Thermodynamic epimeric equilibration and crystallisation-induced dynamic resolution of lobelanine, norlobelanine and related analogues.

The step-economical synthesis of lobelanine involving a ring closing double aza-Michael (RCDAM) reaction is revisited and successfully extended to the synthesis of various configurationally more stable analogues. Owing to the presence of a configurationally labile ß-aminoketone subunit, lobelanine is prone to self-catalyze mutarotation in solution. Through the synthesis of original lobelanine analogues, we studied the influence of (i) the size of the central heterocycle, (ii) the bulkiness of the nitrogen protecting group, and (iii) the phenacyl arm substituent on the thermodynamic equilibrium and its displacement by crystallisation-induced dynamic resolution (CIDR). We demonstrated that fine structural tuning combined with optimized CIDR conditions favours the first efficient diastereoselective synthesis of lobelanine's analogues.

[Cardiogenic shock due to spontaneous neonatal thrombosis of the abdominal aorta]. / Choc cardiogénique dû à une thrombose spontanée néonatale de l'aorte abdominale.

Neonatal arterial thrombosis is unusual and generally associated with an arterial umbilical catheter. Spontaneous aortic thrombosis is exceptional but its severity is related to high mortality rate and renovascular morbidity. We report here the observation of a 10-day-old term infant showing a large abdominal aortic thrombosis revealed by cardiogenic shock induced by systemic arterial hypertension. The resolution was fast following anticoagulant and antihypertensive therapy. Etiologic investigations showed renal failure and moderate hyperhomocysteinemia controlled by a vitamin supplement. Following this observation, we did a brief review of the neonatal spontaneous arterial thrombosis literature to discuss the neonatal hemostasis specific aspects. Management of infants presenting an arterial thrombosis varies depending on the hospital and there are no guidelines at this time concerning the etiologic investigation and treatment in France or internationally.

[Myocardial infarction by spontaneous dissection of coronary arteries in a subject with type IV Ehlers-Danlos syndrome]. / Infarctus du myocarde par dissection spontanée des artères coronaires chez un sujet atteint d'un syndrome d'Ehlers-Danlos de type IV.

Acute myocardial infarction with spontaneous coronary dissection was fatal in a 33-years-old man. Autopsy and family history revealed type IV Ehlers-Danlos syndrome. In this disease, conjunctive tissue is fragilized due to a deficit in type III collagen which leads to spontaneous ruptures in large and medium sized arteries. The present case is the first with a proven rupture of the coronary arteries. This disease should be entertained in young people with no atherogenous risk factor and an acute coronary disorder since peripheral skin and joint syndromes may be discreet or missing. Treatment is difficult in case of spontaneous coronary dissection. Thrombolysis is not possible and diagnosis may require angiography which is in itself dangerous due to the fragility of the coronary vessels.

[Pneumococcal pneumonia in a patient with HIV infection. Development to excavation. Apropos of a case]. / Pneumopathie à pneumocoque chez une patiente infectée par le VIH. Evolution vers l'excavation. A propos d'un cas.

An HIV-infected patient presented with pneumococcal pneumonia with abscess formation. The causal effect of the pneumococcal infection on abscess formation was discussed. Since the advent of antibiotics, necrotizing pneumococcal pneumonia is rarely observed but clinicians should nevertheless be aware of this possibility, particularly because of the HIV epidemic.