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Arlet JB. [Sickle cell disease imposes itself to French internists in the 21st century]. Rev Med Interne 2023; 44:325-327. [PMID: 37246036 DOI: 10.1016/j.revmed.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Affiliation(s)
- J-B Arlet
- Université Paris-Cité, Paris, France; Service de médecine interne, Centre national de référence drépanocytose, thalassémie, autres maladies rares des globules rouges et de l'érythropoïèse, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris cedex 15, France.
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Tennenbaum J, Volle G, Buffet P, Ranque B, Pouchot J, Arlet JB. [Splenic dysfunction in sickle cell disease: An update]. Rev Med Interne 2023:S0248-8663(23)00005-X. [PMID: 36710088 DOI: 10.1016/j.revmed.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/01/2023] [Accepted: 01/08/2023] [Indexed: 01/30/2023]
Abstract
The spleen filters blood cells and contributes to the immune defense. The red pulp clears the blood from altered red blood cells via its unique microcirculatory network ; while the white pulp is a secondary lymphoid organ, directly connected to the bloodstream, whose specificity is the defense against encapsulated bacteria through the production of "natural" IgM in the marginal zone. Various health conditions can cause acquired impairment of the splenic function (or hyposplenism) directly and/or through therapeutic splenectomy. Hypo/asplenia is complicated by an increased susceptibility to encapsulated germ infections, but an increased risk of thrombosis and pulmonary hypertension has also been reported after surgical splenectomy. Homozygous sickle cell disease is the most common disease associated with functional asplenia. The latter appears early in childhood likely through repeated ischemic alterations caused by the sickling of red blood cells. In addition, specific complications such as hypersplenism and acute splenic sequestration can occur and may be life-threatening. We provide here an update on the role and physiology of the spleen, which will allow a better understanding of the pathophysiology of spleen damage and its consequences in sickle cell disease.
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Affiliation(s)
- J Tennenbaum
- Service de médecine interne, Centre de référence national de la drépanocytose de l'adulte, Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France.
| | - G Volle
- Service de médecine interne, Hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France
| | - P Buffet
- Laboratoire d'Excellence GR-Ex, Biologie intégrée du globule rouge (BIGR), Université Paris Cité, Inserm, Paris, France
| | - B Ranque
- Service de médecine interne, Centre de référence national de la drépanocytose de l'adulte, Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France; Laboratoire d'Excellence GR-Ex, Biologie intégrée du globule rouge (BIGR), Université Paris Cité, Inserm, Paris, France; Faculté de médecine Paris Cité, Paris, France
| | - J Pouchot
- Service de médecine interne, Centre de référence national de la drépanocytose de l'adulte, Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France; Faculté de médecine Paris Cité, Paris, France
| | - J-B Arlet
- Service de médecine interne, Centre de référence national de la drépanocytose de l'adulte, Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France; Laboratoire d'Excellence GR-Ex, Biologie intégrée du globule rouge (BIGR), Université Paris Cité, Inserm, Paris, France; Faculté de médecine Paris Cité, Paris, France; Inserm U1163, CNRS 8254, Institut IMAGINE, Hôpital Necker, Assistance publique-Hôpitaux de Paris, Paris, France
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Volle G, Alexandre C, Rotenberg L, Derobertmasure A, Michon A, Flamarion E, Ranque B, Arlet JB, Pouchot J, Martis N. [Visual and auditory hallucinations in a 80 year-old man]. Rev Med Interne 2023; 44:42-44. [PMID: 36335046 DOI: 10.1016/j.revmed.2022.10.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 01/02/2023]
Affiliation(s)
- G Volle
- Service de médecine interne, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - C Alexandre
- Service de psychiatrie, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - L Rotenberg
- Service de psychiatrie, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Derobertmasure
- Service de pharmaco-toxicologie, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Michon
- Service de médecine interne, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - E Flamarion
- Service de médecine interne, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - B Ranque
- Service de médecine interne, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - J-B Arlet
- Service de médecine interne, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - J Pouchot
- Service de médecine interne, hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - N Martis
- Service de médecine interne, CHU de Nice, 151, route Saint-Antoine de Ginestière, 06200 Nice, France
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Régent A, Arlet JB, Cheminet G, Pouchot J, Mouthon L, Le Jeunne C. [Contribution and limits of "OSCE", "long-case" and "global end-of-placement marking" as end-of-rotation assessment methods. Experience from two internal medicine wards]. Rev Med Interne 2022; 43:581-588. [PMID: 36089428 DOI: 10.1016/j.revmed.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/11/2022] [Accepted: 07/27/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION During placements, there is an opportunity to learn clinical skills and to assess their application. However, it represents two different goals. The validity of an end-of-placement assessment is questionable, as the medical competency is contextual. We decided to evaluate the contribution and limits of different assessment modalities as an end-of-placement assessment. MATERIAL AND METHODS Internal medicine clerks were assessed using the Mini-Cex grid by a structured objective clinical examination (OSCE), a long-case clinical examination (LCE) and a global end-of-placement marking (GEPM). Following these evaluations, students and teachers fulfilled an open questionnaire. RESULTS In 2021, 41 students and 16 teachers participated in the study. Physical examination was evaluated in 0%, 97% et 76% of cases during OSCE, LCE and GEPM, respectively; teaching skills were assessed for 100, 42 et 49% of students in OSCE, LCE and GEPM, respectively. As compared to OSCE, there was a perceived superiority of LCE regarding its formative value (P=0.07 and P=0.03) and its summative value (P=0.0007 and P=0.02), for students and teachers, respectively. Qualitative analysis highlights the breadth of clinical skills that could be assessed during OSCE stations. Integration into a team was an additional skill that could specifically be assessed during GEPM. GEPM could also take into account the progress made during placement. CONCLUSION Despite its subjectivity, LCE seemed to be the preferred modality for an end-of-rotation assessment.
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Affiliation(s)
- A Régent
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence maladies auto-immunes et systémiques rares d'ile de France, hôpital Cochin, AP-HP-CUP, 75014 Paris, France.
| | - J-B Arlet
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence des syndromes drépanocytaires majeurs, hôpital européen Georges-Pompidou, AP-HP-CUP, 75015 Paris, France
| | - G Cheminet
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence des syndromes drépanocytaires majeurs, hôpital européen Georges-Pompidou, AP-HP-CUP, 75015 Paris, France
| | - J Pouchot
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence des syndromes drépanocytaires majeurs, hôpital européen Georges-Pompidou, AP-HP-CUP, 75015 Paris, France
| | - L Mouthon
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence maladies auto-immunes et systémiques rares d'ile de France, hôpital Cochin, AP-HP-CUP, 75014 Paris, France
| | - C Le Jeunne
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence maladies auto-immunes et systémiques rares d'ile de France, hôpital Cochin, AP-HP-CUP, 75014 Paris, France
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Cheminet G, Mekontso-Dessap A, Pouchot J, Arlet JB. [Acute chest syndrome in adult sickle cell patients]. Rev Med Interne 2022; 43:470-478. [PMID: 35810055 DOI: 10.1016/j.revmed.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/26/2022] [Accepted: 04/09/2022] [Indexed: 11/17/2022]
Abstract
Sickle cell disease is a frequent genetic condition, due to a mutation of the β-globin gene, leading to the production of an abnormal S hemoglobin and characterized by multiple vaso-occlusive events. The acute chest syndrome is a severe complication associated with a significant disability and mortality. It is defined by the association of one or more clinical respiratory manifestations and a new infiltrate on lung imaging. Its pathophysiology is complex and implies vaso-occlusive phenomena (pulmonary vascular thrombosis, fat embolism), infection, and alveolar hypoventilation. S/S or S/β0-thalassemia genotype, a history of vaso-occlusive crisis or acute chest syndrome, a low F hemoglobin level (<5%), a high steady-state hemoglobin level (> 10 g/dL), or a high steady-state leukocytosis (>10 G/L) are the main risk factors. Febrile chest pain, dyspnea, sometimes cough with expectorations are its main clinical manifestations, and bi-basal crackles are found at auscultation. Inferior alveolar opacities with or without pleural effusions are identified on chest X-ray or CT-scan. Management of the acute chest syndrome should be prompt and implies, besides the recognition of severity signs, a multimodal analgesia, oxygen supplementation, sometimes a parenteral antibiotic treatment and the frequent use of blood transfusions especially in the most severe cases. Prevention is important and includes a regular monitoring of hospitalized patients and the use of incentive spirometry.
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Affiliation(s)
- G Cheminet
- Service de médecine interne, Centre de référence national des syndromes drépanocytaires majeurs de l'adulte, hôpital européen Georges Pompidou, Assistance-Publique hôpitaux de Paris, 75015 Paris, France; Faculté de médecine Paris Centre, université de Paris, 75006 Paris, France.
| | - A Mekontso-Dessap
- Service de médecine intensive-réanimation, hôpitaux Universitaires Henri-Mondor, Assistance-Publique hôpitaux de Paris, 94010 Créteil, France; Université Paris Est Créteil, INSERM, IMRB, CARMAS, Créteil, 94010, France
| | - J Pouchot
- Service de médecine interne, Centre de référence national des syndromes drépanocytaires majeurs de l'adulte, hôpital européen Georges Pompidou, Assistance-Publique hôpitaux de Paris, 75015 Paris, France; Faculté de médecine Paris Centre, université de Paris, 75006 Paris, France
| | - J-B Arlet
- Service de médecine interne, Centre de référence national des syndromes drépanocytaires majeurs de l'adulte, hôpital européen Georges Pompidou, Assistance-Publique hôpitaux de Paris, 75015 Paris, France; Faculté de médecine Paris Centre, université de Paris, 75006 Paris, France; Laboratoire d'excellence sur le globule rouge GR-ex, 75015 Paris, France; Inserm U1163, CNRS 8254, institut IMAGINE, hôpital Necker, Assistance-Publique hôpitaux de Paris, 75015 Paris, France
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Tordjmane I, Michon A, Giraud C, Arlet JB, Orssaud C. [Lipemia retinalis: A rare manifestation of hypertriglyceridemia]. J Fr Ophtalmol 2021; 44:740-741. [PMID: 33610400 DOI: 10.1016/j.jfo.2020.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/06/2020] [Accepted: 09/15/2020] [Indexed: 11/20/2022]
Affiliation(s)
- I Tordjmane
- Unité fonctionnelle d'ophtalmologie, CRMR Ophtara, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - A Michon
- Service de médecine, centre référent de la drépanocytose, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - C Giraud
- Service de médecine, centre référent de la drépanocytose, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - J-B Arlet
- Service de médecine, centre référent de la drépanocytose, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Faculté de médecine Paris-Descartes, université de Paris, Paris, France
| | - C Orssaud
- Unité fonctionnelle d'ophtalmologie, CRMR Ophtara, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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Marcombes C, Lafont E, Jullien V, Flamarion E, Dion J, Costedoat-Chalumeau N, Pouchot J, Arlet JB. [Sickle cell trait complications: A case series of 6 patients]. Rev Med Interne 2020; 41:583-590. [PMID: 32768266 DOI: 10.1016/j.revmed.2020.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Patients with sickle cell trait (SCT) are commonly considered as asymptomatic carriers. However, some clinical manifestations may occur. METHODS Here we present a retrospective descriptive study about SCT subjects with at least one complication diagnosed in a sickle cell disease referral center, in Paris, between 2008 and 2019. We also performed a literature review on the complications of SCT subjects. RESULTS Six patients (between 19 and 65 years old) were included. SCT was already known only for 4 of them at the time of the complication. Four patients presented with a splenic infarct after a stay in high altitude or a plane trip, one of them was associated with papillary necrosis; one patient had isolated papillary necrosis, and the last one had splenic sequestration. These complications happened for most of them after exposure to an unusual situation of hypoxia or deshydratation. Five out of 6 patients had a marked elevated C reactive protein. CONCLUSION SCT may cause acute ischemic complications in a context of prolonged hypoxia or dehydration. The most commonly reported are the splenic infarct and the renal papillary necrosis. A study of hemoglobin should be considered in these clinical situations in patients with compatible ethnic origin.
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Affiliation(s)
- C Marcombes
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France
| | - E Lafont
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France; Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France
| | - V Jullien
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France
| | - E Flamarion
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France
| | - J Dion
- Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France
| | - N Costedoat-Chalumeau
- Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France; Département de médecine interne, Hôpital Cochin (AP-HP), rue Saint Jacques, 75014 Paris, France
| | - J Pouchot
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France; Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France
| | - J B Arlet
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France; Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France.
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Affiliation(s)
- J-B Arlet
- Centre de référence des syndromes drépanocytaires majeurs, thalassémie et autres maladies des globules rouges et de l'érythropoïèse, service de médecine interne, université de Paris et hôpital européen Georges-Pompidou (AP-HP), 20, rue Leblanc, 75015 Paris, France.
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Flamarion E, Saada N, Khellaf M, Michon A, Passeron A, Pouchot J, Arlet JB, Ranque B. [Opioid-induced adrenal insufficiency: Case report and synthesis of the literature]. Rev Med Interne 2019; 40:758-763. [PMID: 31444021 DOI: 10.1016/j.revmed.2019.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 07/01/2019] [Accepted: 07/17/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Opioid therapy for pain relief is associated with several adverse effects. Herein, we report the potential consequences of opioid use on the adrenal function. OBSERVATION A 49-year-old woman with sickle cell anemia (Hemoglobin SS) was admitted for the treatment of a vaso-occlusive crisis. Morphine was used for pain management, provided by intravenous intermittent dosing (patient-controlled analgesia). She developed during the hospitalization low blood pressure, due to secondary adrenal insufficiency (cortisol 74 nmol/L; ACTH 2.9pmol/L). Pituitary gland was normal on brain magnetic resonance imaging and adrenal function recovered after morphine discontinuation. CONCLUSION Opioids suppress cortisol secretion, primarily mediated by direct negative effect on hypothalamus and pituitary gland. Further studies are needed to define the incidence and the clinical significance of opioid-induced adrenal insufficiency, as well as the need for hormone replacement.
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Affiliation(s)
- E Flamarion
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.
| | - N Saada
- Service de médecine interne, hôpital Henri-Mondor, université Paris Est Créteil, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - M Khellaf
- Service d'accueil des urgences et département d'aval des urgences, hôpital Henri-Mondor, université Paris Est Créteil, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - A Michon
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - A Passeron
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - J Pouchot
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - J-B Arlet
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - B Ranque
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
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Michon A, Jammal S, Passeron A, De Luna G, Bomahou C, Jullien V, Pouchot J, Arlet JB, Ranque B. [Use of pocket-sized ultrasound in internal medicine (hospitalist) practice: Feedback and perspectives]. Rev Med Interne 2018; 40:220-225. [PMID: 30078545 DOI: 10.1016/j.revmed.2018.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/20/2018] [Accepted: 07/02/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Point of care ultrasound (POCUS) is routinely used by intensivists and emergency physicians for many years. Its interest is not arguable any more for these specialists, despite the large variety of diseases they care. Hospitalists and internists also should find some interest in POCUS, which convenience and wide range of indications responds well to the variety of their practice. However, it is still not widely used in internal medicine departments. METHODS We here report our experience of using a pocket-sized ultrasound device in a French internal medicine department. The device used was a Vscan Dual Probe, GE, whose two probes and presets allow for cardiac, abdominal, pulmonary, obstetric, vascular, pulmonary, and superficial soft tissue exploration. One physician of the ward received a course for POCUS that was initially dedicated for emergency physicians. This study reports on the results of the examinations made between January and September 2015. For each examination performed, clinical usefulness was assessed at the time of patient discharge, by two independent physicians who reviewed the clinical course and the results of conventional imaging and rated their evaluation on a Likert scale. RESULTS One hundred and four examinations were evaluated. The mean duration of the ultrasound examination was 9±5minutes. The POCUS conclusions were corrected by disease course or the results of conventional imaging in 10 (9.6%) cases. The presets of the device: heart, soft tissue, lung, abdomen and vascular were used respectively in 32, 30, 21, 12 and 5% of the examinations. The main indications of POCUS examination were for identification of pleural, pericardial or peritoneal effusion, and to assess the central venous pressure by inferior vena cava examination. Eighteen examinations were performed for puncture of effusion. The retrospectively evaluated clinical benefit was clearly demonstrated in 78% of cases. The agreement between the two blinded assessors was good (kappa coefficient at 0.82). CONCLUSION Pocket-sized ultrasound device could be used in internal medicine wards. However, its limited performance compared to more sophisticated echography limits the possible explorations and their reliability, which encourages caution and makes critical the question of the initial training of doctors and medical students.
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Affiliation(s)
- A Michon
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France.
| | - S Jammal
- Service de radiologie, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - A Passeron
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - G De Luna
- Unité des maladies génétiques du globule rouge, hôpital Henri-Mondor, université Paris Est Créteil, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - C Bomahou
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - V Jullien
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - J Pouchot
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - J-B Arlet
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - B Ranque
- Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France
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David C, Michon A, Passeron A, Arlet JB, Pouchot J, Maisonobe T, Ranque B, Audemard-Verger A. [Acute myositis in a 53 year-old man]. Rev Med Interne 2018; 39:824-826. [PMID: 29907441 DOI: 10.1016/j.revmed.2018.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 11/19/2022]
Affiliation(s)
- C David
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015, Paris, France
| | - A Michon
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015, Paris, France
| | - A Passeron
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015, Paris, France
| | - J-B Arlet
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015, Paris, France
| | - J Pouchot
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015, Paris, France
| | - T Maisonobe
- Service de pathologie neuromusculaire, hôpital Pitié-Salpétrière, 4-83, boulevard de l'hôpital, 75013 Paris, France
| | - B Ranque
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015, Paris, France.
| | - A Audemard-Verger
- Service de médecine interne, CHU de Caen, avenue de la Côte de Nacre CS3001, 14033 Caen cedex 9, France
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Alexandre L, Taillieu F, Arlet JB, Passeron A, Michon A, Bats AS, Pouchot J, Ranque B. [Benign metastasizing leiomyoma: An unusual cause of aggressive femoral bone tumor]. Rev Med Interne 2018; 39:431-434. [PMID: 29502928 DOI: 10.1016/j.revmed.2018.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/27/2018] [Accepted: 02/05/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Benign metastasizing leiomyoma (BML) is a rare condition characterized by histologically benign "metastatic" smooth muscle tumors, which can affect women with history of uterine surgery. We report the case of a patient with bone metastases of BML. CASE REPORT A 78-year-old woman who had undergone uterine surgery six years before hospital admission, was diagnosed with large pulmonary and pleural metastases that necessitated surgical removal. Pathological examination allowed the diagnosis of BML with positive staining for estrogen and progesterone receptors. Three years later, a BML metastasis in the right femoral diaphysis was unexpectedly discovered and treated by osteosynthesis because of a high risk of fracture. Despite an aromatase-inhibitor treatment, new lungs lesions appeared in the next few months. CONCLUSION BML is a potential cause of aggressive, although histologically benign, bone tumor in women with a history of uterine surgery.
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Affiliation(s)
- L Alexandre
- Service de médecine interne, hôpital Européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - F Taillieu
- Service de radiologie, hôpital Européen-Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
| | - J-B Arlet
- Service de médecine interne, hôpital Européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - A Passeron
- Service de médecine interne, hôpital Européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - A Michon
- Service de médecine interne, hôpital Européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - A-S Bats
- Service de gynécologie, hôpital Européen-Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'école de médecine, 75006 Paris, France
| | - J Pouchot
- Service de médecine interne, hôpital Européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'école de médecine, 75006 Paris, France
| | - B Ranque
- Service de médecine interne, hôpital Européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'école de médecine, 75006 Paris, France.
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Pais A, de Luna G, Arlet JB, Chennebault H, Michon A, Nochy D, Pouchot J, Paule R, Ponsoye M. [Edema and fever in a 31-year-old woman]. Rev Med Interne 2016; 38:214-217. [PMID: 27639915 DOI: 10.1016/j.revmed.2016.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Affiliation(s)
- A Pais
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - G de Luna
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - J-B Arlet
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - H Chennebault
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Michon
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - D Nochy
- Service d'anatomie pathologique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - J Pouchot
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - R Paule
- Service de médecine interne, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - M Ponsoye
- Service de médecine interne, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt, France
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14
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Habibi A, Arlet JB, Stankovic K, Gellen-Dautremer J, Ribeil JA, Bartolucci P, Lionnet F. [French guidelines for the management of adult sickle cell disease: 2015 update]. Rev Med Interne 2016; 36:5S3-84. [PMID: 26007619 DOI: 10.1016/s0248-8663(15)60002-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sickle cell disease is a systemic genetic disorder, causing many functional and tissular modifications. As the prevalence of patients with sickle cell disease increases gradually in France, every physician can be potentially involved in the care of these patients. Complications of sickle cell disease can be acute and chronic. Pain is the main symptom and should be treated quickly and aggressively. In order to reduce the fatality rate associated with acute chest syndrome, it must be detected and treated early. Chronic complications are one of the main concerns in adults and should be identified as early as possible in order to prevent end organ damage. Many organs can be involved, including bones, kidneys, eyes, lungs, etc. The indications for a specific treatment (blood transfusion or hydroxyurea) should be regularly discussed. Coordinated health care should be carefully organized to allow a regular follow-up near the living place and access to specialized departments. We present in this article the French guidelines for the sickle cell disease management in adulthood.
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Affiliation(s)
- A Habibi
- Unité des maladies génétiques du globule rouge (UMGGR), service de médecine interne, centre de référence de la drépanocytose, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; Université Paris-Est Créteil (Upec), avenue du Général-de-Gaulle, 94010 Créteil cedex, France; Équipe 2, IMRB, Inserm U955, Créteil, France.
| | - J-B Arlet
- Service de médecine interne, centre de référence de la drépanocytose, hôpital européen Georges-Pompidou, AP - HP, 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris Descartes, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - K Stankovic
- Service de médecine interne, centre de référence de la drépanocytose, hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France
| | - J Gellen-Dautremer
- Unité des maladies génétiques du globule rouge (UMGGR), service de médecine interne, centre de référence de la drépanocytose, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - J-A Ribeil
- Faculté de médecine, université Paris Descartes, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Département de biothérapie, centre de référence de la drépanocytose, hôpital Necker - Enfants-malades, AP - HP, 149, rue de Sèvres, 75743 Paris cedex, France
| | - P Bartolucci
- Unité des maladies génétiques du globule rouge (UMGGR), service de médecine interne, centre de référence de la drépanocytose, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; Université Paris-Est Créteil (Upec), avenue du Général-de-Gaulle, 94010 Créteil cedex, France
| | - F Lionnet
- Service de médecine interne, centre de référence de la drépanocytose, hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France
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Hermine O, Arlet JB, Ribeil JA, Guillerm F, Vandekerkhove J, Courtois G. [HSP70, an erythropoiesis regulator that determines the fate of erythroblasts between death and differentiation]. Transfus Clin Biol 2013; 20:144-7. [PMID: 23643330 DOI: 10.1016/j.tracli.2013.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Erythropoiesis is finely regulated by two major cytokines, stem cell factor (SCF) and erythropoietin (Epo). Decrease levels of Epo result in caspase activation and erythroid progenitors apoptosis. However, normal erythroid cell maturation requests caspase activation and cleavage of various caspase substrates, except the erythroid transcription factor GATA-1, that is protected by interaction with the chaperone HSP70 in the nucleus. Therefore, molecular abnormalities associated with decrease of HSP70 expression in the nucleus may result in ineffective erythropoiesis characterized by apoptosis and impaired maturation of erythroid precursors. These findings open new potential targeted therapies for erythroid disorders.
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Affiliation(s)
- O Hermine
- CNRS UMR 8143, labex des globules rouges GR-ex, hôpital Necker, institut Imagine, université Sorbonne Paris Cité, Paris Descartes, Paris, France.
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Geri G, Passeron A, Heym B, Arlet JB, Pouchot J, Capron L, Ranque B. Paradoxical reactions during treatment of tuberculosis with extrapulmonary manifestations in HIV-negative patients. Infection 2012. [PMID: 23203899 DOI: 10.1007/s15010-012-0376-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Tuberculous paradoxical reactions (PR) have been seldom studied in non-immunocompromised patients. We conducted a study to describe the incidence, clinical and biological features, treatment and outcome of PR in human immunodeficiency virus (HIV)-negative patients treated for extrapulmonary tuberculosis (TB) and to identify predictive factors of PR. METHODS A single-center retrospective study was conducted in consecutive HIV-negative patients presenting with TB with at least one extrapulmonary manifestation who were hospitalized in an internal medicine department between 2000 and 2010. RESULTS Seventy-six patients were enrolled in the study. Lymphadenitis was the most common extrapulmonary manifestation of tuberculosis among this patient population (72 %). PR occurred in 19 (25 %) patients, mostly involving the lymph nodes (68 %) and lung (16 %), but also the pericardium, pleura, bone, muscle and brain. Median time to PR onset after initiation of anti-TB regimen was 86 days (interquartile range 36-125). Treatment of PR consisted mainly of corticosteroids (47 % of patients) and needle aspiration of PR lymph nodes (31 %). Peripheral lymph node involvement (p = 0.009), lymphopenia (p = 0.03) and anemia (p = 0.002) at presentation were associated with PR occurrence. Outcome was favorable in all patients with PR but one; the latter suffered residual paraplegia. CONCLUSIONS Paradoxical reactions are frequent in the course of extrapulmonary TB treatment in HIV-negative patients but their outcome is excellent, except in some cases with central nervous system involvement.
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Affiliation(s)
- G Geri
- Service de médecine interne, hôpital européen Georges Pompidou, Assistance publique-hôpitaux de Paris, 20 rue Leblanc, 75015, Paris, France
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17
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Arlet JB, Ribeil JA, Chatellier G, Pouchot J, de Montalembert M, Prié D, Courbebaisse M. [Hyperuricemia in sickle cell disease in France]. Rev Med Interne 2011; 33:13-7. [PMID: 21907467 DOI: 10.1016/j.revmed.2011.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 06/14/2011] [Accepted: 07/16/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Hyperuricemia has been reported to be a common feature of sickle cell disease occurring between 32 to 41% of the patients, in studies conducted during the 1970's. Since then, this notion has been rarely challenged. The objective of this study was to assess the prevalence of hyperuricemia and gout in adult patients with sickle cell disease in France. METHODS Between May 2007 and March 2009, serum and urinary urate concentration, creatininemia and hemogram were prospectively assessed in all consecutive sickle cell patients, followed in our sickle cell disease centre. All subjects were in a clinically steady state. Clinical acute gout history was also recorded. RESULTS Sixty-five patients (mean age 31±10.3 years) were investigated. Mean uric acid serum level was 281.6±74μmol/L. Hyperuricemia was evidenced in six patients only (9.2%) (95% IC: 3.5-19.0). None of the patient had a medical history of acute gout. Patients in the higher serum uric acid tertile concentration had higher serum creatinine level (62.3±17.1μmol/L vs 51.5±12.6μmol/L, P<0.01), lower fractional excretion of urate (4.5% vs 6.8%, P<0.03) and higher reticulocyte count (median 219500/mm(3) vs 144000/mm(3), P=0.08) compared to the other patients. CONCLUSION Hyperuricemia and gout are not a clinical problem in sickle cell disease in our country. Nevertheless, our findings indicate that kidney function has to be fully explored if serum uric acid level is elevated or significantly deteriorates during follow-up. Serum uric acid level could be an early marker of renal dysfunction in sickle cell disease patients.
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Affiliation(s)
- J-B Arlet
- Hôpital européen Georges-Pompidou, université Paris-Descartes, Paris cedex 15, France.
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18
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Chaker S, Very S, Helley D, Gaussem P, Pouchot J, Darnige L, Fischer AM, Capron L, Arlet JB. [Thrombocytopenia associated with iron deficiency: a rare differential diagnosis of auto-immune thrombocytopenic purpura]. Rev Med Interne 2010; 31:631-6. [PMID: 20627480 DOI: 10.1016/j.revmed.2010.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 01/09/2010] [Accepted: 01/30/2010] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Iron deficiency is typically associated with microcytic anemia and thrombocytosis. It is a very uncommon cause of thrombocytopenia. CASE REPORT A 17-year-old female presented with marked fatigue and dyspnea on exertion. Review of systems was only remarkable for abundant menstruations during the past two years. The hemogram revealed a profound microcytic anemia (4.4 g/dL, mean corpuscular volume [MCV] 49 fL) and a thrombocytopenia (33 G/L). Marked iron deficiency was also present: ferritinemia <3 μg/L. Investigations did not find any cause of iron deficiency anemia other than excessive menstrual loss. Bone marrow examination showed an increase number of megakaryocytes, compatible with an immune thrombocytopenia purpura. Iron supplementation completely normalized the platelet count within 48 hours. CONCLUSION Iron affects thrombopoiesis. Because the number of megakaryocytes may then increase in the bone marrow, "iron deficiency thrombocytopenia" may be falsely diagnosed as immune thrombocytopenic purpura, leading to inappropriate corticosteroid therapy. Iron supplementation is the appropriate treatment of iron deficiency thrombocytopenia and allowed a rapid correction of the platelet count in all the 24 cases that have been previously reported with sufficient detail to be analyzed in the literature.
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Affiliation(s)
- S Chaker
- Service d'hématologie biologique, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, université Paris Descartes, 75908 Paris cedex 15, France
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Affiliation(s)
- J-B Arlet
- Service de médecine interne, centre de référence de la drépanocytose, faculté de médecine Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France
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20
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Abstract
Sickle cell disease is a systemic disease that can potentially involve all organs. As the prevalence of patients with sickle cell disease increases gradually in France, every physician can be potentially involved in the care of these patients. Complications of sickle cell disease can be acute or chronic. Pain is the main symptom and should be treated quickly and aggressively. Acute chest syndrome is the leading cause of acute death and must be prevented, detected, and treated without delay. Chronic complications are one of the main concerns in adults and should be identified as early as possible in order to prevent sequels. Many organs can be involved, including the bones, kidneys, eyes, lungs... The indications for a specific treatment (blood transfusion or hydroxyurea) should be discussed. Health care should be carefully organized to allow both a regular follow-up near the living place and access to specialized departments. We present in this article the French guidelines for the sickle cell disease management in adulthood.
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Affiliation(s)
- F Lionnet
- Service de médecine interne, centre de référence de la drépanocytose, hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France.
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21
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Arlet JB. [How junior internists imagine the future of their specialty in France?]. Rev Med Interne 2008; 29:1083-6. [PMID: 18945524 DOI: 10.1016/j.revmed.2008.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 07/24/2008] [Accepted: 08/30/2008] [Indexed: 11/29/2022]
Abstract
Understanding the motivation of physicians to become internist is critical to recruitment efforts within the specialty of internal medicine. A questionnaire was designed by "the French young internist association (FYIA)" to analyze the quality of life of young specialists and their vision of the internal medicine specialty, in France. The questionnaire was administered online to the young internists (resident and junior hospital assistants) who had already chosen the specialty of internal medicine and collated through the FYIA. The majority of young internists in France work more than 60hours per week (57%) and have a very high intellectual interest for their specialty. For 89% of young internists, the specialty field should include management of patients with systemic or rare diseases as well as patients who need hospitalization after their admission from the emergency department. In the context of medical ultraspecialization, and because of a wide medical knowledge and a global approach of the patient's problems, French internists appear as an expert clinician specialist of difficult diagnosis and management of patients with multiple diseases. Because of these specificities, this specialty is attractive for medical students.
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Affiliation(s)
- J-B Arlet
- Service de médecine interne, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris cedex 15, France.
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Arlet JB, Le THD, Marinho A, Amoura Z, Wechsler B, Papo T, Piette JC. Reactive haemophagocytic syndrome in adult-onset Still's disease: a report of six patients and a review of the literature. Ann Rheum Dis 2006; 65:1596-601. [PMID: 16540551 PMCID: PMC1798476 DOI: 10.1136/ard.2005.046904] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the prevalence and characteristics of patients with reactive haemophagocytic syndrome (RHS) complicating adult-onset Still's disease (AOSD). METHODS Of 50 patients with AOSD fulfilling Yamaguchi and Fautrel criteria followed in our department, clinical and laboratory data, course and treatment of six patients with histologically proven RHS and without any obvious cause other than AOSD were retrospectively recorded. RESULTS RHS led to AOSD in two cases, whereas it appeared after a mean duration of 3.5 years from onset of AOSD in the other cases. The main symptoms were fever (n = 6), polyarthralgias or myalgias (n = 4), lymphadenopathy or splenomegaly (n = 3), pharyngitis (n = 3), rash (n = 3), pleuritis (n = 3), hepatomegaly (n = 1), normal or low leucocyte count (n = 4), anaemia (n = 6), lymphocytopenia (n = 6), thrombocytopenia (n = 4), hyperbasophilic lymphocytes (n = 2), abnormal liver function tests (n = 6) and increased serum triglyceride level (n = 6). Serum ferritin concentration was constantly increased (>10,000 microg/l in five cases, with <5-35% in glycosylated form). Two patients presented with coagulopathy. Treatment comprised corticosteroids (n = 4) and intravenous immunoglobulins (n = 3), whereas prednisone was unchanged in one case. One death due to pneumonia occurred 15 days after RHS. With a follow-up ranging from 2 to 7.5 years, the other patients were in remission with prednisone plus etanercept (n = 1), prednisone plus methotrexate (n = 1), low-dose prednisone (n = 2) or without treatment (n = 1). CONCLUSION RHS is not uncommon in AOSD. It should be evoked in a patient with AOSD in the absence of hyperleucocytosis, thrombocytopenia, lymphopenia and coagulopathy, or in the presence of high serum ferritin and triglyceride levels.
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Affiliation(s)
- J-B Arlet
- Department of Internal Medicine, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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Arlet JB, Le Thi Huong DB, Pouchot J, Piette JC. [Current concepts on the physiopathology of adult-onset Still's disease]. Rev Med Interne 2004; 26:549-56. [PMID: 15996569 DOI: 10.1016/j.revmed.2004.11.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Accepted: 11/29/2004] [Indexed: 11/25/2022]
Abstract
PURPOSE Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown origin. It is characterized by hectic fever, evanescent rash, polyarthralgias or polyarthritis, sore throat, hepatosplenomegaly, lymphadenopathy, polynuclear leukocytosis, liver cytolysis, and high serum level of ferritin with low glycosylated fraction. CURRENT KNOWLEDGE AND KEY POINTS An increased serum level of ferritin, IL-8, IL-6, IL-18 and TNF-alpha indicates that macrophages are highly activated in AOSD. Interleukin 18 (IL-18) seems to be a key cytokine in the pathogenesis of AOSD. Serum IL-18 levels are increased in AOSD patients compared to other systemic inflammatory diseases such as rheumatoid arthritis and they are well correlated with serum ferritin levels and disease activity. IL-18 could cause acute liver injury and arthritis. Macrophages could be activated by infectious agents such as viruses and by an inadequate control of T cell response secondary to depressed Natural Killer lymphocyte function, similarly to that observed in systemic juvenile idiopathic arthritis. Sustained macrophage activation can lead to the hemophagocytic syndrome, a severe complication of both AOSD and systemic juvenile idiopathic arthritis. FUTURE PROSPECTS Cytotoxic cell functions should be probably studied in AOSD as they were in the hemophagocytic syndrome and systemic juvenile idiopathic arthritis because AOSD, characterised by a marked macrophage activation may be related to an immunological deficiency.
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Affiliation(s)
- J B Arlet
- Service de médecine interne, groupe hospitalier Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Affiliation(s)
- J B Arlet
- Service des Maladies Infectieuses et Tropicales, 1 avenue Claude Vellefaux, 75475 Paris 10, France
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Abstract
INTRODUCTION Ankylosing spondylitis is a chronic inflammatory disorder that is rarely associated with severe systemic manifestations. EXEGESIS We report the case of a 29-year-old man presenting with an atypical ankylosing spondylitis. The patient presented with a high spiking fever, a marked weight loss, and an unusual increase of acute phase response markers. Such features are rarely associated with ankylosing spondylitis and the review of the few similar reported cases in the literature showed that this presentation is usually associated with a severe disease course, and an asymmetrical joint involvement that is unresponsive to nonsteroidal anti-inflammatory agents. CONCLUSION Clinicians should be aware of this unusual presentation of ankylosing spondylitis, which should be included in the list of aetiologies of fever of unknown origin, to avoid useless diagnostic procedures. The severity of the disease course may lead to the consideration of a more aggressive treatment strategy.
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Affiliation(s)
- J B Arlet
- Service de médecine interne, hôpital Louis-Mourier, 178, rue des Renouillers, 92700 Colombes, France
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