While computed tomography (CT) exams are the major cause of medical exposure to ionising radiation, there is increasing evidence that the potential radiation-induced risks must be documented. We investigated the impact of cellular models and individual factor on the deoxyribonucleic acid double-strand breaks (DSB) recognition and repair in human fibroblasts and mammary epithelial cells exposed to current chest CT scan conditions. Twelve human primary fibroblasts and four primary human mammary epithelial cell lines with different levels of radiosensitivity/susceptibility were exposed to a standard chest CT scan exam using adapted phantoms. Cells were exposed to a single helical irradiation (14.4 mGy) or to a topogram followed, after 1 min, by one single helical examination (1.1 mGy + 14.4 mGy). DSB signalling and repair was assessed through anti-γH2AX and anti-pATM immunofluorescence. Chest CT scan induced a significant number of γH2AX and pATM foci. The kinetics of both biomarkers were found strongly dependent on the individual factor. The topogram may also influence the biological response of radiosensitive/susceptible fibroblasts to irradiation. Altogether, our findings show that a chest CT scan exam may result in 2 to 3 times more unrepaired DSB in cells from radiosensitive/susceptible patients. Both individual and tissue factors in the recognition and repair of DSB after current CT scan exams are important. Further investigations are needed to better define the radiosensitivity/susceptibility of individual humans.

L’inhalation de corps étranger est exceptionnellement observée chez l’adulte jeune, pouvant passer inaperçue. Il s’agit d’une patiente âgée de 37 ans, sans antécédents pathologiques notables, admise pour une pleuro-pneumopathie basale droite. L’exploration endoscopique a objectivé la présence d’une formation jaunâtre friable. Il s’agissait d’un fragment osseux, inhalé accidentellement par la patiente lors d’une invitation. Il est nécessaire de rechercher une inhalation de corps étranger en cas d’infection grave inhabituellement observé dans un terrain d’immunocompétence.Inhalation of foreign bodies is not often observed in young adults, and may go unnoticed. A 37-year-old patient, with no significant medical history, was admitted for right basal pleuro-pneumopathy. Endoscopic examination revealed the presence of a brittle yellowish formation. It was a bone fragment, accidentally inhaled by the patient. It is necessary to look for an inhaled foreign body in cases of serious infection unusually observed in an immuno-competent patient.

Le syndrome hyperéosinophilique (SHE) est caractérisé par une hyperéosinophilie (HE) sanguine et une infiltration éosinophylique touchant plusieurs organes sans cause retrouvée. De multiples organes peuvent être atteints comme le cœur, le système digestif et le poumon. L’association d’une œsophagite, d’une gastrite, d’une atteinte grélique et d’une cystite est très rarement combinée chez un même patient. Devant une suspicion de syndrome hyperéosinophylique, la recherche d’une étiologie est indispensable pour éliminer une cause infectieuse, tumorale, médicamenteuse ou autres avant de retenir le diagnostic et de débuter un traitement adapté, le plus souvent par corticoïde.

To compare BASDAI 50 response rate to TNFi in axial spondyloarthritis (axSpA) depending on the presence or not of objective signs of axSpA and to look for predictive factors of TNFi efficacy.Patients diagnosed with axSpA according to ASAS criteria "clinical arm" and treated between January 2001 and September 2015 with TNFi were included. First group included patients with at least one objective sign such as arthritis, dactylitis, enthesitis, uveitis, inflammatory bowel disease, elevated C-reactive protein or radiological sacroiliitis, and second group included non-radiographic axSpA (nr-axSpA) patients without any objective sign corresponding to patients with inflammatory back pain and either a good response to NSAID or a SpA family history. The primary outcome was the TNFi efficacy, defined as an achievement of BASDAI 50 at 3 months. The secondary outcomes were BASDAI 50 achievement over 1 year and analysis of predictive factors of TNFi response.We included 84 nr-axSpA patients without any objective signs and 84 axSpA patients with objective signs (48.2% r-axSpA and 52.8% nr-axSpA). BASDAI 50 achievement rates were significantly higher in patients with objective signs than in patients without, at 3 months (45.1% versus 13.7%, P < 0.0001) and at any of the visit-time points over the first year (61.9% versus 21.4%, P < 0.0001). In multivariate analysis, overweight/obesity and sacroiliitis on MRI were respectively negative and positive predictive factors of TNFi efficacy in the total population at 3 months (OR = 0.32, 95%CI [0.11, 0.96], P = 0.041 and OR = 6.92, 95% CI (2.41, 19.8), P < 0.0001, respectively).TNFi should be used with caution in axSpA when objective signs are absent as only 13.7% of these patients were BASDAI 50 responders at 3 months.

For a patient recently returned from a tropical country in intensive care, the leading hypothesis for a fever leading to multiple organ failure is evidently malaria. Nonetheless, many other causes are possible and should be considered: parasites, viruses, and bacteria. A multidisciplinary discussion between specialists in emergency medicine, radiology, pathology, and infectious diseases is essential to start appropriate treatment as quickly as possible without impairing the patient's prognosis.

Clinical cone beam computed tomography (CBCT) was compared to high-resolution peripheral quantitative computed tomography (HR-pQCT) for the assessment of ex vivo radii. Strong correlations were found for geometry, volumetric density, and trabecular structure. Using CBCT, bone architecture assessment was feasible but compared to HR-pQCT, trabecular parameters were overestimated whereas cortical ones were underestimated.

Introduction. The association granulomatosis combined variable immunodeficiency (CVID) is well known from the clinicians. However, the association with a large granular lymphocyte (LGL) leukemia has not been yet reported.Case report. We report a 50-year-old woman, followed for CVID associated with a granulomatous disease. During the follow-up, the patient developed a granulomatous lymphocytic interstitiel lung disease (GLILD). Secondarily, she presented a LGL leukemia.Conclusion. To our knowledge, this is the first reported case of an association between CVID and LGL leukemia. (C) 2014 Societe nationale francaise de medecine interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

Les atteintes ophtalmologiques permanentes, à type de neuropathie optique ischémique antérieure ou plus rarement d’occlusion artérielle rétinienne, dominent de nos jours encore le pronostic de la maladie de Horton, par leur fréquence (14–20 %) et leur gravité extrême, en contraste avec la remarquable efficacité préventive de la corticothérapie sur leur apparition. Des symptômes ischémiques fugaces (amaurose fugace ou brouillard visuel, diplopie, visions colorées) les précédent une fois sur deux, ou peuvent rester isolés. Les atteintes graves sont, pour la plupart, évitables par un diagnostic plus précoce de l’artérite temporale. L’amaurose fugace, la claudication des masséters, l’absence de symptômes systémiques, et un syndrome inflammatoire modeste représentent des facteurs de risque d’amaurose permanente. L’examen ophtalmologique en urgence, complété d’une angiographie à la fluorescéine et de tests biologiques simples (vitesse de sédimentation [VS], CRP, hémogramme), doit conduire à la mise en route immédiate d’une corticothérapie intensive (1 mg/kg par jour), éventuellement précédée d’emboles intraveineux de méthylprednisolone, plus pour stabiliser l’atteinte constituée et prévenir la cécité controlatérale, que pour tenter d’obtenir une récupération visuelle significative, exceptionnelle. La durée de la corticothérapie d’une forme ophtalmologique n’est pas codifiée ; l’objectif est le contrôle parfait de la maladie, en raison notamment d’un risque élevé (8–18 %) de récidive d’amaurose en cours de décroissance cortisonique. Des études rétrospectives suggérant un effet préventif de l’aspirine à faibles doses sur l’atteinte visuelle et cérébrovasculaire de la maladie de Horton, il est logique de l’associer aux corticoïdes dans les formes avec complication visuelle initiale.Permanent visual loss (PVL) is the most dreaded complication of giant cell arteritis (GCA). It results from anterior ischemic optic neuropathy or, less commonly, retinal artery occlusion. This complication still occurs in 14 to 20% of patients and is typically devastating and permanent, although it is highly preventable by an early diagnosis of giant cell arteritis and appropriate glucocorticoid treatment. Transient ischemic symptoms such as amaurosis fugax, episodes of blurred vision or diplopia may occur, either heralding visual loss or remaining isolated. In studies, the main predictors of PVL are jaw claudication, amaurosis fugax, lack of systemic “B” symptoms, a modestly increased ESR and a higher haemoglobin level. The evaluation of a GCA patient with PVL includes emergency fundoscopy completed by fluorescein angiography, immediate erythrocyte sedimentation rate, C-reactive protein, and complete blood count. Treatment is extremely urgent mainly because, if left untreated, GCA is associated with visual loss in the fellow eye within days in up to 50% of individuals. Treatment may begin with high-dose intravenous methylprednisolone, followed by oral prednisone administered at 1 mg/kg per day. Daily adjunctive aspirin orally may be added since it has been shown, in retrospective studies, to protect against stroke and visual loss. Although treatment duration of complicated GCA is not codified, an initial PVL deserves close monitoring of patient's systemic symptoms, ESR and CRP to avoid relapses due to a significant risk of late recurrence of visual loss during steroid tapering.

The sentinel lymph node procedure is still under evaluation for the management of cervical and endometrial carcinomas. The aim of our study was to determine the diagnostic accuracy of single-photon emission computed tomography/computed tomography (SPECT/CT) for preoperative sentinel lymph node mapping in uterine cancers. Sixty-eight patients with cervical (n = 42) or endometrial carcinoma (n = 26) underwent preoperative lymphoscintigraphy for sentinel node mapping. Sentinel node detection rate with conventional planar imaging was similar to that of SPECT/CT (87.1 versus 91.8 %) in the whole cohort. However, SPECT/CT detected a higher number of sentinel nodes in more than one third of patients, affected by either cervical or endometrial carcinoma. The rate of non or insufficiently contributive procedures (lack of uptake or unilateral uptake) in endometrial carcinomas was 47 % with conventional planar imaging, and 30 % with SPECT/CT. Sensitivity of both procedures for the detection of metastatic nodes was 81.8 %, compared to 100 % for the intraoperative combined detection (gamma probe sonde and blue dye). The impact of SPECT/CT for the sentinel lymph node detection in cervical and endometrial carcinomas needs further evaluation. Nevertheless, SPECT/CT may provide additional information when conventional planar imaging detects only unilateral uptake, may improve identification of atypical localizations, and facilitate surgical approach. (C) 2013 Elsevier Masson SAS. All rights reserved.

INTRODUCTION:The sensitivity of the detection of irregular antibodies (DIA) is one of the fundamental basis of transfusion safety. The production of alloantibodies is the first cause of adverse events following transfusion. CASE REPORT:We report a 77-year-old woman who was transfused and presented with a delayed haemolytic anemia due to anti-JK1 alloimmunization. This event highlights the limits of DIA performed before a transfusion, the hazard of this specific type of antibody and the difficulties of the diagnosis of haemolytic anaemia. The preventive measures necessary to avoid this undesirable effect are reminded. CONCLUSION:Despite the sensitive routine test method, the anti-JK1 antibodies could be missed. We should keep in mind the possibility of an anaemia due to alloantibodies we confronted to an unexplained haemolytic episode.

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