A. Bellou

Cobalamin deficiency with megaloblastic anaemia in one patient under long-term omeprazole therapy.

The first case of cobalamin deficiency with megaloblastic anaemia in a patient under long‐term omeprazole therapy is presented. This patient received omeprazole at a daily dose of 40–60 mg for 4 years as treatment for a gastro‐oesophagal reflux complicated by peptic oesophagitis. Seric vitamin B12 was dramatically decreased at 80 pmol L‐1. The Schilling test was normal (13%) with crystalline [57Co] cobalamin and it was at 0% with [57Co] cobalamin‐labelled trout meat. All other assimilation tests were normal except an expiratory hydrogen breath test performed with lactulose. The haematological status was restored after intramuscular treatment with cobalamin. In conclusion, prolonged omeprazole therapy can be responsible for a cobalamin deficiency due to protein‐bound cobalamin malabsorption.

Constitutive nitric oxide synthase inhibition combined with histamine and serotonin receptor blockade improves the initial ovalbumin-induced arterial hypotension but decreases the survival time in brown norway rats anaphylactic shock.

Anaphylactic shock accidents after allergen exposure are frequent. After immunization with ovalbumin (OVA), a common dietary constituent, we evaluated the efficacy of pretreatment with histamine-receptor or serotonin-receptor blockers administered alone or in combination with a nitric oxide synthase inhibitor (L-NAME) on OVA-induced anaphylactic shock in Brown Norway rats. Animals were allocated to the following groups (n = 6 each): control (0.9% saline); diphenydramine (15 mg kg−1); cimetidine (20 mg kg−1); diphenydramine + cimetidine; dihydroergotamine (50 &mgr;g kg−1); diphenydramine + cimetidine + dihydroergotamine; L-NAME (100 mg/kg) alone or associated with diphenydramine, cimetidine, diphenydramine + cimetidine, dihydroergotamine, or diphenydramine + cimetidine + dihydroergotamine. Mean arterial blood pressure (MABP), heart rate (HR), and survival time were monitored for 60 min following treatment. The shock was initiated with i.v. OVA. The MABP drop after i.v. OVA was worsened by diphenydramine and was modestly attenuated by cimetidine, dihydroergotamine, or both together. L-NAME potentiated slightly the effects of cimetidine and dihydroergotamine by lessening the initial MABP decrease, but this transient effect was not sufficient to prevent the final collapse or to improve survival time. Decreased vasodilatory (prostaglandins E2), increased vasoconstrictory (thromboxane B2) prostaglandins, and unchanged leukotriene C4 concentrations were contributory to the overall hemodynamic changes. Thus, the combined blockade of vasodilator mediators (histamine, serotonin, and nitric oxide) slowed the MABP drop in anaphylactic shock, but did not improve survival. More studies are needed to understand these discordant effects.

Myocardiopathie fatale au cours d'un lupus érythémateux disseminé révélé par une maladie thrombo-embolique et un infarctus hépatique. Discussion physiopathologique

We report the case of a 23 year-old woman with a history of spontaneous abortion and venous thrombo-embolic disease presenting with a systemic lupus erythematosus (SLE) complicated by an hepatic infarct and a fatal myocardiopathy.

Une cause rare de myopathie acquise: la réticulo-histiocytose multicentrique

A case of multicentric reticulohistiocytosis in a 63-year-old man is presented, associated with a severe pelvic and scpular myositis. The giants cells were present only in synovial membranes.

Polyneuropathies inflammatoires chroniques. Dépôts immuns au niveau des structures nerveuses et efficacité du traitement immunomodulateur

We report four cases of chronic inflammatory polyneuropathies presented with immune deposits (mainly immunoglobulins) within sural nerve biopsies. Successful treatment with plasma exchanges and/or corticosteroids or cyclophosphamide suggest the existence of an underlying immunopathologic process of autoimmune origin.

Maladie de Wegener révélée par des adénopathies médiastinales et une probable atteinte hépatique granulomateuse

We report a case of fatal Wegener granulomatosis revealed by mediastinal lymph nodes and a probable hepatic localisation. Diagnosis was proved by the mediastinal biopsy and CT scan showed a typical aspect of macronodular hepatic granulomatosis.

Abcès du tronc cérébral révélant une maladie de Rendu-Osler. À propos d'un cas

The authors report one case of cerebral abscess complicating Rendu Osler disease (hereditary haemorragic telangiectasia) with multiple localizations (hepatic, pulmonary, cerebral). Preventive treatment consist in excluding pulmonary fistulae in order to prevent neurological complications.