Les déficits immunitaires primitifs de l’adulte pouvant s’accompagner de granulomatose concernent quasi-exclusivement le déficit immun commun variable (DICV). La découverte d’une ...hypogammaglobulinémie chez un adulte impose de rechercher en priorité un déficit secondaire de l’immunité humorale et en cas de granulomatose associée, une infection opportuniste. Pour des raisons mal connues, environ 10 % des patients atteints de DICV développent en dehors de tout contexte infectieux ou iatrogène des lésions de granulomatose prédominant au niveau médiastino-pulmonaire. La moitié de ces patients présente également des cytopénies auto-immunes dont le traitement est mal codifié. Une atteinte pulmonaire non infectieuse est présente chez un peu plus de la moitié des patients porteurs de l’association DICV et granulomatose. Elle constitue généralement un critère pronostique péjoratif.
Primary immunodeficiency with granulomatosis in the adulthood mainly concern common variable immunodeficiency (CVID). Hypogammaglobulinemia in the adulthood is usually related to a secondary immunodeficiency. When a patient presents with the association of a hypogammaglobulinemia and a granulomatosis, an opportunistic infection must first be ruled out. For unknown reasons, about 10% of the patients affected by CVID also present with granulomatosis. Lesions usually affect the pulmonary tract or the mediastinum. Half of these patients are also affected by an autoimmune cytopenia. Treatment is not codified. Severe pulmonary complications can occur in about 50% of the patients.
Une cause rare de douleurs abdominales Bergmann, C.; de Charry, C.; Karkowski, L. ...
La revue de medecine interne,
10/2012, Letnik:
33, Številka:
10
Journal Article
Pancreatic adenocarcinoma (PAC) is a highly malignant tumor with relevant morbidity and mortality. The role of adjuvant chemoradiotherapy (CRT) for primarily resected tumors remains controversial. We ...aimed to assess the outcome of patients treated at our institution with postoperative CRT for PAC.
We present a retrospective case series of patients with pancreatic adenocarcinoma at a single center in Switzerland. These patients were treated by primary surgery followed by adjuvant CRT between 1995 and 2015. The results were compared with published data.
Median follow-up for the 60 patients was 33 months (range 19.9–193.9); median overall survival (OS) for patients undergoing a resection followed by combined CRT was 25.5 months. Overall, disease-free survival (DFS) was 15.2 months. A local recurrence occurred in 14 patients (23.3%) after a median time of 8.8 months, and in 43 patients (71.7%) distant metastasis was demonstrated with a median time to metastasis of 10.6 months.
This retrospective study represents one of the sole reviews of outcome data after adjuvant CRT in resected PAC in Europe within the past years. OS was comparable to that of other institutional outcome data published previously but inferior when compared to most recent published results with an intense chemotherapy. However, not all patients are suitable to undergo such an intense chemotherapy with modified FOLFIRINOX after the extensive surgery for the PAC – these patients could benefit from adding adjuvant CRT to a less intensive chemotherapy with gemcitabine to enhance the benefit regarding locoregional recurrence-free survival.
•We investigated overall survival after resection of pancreatic cancer with adjuvant chemoradiotherapy.•Our cohort treated with chemoradiotherapy showed comparable overall survival to previously published data which have more favorable pathologic disease.•We recommend chemoradiotherapy as adjuvant treatment in patients with pancreatic cancer when modified FOLFIRINOX is too demanding.
La protéine C-réactive (CRP) est un marqueur biologique performant, de cinétique rapide, utilisé en routine pour apprécier le syndrome inflammatoire. L’objectif de cette étude était d’étudier le ...profil étiologique et la gravité associés à des valeurs très élevées de CRP supérieures ou égales à 500 mg/L.
Étude rétrospective exhaustive réalisée de janvier 2004 à juillet 2009 au sein d’un hôpital général, analysant toutes les CRP supérieures ou égales à 500 mg/L quel que soit le service d’hospitalisation. Tous les dossiers ont fait l’objet d’un remplissage d’une grille de données standardisées par un seul observateur.
Cent soixante-huit valeurs de CRP supérieures ou égales à 500 mg/L ont été identifiées parmi 106 758 dosages (0,16 %), correspondant à 113 patients : 51 % étaient des hommes et l’âge moyen était de 59,5 ans. La CRP moyenne était de 561 mg/L (500–772). Une immunodépression était retrouvée chez 52 % des patients. Seulement 13 patients présentaient un diagnostic non infectieux. Pour les patients infectés, l’analyse microbiologique retrouvait 59 cocci à Gram positif (20 staphylocoques et 35 streptocoques dont 21 pneumocoques), deux cocci à Gram négatif, 48 bacilles à Gram négatif (dont 19
Escherichia coli), trois bacilles à Gram positif, 16 champignons, un virus. Le siège de l’infection était pulmonaire (63 %), urologique (17 %), digestif (16 %). À j30, on notait 27 % de décès et 41 % de retour au domicile.
Une CRP supérieure ou égale à 500 mg/L est fortement associée à une infection bactérienne, sans surreprésentation évidente d’un germe donné. Le risque de mortalité à un mois est important (27 %).
The C-reactive protein (CRP) is a useful inflammatory marker with a rapid kinetics during the inflammatory process. The objective of this study was to determine the etiology and prognosis of extremely elevated CRP values greater or equal to 500 mg/L.
We performed an exhaustive retrospective study from January 2004 to July 2009, in a general hospital, of all patients with a CRP value above 500 mg/L, admitted in all clinical departments. Clinical data were collected by a single observer using a standardized questionnaire.
One hundred and sixty-eight CRP values greater or equal to 500 mg/L were identified amongst 106,758 tests (0.16%) corresponding to 113 patients: 51% were men and their mean age was 59.5 years. Mean CRP value was 561 mg/L (500–772). An immunocompromised condition was observed in 52% of the patients. All but 13 patients presented an infectious disease. Microbiological analysis of the infected patients identified 59 Gram-positive cocci (20
Staphylococcus spp., 35
Streptococcus spp. including 21
Streptococcus pneumoniae), two Gram-negative cocci, 48 Gram-negative bacilli (including 19
Escherichia coli), three Gram-positive bacilli, 16 fungal infections, one viral infection. Site of infection was respiratory in 63%, urinary in 17% and abdominal in 16%. At day 30, mortality rate was 27% and only 41% of the patients were discharged at home.
CRP value above 500 mg/L is highly related to bacterial infections, without over-representation of a given microorganism. One-month mortality is high (27%).
