[Facial palsy: diagnostic traps]. / Paralysie faciale : pièges diagnostiques.

Peripheral facial palsy is a common, often idiopathic and self-limiting mononeuropathy. However, secondary facial palsies require specific management: they are most often of infectious, vascular or dysimmune causes. The presence of red flags in the history, clinical examination or medical follow-up should alert clinicians. Because of the high incidence of Lyme disease in our region, this etiology deserves special attention. The management is based on general measures (eye protection, rehabilitation) and corticosteroid therapy; antivirals may provide additional benefit.

La paralysie faciale périphérique (PFP) est une mononeuropathie fréquente, souvent idiopathique et autorésolutive. Cependant, les paralysies faciales secondaires nécessitent une prise en charge spécifique : elles sont le plus souvent de causes infectieuses, vasculaires ou dysimmunes. La présence de drapeaux rouges à l'anamnèse, à l'examen clinique ou lors du suivi médical doivent alerter les cliniciens. En raison de l'incidence élevée de la borréliose dans nos régions, cette étiologie mérite une attention particulière. La prise en charge repose sur des mesures générales (protection oculaire, rééducation) et sur la corticothérapie ; l'ajout d'antiviraux pourrait apporter un bénéfice supplémentaire.

[High blood pressure in hospital: should it be treated?] / Hypertension artérielle à l'hôpital : faut-il la traiter ?

Uncontrolled blood pressure is a problem frequently encountered in hospital. Health workers may be inclined to initiate or increase hypertensive treatment to decrease blood pressure. However, studies have shown that in the absence of hypertensive emergency, there is no indication to treat hypertension in hospitalized patients. On the contrary, a treatment modification would increase the occurrence of complications without achieving better long-term blood pressure control. The role of the hospital physician is to recognize hypertensive emergencies, to look for and treat reversible external factors that could influence blood pressure and finally to refrain from treating blood pressure in the absence of target organ damage.

L'hypertension artérielle non contrôlée est une problématique fréquemment rencontrée en milieu hospitalier. Il n'est pas rare que le personnel médico-soignant se questionne sur l'instauration ou l'optimisation d'un traitement hypertenseur. Les études ont cependant montré qu'en l'absence d'urgence hypertensive, il n'y a pas d'indication à traiter une hypertension durant le séjour hospitalier. Au contraire, une modification du traitement favoriserait la survenue de complications sans permettre d'améliorer le contrôle de la tension artérielle à plus long terme. Le rôle du médecin hospitalier est de reconnaître les urgences hypertensives, de chercher et traiter les facteurs externes réversibles pouvant influencer le profil tensionnel et enfin de s'abstenir de traiter en l'absence d'atteinte d'organes cibles.

[Refractory pneumonia : when evoke an Adult-Onset Still's Disease ? Case report and review of literature]. / Pneumonie réfractaire : quand évoquer la maladie de Still de l'adulte ? - Rapport de cas et revue de la littérature.

Adult-Onset Still's Disease (AOSD) is an inflammatory systemic disease, including fever, arthralgia and rash. The disease can also cause organic involvement, and lead to serious complications. We report the case of a patient who presented a pulmonary form of AOSD, initially diagnosed and treated as pneumonia. Marked hyperferritinemia oriented us to the right diagnosis. In this article, we proceed to a review of literature to look for a better comprehension of physiopathology of pulmonary involvement in AOSD, and to withhold some practical advice in the diagnostic procedure.

La maladie de Still de l'adulte (MSA) est une maladie systémique inflammatoire, comprenant classiquement fièvre, arthralgies et rash cutané. La maladie peut également entraîner des atteintes d'organes et de graves complications. Nous rapportons le cas d'un patient qui a présenté une MSA avec atteinte pulmonaire, diagnostiquée et traitée initialement comme pneumonie. Une hyperferritinémie marquée nous a orientés vers le bon diagnostic. Dans cet article, nous réalisons une revue de la littérature visant à mieux comprendre la physiopathologie de l'atteinte pulmonaire de la MSA et d'en retenir des conseils pratiques dans l'aide au diagnostic.

[The role of splenectomy in fever of unknown origin : a literature review based on a case report]. / Place de la splénectomie dans la fièvre d'origine indéterminée - Revue de la littérature à partir d'un cas.

The management fever of unknown origin (FUO) is a situation often encountered in internal medicine and remains considered a challenge despite advances in the medical field. Defined as a persisting fever despite extensive investigation, cases of FUO often require hospitalization and invasive diagnostic procedures. The role of PET-CT in FUO has been well described in recent years. However, the literature concerning the role of splenectomy in the diagnostic workup is scarce and no standard protocol has been established. Based on a case report, we describe a situation where splenectomy was key in the investigation of a case of FUO, leading to the diagnosis of a high-grade B cell lymphoma. We performed a non-systematic review of the literature to assess the relevance, utility, and risks of splenectomies in the investigation of fever of unknown origin.

La prise en charge d'une fièvre d'origine indéterminée (FOI) est une situation souvent rencontrée en médecine interne. Définie comme une fièvre persistante sans étiologie malgré plusieurs investigations, elle requiert souvent une hospitali sation et des examens parfois invasifs. La place du PET-CT dans la FOI a bien été décrite ces dernières années. Cependant, la littérature concernant l'utilité de la splénectomie dans la recherche étiologique de la FOI est peu abondante. À partir d'un cas clinique, nous décrivons une situation dans laquelle la splénectomie a été l'élément clé dans l'investigation d'une FOI menant au diagnostic de lymphome à cellules B. Nous avons réalisé une revue non systématique de la littérature pour évaluer la pertinence, l'utilité et les risques de la splénectomie dans l'investigation d'une FOI.

Effects of particulate matter on inflammatory markers in the general adult population.

BACKGROUND: Particulate air pollution is associated with increased risk of cardiovascular disease and stroke. Although the precise mechanisms underlying this association are still unclear, the induction of systemic inflammation following particle inhalation represents a plausible mechanistic pathway. METHODS: We used baseline data from the CoLaus Study including 6183 adult participants residing in Lausanne, Switzerland. We analyzed the association of short-term exposure to PM(10) (on the day of examination visit) with continuous circulating serum levels of high-sensitive C-reactive protein (hs-CRP), interleukin 1-beta (IL-1ß), interleukin 6 (IL-6), and tumor-necrosis-factor alpha (TNF-α) by robust linear regressions, controlling for potential confounding factors and assessing effect modification. RESULTS: In adjusted analyses, for every 10 µg/m(3) elevation in PM(10), IL-1ß increased by 0.034 (95 % confidence interval, 0.007-0.060) pg/mL, IL-6 by 0.036 (0.015-0.057) pg/mL, and TNF-α by 0.024 (0.013-0.035) pg/mL, whereas no significant association was found with hs-CRP levels. CONCLUSIONS: Short-term exposure to PM(10) was positively associated with higher levels of circulating IL-1ß, IL-6 and TNF-α in the adult general population. This positive association suggests a link between air pollution and cardiovascular risk, although further studies are needed to clarify the mechanistic pathway linking PM(10) to cardiovascular risk.

Acute effects of passive smoking on peripheral vascular function.

Environmental tobacco smoke (ETS) acutely affects peripheral and coronary vascular tone. Whether ETS exerts specific deleterious effects on aortic wave reflection through nicotine exposure, whether they persist after ETS cessation, and whether the smoke environment impairs microvascular function and increases asymmetrical dimethyl-arginine levels are not known. We tested these hypotheses in a randomized, crossover study design in 11 healthy male nonsmokers. The effects of 1 hour of exposure to ETS, as compared with a nontobacco smoke and normal air, on augmentation index corrected for heart rate and skin microvascular hyperemia to local heating were examined. Augmentation index increased both during (P=0.01) and after (P<0.01) the ETS session but remained unchanged in the nontobacco smoke session when compared with normal air. Nicotine levels after the exposure were related to the peak rise in augmentation index (r=0.84; P<0.01), denoting a predominant role of nicotine in ETS vascular effects. This was confirmed in a second set of experiments (n=14), where the sublingual administration of nicotine was associated with an acute impairment in wave reflection as compared with placebo (P=0.001). Both ETS and nontobacco smokes increased plasma asymmetrical dimethyl-arginine levels (P<0.001), but only ETS reduced the late rise in skin blood flow in response to heating (P=0.03). In conclusion, passive smoking specifically increases aortic wave reflection through a nicotine-dependent pathway and impairs microvascular function, even after the end of the exposure. However, both tobacco and nontobacco passive smoking inhalation increase plasma asymmetrical dimethyl-arginine levels.