Annales de médecine interne
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It is now well established that sarcoidosis is a granulomatous disorder resulting from an uncontrolled cell-mediated immune reaction in response to unknown antigens. This reaction is characterized by the presence of typical granulomas at the sites of the disease, made of activated macrophages (epithelioid cells) and T lymphocytes. The interactions between both cell types lead to the production of numerous inflammatory mediators which are essential for the development of granulomas. ⋯ Recent data have emphasized in some patients the expression of particular HLA haplotypes, the polymorphism of various genes, and the presence of oligoclonal T lymphocytes. The characterization of the antigenic specificity of these T cells could be helpful in identifying agents responsible for the disease. The role of mycobacterial agents is still controversial.
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Ann Med Interne (Paris) · Feb 2000
Review Case Reports[Aneurysm of the sinus of Valsalva. Apropos of a case of right intra-atrial rupture].
An unusual systolo-diastolic heart murmur was discovered fortuitously in a 39-year-old man undergoing a routine check-up. Transesophageal echocardiography gave the diagnosis of Valsalva sinus aneurysm ruptured into the right atrium. ⋯ We reviewed the literature on this unusual condition, focusing on the pathophysiological, clinical, diagnostic and therapeutic aspects. Transesophageal echocardiography provides the diagnosis.
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Ann Med Interne (Paris) · Dec 1999
Review Comparative Study[What present strategies are helpful in improving transfusion safety in France?].
Transfusion safety rests on measures ensuring that patients are transfused in accordance with the requirements of state-of-the-art scientific knowledge. This strict attitude is part of a quality approach which now applies to all fields of health. Transfusion is historically characterized by its ambivalence: it was the first medical discipline which integrated Quality Assurance concepts, it was also the first which proved unable to respond adequately in the face of uncontrolled risks. ⋯ Numerous R&D; programs address substitution products. Transfusion safety requires all actors in the field of health being equally involved. Putting together experiences and know-how will continuously strengthen the quality approach adopted in transfusion.
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Ann Med Interne (Paris) · Oct 1999
Review Case Reports[Hepatotoxicity caused by therapeutic doses of paracetamol in alcoholics. Report of 2 cases of fatal hepatitis in cirrhosis].
Paracetamol is a widely used medication as it is an effective analgesic and antipyretic. Because of the absence of gastro-intestinal side effects, it has been used as the analgesic of choice for alcoholic patients. ⋯ However, cases of severe liver damage have been reported after absorption of therapeutic doses of paracetamol in alcoholics. We report 2 cases with a fatal outcome and discuss the mechanisms of toxicity, the prognostic factors and treatment of such event.
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Hutchinson-Gilford progeria syndrome is a rare syndrome of premature aging with multiple skeletal abnormalities. We report one case. ⋯ Pronounced acro-osteolysis, osteolysis of the clavicle are the main features. Modern imaging is useful to diagnose the complications.