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La carence en vitamine B12 reste une anomalie biologique fréquente chez le sujet âgé. Son retentissement clinique et ses étiologies diverses et variées constituent un réel défi pour le gériatre. En effet, son diagnostic est souvent difficile car la symptomatologie clinique et biologique est très souvent fruste et non spécifique, notamment chez le sujet âgé. La prise orale est une alternative intéressante pour traiter la carence en vitamine B12 dans cette population.

Nous réalisons ici une revue de la littérature centrée sur les projets de télémédecine développés dans le domaine de l’insuffisance cardiaque. Nous détaillerons tout particulièrement le projet de télésurveillance appelé E-care, dédié à la détection précoce des situations à risque de décompensation cardiaque. Les perspectives du développement du système E-caredans le domaine de la diabétologie seront également abordées.

We have previously developed a communicating and intelligent electronic digital stethoscope. Part of the developments has been conducted in collaborative and institutional projects. These research projects resulted in the implementation of a Bluetooth electronic stethoscope (eStetho), together with signal processing and data communication techniques.

Il a été évoqué, et mis en évidence, dans des travaux avant tout épidémiologiques, un lien entre carence en vitamine B12 (cobalamine) et prise de metformine au long cours. Ce lien semble se faire par le biais d’un syndrome de maldigestion des cobalamines alimentaires. Cet article développe les acquisitions récentes, utiles au praticien, concernant ce syndrome. Il s’agit d’une entité nouvellement décrite, qui occupe actuellement la première place parmi les étiologies des carences en cobalamine.

Monitoring patients with heart failure by using telemedicine systems is a potential means for optimizing the management of these patients and to facilitate the job of health care professionals. We report the experience of the deployment of such a monitoring platform, through the E-careproject.

This paper describes state of the art, scientific publications and ongoing research related to the methods of analysis of respiratory sounds. The study includes a description of the various techniques that are being used to collect auscultation sounds, a physical description of known pathologic sounds for which automatic detection tools were developed. The next step will consist in finding new markers so as to increase the efficiency of decision aid algorithms and tools.

Drug‐induced agranulocytosis (DIA) is often caused by antithyroid drugs. We retrospectively studied the use of granulocyte colony‐stimulating factor (G‐CSF) therapy in antithyroid‐DIA. Data for 20 patients (10 treated with G‐CSF) with antithyroid‐DIA (neutrophil count <0.5×109/l) were extracted from a cohort study of DIA patients (n=110). G‐CSF (300 μg/day subcutaneously) was used where the neutrophil count was <0.1×109/l, or the patient was aged >70 years, or there were severe features of infection or underlying disease. Mean patient age was 62 years (range 34–87); sex ratio (M/F) was 0.05. Carbimazole (n=19) and benzylthiouracile (n=1) were the causative drugs, at mean doses of 30 mg/day (range 20–60) and 100 mg/day (range 50–150), respectively, for a mean of 37 days (range 31–90). Antithyroid drugs were prescribed for Graves' disease (n=8), thyrotoxicosis related to amiodarone intake (n=6) and multinodular goitre (n=6). Clinical features included isolated fever (n=7), pneumonia (n=5), septicaemia or septic shock (n=5) and acute tonsillitis (n=3). Mean neutrophil count was 0.07±0.1×109/l. No patient died. Mean durations of haematological recovery, antibiotic therapy and hospitalization were significantly reduced with G‐CSF: 6.8±4 days vs. 11.6±5; 7.5±3.8 days vs. 12±4.5; and 7.3±4.8 days vs. 13±6.1, respectively (all p<0.05). G‐CSF induced flu‐like symptoms in 30% of patients, but reduced overall costs.

The structure of the title compound, [Ta2O(C2B9H11)2(C4H9­N2)4]·0.5CH2Cl2, contains two (C2B9H11)Ta[NC(Me)NMe2]2units bridged by a nearly linear [Ta—O—Ta 163.4 (4)°] μ‐oxo ligand. The dichloromethane molecule lies on a twofold axis.

Le suivi au quotidien des patients insuffisants cardiaques par des professionnels de santé empêche la décompensation cardiaque. L’utilisation de systèmes de télémédecine est un moyen potentiel pour faciliter le suivi, optimiser la gestion de ces patients. Nous rapportons ici l’expérience du développement et déploiement d’une telle plate-forme de suivi des patients présentant une insuffisance cardiaque à travers le projet E-care.

Human leukocyte antigen (HLA) class I deficiency is a rare disease with remarkable clinical and biological heterogeneity. The spectrum of possible manifestations extends from the complete absence of symptoms to life-threatening disease conditions. It is usually diagnosed when HLA class I serological typing is unsuccessful; flow cytometric studies then reveal a severe reduction in the cell surface expression of HLA class I molecules (90–99% reduction compared to normal cells). In most cases to date, this low expression is due to a homozygous inactivating mutation in one of the two subunits of the transporter associated with antigen processing (TAP), critically involved in the peptide loading of HLA class I molecules. Although asymptomatic cases have been described, TAP deficiencies are usually characterized by chronic bacterial infections of the upper and lower airways, evolving to bronchiectasis, and in half of the cases, also skin ulcers with features of a chronic granulomatous inflammation. Despite the defect in HLA class-I-mediated presentation of viral antigens to cytotoxic T cells, the patients do not suffer from severe viral infections, presumably because of other efficient antiviral defence mechanisms such as antibodies, non-HLA-class-I-restricted cytotoxic effector cells and CD8+ T-cell responses to TAP-independent antigens. Treatment is at present exclusively symptomatic, and should particularly focus on the prevention of bronchiectasis, which requires early detection.

Drug‐induced agranulocytosis (DIA) is often caused by antithyroid drugs. We retrospectively studied the use of granulocyte colony‐stimulating factor (G‐CSF) therapy in antithyroid‐DIA. Data for 20 patients (10 treated with G‐CSF) with antithyroid‐DIA (neutrophil count <0.5×109/l) were extracted from a cohort study of DIA patients (n=110). G‐CSF (300 μg/day subcutaneously) was used where the neutrophil count was <0.1×109/l, or the patient was aged >70 years, or there were severe features of infection or underlying disease. Mean patient age was 62 years (range 34–87); sex ratio (M/F) was 0.05. Carbimazole (n=19) and benzylthiouracile (n=1) were the causative drugs, at mean doses of 30 mg/day (range 20–60) and 100 mg/day (range 50–150), respectively, for a mean of 37 days (range 31–90). Antithyroid drugs were prescribed for Graves' disease (n=8), thyrotoxicosis related to amiodarone intake (n=6) and multinodular goitre (n=6). Clinical features included isolated fever (n=7), pneumonia (n=5), septicaemia or septic shock (n=5) and acute tonsillitis (n=3). Mean neutrophil count was 0.07±0.1×109/l. No patient died. Mean durations of haematological recovery, antibiotic therapy and hospitalization were significantly reduced with G‐CSF: 6.8±4 days vs. 11.6±5; 7.5±3.8 days vs. 12±4.5; and 7.3±4.8 days vs. 13±6.1, respectively (all p<0.05). G‐CSF induced flu‐like symptoms in 30% of patients, but reduced overall costs.