Baseline physiological data from anesthetized pigs in a VX intoxication model.

Over the past fifty years, swine models have been used for organophosphorus intoxication studies. Among these studies and others on the swine model in general, some physiological data, especially cholinesterase activity highly impacted by organophosphorus compounds like nerve agent VX, still need to be completed. To support and compare our model to others, we have published the experimental protocol, the physiological values of 31 juvenile anesthetized pigs, and the 6 h-follow-up of six supplementary anesthetized control animals and 7 VX-intoxicated pigs. We reported hemodynamics and respiratory parameters, blood levels in several biochemical parameters, blood gas, and complete blood count and compared them to the literature. We also focused on tissue and blood cholinesterase activities and detailed them for acetylcholinesterase and butyrylcholinesterase. After establishing a broad physiological data set consistent with the literature, we reported several cardio-respiratory parameters that seem more affected by an organophosphate intoxication, like heart rate, arterial blood pressure, cardiac output, and respiratory rate. Within the blood, oxygen saturation (SpO2), lactatemia, base excess, and glycemia can also be measured and associated with the other parameters to evaluate the life-threatening status. This swine model is currently used to develop and evaluate medical countermeasures against organophosphate nerve agent intoxications.

[Plasmodium knowlesi: an emerging species in humans?]. / Plasmodium knowlesi: une espèce émergente chez l'homme ?

Plasmodium knowlesi is typically found in macaques and has recently been recognized as the fifth Plasmodium species to cause malaria in humans. Several cases of P. knowlesi malaria have been reported in people in Southeast Asia. Most cases are simple but approximately one in 10 patients develops complications. The morphology of P. knowlesi parasites in human infections closely resembles that of Plasmodium malariae or Plasmodium falciparum, so a molecular method is the optimum diagnostic procedure. The treatment of choice for uncomplicated P. knowlesi malaria is oral chloroquine, whereas severe infection should be treated with intravenous quinine.

[The old man and the syrup]. / Le vieil homme et le sirop.

Intoxication by glycyrrhizin is a rare cause of hypokalemia. We describe a patient with severe hypokalemia caused by long-term consumption of syrup containing liquorice. The physiopathological mechanism of the intoxication and the differential diagnosis are presented.

[Propylthiouracil-induced multispecific antineutrophil cytoplasmic antibodies]. / Anticorps anticytoplasme des polynucléaires neutrophiles multispécifiques induits par le propylthiouracile.

We report the case of a 28-year-old woman who presented with arthralgia during a treatment with propylthiouracil (PTU) for hyperthyroidism. Detection of antineutrophil cytoplasmic antibodies (ANCA) against myeloperoxidase, proteinase 3 and elastase led to suspect PTU induced vasculitis.

[Value of assaying adenosine deaminase level in patients with neuromeningeal tuberculosis]. / Intérêt du dosage de l'adénosine désaminase dans les infections tuberculeuses neuro-méningées.

Neuromeningeal tuberculosis is a rare extrapulmonary location in France. Delayed diagnosis can lead to therapeutic failure and severe sequels. However early diagnosis is a major challenge that requires the proper epidemiological, clinical, radiological and biological resources. Problems related to diagnosis of mycobacteria infection and to shortcomings in certain healthcare systems can hinder early diagnosis. The purpose of this review was to describe the diagnostic value of assaying adenosine deaminase activity in cerebrospinal fluid from patients with neuromeningeal tuberculosis. Evidence from studies published over the last 25 years indicate that the sensitivity and specificity of measuring adenosine deaminase activity range from 36 to 92% and 71 to 100% respectively depending of cutoff values used. Before performing this assay, it is necessary to rule out obvious or frequent etiologies such as purulent bacterial meningitis or cryptococcosis in HIV patients. Taken together these studies show that this simple, inexpensive technique is a valuable tool for early diagnosis and management of tuberculosis patients and that it can be easily implemented in hospital labs regardless of technical or financial resources.

[HLA-B*5701 and abacavir hypersensitivity reaction]. / Génotype HLA-B*5701 et hypersensibilité à l'abacavir.

A potentially life-threatening hypersensitive reaction occurs in association with initiation of HIV nucleoside analogue abacavir therapy in 4 to 8% of patients. Preliminary studies appear to confirm the role of the immune system in abacavir hypersensitivity. The reaction is possibly the result of presentation of drug peptides onto HLA, that may induce a pathogenic T-cell response. Hypersensitivity reaction to abacavir is strongly associated with the presence of the HLA-B*5701 allele and prospective HLA-B*5701 genetic screening has now been instituted in clinical practice to reduce the risk of hypersensitivity reaction.

[Fondaparinux: the present and the future]. / Fondaparinux: mise au point et perspectives.

The development of new antithrombotic molecules which induced an inhibition of activated factor X (fondaparinux, Arixtra) shows effectiveness and safety in prevention of thromboembolic disease in surgery, but also in the treatment of the pulmonary embolism and major venous thromboses and acute myocardial infarction. Recent clinical trials show that new anti-Xa inhibitors also have interesting properties in antithrombotic therapy. Fondaparinux could offer new therapeutic possibilities that could simplify the management of patients under anticoagulant treatment.

[Evaluation of the Unicel DXC 600 (Beckman Coulter) and comparison with Integra 800 (Roche Diagnostics)]. / Evaluation des performances analytiques du système Unicel DXC 600 (Beckman Coulter) et étude de la transférabilité des résultats avec l'Integra 800 (Roche diagnostics).

The Unicel DXC 600 is an automated analytical system from Beckman Coulter for measuring usual biochemistry parameters (electrolytes, substrates and enzymatic activities), therapeutic drugs, drugs of abuse and specific proteins. According to the "Société française de biologie clinique (SFBC)" validation protocol, we tested the following parameters: electrolytes (sodium, potassium, chloride, total CO2), substrates (uric acid, calcium, phosphate, glucose, creatinine, urea, cholesterol, HDL cholesterol, bilirubin, iron, triglycerides), enzymes (ALAT, ASAT, amylase, CK, GGT, LDH, lipase, ALP), total proteins and specific proteins (albumin, CRP, haptoglobin). The results confirm the excellent analytical performances regarding imprecision. The comparison study shows differences between values obtained with Unicel DXC 600 and Integra 800 (Roche diagnostics), leading to the use of correcting factors for some parameters.

[Ectopic ACTH syndrome and severe hypokalaemia]. / Hypokaliémie sévère au cours d'un syndrome de Cushing paranéoplasique.

Cushing's syndrome is rare and remains a challenge to diagnose. Particularly difficult are the differentiation between Cushing's syndrome and Pseudo-Cushing's states and between the two forms of ACTH dependent Cushing's: Cushing's disease and ectopic ACTH syndrome. We report the case of a patient diagnosed with a metastatic small cells lung carcinoma associated with ectopic ACTH-syndrome. Hypokalaemia was a clue to diagnosis. We focus on critical questions addressing diagnosis and differential diagnosis of Cushing's syndrome and we explain the mechanism of hypokalaemia.

[Variations of plasma concentrations of h-FABP during a muscular exercise]. / Variations des concentrations plasmatiques en h-FABP au cours d'un exercice musculaire intense.

OBJECTIVE: To test whether heart-Fatty Acid Binding Protein (h-FABP) is a useful plasma marker for the detection of acute coronary syndrome during muscular exercise. METHODS: Plasma concentrations of h-FABP were measured in 42 volunteers before and after muscular exercise (military aptitude test). Myoglobin and troponin Ic were measured for comparison. RESULTS: Significant increase were found in plasma myoglobin (mean = 195,9 microg/L) and h-FABP (mean = 5,71 microg/L). Myoglobin and h-FABP concentrations were already significantly elevated (p < 10(-6)) at 60 minutes after exercise and h-FABP concentrations were superior to baseline values in 15 volunteers. Whereas h-FABP decreased to normal levels within 24 hours, myoglobin remained elevated in 12 volunteers. The myoglobin to h-FABP ratio in plasma is between 8,0 and 57,0 which is different from the reported plasma ratio after myocardial injury (<6). CONCLUSION: h-FABP can be used to exclude an acute coronary syndrome during exercise. The myoglobin to h-FABP ratio seems to be useful to identify the type of muscle injured. New studies are necessary to evaluate its diagnostic accuracy.

[Heart fatty-acid binding protein (h-FABP): a new cardiac marker]. / Un nouveau marqueur cardiaque: la heart fatty-acid binding protein (h-FABP).

Heart Fatty-Acid Binding Protein (h-FABP) is a small cytosolic protein that is abundant in the heart and found at lower concentrations in muscle or in the brain. h-FABP is released into the circulation shortly after the onset of ischemia. Several studies indicate its usefulness in cardiology: exclusion of acute myocardial infarction, detection of reperfusion, prognostic value... A rapid immuno-chromatographic assay (Cardiodetect) was recently commercialized in France with a result obtainable within 15 minutes. We review the strengths and weakness of h-FABP for detecting myocardial injury.

[ROC (receiver operating characteristics) curve: principles and application in biology]. / La courbe ROC (receiver operating characteristic): principes et principales applications en biologie clinique.

Laboratory test's diagnostic performances are generally estimated by means of their sensibility, specificity and positive and negative predictive values. Unfortunately, these indices reflect only imperfectly the capacity of a test to correctly classify subjects into clinically relevant subgroups. The appeal to ROC (receiver operating characteristic) curve appears as a tool of choice for this evaluation. Used in the medical domain since the 60s, ROC curve is a graphic representation of the relation existing between the sensibility and the specificity of a test, calculated for all possible cut-off. It allows the determination and the comparison of the diagnostic performances of several tests. It is also used to consider the optimal cut-off of a test, by taking into account epidemiological and medical - economic data of the disease. Used in numerous medical domains, this statistical tool is easily accessible thanks to the development of computer softwares. This article exposes the principles of construction and exploitation of a ROC curve.