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If the Begin military teaching hospital, a level 1 health facility, managed to maintain its position during the covid-19 crisis, it is thanks to the total commitment of its staff. To face the crisis, the hospital director ensured a very good level of preparedness and mobilisation of the teams.

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.

If the Bégin military teaching hospital, a level 1 health facility, managed to maintain its position during the covid-19 crisis, it is thanks to the total commitment of its staff. To face the crisis, the hospital director ensured a very good level of preparedness and mobilisation of the teams.

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.

Introduction Un antecedent d’infection par le virus de l’hepatite B (VHB), present chez 5 a 10 % de la population, impose des mesures de prevention du risque de reactivation en cas de traitements immunosuppresseurs. La persistance d’ADN viral super-enroule intrahepatocytaire expose au risque de replication virale avec possible hepatite aigue grave, parfois fatale. L’objectif est, ici, une evaluation des pratiques visant a prevenir la reactivation virale B en situation d’immunosuppression chimio-induite ou par immunotherapies ciblees. Patients et methodes Il s’agit d’une etude retrospective multicentrique realisee dans des services de medecine interne, gastroenterologie, rhumatologie, dermatologie et oncologie. Les criteres d’inclusion etaient une serologie virale B positive (Ag HBs et/ou ADN VHB et/ou anti-HBc) et une selection des patients a l’aide des donnees du PMSI identifiant une maladie neoplasique, une maladie inflammatoire ou une seance de chimiotherapie/biotherapie. Seuls les patients avec pathologie et immunosuppresseurs a risque entre octobre 2013 et juillet 2016 etaient inclus. Resultats Apres exclusion des doublons, 185 patients etaient eligibles et apres verification des donnees du PMSI, 118 patients etaient inclus. Les profils serologiques etaient Ag HBs+/ADN VHB + (5,1 %), Ag HBs+/ADN VHB− (3,4 %), Ag HBs−/ADN VHB−/Ac HBc+ (89 %) et autres (2,5 %). Les pathologies rencontrees etaient : hemopathie maligne (13,6 %), neoplasie solide (39,8 %) ou pathologie a mediation immune (46,6 %). Les immunosuppresseurs administres etaient : anti-TNF-α (18,6 %), agents depletants lymphocytaires B (7,6 % dont 77,8 % de rituximab), antimetabolites (40,7 % dont 89,6 % de methotrexate), corticotherapie de plus de 3 mois et a plus de 5 mg/j de prednisone (19,5 %), chimiotherapie antineoplasique (50,8 % dont 18,3 % de cyclophosphamide). Le traitement preemptif (TPr) etait indique dans 19,5 % des cas et 60,9 % l’ont recu. Les recommandations francaises etaient respectees chez 89,8 % des patients. Parmi les patients n’ayant pas recu le traitement (39,1 %, n = 12), 75 % ( n = 9) avaient des Ac anti-HBc isoles sous rituximab et/ou cyclophosphamide. Un patient etait traite par une molecule non recommandee, et un patient recevait le TPr par exces (anticorps anti-HBc sans traitement a risque du type rituximab ou cyclophosphamide). Deux reactivations virales etaient observees dont l’une etait fatale. Le TPr etait administre dans 3,6 % des cas d’anti-HBs+ contre 27,6 % des cas d’anti-HBs− ( p = 0,003) mais le TPr etait indique dans 8,4 % des cas d’anti-HBs+ contre 37,9 % des cas d’anti-HBs− ( p = 0,005). Discussion Peu d’etudes se sont interessees en pratique courante a l’evaluation a priori du risque de reactivation du VHB. Une etude francaise menee par Terrier et al. evaluait par sondage les connaissances individuelles des praticiens de medecine interne. Les indications precises de TPr semblaient ainsi mal connues des medecins. Ces resultats imposent toutefois de les confronter a l’evaluation objective et en situation reelle des mesures preemptives appliquees directement par les equipes medicales sur le terrain. Si la majorite des patients inclus ont ici un profil serologique avec anti-HBc+ isoles (quel que soit le statut anti-HBs), c’est dans cette situation que les recommandations ne s’accordent pas. Selon les recommandations francaises (GERMIVIC), un TPr est indique en cas de traitement immunosuppresseur par rituximab et/ou cyclophosphamide alors que les recommandations americaines (AGA) le preconisent egalement chez les patients sous anti-TNFα, inhibiteurs de cytokines ou integrines (abatacept, natalizumab), inhibiteurs de tyrosine kinase (imatinib), corticoides moyenne a forte dose (> 1 mois) et/ou sous doxorubicine–epirubicine. Enfin, les recommandations europeennes (EASL) ne preconisent qu’une surveillance de la charge virale et des transaminases dans cette meme situation. Ainsi, une harmonisation des recommandations serait souhaitable. Dans notre etude, en cas d’anti-HBc+ et en l’absence d’indication de TPr, il etait difficile d’apprecier si les praticiens avaient reellement pris en compte les donnees serologiques justifiant la non-prescription de TPr en accord avec l’une ou l’autre des recommandations. Par ailleurs, nous n’avons inclus que des patients ayant beneficie d’un depistage serologique du VHB dans notre laboratoire alors que la proportion de patients non depistes n’est pas connue. Si le statut anti-HBs ne rentre pas en consideration pour l’indication de TPr, ce dernier etait significativement moins prescrit en cas d’anti-HBs+. L’ajustement sur l’indication de TPr selon les recommandations expliquait cela. Conclusion Cette evaluation des pratiques de prevention souligne la necessite de renforcer nos connaissances du risque viral B et d’etre vigilant selon le type d’immunosuppresseur choisi et le profil serologique du VHB pour prevenir toute reactivation virale potentiellement severe.

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.

Resume Nous avons observe un cas de syndrome RS3PE repondant aux criteres admis pour ce syndrome, apparu lors de la rechute d’un lymphome malin non hodgkinien. Une revue des cas de syndrome RS3PE associes a des neoplasies, notamment des hemopathies, est presentee.

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.

The disorder now known as the "metabolic syndrome "was first recognized 50 years ago, but the use of various definitions led to confusion over its real nature. The metabolic syndrome is directly linked to android obesity, which reflects insulin resistance; it lies at the root of all associated risk factors and is a forerunner of type 2 diabetes. Screening is based on systematic waist measurement, taking ethnic origin into account. This pragmatic approach avoids the uncertainties generated by different definitions and is less restrictive than a simple diagnosis of the metabolic syndrome. Non drug treatment of android obesity is inexpensive and effective but may be difficult to apply, owing to a number of social issues.

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.

From 1978 to 2002, 30 patients presenting hairy-cell leukemia were seen in two different hospitals. We reviewed clinical, biological and therapeutic data. At diagnosis, the median age was 67.8 years; 47% were clinically asymptomatic, 12 patients had anaemia, 15 thrombocytopenia (platelets100,000/mm3). A treatment was required for 29 patients. At the end of the study, 27 patients are alive and none died because of the disease. This study confirms the good prognosis of hairy-cell leukemia, especially since the advent of new therapeutics such as purine analogs. Based on the results in this series, we examined the different aspects of the disease referring to diagnosis, treatment and prognosis.

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 La localisation prostatique d'une actinomycose est exceptionnelle. Fait clinique Nous rapportons l'observation d'un homme diabetique de 59 ans, hospitalise pour une actinomycose prostatique ayant spontanement fistulise dans le rectum. La mise en evidence simultanee, dans les hemocultures et dans le pus de la fistule, de deux especes d' Actinomyces confirmait le diagnostic. Discussion Le traitement avec mise a plat chirurgicale et l'antibiotherapie prolongee permettait la guerison de l'infection prostatique a Actinomyces .

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.