HLA-DPB1 gene polymorphism and multiple sclerosis: a large case-control study in the southwest of France.

The polymorphism at the HLA-DPB1 locus has been characterized in a large number of patients with multiple sclerosis (n = 112) and in healthy controls (n = 115). Both patients and controls lived in the southwest of France (in the Pyrénées Atlantiques) and had similar ethnic background. The typing procedure involved the selective amplification of the second exon of the DPB1 locus by polymerase chain reaction, followed by hybridization of the amplified DNA with 14 sequence-specific oligonucleotide probes. Individual alleles were identified by the pattern of hybridization of the different probes. The distribution of the DPB1 alleles was not significantly different in multiple sclerosis patients and controls (p = 0.11). This does not corroborate the reported association of multiple sclerosis with the primed lymphocyte typing (PLT)-defined DPw4 specificity and is not in favour of a role played by polymorphic residues of the DP molecule in susceptibility to multiple sclerosis.

[Proposal for a new multifactor screening score of difficult intubation in ORL and stomatognathic surgery: preliminary study]. / Proposition d'un nouveau score multifactoriel de dépistage de l'intubation difficile en chirurgie ORL et stomatologique: étude préliminaire.

This study assessed prospectively in 295 ENT adult patients the predictive value of clinical indicators for difficult intubation and of a new multifactorial score, established by the allocation of points (0, 3, 5 or 7) depending on the degree of presence of seven factors: pathology known to be associated with a difficult intubation, clinical signs of airways' pathology, inter-incisors gap and mandible's luxation, submental mandibular-thyroid distance, normal or short and broad neck, head and neck movements, and Mallampati's test. The incidence of difficult laryngoscopy was 14% and the use of particular techniques for tube insertion was required in 8% of patients. The presence of malformation or pathology often associated with a difficult intubation and the presence of functional signs of airways' pathology predict the difficulties of laryngoscopy and tracheal intubation with a good sensitivity and specificity. The analysis of the "Receiver Operating Characteristic curves" showed that a score higher or equal to 11 allows the prediction of difficult intubations with a sensitivity of 96% and a specificity of 90%.

[Continuous hemofiltration in the treatment of acute kidney failure in multiple organ failure]. / Hémofiltration continue dans le traitement de l'insuffisance rénale aiguë au cours de défaillance polyviscérale.

Twenty-nine patients with acute renal failure and multiple organ failure were treated with continuous arterio-venous or veno-venous haemofiltration for a period of 6 +/- 5 days. Sixteen of these patients were improved and haemofiltration was withdrawn, but secondary worsening occurred in 8 cases. The method is well tolerated by the cardiovascular system and provides a satisfactory metabolic control. The low patient's survival rate (27 percent) is due to the severity of the disease. In the absence of controlled studies, it is difficult to assert that continuous haemofiltration is better than conventional haemodialysis.

[Pourfour Du Petit syndrome following brachial plexus block]. / Syndrome de Pourfour Du Petit après bloc du plexus brachial.

While Horner's syndrome resulted from a paralysis of the cervical sympathetic outflow, its opposite, Pourfour Du Petit's syndrome, was caused by the irritation of these nerves. The case described occurred after brachial plexus block.

Preoperative assessment for difficult intubation in general and ENT surgery: predictive value of a clinical multivariate risk index.

Several clinical multifactorial indexes have been described for predicting difficult laryngoscopy or intubation, or both, mostly in general surgery, and less frequently in ENT surgery. The objective of this study was to develop and validate a single clinical index for prediction of difficulty in tracheal intubation in both ENT and general surgery. We studied a population of 1200 consecutive ENT and general surgical patients. Clinical criteria were tested using univariate and multivariate analysis. Difficult intubation was defined as requiring unusual techniques. Logistic regression identified seven criteria as independent predictors of difficult tracheal intubation; previous history of difficult intubation; pathologies associated with difficult intubation; clinical symptoms of pathological airway; inter-incisor gap and mandible luxation; thyromental distance; head and neck movement; and Mallampati's modified test. Point values were assigned to each of these factors in proportion to regression coefficients representing the relative weight of each predictive intubation difficulty factor, the sum comprising the score. The best predictive threshold was chosen using a receiver operating characteristic curve. We then prospectively studied and validated the score in a population of 1090 consecutive ENT and general surgery patients. The sensitivity and specificity of the predictions were 94% and 96% in general surgery, 90% and 93% in non-cancer ENT surgery, and 92% and 66% in ENT cancer surgery, respectively.

[Major hypertriglyceridemia, associated with severe acute pancreatitis, successfully treated with plasma exchange]. / Hypertriglycéridémie majeure, associée à une pancréatite aiguë grave, traitée avec succès par échanges plasmatiques.

A 27 year-old alcoholic patient with severe acute pancreatitis (4 Ranson's objective prognostic signs), complained of abdominal pain and vomiting and presented fever and rigors. The plasma was of milky turbidity and the concentration of triglycerides (TG) very high (26 Mmol/l, Normal: 3-1.6). Serum pancreatic amylase was elevated (262 U/l, Normal: 10-200). The electrocardiogram (ECG) showed S-T depression. The diagnosis was confirmed by computed tomography which showed a pancreatic phlegmon and a collection in the left pararenal space (Ranson's grade D). After PE on days 1 and 2: the amylase became normal, plasma clear, TG decreased (7.8 Mmol/l), the clinical picture improved and the ECG normal. Assisted ventilation was necessary over 10 days. Pancreatic morphology remained unchanged. The patient was discharged to intensive care on day 18. There was no indication for surgery. The fast drop in TG levels, the precursors of free fatty acids, may have limited their toxicity the pancreas, allowing a difficult stage to be over come and the course of the illness to interrupted. Normalization of the ECG requires emphasis. The association of HG, increased plasma amylase and abdominal pain justifies early iterative PE.