A. Ghali

Systemic and immune manifestations in myelodysplasia: A multicenter retrospective study

The presence of systemic and/or immune manifestations in myelodysplasia has been currently reported. The influence of these manifestations on the natural outcome of myelodysplastic syndrome has to be considered. We present a multicenter retrospective study (2002–2009) of patients with myelodysplastic syndrome disclosing systemic and/or immune manifestations.

A 5-year prospective follow-up study in essential cryofibrinogenemia patients.

INTRODUCTION Cryofibrinogenemia may be essential, or secondary to diseases such as neoplasia, infection, thrombosis, and collagen vascular diseases. In a previous study, we reported the occurrence of neoplasia in some essential cryofibrinogenemia patients after a short period of follow-up. PURPOSE We performed a prospective multi-center 5-year follow-up study in essential cryofibrinogenemia patients (2005-2009). RESULTS 23 patients with essential cryofibrinogenemia were included, mean age 59 years (range: 33-79), 14 males. After a mean follow-up period of 24 months, 11/23 (47%) of cases that were initially diagnosed as essential cryofibrinogenemia were found to have an underlying lymphoma (6 T lymphoma and 5 B lymphoma). CONCLUSION This prospective study suggests that some cases of cryofibrinogenemia that are initially considered as essential, may have underlying lymphoma. Thus, we further suggest that regular follow-up should be performed in patients with essential cryofibrinogenemia.

Arterial Stiffness and Stroke in Sickle Cell Disease

Background and Purpose— Large vessels are also affected in sickle cell disease. The aim of this study was to assess several parameters in adult patients with sickle cell disease compared with control subjects and in patients with sickle cell disease with stroke. Methods— Carotid arterial stiffness, intima-media thickness, and transcranial Doppler ultrasonography were measured. Results— Arterial stiffness and transcranial Doppler velocity were significantly increased in 49 patients with sickle cell disease compared with 47 control subjects (P<0.05) and especially in patients with stroke (P<0.05). Conclusions— These data suggest that transcranial Doppler and arterial stiffness might be associated to stroke in adult patients with sickle cell disease.

Thrombocytopenic Purpura Associated with Dietary Supplements Containing Citrus Flavonoids

We report a case of thrombocytopenic purpura associated with the intake of two dietary supplements containing mainly citrus flavonoids. This is the first case to be notified to the French Agency for Food, Environmental and Occupational Health Safety (ANSES). It addresses the importance of an accurate medication history interview for each patient.

Le diagnostic d’un cancer chez les sujets âgés lors d’une thrombose veineuse profonde modifie-t-il le pronostic à moyen terme ?

Une etude prospective, cas-controles, conduite dans le departement de medecine interne et de geriatrie du Centre hospitalier d’Angers, de fevrier 1999 a janvier 2000, a evalue le benefice d’une recherche systemique d’un cancer occulte chez les sujets âges presentant une thrombose veineuse profonde (TVP), en termes de pronostic vital. Le suivi, sur une periode de 5,8 ans, a ete realise a l’aide d’un questionnaire adresse aux medecins traitants des patients. Cent dix-huit patients hospitalises pour TVP ont ete recrutes et repartis en deux groupes (A et B), en fonction de l’âge de 75 ans. Chaque patient a ete apparie a un patient exempt de TVP, pour l’âge, le sexe et l’annee de l’hospitalisation (groupes C et D respectivement). La TVP etait confirmee par un examen Doppler veineux et le cancer a ete depiste systematiquement par un bilan limite. Au cours du suivi apres hospitalisation, deux principaux criteres etaient recherches : le deces et la decouverte de cancer. La frequence des cancers decouverts au cours de l’hospitalisation est comparable entre les groupes (A : 10,2 % vs C : 5,1 %, p = 0,488 ; B : 8 % vs D : 0 %, p = 0,06), et celle des cancers apparus apres l’hospitalisation est similaire (A et C : 5,1 % ; B et D : 3,4 %). Le nombre de deces lies a un cancer n’est pas statistiquement different (A : 6/21 vs C : 5/23, p = 0,85 ; B : 6/8 vs D : 1/5, p = 0,103). Les taux de mortalite sont comparables (A : 35,6 % vs C : 39 %, p = 0,849 ; B : 13,5 % vs D : 8,5 %, p = 0,555). En revanche, un exces de mortalite est observe uniquement dans le groupe B par rapport au groupe C (57 % vs 8 % ; p = 0,0006), au cours de la premiere annee apres la TVP. La decouverte d’un cancer a l’occasion d’une TVP ne modifie donc pas le pronostic des patients âges de 75 ans et plus. Ainsi, la recherche systematique d’un cancer chez ces patients n’apparait pas justifiee en termes de pronostic vital. D’autres etudes cas-controles sont necessaires pour valider ces resultats.