[Breastfeeding and drug management in connective tissue and rheumatic diseases]. / Traitements de fond des affections inflammatoires systémiques au cours de l'allaitement.

Breastfeeding is often contraindicated when drugs are prescribed for a chronic maternal disease. Many of the restrictions are based on theoretical concerns only and may be excessively cautious. An updated review is mandatory. Many antirheumatic drugs can be safely used during lactation: nonsteroidal anti-inflammatory drugs, corticosteroids, sulfasalazine, antimalarial agents. Doubt remains about safety of cochicine or dapsone. Expert opinions still diverge but move on in favor the use of azathioprine, ciclosporin, and even methotrexate. Leflunomide, mycophenolate mofetil and cyclophosphamide are contraindicated. No conclusion can be reached regarding anti-TNF-alpha and rituximab. Current knowledge about drug transfer in breast-milk and cumulative empirical data have expanded the possibilities to allow breastfeeding when the mother is treated with antirheumatic medications. The data provided by pharmaceutical industry should not be the only source of the physician's information in the risk assessment.

[Digital arteritis preceding the diagnosis of a malignant B cell lymphoma]. / Artérite digitale précédant la découverte d'un lymphome malin B.

We report the case of a young smoker woman who developed a severe acrosyndrome of rapid onset, involving both hands except the thumbs. The angiography showed digital arteritis. Antinuclear antibodies were present at high level. Three months later, a large B cell lymphoma was diagnosed. Complete remission was achieved, but the acrosyndrome persisted with only partial improvement. The antinuclear antibodies disappeared. The paraneoplastic nature of the acrosyndrome is discussed.

[Invasive Streptococcus agalactiae infections in non-pregnant adults]. / Les infections invasives à Streptococcus agalactiae chez l'adulte (femme enceinte exclue).

OBJECTIVES: Streptococcus agalactiae (Group B streptococcus) is a major cause of invasive diseases in non-pregnant adults, particularly in the elderly and those with underlying conditions. We describe these conditions and clinical characteristics of patients followed in our teaching hospital. METHODS: We retrospectively reviewed clinical records of 64 patients with S. agalactiae-related invasive infection, hospitalized between January 1997 and January 2006. RESULTS: The mean age of patients was 59 (+/-17 years). The H:F sex ratio was 1.06. At least one underlying condition was found in 90.6%. Diabetes mellitus (43.7%), peripheral vascular disease (34.4%), myocardial ischemia (20.3%) and malignant neoplasms (20.3%) were among the most frequent conditions. The mean index of comorbidity (Charlson) was 2.5 (+/-2). Common clinical manifestations included infection of the urinary tract (32.8%), skin and soft-tissue (25%), and osteoarthritis (21.9%). Bacteremia occurred in 31.2% with no identified source in 2 patients. During the first month, 2 cases of endocarditis, 1 case of meningitis, and 4 deaths occurred. CONCLUSION: We confirm the importance of underlying diseases in the emergence of S. agalactiae infections.

Thermal avoidance during flight in the locust Locusta migratoria

In this paper, thermal avoidance in tethered flying locusts is described for the first time. Changes in body posture examined using high-speed cinematography revealed that the animals responded to a laterally positioned heat source with contralaterally directed abdomen and hindleg ruddering, behavioural patterns resembling manoeuvres observed in collision avoidance and in response to auditory signals. The analysis also showed that, during stimulation, left and right forewing depression became asymmetrical during the downstroke but remained symmetrical during the upstroke. Hindwing depression and elevation remained symmetrical during stimulus presentations. Electromyographic recordings from the left and right first basalar muscles (M97; forewing depressors) showed that contralateral depressor muscle activity was advanced by 10­12 ms relative to that on the stimulated side. There was also an increase in burst duration on the contralaterally stimulated side and an increase in wingbeat frequency of approximately 3 Hz. Ablation experiments showed that removal of the antennal flagella, which are the site of previously described thermoreceptors, did not abolish thermal avoidance manoeuvres. We conclude that thermal avoidance is triggered by an infrared sensitivity that is not mediated by the compound eyes, the ocelli or the antennal flagella.

[Sepsis syndrome and bone marrow granulomatosis after intravesical instillation of BCG]. / Syndrome septicémique et granulomatose médullaire dans les suites d'une instillation intra vésicale de BCG.

BACKGROUND: BCG therapy is an effective treatment for superficial bladder carcinoma. Exceptionally, systemic disorders including hypersensitivity reactions or infections may occur. CASE REPORT: A 70-year-old man developed septicemia with bone marrow granulomatosis with a favorable course after intravesicle administration of bacillus Calmette-Guérin for bladder carcinoma. DISCUSSION: High grade fever, septicemia, hepatitis or pulmonary granulomatosis as well as bone marrow involvement are reported in less than 1% of all cases of BCG therapy. The pathogenic mechanisms are complex. Anti-tuberculous drugs are generally given.

[Pulmonary histiocytosis, then bronchiolo-alveolar cancer in HIV-1 infection]. / Histiocytose pulmonaire, puis cancer bronchiolo-alvéolaire au cours d'une infection par VIH-1.

INTRODUCTION: Langerhans cell pulmonary histiocytosis is a rare disease, primarily enhanced by smoking, and of unclear mechanism. OBSERVATION: A 42 year-old man, smoking 25 packs-years, was infected by a type 1 human immunodeficiency virus (HIV-1). He successively developed pulmonary emphysema, Langerhans cell pulmonary histiocytosis and alveolar bronchial carcinoma of the lower right pulmonary lobe, which was fatal. DISCUSSION: We discuss the concomitance of pulmonary histiocytosis and alveolar bronchial carcinoma, exceptional in the literature, and the eventual enhancing role of HIV-1 infection. The principal incriminating factor in pulmonary histiocytosis probably remains smoking, but the HIV-1 infection may have participated in the emergence of the neoplastic pathology.

[Pulmonary hypertension due to tumor embolism]. / Hypertension artérielle pulmonaire par embolisation de cellules tumorales.

We report a 46-year-old woman with a metastatic breast cancer who developed a subacute pulmonary hypertension. The final diagnosis was microscopic pulmonary neoplastic emboli. She presented with the typical clinical picture of a pulmonary hypertension with a normal pulmonary angiographic computer tomography and multiple sub-segmental perfusion defects on radionuclide imaging. This serious condition must be known by physicians, because of an opportunity to obtain the diagnosis by the cytologic analysis of sampled microvascular blood obtained with a pulmonary artery catheterization. The prognosis is poor and there is no efficient therapy.

[Occurrence of depression with internal diseases]. / Zum Vorkommen depressiver Zustände bei internen Kranken.

Depressions belong to the most frequent diseases. They are only partly recognized. The largest number of depressive patients is to be found in the practice of the general practitioner and the internist. The relations between an internal disease and physical complaints, respectively, and a depressive syndrome are varied. It is reported on the results of an examination of 420 patients of a Clinic for Internal Diseases. 57 patients (13.6%) showed a depressive concomitant syndrome. Psychogenic depressions were more frequent than endogenic forms, the latter particularly as masked depression. These and other results are discussed and conclusions are made for the practice, in which cases the authors particularly enter the recognition of depressive conditions and the problems of psychic care as well as the therapy with psychopharmaca.

[Infected scalp hematoma]. / Das infizierte Kephalhämatom.

In a newborn after delivery by vacuum extraction and after application of a scalp electrode for fetal monitoring a cephalhematoma followed by infection due to E. coli was observed.--It was treated by antibiotics and incision. In a brief review of the literature the problems of the origin, diagnostic, and therapy of infected cephalhematoma are discussed. For the detection of local infection and bacteremia the authors emphasize careful bacteriological examinations (aspirate from hematoma, blood culture) as well as radiographs of the skull. The treatment of infected cephalhematoma must consist of antimicrobial chemotherapy and incision of the local process.