Olmesartan-associated enteropathy: results of a national survey.

BACKGROUND: Recently, a new enteropathy has been described: olmesartan-associated enteropathy. However, the association has been questioned: a phase 3 trial and a cohort study found no association between gastrointestinal events and olmesartan. AIM: To collect French cases of sartan-associated enteropathy to describe further this entity, confirm or refute causality, and determine if the association exists with other sartans. METHODS: French gastroenterologists were invited to report cases of sartan-associated enteropathy and collect clinical, biological and histological data. Patients with diarrhoea and histological duodenal abnormalities were included. RESULTS: Thirty-six patients with olmesartan-associated enteropathy were reported, including 32 with villous atrophy and four without. There was only one patient with irbesartan-associated enteropathy. None of the patients died. Patients with villous atrophy had diarrhoea, vomiting, renal failure, hypokalaemia, body weight loss and hypoalbuminaemia. Thirty-one patients were hospitalised; four required intensive care. Anti-transglutaminase and anti-enterocyte antibodies were negative; anti-nuclear antibodies were positive (9/11). Endoscopic duodenal biopsies showed villous atrophy (32/32) and polyclonal intra-epithelial CD3+CD8+ lymphocytosis (11/11). Exactly, 14/15 patients responded to steroids and/or immunosuppressants, prescribed because of suspected autoimmune enteropathy. Ten olmesartan interruptions were followed by reintroductions before steroids or immunosuppressants. Interruptions were followed by remissions (9/10), but reintroductions were followed by relapses (9/9). Twenty-nine patients were in remission since olmesartan interruption, including 26 without immunosuppressants. Patients with normal villi had similar clinical characteristics, but mild histological abnormalities (intra-epithelial lymphocytosis and lamina propria lymphocytic infiltration). CONCLUSIONS: Olmesartan causes a severe and immune-mediated enteropathy, with or without villous atrophy. Enteropathy associated with other sartans seems to be very rare.

Dysregulation of laminins in intestinal inflammation.

Laminins are structural components of basement membranes that regulate and control many cellular functions. Changes in basement membrane composition play significant roles in etiology of diseases. Inflammatory bowel diseases are conditions that lead to defects in the mucosal barrier which includes the basement membrane underlying the epithelium. This review will summarize the main findings related to the involvement of laminins and of the laminin-binding receptors in inflammatory conditions such as Crohn's disease and ulcerative colitis. We will review the current literature devoted to studies in humans (immunolocalisation, genetic factors, microarray data), as well as experimental cell models that show that laminins contribute to the inflammation process probably linked to the deregulation of proinflammatory cytokines.

[Antenatal emergency call. Indications. Role of the SAMU (Medical Emergency Care Services)]. / L'appel anténatal. Indications. Rôle du SAMU.

The increased incidence of antenatal distress calls to the SAMU (emergency medical squad) by pediatric obstetricians in maternity departments (6 times in 5 years) poses the problem of recognizing their indications. Based on case reports of 128 newborns who profited from antenatal assistance, the authors attempt to define the indications. The elimination of student physicians in training for anesthesiology-intensive care, additional participants during SAMU transportation of patients, makes it even more necessary to define these indications accurately so that a single language of communication and procedure may be instituted for all who are involved in this effort.

[Effect of levamisole on the prevention of developmental flare-ups in quiescent Crohn's disease: a prospective multicenter controlled trial in 155 patients]. / Effet du levamisole sur la prévention des poussées évolutives de la maladie de Crohn quiescente: un essai prospectif multicentrique contrôlé sur 155 malades.

The prevention of relapse in quiescent Crohn's disease remains a major therapeutic challenge. The present study is a double blind placebo (P)-controlled, randomized, multicentre cooperative trial designed to test the effectiveness of levamisole (L) in the prophylaxis against flare up in patients with quiescent Crohn's disease. The trial included 2 successive phases: a) phase I:167 patients with inactive disease (but who had not had previous resection of all diseased tissue) were randomly and double blindly assigned to receive either L (150 mg orally once weekly) or P; patients were randomized in 2 strata: those having experienced a recent flare up (within the 3 months preceding their entry into the trial: red strata) versus others (blue strata). Patients were followed up at 3 monthly intervals during 2 years. Initially there was no significant difference between L and P groups as regard to age, sex ratio, duration of disease at the time of randomization, incidence of prior intestinal resection, Crohn's disease topography, clinical activity; biological activity was slightly but significantly higher (P less than 0.05) in the P group. Twelve patients were withdrawn from analysis (lost to follow-up: 2; inadequate respect of the protocol: 10), leaving 155 patients (78 L, 77 P) who completed the study. L did not significantly influence any of the following parameters: incidence of attacks (L: 37 p. 100; P: 35 p. 100), lag time between the entry into the trial and the occurrence of the attack (L: 32.7 +/- 5.2; P: 41.8 +/- 5.8; m +/- SEM; weeks), curves of maintenance in remission (Kaplan-Meier method), outcome rank, severity of attacks. Attempts to analyse separately certain subgroups--subjects with purely colonic (+/- anal) disease, subjects with small bowel localization (+/- anus), patients of the red or blue strata--did not show any statistical difference between L and P. Thirteen patients left the trial for minor intolerance (10 L, 3 P). b) Phase II lasted one further year and involved the patients still in remission and in the trial at the end of phase I (n = 57). Those who had received L during phase I were randomized between continuance of L (L leads to L) vs. a change to P (L leads to P); those who had been on P during phase I were randomized between continuance of P vs. a switch to L.(ABSTRACT TRUNCATED AT 400 WORDS)

Two patients with pancreatic apudomas secreting neurotensin and VIP.

Two patients have been studied with a two and a half and nine year history of metastatic pancreatic apudoma. In both patients the main feature was chronic watery diarrhoea with remissions after partial tumour resection and streptozotocin therapy. Plasma levels of circulating VIP and neurotensin were persistently raised in both patients. Chromatographic analysis of the plasma showed that a significant proportion of the raised immunoreactivity of both peptides eluted in an identical position to pure VIP and neurotensin. The extremely high concentrations of neurotensin did not appear to result in any feature which would allow distinction from the classical VIPoma syndrome.

[Sensibility study to antibiotics of Neisseria gonorrhoeae by serotype]. / Etude de la sensibilitè aux antibiotiques de Neisseria gonorrhoeae en fonction du sèrotype

A study to 100 N. gonorrhoeae strains demonstrated a sensitivity to antibiotics similar to that observed in 1973. On the other hand, an antibiogram for each of the 5 serotypes showed the peculiar sensitivity of the D serotype to penicillin in vitro.