[Duration of seclusion and exit of the seclusion room, study of the impact of anamnestic and institutional factors]. / Durée d'isolement et levée de la mesure ; étude de l'influence des facteurs anamnestiques et institutionnels.

INTRODUCTION: In France, the use of seclusion in psychiatric hospitals is regulated by the Act of January 26th 2016 which enforces a reduction of the use of coercive measures and limiting their duration. Criteria that are unrelated to the patient's symptoms might affect this decision and extend the duration of seclusion. The goal of the current observational study is, firstly, to determine which factors - unrelated to the patient's symptoms - influence the length of stay in seclusion. Secondly, it is to compare the composition of the medical and nursing teams at two times, the beginning and the end of the seclusion time period. METHOD: We conducted this study in a La Rochelle regional hospital from October 2017 to July 2018. There were one hundred and twenty-four episodes of seclusion that occurred in the different psychiatric inpatient wards during this time. The episodes were divided into two groups: short-term and long-term seclusion, defined by the median duration of seclusion. Data were collected using a survey, completed by the nursing teams, based on the recommendations of good clinical practice published in 1998 and revised in 2017 by the French health authority. For each episode of seclusion, we collected the following data: socio-demographic information, history of psychiatric care of the patient and of violent acting-out, admission status, medical indication for seclusion, day of the week and time at the beginning and the end of seclusion, prior administration of a sedative before seclusion, exceptional events that might justify the end of seclusion, transfer to a protected room after seclusion, as well as the composition of the medical and nursing team on duty at the beginning and the end of the seclusion period. We compared the anamnesis between the short-term and the long-term seclusion groups, and we analyzed the composition of the medical and nursing teams at the two time points of seclusion. Statistical analyses were performed using R software (v. 3.5.1). RESULTS: The mean duration of seclusion was 4.7 days and the median was 1.9 days. The average age was 37-years-old, with a ratio of 0.6 for females to males. Variables associated with a long-duration of seclusion were: the male gender (P=0.005), Compulsory Admission at the Request of a State Representative (P=0.008), a prevention measure of any hetero-aggressive action (P=0.007), the lack of psychiatric care (P=0.004), previous medico-legal issues (P=0.006), violent behavior during a previous hospitalization (P=0.022) and the use of seclusion on the weekend (P=0.01). The composition of the medical and nursing teams related to the period of the end of seclusion were: the presence of the physician in charge of the patient (P<0.001), a male caregiver in the team (P<0.001), a specialized psychiatric nurse (P<0.001) and the training of caregivers in the management of violence (P<0.001). The presence of nurses who do not usually work in the psychiatric ward was associated with the period of the beginning of seclusion (P<0.001). CONCLUSION: Our findings showed a strong relationship between several anamnestic factors and the duration of seclusion. Caregivers lacking information about patients, potential violent behaviors and the beginnings of seclusion on weekends are associated with a long-duration of seclusion. Our study also highlights the roles played by the caregivers according to their composition and level of training to determine the ending of patient's seclusion.

[Purtscher-like retinopathy associated with adult onset still disease: Case report and review of the literature]. / Pseudo-rétinopathie de Purtscher dans le cadre d'une maladie de Still de l'adulte : à propos d'un cas et revue de la littérature.

INTRODUCTION: Putscher-like retinopathy is a retinal disease that is similar to the syndrome initially described in 1910 by Purtscher, but occurring in a non-traumatic context. CASE REPORT: We describe a case of acute, Putscher-like retinopathy in a 48-year-old woman experiencing adult onset Still's disease. The diagnosis was based on fundus examination and fluorescein angiography. Based on a review of the literature, we discuss the current available data on the pathophysiology of this syndrome and its prognostic significance. The treatment remains controversial. CONCLUSION: When visual functional signs appear during adult Still's disease, it is necessary to evoke Putscher-like retinopathy, and to ask for an ophthalmological expertise.

Efficacy of intravenous iron therapy in non-anaemic iron-deficient patients with fatigue.

Iron deficiency, without anaemia, is common in the general population and induces various symptoms. Its management consists of oral and intravenous supplementation for cases of inefficacy of or intolerance to oral iron. We assessed the efficacy of intravenous iron therapy in non-anaemic iron-deficient patients with fatigue. We prospectively evaluated the level of fatigue, using the Fatigue Severity Scale (FSS), in patients suffering from iron deficiency without anaemia, treated by intravenous iron at the moment of the perfusion (W0), after 4 weeks (W4), and 12 weeks (W12). Of 25 patients, at W0, the mean FFS was 49.3+/-13.7. There was a significant improvement in FSS at W4 (44+/-15; p = 0.01) and a sustained response at W12 with an FFS of 35.8+/-17.1 (p < 0,0001). There was no correlation between FSS and serum ferritin level at W12 (p=0.54) or between serum ferritin at W12 and difference between FSS at W0 and W12 (p=0.58). There were six mild adverse events (24%): asthenia (8%), nausea (8%), headache (4%), local pain (4%); and no serious adverse events. Our results suggest the rapid efficacy of intravenous iron in improving fatigue in iron deficiency without anaemia with a good profile of tolerance.

Grimontia hollisae, a potential agent of gastroenteritis and bacteraemia in the Mediterranean area.

Vibrio hollisae was first described in 1982 as an agent of diarrhoea and was reclassified in 2003 into a novel genus as Grimontia hollisae. We report the first case of G. hollisae bacteraemia in the Mediterranean area, in an 81-year-old man with a severe gastroenteritis and hepatitis following the consumption of raw oysters. The incidence of this micro-organism as an agent of gastroenteritis may be underestimated because it may not be detected using routine culture conditions.

[Occupational exposure and systemic sclerosis. Literature review and result of a self-reported questionnaire]. / Evaluation de l'exposition toxique professionnelle de patients atteints de sclérodermie systémique. Revue de la littérature et résultat d'un auto-questionnaire.

Systemic sclerosis (scleroderma) is a rare auto immune disease. Its physiopathology, based on various mechanisms, involves a predisposing genetic background and some exogenous factors. Among them, the role of toxic products is highly suggested according to several case-control studies. The aim of this study is to review the literature concerning occupational exposure associated with scleroderma. This review is completed by the results of a self-reported questionnaire on occupational exposures sent to 82 scleroderma patients followed in Marseille. Scleroderma associated with silica exposure should be declared as occupational disease. Moreover, the role of other toxic agents such as solvents is highly suspected and scleroderma occurring in case of high exposure should also be declared. Our study performed in Marseilles showed a occupational exposure in 10% of cases (five patients having an occupational exposure that could be involved in the genesis of the disease). One had an occupational silica exposure and was declared as occupational silica disease. Other cases had various toxic exposures including solvents and two were declared as disease of occupational nature. Occupational exposure (labour and leisure) must be searched for when faced with a scleroderma patient for two reasons: the possible declaration of an occupational disease and a better knowledge on toxics involved in scleroderma.

[Update on thrombotic thrombocytopenic purpura]. / Le purpura thrombotique thrombocytopénique acquis de l'adulte : actualités.

PURPOSE: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder and early treatment is vital. Here, we review the recent advances in the understanding of the pathophysiology of TTP and its treatment. CURRENT KNOWLEDGE AND KEY POINTS: Recent advances have shown that TTP is caused by deficiency of the (ADAMTS-13) metalloprotease that cleaves von Willebrand factor multimers. Acquired TTP is associated to inhibitory antibodies directed against ADAMTS-13. This has led to assess new therapeutic approaches in refractory and relapsing forms of TTP and the use of rituximab has shown very encouraging results. FUTURE PROSPECTS AND PROJECTS: A better characterization of TTP amongst the other thrombotic microangiopathies has allowed the use of new therapeutic approaches with the use of rituximab. The encouraging results reported with rituximab in some forms of TTP challenge the classic treatment based on plasma exchanges.

[Clinical implications of high cobalamin blood levels for internal medicine]. / Implications cliniques de la découverte d'une hypervitaminémie B12 en médecine interne.

PURPOSE: The high incidence of cobalamin (vitamin B12) deficiency results in frequent dosages of this vitamin in a department of internal medicine may reveal paradoxically high blood levels of cobalamin. The objective of the study was to estimate underlying diseases and potential diagnostic relevance of high cobalamin blood levels in internal medicine. METHODS: A retrospective study was conducted, including in-patients from December 2005 to July 2006 presenting high cobalamin blood levels, as determined with our laboratory normal values (200-950 pg/mL). RESULTS: High cobalamin blood level is not unusual (18.5% of all dosages) and, most of time, it is associated with one or several diseases, among which acute and chronic liver diseases (often of alcoholic origin), various neoplasias, malignant hemopathies (myelodysplasia, myeloproliferative diseases, multiple myeloma), renal insufficiency and transient hematologic abnormalities (neutrophilic hyperleucocytosis, hypereosinophilia). Vitamin B12 supplementation and chronic myeloid leukemia represent less than 5% of all hypervitaminemia. There is no correlation between the level of cobalamin blood level and the number of underlying diseases for each patients. However, very high cobalamin blood levels (>1275 pg/mL) are significantly associated to malignant hemopathies (p<0.05). It is noteworthy that most of diagnosed neoplasia were unknown and at a non-metastatic stage. CONCLUSION: Very high cobalamin blood levels are significantly associated to malignant hemopathies among the population of a department of internal medicine. Referent laboratory should actively advertise the numerous diseases involved with high cobalamin blood levels.

[Retinal vein occlusion in a young patient: Where does intraocular hypertension come from?] / Occlusion de la veine centrale de la rétine chez un sujet jeune : chercher d'où vient l'augmentation de pression intraoculaire.

INTRODUCTION: Retinal vein occlusion presents as an acute, painless and unilateral sight loss. We report two cases of retinal vein occlusion (CRVO) in which the etiology was unusual. CASE REPORTS: Case 1. A 54-year-old woman without any significant past medical history presented with an acute loss of vision. Medical history taking revealed the practice of yoga with headstand posture like "Sirsana". Case 2. A 35-year-old woman presented with an acute loss of vision related to a retinal vein occlusion. The investigation found prolonged and repeated vomiting the days before the retinal vein occlusion. CONCLUSION: Cardiovascular assessment is recommended in the investigation of CRVO. Furthermore, especially in young patients, a situation causing an increase of intraocular pressure as the practice of yoga with taking reverse "head down" body positions or even repeated vomiting efforts may be the cause of slower circulation of blood flow in the retinal veins.

IL-6 and IL-8 production from cultured human endothelial cells stimulated by infection with Rickettsia conorii via a cell-associated IL-1 alpha-dependent pathway.

Mediterranean spotted fever due to infection by Rickettsia conorii, is characterized by a general vasculitis. This vasculitis is thought to be due to a direct injury to endothelial cells induced by R. conorii. However, production and activity of cytokines on endothelial cells is an important pathway in inflammation, and part of the underlying mechanism of vasculitis. In the present studies, human umbilical vein endothelial cells (HUVEC) infected with R. conorii actively secrete high levels of IL-8 and IL-6 (P < 0.002, and P < 0.03, respectively, compared with uninfected cells). IL-1alpha, IL-1beta, or TNFalpha were not detected in the culture supernates. Nevertheless, IL-6 and IL-8 production was due, in a large part, to a cell-associated form of IL-1 alpha expressed on R. conorii-infected HUVEC, since production of these cytokines was suppressed by 80% (P = 0.0001) and 85% (P < 0.04) by the addition of IL-1 receptor antagonist, or anti-IL-1alpha antibodies (60% inhibition, P < 0.01 and 65% inhibition, P < 0.05, respectively) and IL-1alpha was measured after lysis of R. conorii-infected HUVEC but not in uninfected cells (P < 0.01). Rickettsial lipopolysaccharide does not seem to be involved, since polymyxin B did not reduce cytokine secretion. On the contrary, infection by intracellular R. conorii appears to be necessary to induce IL-1alpha and subsequently IL-8, since formalin-fixed R. conorii did not induce cytokine production. These observations demonstrate that R. conorii-infected HUVEC secrete IL-6 and IL-8 via the induction of cell-associated IL-1alpha, providing a possible mechanism for the vasculitis observed in Mediterranean spotted fever.

[Dermatomyositis associated with hepatosplenic gamma delta T-cell lymphoma]. / Lymphome T gamma delta avec atteinte méningée exclusive révélé par une dermatomyosite.

INTRODUCTION: Peripheral T cell lymphomas are a heterogeneous group of post-thymic, mature lymphoid malignancies, accounting for approximately 10-15% of all non-Hodgkin's lymphomas. A rare entity within this group is represented by hepatosplenic T cell lymphoma, characterized by primary extranodal disease with infiltration of the liver and the spleen and by expression of the T cell receptor gamma delta chain. EXEGESIS: A 64-year old man with dermatomyositis developed rapid-onset paraparesia and deafness. Cerebrospinal fluid analysis revealed large granular lymphomatous cells with CD3+ CD4- CD8- CD7+ CD16- CD56- surface antigens, expressing the gamma delta T-cell receptor. There was no evidence of skin or bone marrow infiltration by lymphoma or any other involvement. This is the first report of dermatomyositis associated with a gamma delta T-cell lymphoma (GDTL). Moreover, primitive and isolated meningeal involvement of such lymphomas has never been described before. CONCLUSION: GDTL should be added to the differential list of neoplasia associated with dermatomyositis. Physiopathological mechanisms implicated in the neurological involvement of such lymphomas need to be elucidated.

[Auto-immune hepatitis and antiphospholipids]. / Etude de l'association hépatite auto-immune et antiphospholipides.

INTRODUCTION: Only few series have reported the association of autoimmune hepatitis with antiphospholipid antibodies. The aim of our study is to investigate the frequency of these antibodies in a series of autoimmune hepatitis and to search for a correlation with clinical, biological or histological characteristics. MATERIAL AND METHODS: Antiphospholipid were investigated in 24 patients with well defined autoimmune hepatitis. Characteristics were compared between antiphopholipids positive and negative patients. Characteristics of our patients were also compared toward cases collected in a literature review. RESULTS: The frequency of antiphospholipid antibodies is of 70.8% in our series. Four patients had a well defined antiphospholid syndrome. Seven patients had a systemic lupus erythematosus in the antiphospholipid group whereas none in the antiphospholipid negative group. The frequency of the different antiphopholipid antibodies was: IgG ACL (52.9%), IgM APE (52.9%), ACC (43.7%), IgG Abeta2GP1 (41.2%). We found no correlation between hypergammaglobulinemia and the presence or the isotype of antiphospholipid antibodies. Clinical presentation and outcome as biological and histological parameters were similar in both groups. CONCLUSION: Our study report a high frequency of antiphospholipids antibodies in autoimmune hepatitis patients. However we found no clinical, biological or histological correlation with the presence of antiphospholipids. Further longitudinal studies on larger cohorts should clarify the association between antiphospholipid antibodies and autoimmune hepatitis and potential therapeutic issues.

[Rituximab-induced acute thrombocytopenia in a patient with chronic lymphocytic leukemia]. / Un cas de thrombopénie aiguë au rituximab dans la leucémie lymphoïde chronique.

INTRODUCTION: Rituximab is a chimeric anti-CD20 monoclonal antibody generally well tolerated. However, a severe but rare rituximab-related immune-toxic syndrome, associating fever, chills and thrombocytopenia can occur shortly after the infusion. CASE REPORT: We report a case of severe acute rituximab-induced thrombocytopenia with favorable outcome in a patient with chronic lymphocytic leukemia and discuss the possible underlying mechanisms. CONCLUSION: Despite the potential initial severity of rituximab-induced thrombocytopenia in CLL, chemotherapy should not be discontinued; tolerance might increase as the hematologic disorder is controlled.

[Central nervous system HIV-associated polyarteritis nodosa: long-term outcome]. / Devenir à long terme d'un cas de périartérite noueuse cérébrale associée au VIH.

INTRODUCTION: HIV-associated vasculitis is an infrequent entity, and only few data about its long-term evolution is available. EXEGESIS: We report the long-term outcome of a patient with central nervous system HIV-associated periarteritis nodosa and then discuss the therapeutic options for this class of vasculitis. CONCLUSION: This observation highlights the role of HAART in the treatment of HIV-associated vasculitis. Persistent remission can be obtained when viral replication is under control.

[Dermatomyositis with cutaneous necrosis revealing a fallopian tube carcinoma]. / Dermatomyosite avec nécroses cutanées révélatrice d'un cancer de la trompe utérine.

INTRODUCTION: Adult dermatomyositis is a rare inflammatory myopathy associated with typical cutaneous lesions and an increased incidence of internal malignancies, notably cancers of the female genital tract. Nevertheless, fallopian tube carcinoma is exceptionally associated with dermatomyositis. EXEGESIS: We report an unusual case of dermatomyositis because of cutaneous necrosis revealing a cancer of the fallopian tube. CONCLUSION: Predictive factors of cancer can improve prognosis of dermatomyositis due to earlier diagnosis of associated cancer. In our observation as in literature review, cutaneous necrosis lesions are highly predictive of an associated neoplasia even as rare as a fallopian tube carcinoma.

[Therapeutic intensification and autologous stem cell transplantation in autoimmune diseases]. / Intensification thérapeutique et autogreffe de cellules souches hématopoïétiques pour le traitement des maladies auto-immunes.

THE PATHOPHYSIOLOGY of most autoimmune diseases is often poorly understood. EXPERIMENTAL CONSIDERATIONS and clinical experience suggest that high doses immunoablation followed by stem cell transplantation is a therapeutic option to consider for certain severe autoimmune disorders. THE CONCEPT OF RESTORING NORMAL IMMUNE REACTIVITY must in part br true since current results of 466 transplants (445 autologous, 21 allogeneic) patients suffering from various autoimmune diseases show a beneficial outcome in approximately 2/3 of the patients. TO IMPROVE THE EFFICACY AND SAFETY OF SUCH AN AGGRESSIVE PROCEDURE in patients with potentially affected vital organs by the underlying autoimmune disease, it is especially important to follow international consensus guidelines and to centrally collect clinical data for in depth analysis in the EBMT International Stem Cell Project for Autoimmune Disease in Basel, Switzerland. PHASE III STUDIES ARE RUNNING FOR SYSTEMIC SCLEROSIS (Astis, Autologous Stem cell Transplantation International Rheumatoid Arthritis Trial) started in 2003. A STUDY PROJECT IS PLANNED FOR MULTIPLE SCLEROSIS (Astims, Autologous Stem cell Transplantation International Multiple Sclerosis).

Transfer RNA modification: influence on translational frameshifting and metabolism.

Transfer RNA modification improves the rate of aa-tRNA selection at the A-site and the fitness in the P-site and thereby prevents frameshifting according to a new model how frameshifting occurs [Qian et al. (1998) Mol. Cell 1, 471-482]. Evidence that the presence of various modified nucleosides in tRNA also influences central metabolism, thiamine metabolism, and bacterial virulence is reviewed.

Dapsone for thrombocytopenic purpura related to human immunodeficiency virus infection.

PURPOSE: The purpose of this study was to determine the effect of dapsone on platelet count in patients with human immunodeficiency virus (HIV)-related autoimmune thrombocytopenia. PATIENTS AND METHODS: Eleven patients with HIV-related thrombocytopenia received dapsone (50 to 125 mg/day) for 2 to 43 months. Patients with the acquired immunodeficiency syndrome were not enrolled. RESULTS: Of the 11 patients, six developed platelet counts above 50 X 10(9)/L and did not require any other specific therapy. No significant side effects were observed. CONCLUSION: We conclude that dapsone may be effective in some patients with HIV-related thrombocytopenia.

Cerebral glucose utilization: local changes after microinoculation of scrapie agent in hamster.

The effects of scrapie agent on local cerebral energy metabolism were studied by the [14C]2-deoxyglucose (2-DG) autoradiographic method of Sokoloff et al. after stereomicroinoculation (0.5 microliter, 10(-2) of scrapie suspension) in hamster left striatum. From a group of 20 hamsters inoculated, 2 animals were killed every 10 days from the 30th day after inoculation to the terminal stage of the disease. Experiments were carried out according to the qualitative 2-DG procedure and cerebral autoradiographs of inoculated animals were compared to those of 3 controls. The results show changes of local cerebral glucose utilization in some discrete brain regions, ipsilateral to the side of inoculation, and their sequential spreading to other cerebral structures with a definite order: left anterior thalamus, left posterior thalamus, then medial geniculate body (ipsilateral, then controlateral), and finally some brainstem nuclei (inferior colliculus, superior olivary nucleus); the inoculated striatum is affected very late, after clinical signs. Metabolic changes which first occur ipsilaterally to the side of inoculation precede the clinical symptoms, while their contralateral spreading is concomitant with the clinical signs. The data demonstrate a rostral--caudal sequence of the cerebral metabolic changes, ipsilateral to the side of inoculation, which may reflect in part the slow spread of agent in the central nervous system from the inoculation site.