[Thrombosis of renal veins]. / Thromboses des veines rénales.

According to whether they are acute or progressive, complete or partial, uni- or bilateral, renal venous thromboses have quite various clinical expressions and biological consequences. The diagnosis is readily suggested by acute pain in the side with an increase in the size of one or both kidneys, associated with hematuria, proteinuria, or in case of renal failure, which is characteristic of acute bilateral thrombosis. On the other hand, chronic thrombosis of a renal vein is sometimes suggested only when complications such as pulmonary embolism occur. This explain why it is often discovered on autopsy. The diagnosis is confirmed on the basis of radiology, with ultrasound combined with vascular Doppler becoming increasingly important. Renal venous thrombosis may have various causes: disorders in renal blood flow, especially in the acute forms in newborns; hypercoagulability, in particular in nephrotic syndromes and above all in extramembranous glomerulonephritis; extension of vena cava thrombosis; retroperitoneal diseases involving the renal pedicle or extension of a renal tumor. The treatment of renal vein thrombosis is mainly medical and based on anticoagulants. The role of fibrinolytic treatment is controversial. Surgery is exceptional.

[Buerger's disease disclosed by a perforation in the digestive system. Apropos of a case and review of the literature]. / Maladie de Buerger révélée par une perforation digestive. A propos d'un cas et revue de la littérature.

A 27 year-old man who underwent an intestinal segmental resection for small bowel perforation was hospitalized for chronic abdominal pain with weight loss. Coeliac and mesenteric stenosis was diagnosed and laparotomy was performed. Histologic findings were consistent with Buerger's disease. One month later, he developed intermittent claudication of the left leg, and 8 years later amputation of a toe was performed. Since 1956, 25 cases of abdominal Buerger's disease has been reported in the literature. In eight cases, intestinal involvement inaugurated the disease. The clinical presentation can be various: chronic abdominal pain, mesenteric infartus, occlusion, perforation. Small bowel, colon and rectum can be concerned. The literature points out a mortality rate of 25% in intestinal Buerger's disease, contrasting with a mortality rate of 4% in peripheral forms of the disease. Although rare, intestinal form of Buerger's disease should be diagnosed early, because of its high mortality rate. Doppler of mesenteric arteries may contribute to the early diagnosis.

[Bisalbuminemia disclosing primary hyperparathyroidism with fistulized pancreatic false cyst]. / Bisalbuminémie révélant une hyperparathyroïdie primaire avec faux kyste du pancréas fistulisé.

Discovery on a protein electrophoregram of a bisalbuminemia can orientate according to its migration fast or slow to an hereditary mutation of an amino acid, or an acquired form by excess of beta lactamines due to renal insufficiency or by the rupture of a pancreatic pseudocyst in the peritoneum. This is this late mechanism that we report in this case of bisalbuminemia related to an opened pancreatic pseudocyst secondary to an adenoma of the parathyroid gland.

[Osteoarticular amyloidosis and dysglobulinemia: apropos of 2 cases]. / Amylose ostéoarticulaire et dysglobulinémie: à propos de deux cas.

We report two cases of bone and joint amyloidosis involvement related to plasma cell dyscrasia. The radiographic appearances mimic numerous benign or malignant diseases. MR imaging shows a diffuse low signal in T1 and an heterogeneous low or mild low signal in T2 weighted spin-echo sequence.

[Intrapulmonary hemorrhages associated with Basedow disease]. / Hémorragies intrapulmonaires associées a une maladie de Basedow.

We report the second case of intraalveolar haemorrhage associated with an autoimmune thyrotoxicosis. While intraalveolar haemorrhage was not recurrent since 7 years with corticosteroid therapy, a relapse occurred when we began the treatment for an autoimmune thyrotoxicosis. We discuss the link between intraalveolar haemorrhage and autoimmune thyrotoxicosis or its treatment.

[Pneumocystis carinii infection disclosing untreated systemic lupus erythematosus]. / Infection à Pneumocystis carinii révélatrice d'un lupus érythémateux disséminé non traité.

Pneumocystis carinii pneumonia (PCP) is a well known opportunistic infection in Systemic Lupus Erythematosus (SLE) patients with lymphopenia and treated with corticosteroid or cytotoxics agents. We report a new case of PCP in an untreated SLE with severe lymphopenia. We discuss the origin of lymphopenia in SLE, lymphopenia as a risk factor of Pneumocystis carinii infection, and safety precautions to take.

[Relapsing polychondritis and mesenteric panniculitis: apropos of 2 cases]. / Polychondrite atrophiante et panniculite mésentérique: à propos de 2 cas.

We report two cases of polychondritis associated with mesenteric panniculitis. Case 1. In February 1989, a woman born in 1949 presented with 40 degrees C fever accompanied by pain in the abdomen and pelvis. Eight days later, nodular skin lesions appeared on her lower limbs. The abdomen was swollen with gas and undepressible. An abdominal CT scan revealed partitioned peritoneal collections, and a guided needle aspiration produced a chylous fluid. Direct and indirect bacteriological examinations gave negative results. Histology showed intense inflammatory reaction with giant cells and lipophages, thereby confirming the presence of mesenteric panniculitis. Six months later, the development of chondritic lesions on the nose and the helix of the ear clinched the diagnosis of polychondritis. The patient was put on corticosteroid therapy for a few months, and in January this year (1993) she is durably asymptomatic. Case 2. In October 1977, a woman born in 1937 presented with polychondritis with prolonged fever, inflammatory syndrome and chondritic lesions of the nose, larynx and helix of the ear. In December 1978, she developed signs of abdominal obstruction. Laparotomy revealed infiltration by multiple nodular formations of the entire posterior line of attachment of the mesentery. Biopsies withdrew a puriform fluid. Histology showed a partly necrotic adipose tissue with giant cells and lipophages. High-dose corticosteroid therapy partially controlled the chondritic and abdominal manifestations. The occurrence of abdominal pain in patients with polychondritis may result from several disorders, such as iatrogenic complications, digestive tract vasculitis or ulcerative colitis, but also associated mesenteric panniculitis.

[The Munchausen syndrome: a diagnosis not to be forgotten in urology]. / Le syndrome de Münchausen, un diagnostic à ne pas oublier en urologie.

INTRODUCTION: Among the manifestations of Münchausen's syndrome, "neurological" forms may exist. OBSERVATION: We present the case of a patient presenting with urinary retention following treatment for urinary incontinence. The patient had injected himself with infected urine collected from his catheter, in order to create septicemia. COMMENTS: Nephritic colitis, false gall stones, addition of fecal matter or of food and saliva in the urine or the bladder, neurogenic bladder and urinary infections have all been reported as possible manifestations of Münchausen's syndrome. Diagnosis of this syndrome is often delayed and laborious, after repeated hospitalisations, examinations and often aggressive treatment. Its therapeutic management is difficult. Patients, despite proof, deny their deceit and refuse psychiatric care.