in Bordeaux, France. The light exposure of the fruiting zone was modified using different intensities of leaf removal, cluster position relative to azimuth, and berry position in the cluster. Light exposures were identified and classified by in situ measurements of berry temperatures. Berries were sampled at maturity (>19 Brix) for determination of skin and/or pulp chemical and metabolic profiles based on (1) chemical and physicochemical measurement of minerals (N, P, K, Ca, Mg), (2) untargeted 1H NMR metabolic fingerprints, and HPLC targeted analyses of (3) amino acids and (4) phenolics. Each profile defined by partial least-square discriminant analysis allowed us to discriminate berries from different light exposure. Discriminant compounds between shaded and light-exposed berries were quercetin-3-glucoside, kaempferol-3-glucoside, myricetin-3-glucoside, and isorhamnetin-3-glucoside for the phenolics, histidine, valine, GABA, alanine, and arginine for the amino acids, and malate for the organic acids. Capacities of the different profiling techniques to discriminate berries were compared. Although the proportion of explained variance from the 1H NMR fingerprint was lower compared to that of chemical measurements, NMR spectroscopy allowed us to identify lit and shaded berries. Light exposure of berries increased the skin and pulp flavonols, histidine and valine contents, and reduced the organic acids, GABA, and alanine contents. All the targeted and nontargeted analytical data sets used made it possible to discriminate sun-exposed and shaded berries. The skin phenolics pattern was the most discriminating and allowed us to sort sun from shade berries. These metabolite classes can be used to qualify berries collected in an undetermined environment. The physiological significance of light and temperature effects on berry composition is discussed.

Sequential use of noninvasive pressure support ventilation for acute exacerbations of COPD.

OBJECTIVES: To compare the efficacy of noninvasive pressure support ventilation (NIPSV) in acute decompensation in chronic obstructive pulmonary disease (COPD) by means of a bi-level positive airway pressure support system (BiPAP) in a sequential mode with medical therapy alone; to assess the short-term physiologic effects of the device on gas exchange; and to compare patients successfully ventilated with NIPSV with those in whom NIPSV failed. DESIGN: A prospective case series with historically matched control study. SETTING: A general intensive care unit (ICU) of a university hospital. PATIENTS: We evaluated the efficacy of administration of NIPSV in 42 COPD patients and compared this with standard treatment in 42 matched historical control COPD patients. INTERVENTIONS: NIPSV was performed in a sequential mode, i.e., BiPAP in the spontaneous mode was used for at least 30 min every 3 h. Between periods of ventilation, patients could be systematically returned to BiPAP when the arterial oxygen saturation was < 0.85 or when the respiratory rate was > 30 breaths/min. MEASUREMENTS AND RESULTS: Success rate, mortality, duration of ventilatory assistance, and length of ICU stay were recorded. Eleven of the 42 patients (26%) in the NIPSV group needed tracheal intubation compared with 30 of the 42 control patients (71%). The 31 patients in whom NIPSV was successful were ventilated for a mean of 6 +/- 3 days. In-hospital mortality was not significantly different in the treated versus the control group, but the duration of ventilatory assistance (7 +/- 4 days vs 15 +/- 10 days, p < 0.01) and the length of ICU stay (9 +/- 4 days vs 21 +/- 12, p < 0.01) were both shortened by NIPSV. BiPAP was effective in correcting gas exchange abnormalities. The pH values, measured after 45 min of BiPAP with optimal settings, in the success (7.38 +/- 0.04) and failure (7.28 +/- 0.04) patients were significantly different (p < 0.05). CONCLUSIONS: NIPSV, performed with a sequential mode, may be used in the management of patients with acute exacerbations of COPD.

Fulminant Guillain-Barré syndrome mimicking cerebral death: case report and literature review.

A 45-year-old woman was admitted to the intensive care unit (ICU) for respiratory arrest. One day prior to admission, she had been nauseated and in a state of total exhaustion. On the night of admission she was unresponsive and developed gasping respiration. The patient was comatose with absent brainstem reflexes and appeared brain dead. Blood chemistry findings and brain magnetic resonance imaging were normal. Electroencephalogram revealed an alpha rhythmical activity unresponsive to painful or visual stimuli. The cerebrospinal fluid showed an albuminocytological dissociation. Guillain-Barré syndrome (GBS) was suspected. The electrophysiological evaluation revealed an inexcitability of all nerves. The pathological findings of the sural nerve biopsy indicated an axonal degeneration secondary to severe demyelination. GBS can very rarely present with coma and absent brainstem reflexes. This case illustrates the importance of electrophysiological tests and laboratory and imaging studies in patients with suspected brain death where a cause is not clearly determined.

Airway occlusion pressure at 0.1 s (P0.1) after extubation: an early indicator of postextubation hypercapnic respiratory insufficiency.

OBJECTIVE: To examine variables associated with postextubation respiratory distress in chronic obstructive pulmonary disease (COPD) patients. DESIGN: Prospective, clinical investigation. SETTING: Intensive care unit of a university hospital. PATIENTS: Forty COPD patients, considered ready for extubation. MEASUREMENTS AND MAIN RESULTS: We recorded, from the digital display of a standard ventilator, breathing frequency (f), tidal volume (VT) and f/VT for the respiratory pattern, airway occlusion pressure at 0.1 s (P0.1) for the respiratory drive and measured blood gases: i) before extubation, following 30 min of a 6 cm H2O pressure support (PS) ventilation trial, ii) 1 h after extubation, at the 30th min of a face mask 4 cm H2O PS ventilation trial. According to the weaning outcome, the patients were divided into two groups: respiratory distress, and non-respiratory distress within 72 h of the discontinuation of mechanical ventilation. The respiratory distress was defined as the combination of f more than 25 breaths/min, an increase in PaCO2 of at least 20% compared with the value measured after extubation, and pH lower than 7.35. We determined whether those patients who developed respiratory distress after extubation differed from those who did not. Respiratory pattern data and arterial blood gases recorded, either before or after extubation, and P0.1 recorded before extubation, were inadequate to differentiate the two groups. Only P0.1 recorded 1 h after the discontinuation of mechanical ventilation differentiated the patients who developed respiratory distress from those who did not (4.2+/-0.9 vs 1.8+/-0.8, p < 0.01). CONCLUSIONS: P0.1 recorded after extubation may be a good indicator of postextubation respiratory distress. Measuring P0.1 and/or the analysis of the evolution of this parameter could facilitate decisions during the period following extubation.

Sequential production of leukaemia inhibitory factor by blood cell culture in patients with ARDS.

OBJECTIVE: Leukaemia inhibitory factor (LIF) is a polyfunctional cytokine integrated in cytokine networks and its concentration has been shown to be elevated in bronchoalveolar lavage fluid of patients with the acute respiratory distress syndrome (ARDS). The aim of our study was to evaluate the production of LIF by culturing blood cells from patients with ARDS. PATIENTS: 8 patients with ARDS, 8 patients with pneumonia and 5 healthy subjects. MEASUREMENTS AND RESULTS: The blood samples were taken on day 1 after onset of ARDS. LIF was measured, in the cell-free supernatant, with an enzyme-linked immunosorbent assay after 24 h, 48 h and 72 h of blood cell culture. LIF was detectable in some patients in the ARDS group: at i) at 24 h and 48 h: in 2 patients ii) at 72 h in 4/5 patients (140 +/- 231 pg/ml). Only in the 4 patients in whom LIF was measured at 72 h was ARDS associated with the multiple organ dysfunction syndrome. Furthermore, among the 5 patients with ARDS who subsequently died, 4 had a detectable LIF. CONCLUSIONS: We have observed that LIF was produced only in ARDS, but not in all patients. The production of LIF seems to be a good indicator of the severity of ARDS. These preliminary results must be confirmed by a larger study.

Optimal pressure support level for beginning weaning in patients with COPD: measurement of diaphragmatic activity with step-by-step decreasing pressure support level.

PURPOSE: The study objective was to determine an "optimal" individual pressure support (PS) level for beginning weaning with PS ventilation in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: Eleven COPD patients intubated and ventilated for acute respiratory failure and judged ready for weaning were studied. The technique consisted of lowering the PS level from a point that was characteristic for each patient and measurable under controlled mechanical ventilation, after setting the ventilator as recommended for COPD patients judged ready for weaning, that is, peak inflation pressure (PIP). This determination was based mainly on exploring the diaphragm with an electromyographic technique by defining the optimal PS level as the lowest PS level associated with no EMG evidence of diaphragmatic stress. Diaphragmatic electromyographic activity (diEMG) was recorded by a bipolar esophageal electrode (Disa-Denmark), and the high-frequency electrical component/low-frequency ratio (H/L) was calculated. The reference H/L was determined during a few spontaneous ventilatory cycles. Muscle stress was defined as a greater than 20% reduction in H/L compared with the reference value. RESULTS: Optimal PS levels ranged from 4 to 24 cm H2O with a mean of 14+/-6 cm H2O. Two patients with optimal PS level at 4 cm H2O did not require weaning and were quickly extubated. For the nine other patients, optimal PS levels were found to be 70% of PIP; in none was it necessary during weaning to use PS levels higher than individual optimal PS levels. CONCLUSIONS: Optimal PS level established with diEMG monitoring seems to be a useful index for beginning weaning in the PS ventilation mode in COPD patients. The hypothesis of beginning weaning with a PS level equal to 70% of PIP needs to be tested.

Prognostic score of short-term survival in HIV-infected patients admitted to medical intensive care units.

A retrospective cohort was set up to identify prognostic factors associated with in-hospital survival in HIV-infected patients admitted to medical intensive care units (MICUs), from 1991 to 1994. Survival from MICU admission to hospital discharge (or in-hospital fatal issue) was estimated and a prognostic score at MICU admission was developed. One hundred and thirty patients were recruited of whom 20% were AIDS-free prior to admission. In-hospital mortality rate was 65%. Median survival was 20 days. The following variables were predictive of mortality: Simplified Acute Physioloy Score II (SAPS II): (hazard ratio [HR]=1.5 for 10 points higher, P<10(-3)), time between HIV diagnosis and admission >5 years (HR=2.7, P<10(-4)), hypoalbuminaemia (HR=1.2 per 5 g/l lower, P=0.03). The prognostic score developed was: SAPS II+25 (if time between HIV diagnosis and MICU admission >5 years) albuminaemia (g/l). A new prognostic score including SAPS II, prior HIV history and albuminaemia better reflected the in-hospital mortality than SAPS II alone. Our findings may still be useful to better evaluate the immediate prognosis of current HIV-infected patients admitted to MICU, particularly those naive to antiretroviral therapy or in treatment failure.

Levels of toxaphene congeners in fish from Danish waters.

The levels of toxaphene congeners, in addition to PCB congeners and organochlorine pesticides, were determined in various fish samples from different Danish waters. While PCB-153 and p,p'-DDE show different levels depending on the fishing area, with highest levels in fish from the Western Baltic Sea, toxaphene was detected in all the samples investigated at a more constant level. The distribution of the three toxaphene congeners Parlar #26, #50 and #62 depends on the fishing area, with the Western Baltic Sea being different from the other waters by having almost equal levels of toxaphene congeners #26 and #50.

Reduction of organochlorine contaminants from fish oil during refining.

Samples of crude fish oil have been refined, and the crude fish oil together with samples taken out after each step of the refining process have been analysed for organochlorine pesticides and PCB (quantified both as CB congeners and total PCB). The levels of organochlorine contaminants in fish oils remain almost constant during the neutralisation and bleaching steps of the refining process. The deodorisation step seems to cause a decrease in the amount of contaminants, especially for the most volatile compounds (alpha-HCH, lindane, HCB) where the levels were reduced to below the detection level. Concentrations of the less volatile organochlorine pesticides (dieldrin, p,p'-DDE and p,p'-DDD) and PCB are reduced to about half the concentration in the crude fish oil.

Family satisfaction and affect of men and their wives after myocardial infarction.

OBJECTIVE: To describe (1) the affect of patients who have had a myocardial infarction and their spouses during hospitalization, (2) the correlation between patient and spouse on affect and satisfaction with family function, and (3) the relationship between satisfaction with family function and affect for both patient and spouse. DESIGN: Descriptive, correlational, cross-sectional. SETTING: Five hospitals in the Delaware Valley: four were community based and one was a university medical center. PATIENTS: Thirty-five couples who were married and living together. Patients were men with a diagnosis of myocardial infarction without renal, vascular, cerebral, or pulmonary complications who had been transferred from the cardiac care unit before being discharged. MEASURES: The patient completed the medical and demographic data form. Both patient and spouse completed the Family APGAR, a five-item questionnaire designed to give a rapid overview of satisfaction with the functional status of either a nuclear or alternative lifestyle family, and the Affects Balance Scale, a 40-item adjective mood scale that measures positive affect states, negative affect states, and the balance between them. RESULTS: Both patients and spouses experienced considerable negative affect and reduced positive affect during hospitalization when compared with the norms for nonclinical subjects. Patients and spouses were highly correlated on both measures, particularly for satisfaction with family function and positive affect (p < 0.01). Positive affect and satisfaction with family function were significantly positively correlated for spouses (p < 0.05). Additionally, it was found that both patients (p = 0.001) and spouses (p = 0.032) who were married longer were more satisfied with family function and that older patients reported more positive affect (p = 0.023). CONCLUSIONS: Both male patients who have had a myocardial infarction and their spouses experienced considerable emotional distress during hospitalization, with the implications that assessment should focus on the family unit as well as the individual and that interventions be directed toward emotional as well as physical symptomatology. The results of this study also suggest that female spouses with lower satisfaction with family function and younger male patients may be at greater risk for higher levels of negative affect.

Pesticide residues in selected food commodities: results from the Danish National Pesticide Monitoring Program 1995-1996.

The paper presents results of analyses of 4182 samples collected from January 1995 to December 1996 for the Danish National Pesticide Monitoring Program. The program basis is a random sample control supplemented with a target control. The objectives of the control are to monitor consumer exposure to health hazards and to enforce national and European Community regulations. The Danish Veterinary and Food Administration is responsible for establishing methods, data manipulation, and evaluation, but actual analyses are performed at 4 regional laboratories. In addition to a description of the Danish National Pesticide Monitoring Program on food, the effects of lowering the reporting limits are discussed. Pesticides included are those in current use as well as chlorinated pesticides like lindane, DDT, and HCB, occurring in food now primarily as a result of environmental contamination. Commodities analyzed are fruits, vegetables, cereals, bran, fish, and animal products such as meat, butter, cheese, fat, and eggs. In fruits and vegetables, residues were detected in 10% of 2515 samples, with higher incidences of detection for foreign commodities. Violation rate was 0.6%. In food of animal origin, low levels of organochlorine pesticides were detected in most fish samples and in more than half of the animal product samples. However, no results exceeding maximum residue limits were found. No residues of organophosphorus pesticides were detected in the 231 meat samples analyzed.

Cardiac patients and spouses: family functioning and emotions.

This study examined the relationships among satisfaction with family function and emotional states of a nonprobability sample of sixty-six myocardial infarction (MI) patients and their spouses who were recruited from hospitals in the Delaware Valley. Patients and spouses completed the Family APGAR and the Affects Balance Scale. It was found that both patients and spouses experienced substantial emotional distress when compared with the norms for nonclinical subjects. They were highly correlated on both measures, particularly for positive emotion and satisfaction with family function (p < .0001). Satisfaction with family function was significantly correlated with positive affect for spouses (p < .05). These results suggest the importance of assessment of satisfaction with family function and emotional status of both MI patient and spouse, with spouses with lower satisfaction with family function being at greater risk for emotional distress.

[Improved left ventricular endocardial detection by a first generation contrast agent. Effect of dose]. / Amélioration de la détection de l'endocarde du ventricule gauche par un agent de contraste de première génération. Influence de la dose.

The study of global and segmental left ventricular function forms part of every echocardiographic examination. However, this is only possible when the endocardial borders are well identified. The authors report the results of a study with Albunex, a first generation contrast agent used by intravenous injection. The object of this study was to assess the efficacy of Albunex in improving left ventricular endocardial detection compared with standard transthoracic echocardiography (TTE) and the dose-effect relationship. Forty-one patients were included prospectively at two cardiological hospital centres between 1995 and 1997, before the development of second harmonic imaging. Two patients were excluded from the study. Each patient underwent transthoracic echocardiography in the fundamental mode with an apical four-chamber view. The following procedure was adopted: 1) standard examination, 2) low dose Albunex (0.1 mg/Kg) injected via a peripheral vein, 3) high dose Albunex (0.2 mg/Kg) injected via a peripheral vein, 4) low dose Albunex injected via a central vein, 5) high dose Albunex injected via a central vein. The analysis of results was performed by two independent observers and showed that Albunex improved endocardial detection (p < 0.005); this detection was significantly better with high doses of Albunex and with central vein injection (p < 0.005); the septal border was better visualised than the lateral wall endocardium (p < 0.005) but the improvement in endocardial detection was greater for the lateral wall (p < 0.005). No complications were observed during the procedure. The authors conclude that Albunex improves left ventricular endocardial detection. This benefit is mainly due to improved lateral wall detection, and increases with higher doses of the contrast agent.

The effect of social support on educational outcomes.

A review of the social support literature identified the theoretical framework for this prospective descriptive correlational study. The relationship of social support to educational outcomes was investigated in a convenience sample of 67 junior and 60 senior nursing students. Social support was measured by the Inventory of Socially Supportive Behavior (ISSB), indicating the frequency with which respondents were recipients of supportive actions from their total support network. Outcomes included the cumulative grade point averages of all participants and the NCLEX scores of graduating seniors. Social Support was also examined in relation to self-esteem, measured by the Coopersmith Self-Concept scale and test anxiety, measured by the Spielberger Test Anxiety Inventory. Hypotheses tested were: (1) There is a positive relationship between social support and both cumulative grade point average and NCLEX scores. (2) There is a positive relationship between social support and self-esteem. (3) Social support will have greater influence on outcomes under conditions of stress, defined as high test anxiety. Hypotheses 1 and 3 were not supported. Hypothesis 2 was supported at the .05 significance level, using a Pearson Correlation Coefficient. Additional information included a significant inverse correlation for test anxiety and both grade point average (p = .01) and NCLEX results (p = .05). Implications for educational experiences and future research are discussed.

Evaluation of bronchoalveolar lavage for the diagnosis of bacterial pneumonia in ventilated patients.

Fourty-six patients requiring mechanical ventilation and suspected of bacterial pneumonia were examined by fiberoptic bronchoscopy. Specimens recovered by bronchoalveolar lavage (BAL) and using a protected specimen brush (PSB) were quantitatively cultured and the results compared. An assessment of the percentage of cells with intracellular organisms present on cytocentrifuged preparations made from lavage fluid was made to evaluate the utility of this method in early diagnosis of pneumonia. BAL cultures made a correct diagnosis in 43 out of 46 patients and detected 10 false-negative cultures of the PSB. With a threshold of more than 3% of cells with intracellular bacteria, direct microscopic examination diagnosed bacterial pneumonia in 36 out of 46 patients and allowed appropriate antibiotherapy to be instituted earlier. These results demonstrate the ability of BAL to diagnose bacterial pneumonia in ventilated patients.

[Calcium antagonists and chronic obstructive bronchopneumopathies]. / Antagonistes calciques et bronchopneumopathies chroniques obstructives.

Calcium ion acts as a second messenger in numerous cellular functions. The increase in its intracellular free concentration, which is brought about by influx from the extracellular source through voltage-dependent or receptor-operated channels and/or by release from intracellular sources, triggers the contraction of smooth muscle. The currently available calcium antagonists inhibit calcium movement through voltage-dependent channels. Tracheobronchial and pulmonary vascular smooth muscles play an important role in the symptomatic expression of chronic airflow obstruction. Whether an alteration in their functioning is involved in the pathogenic mechanism of the disease has not yet been established. The contraction of bronchial smooth muscle participates in bronchial obstruction and that of vascular muscle in pulmonary arterial hypertension, which complicates hypoxemic airflow obstruction. Numerous clinical and experimental studies show that bronchodilator or anti-bronchoconstrictor effects of calcium antagonists are limited. This limitation may be linked to either a low affinity of calcium antagonists for bronchial smooth muscle or a specificity of the mechanism of excitation-contraction coupling in this muscle. Calcium antagonists are powerful inhibitors of hypoxic pulmonary vasoconstriction. This inhibition may lead to a worsening of hypoxemia in relation to redistribution of blood flow towards low ventilation/perfusion ratio areas although the concomitant rise in cardiac output leads to increased oxygen transport. These effects seem to be maintained in the long term.

[Non-invasive ventilation in immunosuppressed patients]. / La ventilation non invasive chez le patient immunodéprimé

INTRODUCTION: In immunosuppressed patients with acute respiratory insufficiency (ARI) mechanical ventilation is associated with a high mortality. Therefore, in this situation, avoidance of intubation could be an important objective. However, experience of non-invasive ventilation (NIV) in the immunosuppressed remains limited. STATE OF ART: The first descriptive studies have shown that NIV could be an alternative to intubation, particularly in patients with malignant haematological disorders. In a prospective randomised controlled study Antonelli et al. showed that the use of NIV significantly improved the prognosis of patients with ARI following organ transplantation. We have carried out a prospective randomised controlled trial in 52 immunosuppressed patients to determine whether NIV improved the prognosis in patients admitted to intensive care with pulmonary infiltrates, fever and ARI. The use of NIV was associated with significant reductions in the intubation rate, serious complications and ICU and hospital mortality. PERSPECTIVES: Further studies are needed in order to better define the patients susceptible to benefit from NIV, and to establish variables predictive of the success or the failure of the method. CONCLUSIONS: NIV leads to an improvement in the prognosis of some immunosuppressed patients admitted to intensive care.

[Association of type 1 neurofibromatosis and primary hyperparathyroidism]. / Association neurofibromatose de type I et hyperparathyroïdie primitive.

INTRODUCTION: The combination of neurofibromatosis type I with hyperparathyroidism is classical but rare. OBSERVATION: Our report is on the original observation of a patient affected with Von Recklinghausen's disease complicated by chronic restrictive breathing deficiency. After an intense breathing decompensation and a spreading convulsive attack, hyperparathyroidism was diagnosed. DISCUSSION: The similarity of the bone lesions seen in type I neurofibromatosis and in hyperparathyroidism strongly suggests a genetic link between these two pathologies. Hence, hyperparathyroidism should be searched for in all patients affected with Von Recklinghausen's disease, since the adjustment of hypercalcemia can lead to partial reversibility of the bone abnormalities.