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IntroductionIn the French armed forces, the biological checkup required during the recruitment process comprises a urinalysis (urinary dipstick), a complete blood count (CBC), and measurement of serum levels of aspartate aminotransferase, alanine aminotransferase, fasting blood glucose, and creatinine. This study aimed to evaluate the benefits of this biological checkup and to determine the most relevant parameters.Materials and MethodsWe conducted a monocentric retrospective study of all standardized and systematically conducted blood tests (CBC and measurement of aspartate aminotransferase, alanine aminotransferase, fasting blood glucose, and creatinine) over a 15-month period among 726 French Army recruits.ResultsThe population included mainly young males (85.4%, mean age 21.6 years). More than half (54.1%) of the blood tests had at least one abnormal parameter, most often concerning the CBC. Anemia occurred in 5.3% of the population and was mostly normocytic. Microcytosis was mostly not associated with anemia (72.3% of cases). Lymphopenia occurred in 20.1% of the population and was mostly mild. Eosinophilia was present in 5.1% of the population and was never severe. Thrombocytopenia occurred in 0.7% of the population and was never severe. Serum levels of aminotransferases were elevated in 8.1% of the population. Fasting plasma glucose averaged 84 mg/dL (SD: 0.07) ranging from 64 to 123 mg/dL, was abnormal in 0.4% of the population, and one case of diabetes was diagnosed. Serum creatinine concentration was elevated in 0.7% of the population.ConclusionCBCs gave useful information but iron deficiency was common and insufficiently detected by this single analysis. Assessing aminotransferase levels without screening for viral hepatitis and systematic measurement of fasting plasma glucose levels did not appear to be efficient. In addition, the only interest in systematic measurement of creatinine serum levels was to obtain a reference level for long-term follow-up. In addition to the urinary dipstick, the systematic biological checkup at recruitment could be limited to a CBC with measurement of plasma ferritin levels and Hepatitis B virus serology, providing that any CBC abnormalities, in particular cytopenia, eosinophilia, and microcytosis, are systematically investigated. For a public health approach, systematic screening for other sexually transmitted infections could be proposed.

RESUME Connue depuis cinquante ans, l’entite aujourd’hui denommee syndrome metabolique, a fait l’objet de multiples definitions qui ont amene une certaine confusion et meme une remise en cause de son originalite. Le syndrome metabolique est etroitement lie a la presence d’une obesite androide qui temoigne d’une insulinoresistance et se situe au confluent de tous les facteurs de risque et aux avant-postes du diabete de type 2. Son depistage passe par la mesure systematique du tour de taille et par son interpretation en tenant compte de l’ethnie consideree. Cette attitude pragmatique de clinicien evite les incertitudes generees par les differentes definitions et apporte plus de nuances que la presence ou non d’un syndrome metabolique chez un sujet donne. Face a une obesite androide, les mesures therapeutiques non medicamenteuses sont peu couteuses et efficaces mais sous cette simplicite apparente se cachent des difficultes de mises en œuvre qui constituent en fait un probleme de societe en raison de l’epidemie annoncee.

Resume L'amylose articulaire est principalement decrite au cours de l'amylose a β 2 microglobuline chez les dialyses. Elle s'observe plus rarement dans l'amylose AL du myelome multiple et complique exceptionnellement une maladie de Waldenstrom. Nous rapportons une observation associant une hemopathie lymphoplasmocytaire secretant une IgM et une arthropathie amyloide dont l'expression clinique est une polyarthrite bilaterale et symetrique. Le diagnostic repose sur la biopsie synoviale. L'evolution a ete favorable sous chimiotherapie. Toute manifestation articulaire au cours d'une gammapathie monoclonale, y compris a IgM, doit faire evoquer une amylose articulaire. Le traitement de l'hemopathie peut ameliorer la symptomatologie articulaire.

Abdominal pain is uncommon in patient with Epstein-Barr infection and is usually attributed to an enlargement of the liver or spleen. We report on an 8-year-old girl with a pseudoperitonitis due to a mesenteric lymphadenitis associated with Epstein-Barr infection. Outcome was favourable without surgery. We review the different causes of abdominal pain occurring during Epstein-Barr infection.

When focusing on heart disease, most available studies split the two different parts of the adjuvant treatment, i.e., systemic therapies and radiation therapy, making it difficult to implement efficient strategies for preventing treatment-induced cardiac toxicity. This paper reviews the current understanding of treatments-induced cardiac toxicity in a global approach. Many factors should be considered when assessing the cardiac hazard. Treatment-related risk factors include heart dose exposure, chemotherapy, targeted agents such as HER2 inhibitors, but also endocrine agents, or anesthetic procedure. Patients’ characteristics should also be taken into account. Age, menopausal status, stress, previous history of cardiac disease, genetic profile, and body mass index could all impact on cardiac function after adjuvant therapies. Cardiac toxicity should not be analyzed as the consequence of a specific therapy, but should be considered as the result of additive or supra-additive toxicities. By this way, it will be possible to implement new strategies for preventing treatment-induced cardiac toxicity.

Hairy cell leukemia (HCL) is a rare, chronic, B-cell, lymphoproliferative disorder. Treatment has been revolutionized by the advent of interferon (IFN)-α and purine analogs (PA). First-line therapy with PA yields complete response rates of 75–100%, with many long-lasting remissions. In the event of profound neutropenia and/or infectious complications, a short sequence of IFN-α may precede PA treatment. Because of the excellent results achieved with PA therapy, the potential role of rituximab (an anti-CD20 monoclonal antibody that is highly effective against most B-cell lymphomas) in HCL has yet to be elucidated. Six HCL cases treated with rituximab are reported herein with a view to elucidating the potential role of the drug in HCL. The indications essentially consist of relapsing or refractory disease, avoiding the cumulative toxicity of PA, consolidation therapy in order to eradicate minimal residual disease, and first-line therapy for patients with contraindications to PA and IFN-α.

Amyloid arthropathy occurs chiefly as a manifestation of β 2 microglobulin amyloidosis in patients receiving chronic hemodialysis. AL amyloidosis complicating multiple myeloma is a less common cause. Amyloid arthropathy is exceedingly rare in patients with Waldenstrom macroglobulinemia. We report a case characterized by lymphoplasmocytoid malignancy with monoclonal IgM production and amyloid arthropathy manifesting as bilateral symmetric polyarthritis. A synovial membrane biopsy established the diagnosis. Chemotherapy was effective in alleviating the joint manifestations. Joint symptoms in patients with monoclonal gammopathies, including those characterized by IgM secretion, should suggest amyloid arthropathy. Treatment of the blood disease may improve the joint symptoms.

A patient meeting published criteria for remitting seronegative symmetrical synovitis with pitting edema (RS3PE) was found to have a synchronous recurrence of non-Hodgkin's malignant lymphoma. Reported cases of RS3PE associated with hematological malignancies and other forms of cancer are reviewed.

Resume Introduction Les patients gueris par chimiotherapie d’une tumeur testiculaire presentent une morbidite cardiovasculaire accrue. Par contre, la survenue d’un evenement cardiovasculaire durant l’administration du traitement est exceptionnelle. Observation Nous rapportons l’observation d’un infarctus du myocarde chez un homme jeune durant la premiere cure de chimiotherapie par protocole BEP pour une tumeur testiculaire. Discussion Nous suggerons un lien de causalite entre cet evenement cardiovasculaire et la chimiotherapie administree. Les mecanismes physiopathologiques sont discutes.