[What vasoactive agent should be chosen in rupture of esophageal varices in cirrhosis?]. / Quelle substance vaso-active choisir dans la rupture de varices oesophagiennes de la cirrhose?

Variceal esophageal bleeding is a frequent and severe complication of portal hypertension. Balloon compression was the standard therapy for many years. Currently, endoscopic hemostasis with sclerosis or ligation appears to be more effective but requires an experienced operator who is not always present at emergency situations. Parenteral administration of vasoactive agents is one therapeutic option offering new perspectives for the future. Data in the literature suggest that terlipressin or somatostatin would be the preferential choice because of the adverse effects of vasopressin. Data is insufficient concerning sandostatin. Currently, the trend is to administer vasoactive agents as soon as possible, prior to hospitalization and, perhaps, in association with endoscopic hemostasis. Treatment should be maintained for several days although the cost/benefit ratio remains a question of debate.

[Disseminated toxoplasmosis in a patient with HIV infection]. / Toxoplasmose disséminée chez un sujet infecté par le VIH.

The authors describe a case of toxoplasmosis occurring in a subject who is HIV positive who presented with a cough and an infectious syndrome. Toxoplasma gondii was identified in the broncho-alveolar lavage even though the X-ray, the fibroscopy, blood gases and the broncho-alveolar lavage were normal. The frequency of pulmonary disease in the course of a toxoplasma infection in HIV subjects was underlined. Amongst the non invasive diagnostic methods the authors stress the value of broncho-alveolar lavage with a close search for toxoplasma even in the absence of any suggestive paraclinical anomalies.