[Thrombosis risk during pregnancy after history of cerebral venous thrombosis]. / Risque thrombotique des grossesses après un épisode de thrombose veineuse cérébrale.

INTRODUCTION: Few data have been published about the prognosis of a pregnancy following an episode of venous cerebral thrombosis (CVT), and far less about preventive strategy. METHODS: This is a retrospective study of a case series of 11 pregnancies in six women who had previously presented a CVT. RESULTS: The first pregnancies after CVT occurred on average 58 months later. Prevention with aspirin or heparin was administered in ten cases during pregnancy, and in all the cases with heparin in postpartum. No recurrence of CVT was observed. A minor pulmonary embolism was diagnosed in postpartum in one case. CONCLUSION: Prognosis of a pregnancy after a CVT seems to be favourable if a sufficient delay after CVT is respected. Although no results of controlled trials are available, prophylaxis with heparin is probably reasonable as benefit seems higher than risks and is strongly advised during the postpartum period.

[Papillary fibroelastoma. A rare etiology of strokes in young patients]. / Fibroélastome papillaire. Une étiologie rare des accidents vasculaires cérébraux du sujet jeune.

BACKGROUND: The papillary fibroelastomas are cardiac lesions, which typically occur on the cardiac valves, but rarely on the endocardium. The incidence of these benign primitive tumors varies from 0.002 to 0.33% and increases with advancing age. METHODS: We report two cases of stroke, one in a 31-year-old man and the other in a 48-year-old woman, both admitted to the same stroke center. RESULTS: The diagnostic studies were normal in these two patients, except for the echocardiography. The first showed an echogenic mass on the mitral valve on transthoracic echocardiography (TTE), confirmed by the transesophageal echocardiography (TEE). The second demonstrated a mass on the sigmoid aortic valve on TEE, but the TTE was normal. For these two patients, a surgical excision was carried out and pathologic examination concluded to a papillary fibroelastoma. After surgery, no recurrence was observed. CONCLUSIONS: The papillary fibroelastomas are usually asymptomatic and easily detected by TEE. However, it can be revealed by stroke, myocardial infarction and lower limbs ischemia. These cardiac tumors should be surgically removed, since their complete excision remains the only means of avoiding a recurrence of embolism.

[2 new cases of myocardial infarction after injection of vincristine]. / Deux nouveaux cas d'infarctus du myocarde après injection de vincristine.

The authors report two cases of myocardial infarction following the injection of vincristine. The vincristine is held responsible for several reasons: absence of past history or risk factors of coronary artery disease, no past history of mediastinal radiotherapy, the development of coronary manifestations several hours after the injection of vincristine. Both cases followed a fatal course. The pathophysiology of this iatrogenic complications is unclear. Any patient receiving such treatment should be carefully monitored clinically and electrocardiographically.

[Immunoblastic lymphadenopathy occurring during treatment with carbamazepine. 2 cases]. / Lymphadénopathie dysimmunitaire survenant au cours d'un traitement par la carbamazépine. Deux observations.

Dysimmune lymphadenopathies during carbamazepine treatment. A report of two cases. We report on two cases of dysimmune lymphadenopathies with histological aspect of angio immunoblastic lymphadenopathy (AIL) developing after administration of carbamazepine. Clinical manifestations consisted of fever, erythroderma, generalized pruritus, facial edema, lymphadenopathy, liver enlargement. The two patients had anemia, hypogammaglobulinemia, impaired liver function and a negative Coomb's test. Lymphocyte stimulation test with carbamazepine in vitro was positive in both cases. Lymph node biopsy disclosed the angioimmunoblastic proliferation characteristic of AIL. After discontinuing carbamazepine, a complete remission was obtained.

[Paraneoplastic hypercalcaemia in a case of carcinoma of the bladder. Demonstration in the tumour of a substance with parathormone activity (author's transl)]. / Hypercalcémie paranéoplasique au cours d'un cancer de la vessie. Mise en évidence dans la tumeur d'une substance à activité parathormone.

Hypercalcaemia accompanied a bladder tumour in a 77-year-old woman. Immuno-reactive parathormone (IPTH) in the tumour being high, the hypercalcaemia could thus be attributed to secretion by the tumour of a substance with parathormone activity. The rarity of bladder tumours at the origin of paraneoplastic hypercalcaemia is recalled. The mechanism of the metabolic disturbance and the disagreement between serum and tumour levels of IPTH are discussed.

[Temporal arteritis and rhizomelic pseudo-polyarthritis. Clinical aspects and nosologic problems. Apropos of 48 cases]. / L'artérite temporale et la pseudo-polyarthrite rhizomélique. Aspects cliniques et problèmes nosologiques. A propos de 48 observations.

The authors report 40 cases of temporal arteritis, of which 16 were associated with pseudo-polyarthritis, and 8 cases of polyarthritis alone. The clinical picture of temporal arteritis in the elderly, includes headaches in 95% of cases, clinical changes in the superficial head arteries in 75% of cases, joint and muscle signs dominated by pseudo-polyarthritis in 40% of cases; general signs were practically constant. A major inflammatory syndrome was also constant. From the histological point of view, there was pan-arteritis with giant cells, and their wide diffusion is shown by the presence of eye signs in 27.5% of cases, brain signs in 10% of cases, and extra-cephalic vascular signs in 10%. The relationship in classification between temporal arteritis and polyarthritis of the roots of the limbs is recalled. The course is long, the duration of corticosteroid therapy should never be less than two years; relapses are common but the mortality appears low.

[Diabetes mellitus in pheochromocytoma]. / Le diabète du phéochromocytome

The frequency of latent disorders of glucose regulation during pheochromocytoma, is evaluated at 75% of cases. Detailed analysis of 83 cases with a diabetic state, gave the following results: insulin dependent diabetes, 37 cases. Non-insulin dependent, 14 cases. Latent diabetes, 32 cases. The characteristics of the insulin-dependent diabetes were not always suggestive. Insulin dependency was, however, unusual above a certain age. We noted loss of weight in spite of good control of the diabetes, the absence of acidosis and ketosis contrasting with rapid loss of weight. In fact, it is above all the hypertension which should lead to diagnosis. Surgical operation, cures or improves considerably the diabetic state, thus proving the symptomatic nature of this diabetes.

[Meningoradiculitis after tick bites. Apropos of 9 cases]. / Les méningoradiculites après morsure de tiques. A propos d'une série de 9 cas

The authors report a series of 9 cases of meningoradiculitis after tick bites and compare them with 56 other cases in the literature. Clinically, the bite is followed by a free interval, then more or less extensive local erythema, pain then paralysis is undoubtedly the most typical presentation. Uni- or bilateral paralysis of the 7th cranial nerve was found in more than 50% of cases. Erythema may exceptionally be absent. There may be forms with pain alone. Finally, there may sometimes be pyramidal signs or signs of brain irritation. As concerns the course, one should note the absence of respiratory complications, and although there are usually no or minimal sequelae, one should note the slowness of the recovery in certain paralytic cases. In the laboratory, pleocytosis is constantly found in the C.S.F. As concerns physiopathology, there are 3 theories, virus, allergic and toxic.