Prediction of sexual function following spinal cord injury: a case series.

INTRODUCTION: Spinal Cord Injury (SCI) affects sexual response based on the level and degree of completeness of injury. By using the International Standards for the Neurologic Classification of SCI in conjunction with lumbo-sacral reflexes these effects can be predicted. The International Standards for the Assessment of Autonomic Function after SCI (ISAFSCI) document the impact of SCI on sexual responses including psychogenic and reflex arousal (erection or lubrication), orgasm, ejaculation, and sensation of menses. Responses are described based upon a 0 to 2 scale with 0 being absent, 1 altered, and 2 normal response. Additionally, the lesion is described as supraconal, conal or infraconal. CASE PRESENTATION: We present 4 representative cases of the impact of SCI on sexual responses and course of treatment. Case 1 describes a complete supraconal lesion above T6 with upper motor neuron syndrome. Case 2 describes a supraconal complete lesion including the T11-L2 segment. Case 3 describes an infraconal (cauda equina) lesion with lower motor neuron syndrome. Case 4 is theoretical and describes a supraconal lesion above T6 with upper motor neuron syndrome, partial sensation in T11-L2 dermatomes, and other medical comorbidities. DISCUSSION: Neurologic examination combined with reflex testing allows prediction of sexual responses after SCI. It would be useful for version 2.0 of the ISAFSCI to assist clinicians in determining the anticipated changes, whether their patients are functioning as anticipated sexually after SCI or whether other concerns also require treatment.

[Ejaculation capacity in spinal cord injured patients carrying an endo-urethral stent for incontinentation: Descriptive study]. / Capacité éjaculatoire chez les sujets blessés médullaires porteurs d'une prothèse endo-urétrale d'incontinentation : étude descriptive.

OBJECTIVES: To assess the impact of endo-urethral stent (EUP) of incontinentation in spinal cord injured (SCI) men on ejaculation capacity. FIRST CRITERIA: Presence of ejaculation after EUP. SECONDARY CRITERIA: Modification on ejaculation type, stimulation mode, possibility of sperm conservation in the same population. POPULATION AND METHODS: A descriptive monocentric study including SCI subjects which underwent placement or change of temporary (Mémokath™ or Allium™) or definitive (Mémotherm™) EUP between January 2004 and January 2014 with at least one ejaculatory test. Are identified for each patient: the presence of ejaculation, type of ejaculation, stimulation mode used, number of frozen specimen and results from semen analysis. RESULTS: Over 11 men with tetraplegia, complete for motricity, there were 8 (72%) for whom ejaculation was possible after laying EUP. Of these, 6 (55%) had an antegrade or antero-retrograde ejaculation. It was not possible to make a freezing straw in four of them due to infection of semen (2) or terato-oligo-astenospermia (1) or absence of reproductive project (1). CONCLUSION: In this small sample, it was found that over 70% ejaculation have been preserved after laying EUP and more than 50% with antegrade or antero-retrograde ejaculation. A larger study would identify how EUP may alter the ejaculatory capacity or quality of the ejaculate. LEVEL OF EVIDENCE: 4.

[Antibioprophylaxy and urological management of women with spinal cord injury during pregnancy]. / Intérêt de l'antibioprophylaxie et manifestations urologiques des femmes blessées médullaires au cours de la grossesse.

OBJECTIVE: More and more women with spinal cord injury (SCI) can have a pregnancy. Few data have been published on these pregnancies and their urological impact. We report a series of these cases illustrating the urological experience of specialized centers. METHODS: This is a retrospective study that identified pregnancies in women with SCI followed-up between 2000 and 2014. Data covering all urological and obstetric events during pregnancies, before and after implementation of weekly oral cyclic antibiotics (WOCA) program, were collected from medical records. RESULTS: Fifteen women with SCI who gave birth to 20 children were included. Three of them were quadriplegics and 12 were paraplegics. All of them performed themselves intermittent catheterization: 11 by urethral way and 4 by high way because carrying a continent cystostomy. Mean follow-up period before pregnancy was 14.6 years [3-27 years IC 95%] and the mean follow-up for the study was 8.5 months [6.5-9 IC 95%]. We observed a reduction of symptomatic urinary tract infections after WOCA onset (13/13 before vs. 0/7 after, P=0.001), a reduction of recurrent urinary infections (6/13 vs. 0/7, P=0.03), a reduction of threats to premature births (8/13 vs. 0/7, P=0.001). Multi-resistant bacteria appeared to increase (0/13 vs. 3/7, P=0.01). We also observed a trend to significant reduction of premature births number (4/13 vs. 0/13, P=0.1) and that of low birth weight (3/13 versus 0/7, P=0.1). The overall neonatal survival rate was 100%. CONCLUSION: Our study before/after introduction of a weekly oral cycle antibiotic prophylaxis during pregnancy for women with spinal cord injury showed a significant reduction in symptomatic urinary tract infections and a tendency to improve pregnancy outcomes. LEVEL OF EVIDENCE: 4.

Fatal Parastrongylus dujardini infection in captive callitrichids.

Intravascular nematodes were considered the cause of death of 14 captive callitrichids. All animals were captive born at zoos in France and died with little or no premonitory signs of disease. No consistent gross lesions were observed at necropsy, although in certain cases intracardiac adult parasites were noted. The most significant histologic findings were verminous pneumonia and pulmonary endarteritis. In all cases except one, intravascular adult nematodes were observed with eggs and larvae in the lungs. Adult nematodes were obtained from 8 animals and in all cases were identified as Parastrongylus dujardini. To the authors' knowledge, this is the first report of intravascular angiostrongylosis with primary cardiopulmonary location in callitrichids in France.

Use of psychoactive substances in persons with spinal cord injury: a literature review.

OBJECTIVE: To undertake a critical review of literature on use of legal and illegal psychoactive substances (PAS) in persons with spinal cord injury (SCI) before and after trauma. MATERIAL AND METHODS: Hundred and five articles published between 1980 and 2014 on alcohol and drug use in persons with SCI before and after trauma were retrieved from the PubMed and PsycInfo search engines. RESULTS: Before injury, 25% to 96% of people with SCI reported using alcohol, while 32% to 35% had used illegal drugs. At the time of injury, 31% to 50% of individuals with SCI were intoxicated with alcohol, 16% to 33% with drugs and 26% with a combination of drugs and alcohol. Among those reporting PAS use before injury, up to 50% stated that they had reduced their use during active rehabilitation, during which time only 6% consumed psychoactive substances for the first time. A variety of risk factors are associated with consumption subsequent to spinal cord injury: personality alteration (impulsiveness, aggressiveness), posttraumatic depression, poor coping skills, lack of social support and pain. PAS use can affect the process of rehabilitation, diminish the effectiveness of medication and result in various medical complications. DISCUSSION/CONCLUSIONS: Few studies have explored the use of alcohol, drugs and psychoactive medications before SCI and during active rehabilitation. To our knowledge, no study has analyzed the evolution of PAS use after hospital discharge, even though return home is associated with new stressors that may trigger risky behaviors. It should be a priority, as early as possible during rehabilitation, to detect persons at risk of developing PAS abuse.

Premature ejaculation associated with lumbosacral lesions.

STUDY DESIGN: Retrospective study. OBJECTIVES: Spinal cord injuries are usually associated with anejaculation, but few premature ejaculations (PE) are described in lumbosacral lesions. The objective of the study is to analyze the retrospective files of patients with lumbosacral lesions to explore whether PE is systematic, and which type of lesions (conus teminalis, epiconal, cauda equina) is associated with these PE. METHODS: Standard sexological consultations from 34 men with L5-S4 lesions were analyzed including questions on psychogenic and reflexogenic erection, and ejaculation. Medical assessment included bulbocavernosus, anal, and cremasteric reflexes and urodynamics. RESULTS: Thirty one (31/33) patients maintained natural ejaculations, but 18 complained of PE and five of spontaneous ejaculations. Fourteen patients complained of dribbling ejaculation, and 27 of non-climactic ejaculation (13 no sensation, 10 some sensation, 4 painful sensation). Medical assessments showed absent or diminished anal sensation in 28 patients, absent or diminished anal reflexes in 21, absent or diminished bulbocavernosus reflexes in 20, but 12/13 positive cremasteric reflex. Urodynamics showed 12/20 areflex and 2/20 hyperactive bladders. CONCLUSIONS: Most men with lower lumbosacral lesions maintain natural ejaculation, but often complain of PE following injury. The PE is such that a mere sexual thought can trigger the response, or appear spontaneously as daytime ('sticky paints') or nighttime ('sticky sheets') emissions. PE appears to be a direct consequence of the lesion as it is reported from the very first ejaculation post injury, in men who otherwise controlled their ejaculation prior to injury. Underlying mechanisms may involve sacral inhibition on ejaculation, or simultaneous activation of psychogenic erection and emission. Clinical implications are discussed.

Sexual disorders in women with MS: assessment and management.

OBJECTIVES: Summarize the data on sexual disorders in women with multiple sclerosis (MS). METHOD: Review of 99 Pubmed articles covering sexual dysfunction in women with MS. RESULTS: Prevalence of dysfunction in women with MS varies from 34% to 85%. They include poor vaginal lubrication, poor clitoral erection, and anorgasmia, which correlate with level of disability. Specific brain stem and pyramidal lesions appear to correlate with anorgasmia. Age and duration of the disease correlate with sexual disorders, but not age at onset. Secondary consequences of MS, including bladder and bowel dysfunction, spasticity, pain, fatigue, depression, anxiety, and side effects of medication contribute to sexual dysfunction. Treatments can involve alpha-blockers or phosphodiesterase-5 inhibitors to increase smooth muscle relaxation, while lubricants and oestrogen therapy can help vaginal dryness, burning and dyspareunia. Antidepressants can delay (or abolish) orgasm, suggesting reducing dosage or combining them with PDE5 inhibitors. Counselling should emphasize planning sexual activities, reducing fatigue, managing positions, preventing incontinence, promoting sexual aids, extra-genital and other sexual options to achieve pleasurable and intimacy. Psychosocial interventions should include couples' relationship and communication skills to increase satisfaction. CONCLUSION: Sexual dysfunctions in women with MS are amenable to treatments covering primary, secondary and tertiary consequences of the disease.

Pregabalin-associated myoclonic encephalopathy without evidence of drug accumulation in a patient with acute renal failure.

Pregabalin, used for treating partial epilepsy and neuropathic pain, is usually well tolerated. Patients with impaired renal function are at risk to develop more serious adverse events. A 64-year-old woman was admitted in the Emergency Department for altered consciousness and abnormal movements. She recently started to take pregabalin (150 mg/day) for neuropathic pain. The drug was withdrawn 36 h before hospitalization following worsening of neurological symptoms. At physical examination, myoclonus was noted as main finding in the limbs and head, with encephalopathy. Laboratory investigations revealed acute renal failure with serum creatinine at 451.3 µmol/l. Urine output was preserved. After supportive care alone, myoclonus resolved after 24 h and consciousness was normal after 48 h. Renal function was also recovered. At the time of admission, the concentration of plasma pregabalin was 3.42 µg/ml, within therapeutic range. The calculated terminal elimination half-life was 11.5 h. Pregabalin-induced myoclonus may not be strictly related to drug accumulation in acute renal failure, with the possibility of a threshold phenomenon.

[Hereditary hemochromatosis: presenting manifestations and diagnostic delay]. / Hémochromatose héréditaire: circonstances de découverte et délais diagnostiques.

PURPOSE: Hereditary hemochromatosis is characterized by an excessive absorption and progressive accumulation of iron in the liver, the pancreas, the heart, and the joints. Tiredness and joint manifestations occur usually before hepatopathy, diabetes or cardiopathy. Such common and unspecific symptoms seem to be largely unknown and important diagnostic delays have been reported. The aim of this study was to investigate the discovery circumstances and the diagnostic delay. METHODS: A survey was carried out amongst French patients with C282Y homozygous hemochromatosis who were contacted through patients associations or blood centers. RESULTS: The questionnaire was answered by 374 patients. Mean age at diagnosis was 48.6±11.9years. In 53% of the cases, the serum level of ferritin was greater than 1000 µg/L. Diagnosis was based on family genetic survey (29%), or fortuitous analyses showing an abnormal serum ferritin (26%), or clinical manifestations (45%). Main complaints were joint pain, tiredness or liver disease. Only 2.1% consulted for diabetes, cardiopathy or changed complexion. Time to diagnosis was lower than 1 year for 98% of patients who presented with fatigue but from 1 to 15 years for 23.4% and 29% of patients who presented with arthropathy and hepatopathy, respectively. CONCLUSION: For 55% of patients, diagnosis was based on familial genetic survey or fortuitous abnormal results of blood samples. An initial serum level of ferritin greater than 1000 µg/L was a factor of severity for 50% of patient. These two elements must be taken into account to consider a population mass screening. Long time to diagnosis required a sensitization of the population to be aware of the clinical manifestations of hemochromatosis.

[Sexuality of women with neurologic disorders]. / Sexualité de la patiente neurologique.

INTRODUCTION: The prevalence of sexual dysfunction in spinal cord injured (SCI) women is high. METHODS: Medical literature on sexuality in women with SCI was reviewed and combined with expert opinion of the authors. RESULTS: The physiology of the female sexual response including vasocongestion and muscular contractions occurring during sexual arousal and orgasm, and their innervation through somatosensory and autonomic pathways (pudendal, pelvic, hypogastric, vagus nerves) is described. Studies on women with SCI demonstrate the presence of a sacral reflex vasocongestion and/or thoracolumbar psychogenic vasocongestion. Fifty percent of women with SCI report orgasm, most often with genital stimulation, suggesting that an autonomic reflex response, but which can be perceived by vagus nerve transmission. Studies on sexual experience show that the frequency of sexual activities decreases, but interest for intercourse remains. More emphasis is placed on oral-genital stimulation, kisses, cuddling, caresses, fantasies, and erogenous stimulation above the lesion level. Sixty-nine percent of women with SCI report sexual satisfaction. Limitations concern positions during intercourse, spasticity, incontinence and autonomic dysreflexia. Alteration of the sexual sense of self and body image are also reported. Facilitating factors include education level, having a stable partner, occurrence of the lesion in adulthood, and increased posttraumatic delay. Treatment should emphasize neurological assessment of thoracolumbar sensitivity and presence of sacral reflexes. Sexual education should be encouraged during rehabilitation and cover the female sexual response, procreation and pregnancy (risks, prevention), along with precautions concerning various contraceptives. Treatment should include a refined assessment of perineal sensitivity to allow a mental image of the vulva, and trials with vibrostimulation and medication (PDEI5, midodrine) to maximize sexual responses and facilitate perception of sexual pleasure and orgasm. CONCLUSION: Management of sexual dysfunction in SCI women must be holistic and biopsychosocial.

[Transsexualism]. / Le transsexualisme.

UNLABELLED: Transsexual conditions need to be assessed for a psychological, hormonal and surgical evaluation. A multidisciplinary consent is required to perform hormonal and surgical treatment. METHOD: A critical overview has been performed (PubMed) and the main guidelines have been summarised. RESULTS: Hormonal treatments include suppression of the naturally secreted hormone and the administration of hormone of the desired sex. The main comorbidity is thrombo-embolic complications for patients under oestogene therapy. The main surgical treatment for female to male (FtM) surgery are: periareolar mastectomy if possible, hysterectomy, ovariectomy and vaginectomy and phallic reconstruction including metaidioplasty and forearm or suprapubic phalloplasty dependant of patient's wishes. The main treatments for male to female (MtF) surgery are: prosthesis mammoplasty and vaginoplasty and for some facial feminisation. The results in term of global satisfaction are high despite a relatively high rate of complications as well. CONCLUSION: Results in terms of well-being and psychological improvement justify this treatment despite its relatively high morbidity.

Sexual function and autonomic dysreflexia in men with spinal cord injuries: how should we treat?

STUDY DESIGN: Systematic review. OBJECTIVES: Review the literature on the acute or prophylactic treatment of autonomic dysreflexia in the context of sexual activities. SETTING: International. METHODS: Medline search using AD and spinal cord injury and all years of publication. RESULTS: Thirty-seven papers on the specific treatment of AD showed that nifedipine, prazosin, captopril and clonidine are candidates in the context of sexual activities. Prazosin, however, has an initial hypotensive effect requiring to begin treatment 12 h before intercourse, which makes it less ideal for spontaneous sexual activities. Captopril has an initial hypotensive effect and was only studied in acute AD. Its usefulness in prophylaxis remains to be demonstrated. Clonidine has successfully been used clinically for decades, but never studied in randomized control trials. Nifedipine remains the most widely studied and significant treatment of AD whether in acute or prophylactic conditions. Recent concerns suggest increased cardiovascular risks with sublingual nifedipine in non-SCI populations, but negative long-term effects have not been reported in the SCI population. CONCLUSION: Sexual function is a priority for men with SCI. As sexual activities, in particular ejaculation, can be a source of AD, adequate treatments and prophylaxis must be considered in the context of sexual activities. Experts must meet and conclude on the thresholds, parameters and treatments that should be considered in the long-term management of AD in the context of sexual function in men with SCI.

[Who are the recipients of labile blood products? A multicenter nation-wide study--a "donation day." Blood banks, health facilities]. / Qui sont les receveurs de produits sanguins labiles (PSL)? Une étude nationale multicentrique - un jour donné. Etablissement de transfusion sanguine (ETS) - établissements de santé (ES).

During the years 1994-2001, a progressive decrease of the number of blood units transfused has been reported in France. In contrast, since 2002, there is an increasing number of blood units issuing (+7.6% between 2001 and 2006) and this must be investigated. On behalf of the French Society of Blood Transfusion, the "Recipients" working group promoted a nation wide survey with the support of the regional blood transfusion centres. This survey was aimed at describing the profiles of the transfused patients: socio-demographical patterns, and reasons of the blood transfusion (main and associated diagnoses). A cross-sectional survey was designed. All the patients who received a blood unit during a specific day were considered as the population of the study. They were identified by the regional transfusion centres by means of the "individual issuing form". Survey forms were fully filled for 90% of the patients. It has been considered as a good answer rate. Seven thousand four hundred and twenty-two blood units, delivered to 3450 patients were analyzed. Three groups of pathologies were found as a reason of transfusion: haematology-oncology (52.70% of the prescriptions) with 892 patients (27.8%) for haematological malignancies; surgical procedures (23.99%); intensive care and medicine procedures (21.92%). More than 50% of the recipients are 70 years old and more. This result is explained by the age distribution of inpatients. In a context of lack of donors and consequently difficulties to provide patients with optimal number of blood units, this study is helpful. Variability of blood unit issuings must be detected, analyzed and monitored in real time by the actors of the transfusion process, using computerized dashboards: the blood units provider (in order to adjust the strategy of blood units provision) and the health care establishment as well as care blood components prescribers (reasons of blood transfusion and evaluation of practices).

[Health care units in the French blood banks, why?]. / Les structures de soins dans les établissements de transfusion sanguine, pourquoi faire ?

In France for several years, many patients have been treated in Blood Transfusion Centers belonging to the EFS. This partnership between public hospitals and EFS is appreciated by the patients who find a competent staff in transfusion and apheresis process, in a more pleasant environment than in hospital. There is a total of 93 Health Care Units in Blood Transfusion Centers. Sixty-three of these Health Care Units perform only transfusions and bleeding. In the remaining 30 Health Care Units apheresis, peripheral blood hematopoietic stem, cell harvesting, plasmatic exchanges and extracorporeal photopheresis are also performed. Despite the perfect fit between hospital needs, comfort and easiness for patients, an economical problem remains. At the present time, the reimbursement rate by national health insurance is below the real cost. If unsolved, this discrepancy could force an end to this beneficial partnership.

[Organization of urgent blood transfusion in France: analysis of practice patterns in centers involved in care delivery to multiple trauma patients]. / Etat des lieux sur l'organisation de la transfusion sanguine en urgence au sein des établissements de santé français participant à la prise en charge initiale des polytraumatisés.

OBJECTIVE: To describe the organization of medical and transfusion services within the framework of hospital admission for multiple trauma. STUDY DESIGN: National survey in France. MATERIAL AND METHODS: All French hospitals caring for multiple trauma patients were sent a questionnaire. Organization of the medical and transfusion services, and their related resources were evaluated. RESULTS: Among 372 questionnaires sent, 116 replies were received from structures which care for 18 (1-500) multiple trauma patients each year. An orthopaedic and an abdominal surgery unit were widely available whereas a neurosurgeon was available in 21% of responding centers. A transfusion site was found in 43%, whereas others have either a deposit for distribution to specific patients (40%) or a small deposit to cover urgent situations (17%). Comparison with legal or expert based rules of adequate transfusion process disclosed a variable incidence of practice dysfunctions (2-49%) depending on the parameter assessed. CONCLUSION: The French organization of multiple trauma patients' care and blood transfusion delivered for these patients is not homogenous. Dysfunctions were found in all types of hospitals. Recommendations describing good practice seem necessary to be built at the national level.

[Management of blood products in the event of postpartum hemorrhage]. / Gestion des produits sanguins labiles dans le cadre des hémorragies du post-partum immédiat.

Transfusion during the treatment of postpartum hemorrhages is rare. It always occurs in complex situations: failure of the initial manipulations or cataclysmic bleeding. Its management is multidisciplinary and should aim at obtaining blood products within thirty minutes while preventing any risk of alloimmunization detrimental to the obstetrical future of the patient. Upstream process management is essential. The following points will be described: Within the legal bounds, the different options for blood products supply; the best practices procedures that every maternity hospital should set up and formalize; the immunohematologic documents to be used for transfusions, their validity and the criteria for the prescription of irregular antibody testing; the rules for antenatal management to anticipate the transfusion difficulties; the blood products available and their constraints of use to optimize the prescription. Effective management can be achieved only through the strict respect of procedures at every stage. These procedures should be written in conjunction with all actors, issued and regularly assessed.

Molecular characterisation and ovine live vaccine 1B evaluation toward a Chlamydophila abortus strain isolated from springbok antelope abortion.

Chlamydiosis is a zoonosis with a worldwide distribution. The reservoir of susceptible hosts is large and includes birds and both domestic and wild mammals. Chlamydial infection, determined serologically, seems to be widespread among wild ruminants in the Paris zoo (France). In February 2003, an abortion case was reported within the springbok (Antidorcas marsupialis) herd of the zoo. PCR assay using primers targeting the polymorph membrane protein gene (pmp) family was performed on both vaginal swab and placenta samples revealing the presence of Chlamydophila. The inoculation into chicken embryos of an infected placenta extract led to the successful isolation of a C. abortus strain referred to as ASb1. The omp1 gene coding the major outer membrane protein (momp) and the 16S-23S rRNA spacer region of ASb1 were compared to those of various strains by restriction fragment length polymorphism (RFLP). The RFLP analysis showed that this isolate belonged to Chlamydophila abortus species and is highly related to known domestic ruminant's strains causing abortion. The efficacy of a live vaccine 1B, based on a temperature-sensitive mutant of the ovine abortion reference strain AB7, was tested. Protection-challenge experiments in a mouse model show that the ASb1 strain led to mice abortions and that vaccination with 1B vaccine provided them with effective protection.

[Are the indications and choice of labile blood products adapted? National survey on prescriber's knowledge]. / Les indications et le choix des produits sanguins labiles sont-ils adaptés? Enquête nationale sur les connaissances des prescripteurs.

OBJECTIVE: There is little data available on current practice related to prescription of labile blood products (LBP) by French physicians. The aim of this study was to assess whether prescriptions were conform to Anaes (French Medicine's agency) guidelines, with regard not only to indications but also quality of the products, so as to define the improvements that could be made. METHOD: Thirty-four clinical case reports, classified by specialties were sent to prescribing physicians working in the regional health centers, from 17 different blood banks, from October 1997 to February 1998. The prescribers were requested to answer only the questions that were specific to their particular field of experience. Each case description included multiple choice questions on the indication for transfusion of concentrated of red blood cells (RBC) and/or platelets (CP) and/or plasma, and the possible requirements for specification or modification of the guidelines applicable to these products. The primary end point of analysis was the adequation of the answers to the Anaes recommendations. RESULTS: Answers were obtained regarding 5092 clinical cases from 818 physicians. The participation rate was of 30%. The specialties were as follows: 34% anesthesiologists, 14% oncologists-haematologists, 13% internal medicine specialists, 11% emergency physicians, 10% paediatricians, 8% obstetricians, 7% geriatricians, and 3% transplantation surgeons. Eighty-two percent of the answers came from physicians working in the public health services. The adequation with the indication for transfusion was of 90.3% for RBC, 92.3% for platelets and 93.8% for plasma. The percentages of correct answers regarding the indications for specification or modification of the LBP were as follows: 90.3% were correct for irradiation (of either RBC or platelets); 68.8% and 53.2% respectively for leukocyte depletion from RBC and platelets; 64% for phenotyped RBC; 68.2% for compatibilized RBC; and 57.3% for apheresis platelet concentrates. There was no difference in results depending on the type of center, private or public, and the quality of LBP prescribed. The answers obtained from the anaesthesiologists' clinical cases were less accurate with regard to RBC but more accurate with regard to PC compared with other specialists. CONCLUSION: This study shows the correct management of the indications for transfusion by the prescribing physicians who participated in the study, but the lack of knowledge with regard to the indications for specifications and/or transformations of LBP. The respect of the indications for transfusion is the corner stone of safe transfusion and this phase should be optimized with improved dissemination of information on transfusion and training for the physicians and programs that would improve the quality.

[Insisting on intravenous polyvalent immunoglobulin therapy in polymyositis in spite of the occurrence of sever hemolytic anemia]. / Poursuite du traitement d'une polymyosite par les immunoglobulines intraveineuses polyvalentes malgré la survenue d'une anémie hémolytique sévère.

A 23-year-old female with polymyositis received high dose intravenous immunoglobulin (IVIg) therapy. The patient suffered severe hemolytic anemia after receiving first course of IVIg infusion. This adverse reaction was likely due to allohemaglutinin A and B and from or high molecular weight IgG complexes contained in the preparation. Though this effect was observed, the treatment was repeated six times. A mild hemolysis occurred following each IVIg, with no clinical consequence. Involvement of the saturation of macrophagic receptors might explain this partial destruction of erythrocytes.