[Opsoclonus-myoclonus syndrome: a case report]. / Syndrome opsoclonus-myoclonies : à propos d'un cas.

Opsoclonus-myoclonus syndrome is a rare disorder. We report a 44-year-old patient with opsoclonus associated with a cerebellar syndrome revealing a small cell lung carcinoma. The treatment with chemotherapy initially improved the clinical symptoms but these eventually recurred. Opsoclonus is a complex disorder of the ocular motility, characterized by irregular, continuous and chaotic eye saccades. When it is associated with other manifestations of the central nervous system (head myoclonus and ataxia), it constitutes a clinical picture known as opsoclonus-myoclonus syndrome. In adults, the most frequent causes are post-infectious, paraneoplastic and idiopathic. The symptomatic treatment is not defined, but the treatment of the underlying cause may improve the clinical features of this syndrome.

[Anticoagulant induced intramural duodenal hematoma presenting as duodenal obstruction]. / Syndrome occlusif et hémorragique révélant un hématome duodénal intramural iatrogène.

An intramural hematoma of the duodenum was first reported in an article in the Lancet in 1838. At least, 90% of cases are caused by blunt abdominal trauma, typically accidents involving bicycles or motor vehicles. Intramural duodenal hematoma is a rare complication of anticoagulant therapy. It occurs in patients who receive excessive anticoagulation with warfarin or who have some other risk factor for bleeding. CT characteristics include circumferential wall thickening, intramural hyperdensity, luminal narrowing, and intestinal obstruction. Early diagnosis is crucial because most patients are treated nonoperatively with a good outcome.

[Environmental factors and iatrogenic elements in systemic scleroderma and related syndromes. Review of the literature]. / Les facteurs d'environnement et les éléments iatrogènes dans la sclérodermie systémique et les syndromes apparentés. Revue de la littérature.

The etiology of scleroderma remains unknown. Although a genetic susceptibility seems to play a role, some environmental and iatrogenic factors have been suggested to trigger the disease. Contact for many months or years with natural or synthetic "toxic" products (by inhalation, cutaneous contact, injection, swallowing or surgical implant) could be implicated in the development of typical scleroderma or pseudo-scleroderma. These products are either occupational or non occupational like those used at home in daily life. We will sum up the knowledges about this subject.

Remitting seronegative symmetrical synovitis with pitting oedema: disease or syndrome?

OBJECTIVE: To evaluate the outcome of patients with remitting seronegative symmetrical synovitis with pitting oedema (RS3PE). METHODS: In a retrospective chart review study, we identified all the patients presenting with polyarthritis and pitting oedema in the past 20 years. We tried to recall the 24 patients with characteristics of RS3PE according to McCarty et al. Two patients had died and four could not be traced. Five could not be seen after the initial period of follow up; relevant data were obtained from their practitioner. For the remaining 13 patients, clinical, radiological, and biological evaluation was performed in our department, with the last assessment in 1993. RESULTS: The follow up period was from one to 18 years (mean 4.6 (SD 4.5) years). Eleven patients developed one or several recurrences of articular manifestations consisting of mild oligoarthritis (n = 8), definite spondyloarthropathy (n = 2), and rheumatoid arthritis (n = 1). The delay of the first recurrence was 18 months to 12 years after the first attack. Thirteen patients had no recurrence, but three of them developed remarkable features: rheumatoid factor, antinuclear antibodies (1/2000), Sjögren's syndrome. HLA B typing was performed in nine patients and revealed B7 (n = 2), B27 (n = 2) and B22 (n = 2). Isolated HLA B27 typing was performed in two other patients and was positive in one. CONCLUSION: The long term outcome of RS3PE can lead to different rheumatic diseases. RS3PE appears to be a syndrome related to the elderly onset of the rheumatic diseases, including spondyloarthropathy and rheumatoid arthritis, rather than a specific entity.