Despite a better prognosis for patients with haematologic malignancies (PHM) over these past years due to progress in management, intensivists are reluctant to admit those patients to the ICU because of high mortality rates, above 50%. The aim of this study was to retrospectively evaluate the value of intensive care therapy of PHM and predictive factors of short-term and long-term survival with the best post-ICU quality of life.

Corticosteroid allergy is rare and can be fatal. Many asthmatic or acetylsalicylic acid intolerant patients may be concerned. The diagnostic of corticosteroid allergy have to be confirmed by clinical history and skin tests of the different groups to try to identify one or more allergens and to propose a alternative treatment if necessary.

Les fistules duodénocaves sont très rares. Nous rapportons le cas d'un patient de 44 ans qui avait présenté un ulcère duodénal perforé fistulisé dans la veine cave inférieure avec un thrombus flottant. Il n'avait pas d'antécédent connu de pathologie ulcéreuse. Le patient avait présenté un choc septique puis secondairement un choc hémorragique. Seule la laparotomie avait permis de faire un diagnostic positif. Le traitement était chirurgical et l'évolution avait été rapidement favorable. Le pronostic dépend de la rapidité du geste chirurgical et de l'expérience de l'opérateur.

The duodenocaval fistula is exceptional. We report the case of a 44-year-old patient with duodenocaval fistula. The patient had no history of peptic ulcer disease. The clinical feature was firstly a septic shock and then an haemorrhagic shock. Only laparotomy confirmed the diagnosis. The treatment was a surgical one with a rapid improvement. The prognosis depends on surgical experience and remains serious.

Introduction. - Corticosteroids are widely used for the management of many diseases because of anti-inflammatory and immunomodulatory properties. Sulfite intolerance is well known but immediate hypersensitivity to corticosteroids is rarer and must be reported.Exegesis. - We report a case of a 38-year-old man, followed since 1986 for asthma with sulfite intolerance. He twice developed urticaria after ingesting betalactam antibiotics associated with corticosteroids of the group A, according to the Matura and Goossens's classification. The allergy inquiry confirmed not only a beta-lactame allergy but also in corticosteroids of the group A. Intradermal reactions with methylprednisolone and hydrocortisone were positive at 7 mm for methylprednisolone on 1/1000 dilution and at 4 mm for hydrocortisone on 1/10 dilution. Thus immediate allergy to corticosteroids was confirmed. But those skin tests were negative for corticosteroids of group B and C. In order to propose an alternative therapy for acute asthma, an intravenous injection of 4 mg of betamethasone was performed without inducing immediate and delayed allergic reactions.Conclusion. - Corticosteroid allergy is rare and can be fatal. Many asthmatic or acetylsalicylic acid intolerant patients may be concerned. The diagnostic of corticosteroid allergy have to be confirmed by clinical history and skin tests of the different groups to try to identify one or more allergens and to propose a alternative treatment if necessary. (c) 2005 Elsevier SAS. Tous droits reserves.

L’hypersensibilité aux antipaludéens de synthèse est peu décrite dans la littérature. La chloroquine sulfate est un antipaludéen de synthèse d’utilisation répandue. Nous rapportons deux observations personnelles d’hypersensibilité retardée à la chloroquine sulfate mises en évidence par un test de provocation orale associé à un protocole de réintroduction sur plusieurs jours. La chloroquine sulfate est une molécule de demi-vie longue. Ces deux cas illustrent le fait que la négativité des tests cutanés peut être faussement rassurante, d’où la rareté des cas de réactions d’hypersensibilité à la chloroquine sulfate décrits dans la littérature. La poursuite du bilan allergologique par ce schéma (test de provocation orale suivi d’une réintroduction sur plusieurs jours) peut permettre d’identifier les cas douteux d’hypersensibilité à la chloroquine ou tout autre antimalarique de demi-vie longue. Few cases of hypersensitivity reactions due to antimalarials are described in the literature. Chloroquine sulfate is a widely used antimalarial drug with a long elimination half-life. We report two cases of delayed hypersensitivity to chloroquine diagnosed by open oral challenge and programmed re-introduction of the drug over several days. These cases point out the possibility of false negative skin tests, from which it follows that there are few reports of chloroquine hypersensitivity syndrome in the medical literature. We recommend that the allergy work-up when these conditions suspected include open oral challenge and drug re-introduction over several days. This approach may help identify cases of possible hypersensitivity to chloroquine or other anti-malarial drugs with a long elimination half-life.

Introduction Paradoxial hypertrophy is frequent in cases of peripheral lymph node tuberculosis. Its management remains controversial.Case study We report a case of susclavicular and anterior cervical lymph nodes tuberculosis complicated by paradoxical hypertrophy after 4 months of treatment in a 59-year-old woman. The lymph node was not compressive but was limiting the cervical mobilisation. The caseum was sucking three times with a fine needle. Thereafter we performed an isoniazid injection each 24 hours for three days at three different lymph node sites. Anti-tuberculous treatment was reinitiated for 10 months at all and lymph nodes completely disappeared without functional sequels.Conclusion Paradoxical hypertrophy is a frequent complication of peripheral lymph node tuberculosis. Caseum suction of the paradoxical hypertrophy with a fine needle may constitute an alternative treatment of surgery.

INTRODUCTION:Paradoxical hypertrophy is frequent in case of peripheral lymph node tuberculosis. Its management remains controversial.CASE STUDY:We report a case of susclavicular and anterior cervical lymph nodes tuberculosis complicated by paradoxical hypertrophy after 4 months of treatment in a 59-year-old woman. The lymph node was not compressive but was limiting the cervical mobilisation. The caseum was sucking three times with a fine needle. Thereafter we performed an isoniazid injection each 24 hours for three days at three different lymph node sites. Antituberculous treatment was reinitiated for 10 months at all and lymph nodes completely disappeared without functional sequels.CONCLUSION:Paradoxical hypertrophy is a frequent complication of peripheral lymph node tuberculosis. Caseum suction of the paradoxical hypertrophy with a fine needle may constitute an alternative treatment of surgery.

Hypersensitivity reactions to anti-tuberculosis agents are relatively uncommon, but when they occur they result in therapeutic problems. We report a case of hypersensitivity to both isoniazid and pyrazinamide. Rapid oral desensitization to Rifater(R), necessitated by the progression of the patient's tuberculosis, was successfully conducted, allowing the patient to proceed with an optimal anti-tuberculosis regimen. (C) 2002 Editions scientifiques et medicales Elsevier SAS. All rights reserved.

Des réactions anaphylactiques après consommation de calmar chez des patients allergiques aux acariens ont été plusieurs fois décrites.

UNLABELLED:Anaphylactic reactions after consumption of squid by patients sensitized to house dust mites have been reported several times.CASE REPORT:A child allergic to dust mites developed an angioneurotic edema after eating squid. An immunoallergological assessment, including the prick test, labial test and IgE RAST revealed an allergy associated to both dust mites and squid.CONCLUSIONS:In light of the potential seriousness of anaphylactic reactions, parents of children allergic to dust mites and these children should be made aware of the increased risk of allergies to squid that they may face.