Annales de medecine interne最新文献

First trimester recurrent fetal loss and severe second or third trimester placental vascular disorders are still frequently unexplained. Acquired biological thrombophilia (antiphospholipid syndrome, essential thrombocythemia) are known risk factors. Genetic thrombophilia may represent a new risk factor for placental vascular diseases, but reported data are conflicting. Combined hereditary thrombophilias are indeed a moderate risk factor, but even in these cases most pregnancies are normal giving healthy live birth children. Whether hereditary thrombophilia is associated with recurrent severe placental vascular disorders is unknown.

Progress in immunologic methods and diagnostic assays over the last two decades has led the description of an association between some cases of recurrent fetal loss and recurrent spontaneous abortion of unknown cause to immunological factors. Some causal immunological diseases or dysregulations have been identified in pregnant women. These abnormalities may precede or be triggered by the pregnancy, or occasionally result from an impairment of the mother's allogeneic response to the fetus. In this article we review the principal immunological factors and abnormalities implicated in recurrent pregnancy loss and focusing on those generally accepted by the majority of authors.

We report two cases of constrictive pericarditis revealing neoplasia. Both patients underwent pericardiotomy with drainage and biopsy that did not disclose malignancy. Likewise, the initial radiologic were not suggestive of cancer.

Background: Celiac disease is an autoimmune disorder which may be associated with another autoimmune or systemic disease.

Objective: To determine the links between autoimmune diseases and celiac disease.

Patients and methods: Among 31 patients with a celiac disease, we selected those who had another autoimmune or systemic disease.

Results: We report 6 patients with such disease association: 3 with autoimmune thyroiditis including one also with Grave's disease, 2 with systemic lupus erythematosus including one also with insulin-dependent diabetes mellitus, and 1 with temporal arteritis.

Conclusion: The link between celiac disease and autoimmune thyroiditis or insulin-dependent diabetes mellitus seems to be real but many discrepancies are observed for the other autoimmune diseases. After a literature review, we suggest a summary of effective associations between celiac disease and autoimmune or systemic diseases.

Predisposing clinical features in pregnant women are poorly evaluated in the literature. Several factors are undeniable, for example extrinsic compression of the iliac vein (Cockett syndrome), post phlebitis disease, varicose vein disease, and, for most patients, unquantifiable risk factors. Careful assessment of the overall sensitivity to venous thrombosis, on the basis of history taking (patient and family), will allow better assessment of the predisposition to thromboembolism.

A traumatic event (assault, traffic accident, bomb attack or war, disasters.) is often followed by a reaction of fear and anxiety which can evolve to a posttraumatic stress disorder (PTSD). Its severity and associated handicap justify treatment as early as possible. We present the various PTSD treatments and discuss their respective efficiency and limitations. Most of available treatments (cognitive and behavioral therapies, antidepressants.) are efficient on PTSD and co-morbid disorders. However, the efficiency of some therapies (eye movement desensitization) on the treatment of PTSD are controversial. Studies are necessary to evaluate various treatment strategies, optimal duration of antidepressant treatment and pediatric therapies.

Venous thromboembolism is the leading cause of death in the ante-partum and post-partum period. The role of genetic thrombophilia in venous thrombosis has been analyzed in several studies, but the role of genetic thrombophilia in fetal loss, intra-uterine growth restriction and pre-eclampsia is much more controversial. While we can give some recommendations on thromboprophylaxis of venous thromboembolism, data concerning the usefulness of antithrombotic treatment in obstetric complications of genetic thrombophilia are lacking. When a laboratory work-up of thrombophilia is required, all the known causes of thrombophilia must be checked as none of them is specific of a single clinical feature, but also because they can be associated in the same patient.