[Clinical case of the month. Spontaneous hematoma and acquired hemophilia]. / Le cas clinique du mois. Hématomes spontanés et hémophilie acquise.

Acquired haemophilia is a rare disease, 50% of the cases are idiopathic. We report a case admitted in cardiology for spontaneous hematoma. Observation of isolated prolonged activated partial thromboplastin time (aPPT) without anticoagulation treatment and the absence of correction with normal plasma suggested diagnosis. Confirmation of inhibitors to FVIII allowed perfusions of activated prothrombin complex concentrates.

[Acute intermittent porphyria: a rare contra-indication to acute myocardial infarction treatment]. / La porphyrie intermittente aiguë: une contre-indication rare au traitement de l'infarctus du myocarde.

The treatment of acute myocardial infarction as described in guidelines, generaly meets with few contra-indications. In our clinical practice, we have met an exceptional one: acute intermittent porphyria. This disease is characterized by acute abdominal pain, neurologic disturbances and cardiac arrhythmias related to different stimuli such as some drugs. Among these drugs, several molecules are usually used for treatment of acute coronary syndromes. Knowledge of these the therapies is crucial to avoid some dangerous consequences.

[Aspirin resistance in diabetic patients: laboratory entity or clinical reality?]. / La résistance à l'aspirine chez le patient diabétique: découverte de laboratoire ou réalité clinique?

Aspirin is considered the gold standard antiplatelet therapy for primary and secondary prevention of cardiovascular (CV) disease. However, it appears less protective in diabetic patients than in the general population. This difference is attributed to a higher level of aspirin resistance observed in these subjects when in vitro tests are performed. The frequency of this problem, its mechanistic aspects and its clinical relevance remain largely unknown. Our analysis of the literature confirms a higher proportion of platelets resistant to aspirin in diabetic than in control individuals. This observation deserves further research because it may be associated with an increased risk of CV events and worse prognosis.

[Aspirin therapy for cardiovascular prevention in the diabetic patient: what have we learned from the evidence?]. / Prévention cardiovasculaire par l'aspirine chez le patient diabétique: que nous apprend la médecine factuelle?

Diabetes mellitus markedly increases the risk of cardiovascular diseases, with an especially elevated relative risk among women. Aspirin prescription is mandatory in secondary prevention, even if the protection by aspirin appears less efficacious in diabetic than in non-diabetic patients. In primary prevention, available data are paradoxically rather scarce, but also suggest a less effective prevention when diabetes is present. Aspirin remains the first antiplatelet agent in the diabetic population in all international guidelines of cardiovascular prevention although a higher daily dose may be proposed in this subgroup of patients (160-300 mg rather than 75-100 mg).

[Aspirin for primary prevention of cardiovascular diseases in diabetic patients: focus on gender difference and insulin resistance]. / L'aspirine en prévention primaire des maladies cardio-vasculaires chez le patient diabétique.

Acetylsalicylic acid (aspirin) is widely used as antiplatelet therapy for the primary and secondary prevention of cardiovascular diseases. However, the effects appear to be different according to the studied population, with a reduction of coronary events in men and, rather, a diminution of strokes in women. Diabetes mellitus markedly increases the risk of cardiovascular diseases, with an especially elevated relative risk among women. We present a detailed analysis of the literature about the efficacy of aspirin in the primary prevention of cardiovascular complications in the diabetic population. Limited available data suggest a lower protection in the diabetic than in the non-diabetic population. A greater aspirin resistance has been suggested in diabetic patents, which might lead to the use of a higher daily dosage of aspirin in diabetic than in non diabetic patients. Whatsoever, aspirin remains the first antiplatelet agent in the diabetic population in all international guidelines of cardiovascular prevention.

[Continuous subcutaneous insulin infusion with portable pumps]. / L'insulinothérapie par pompe externe à perfusion continue d'insuline.

Type I diabetes mellitus requires an exogenous supply of insulin that ideally mimics physiological insulin secretion. The treatment goal is to achieve normoglycaemia in order to prevent or delay chronic complications, while limiting the risk of hypoglycaemia. Numerous advances have been performed in the last 10 years, as far as nature of insulin formulations, home blood glucose monitoring devices and modes of insulin delivery. Among the latter, continuous subcutaneous insulin infusion (CSII) using portable pumps represents the most sophisticated treatment capable of best mimicking normal insulin secretion. Such treatment provides better glucose control and glucose stability as compared to conventional multiple injection insulin therapy. However, it is essential to respect well defined indications and to organize a structured management by a multidisciplinary team in order to get the best metabolic results. The present paper describes recommendations, advantages and limits as well as cost of CSII with portable pumps in type 1 diabetic patients.