[Cat scratch disease with bone involvement: a case report and literature review]. / Maladie des griffes du chat avec localisations osseuses: une observation et revue de la littérature.

INTRODUCTION: Cat scratch disease is an infectious disease caused by Bartonella henselae. Most of the patients present with a lymphadenopathy associated with a local infection at the site of the cat scratch. Disseminated infection is uncommon. CASE REPORT: We report an immunocompetent 61-year-old woman who presented with a systemic cat scratch disease including a multifocal osteomyelitis. Diagnosis was confirmed by PCR on the adenopathy. A literature review identified 51 other cases of osteomyelitis associated with cat scratch disease, 14 of those confirmed by PCR. CONCLUSION: Bone involvement in cat scratch disease is rare, especially in adults. The diagnosis should be suspected on the basis of patient questioning. The antibiotherapy and the place of surgery are discussed.

Multifocal central nervous system lesions in three patients with trichinosis.

Three patients with trichinosis developed central nervous system complications. Cerebral computed tomography showed multifocal hypodense lesions in two patients. The lesions were associated with contrast enhancement and cortical gyral enhancement in the first case, suggesting hypoxia and infarction. In the second patient, magnetic resonance imaging showed multiple high-signal-intensity lesions. Early cerebral computed tomography was normal in the third patient. All patients recovered after treatment with antiparasitic drugs and corticosteroids. We suggest that neurologic complications of trichinosis should be treated by corticosteroids and flubendazole.

Catabolism of human fibrinogen fragment D in normal subjects and patients with liver cirrhosis.

The catabolism of human fragment D, (FgD), obtained by plasmin digestion of fibrinogen has been investigated in normal subjects and patients with liver cirrhosis and the results compared with those obtained for fibrinogen (Fg). Fg was labelled with I-125 and Fg D with I-131 using the chloramine T method. The plasma disappearance curves of both labelled proteins fitted a two exponential curve. In controls the plasma clearance rate of Fg D was greater than that of Fg as shown by the marked difference between the half-lives of these two tracers: 8,9 and 83,5 hours for Fg D and Fg respectively. The fractional catabolic rate of Fg D was 3.38 times the plasma pool per day. In nine patients with liver cirrhosis, catabolism of Fg was not modified. In contrast, catabolism of Fg D was significantly reduced with a half life of 13.0 hours and a low fractional catabolic rate. These results suggest the role of the liver in the catabolism of Fg D in man.

[Characteristics of benzodiazepine consumption in patients hospitalized in an internal medicine department]. / Caractéristiques de la consommation de benzodiazépines chez des patients hospitalisés dans un service de médècine interne.

We have studied benzodiazepines (BZD) intake among 129 patients admitted in an internal medicine unit. In this population, we have differentiated long term (over 4 months) users (n = 25), occasional users (n = 24), and non users (n = 80). Analysis of the results favoured the fact that BZD users were, more than non users, alike to have a history of cardiovascular and/or rheumatic diseases, to have had multiple surgical procedures and that these patients often took several other psychotropic and non psychotropic drugs. Particular characteristics of long term users are discussed next (prevalence, sex ratio, incidence of depression).

[Myelographic diagnosis of radiculomeningeal metastases of carcinomas. Apropos of 10 cases]. / Diagnostic myélographique des métastases radiculo-méningées des carcinomes. A propos de dix observations.

The authors report ten cases of intra-arachnoid metastases affecting the spinal cord and its roots. These cases illustrate all the myelographic appearances seen: multiple nodular appearances, striated appearance related to thickening of the roots, failure to visualise one or more root sheaths, filling defect of varying regularity preferentially seen in the dural cul-de-sac, but also in the terminal part of the cord associated with varying degrees of block. Myelographic technique is essential of they are to be visualised: water soluble opaque agents and tomography, if possible by complex scanning alone ensure accurate analysis of the roots. This type of involvement raises a pathogenic problem regarding the exact mechanism of such metastases. The prognosis is very poor despite treatment based upon radiotherapy and chemotherapy.

[Clinical and laboratory features of endemic goiter in the Man region (Ivory Coast) (author's transl)]. / Aspect clinique et biologique du goitre endémique dans la région de Man (Côte d'Ivorie).

An epidemiological study involving 616 subjects carried out in the Man region, Côte d'Ivoire, showed endemic goiter in 54,5% of the group overall and in 80% of females. Thyroid function of subjects chosen at random in the goitrous and non-goitrous group (105 G and 71 NG respectively) was identical. Compared with a French control group T4 was significantly lower but T3 and TSH were higher. TBG level is high with low iodine elimination. High levels of TSH are not necessarily associated with low T3 or T4 levels, or with clinical signs of a hypothyroid condition. They are probably the result of a transient reaction. T4-TSH and T3-TSH correlations for NG subjects were (-0,40) but the T3-TSH correlation for the G subjects was significantly lower (-0,23). These differences could be explained by the simultaneous high levels of T3 and TSH more frequently rencountered in G subjects and by the fact that serious hypothyroid conditions are more frequent in the NG group (6 out of 9). The percentage of hypothyroid conditions is high in both clinical and biological investigations. No anti-thyroglobulin antibodies were found in any of the hypothyroid cases with goitre. The histograms illustrate the clinical and biological heterogeneity of a homogeneous non-medicalised population.

[Urologic manifestations of aortocaval fistulas]. / Manifestations urologiques des fistules aorto-caves.

The authors report two cases of aortocaval fistula, resulting from the rupture of an abdominal aneurysm, and revealed by lumbar pains and hematuria. In both cases, the left kidney was mute, and was possibly responsible for the hematuria.

[Disseminated varicella-zoster virus infection with hemorrhagic gastritis during the course of chronic lymphocytic leukemia: case report and literature review]. / Infection disséminée au virus varicelle-zona avec gastrite hémorragique compliquant une leucémie lymphoïde chronique : une observation et revue de la littérature.

INTRODUCTION: The reactivation of varicella-zoster virus occurs in immunocompromised patients, especially in cases of hematological malignancy. Disseminated reactivation could involve digestive tract with life-threatening condition. CASE REPORT: A 76-year-old woman, with a history of chronic lymphocytic leukemia, presented with left hypochondrium pain, and a vesicular rash with hemorrhagic shock that revealed an hemorrhagic gastritis due to varicella-zoster virus. The literature review identified 28 additional cases of gastrointestinal mucosal damage during reactivation of varicella-zoster virus. Mortality is 40%. We report here the first case in the course of low-grade lymphoid malignancy. CONCLUSION: Acute gastrointestinal symptoms in immunocompromised patients should evoke a varicella-zoster virus reactivation with gastrointestinal involvement. This clinical manifestation, although rare, should not be ignored because of its severity.

Treatment of limbic encephalitis with anti-glioma-inactivated 1 (LGI1) antibodies.

We report a 72-year-old patient who developed acute limbic encephalitis initially considered of uncertain aetiology. Detailed information on clinical presentation, MRI appearance, antibody levels, cognitive impairment assessment, treatment and evolution of the patient is reported here. Since the early 2000s, many antibodies implied in central nervous system autoimmune disorders have been identified. Anti-glioma-inactivated 1 (LGI1) antibodies have been recently identified as associated with limbic encephalitis, as was the case in our patient.

[Circulatory and respiratory effects of aspiration and reinfusion of ascites in cirrhosis. Apropos of 14 ascitic attacks treated by this method]. / Conséquences circulatoires et respiratories des ponctions-réinjection d'ascite au cours des cirrhoses. A propos de 14 poussées ascitiques traitées par cette méthode.

Aspiration and replacement of ascites in 14 patients with cirrhosis was carried out using a Rhodiascit (Rhône-Poulenc) apparatus. Hemodynamic studies were used to evaluate the effects of this therapy on circulatory and respiratory parameters. Results showed that the hemodynamic tolerance of the treatment, which produces a slow increase in blood volume, was excellent as there was an increase in the cardiac index without raising the pressure under which replacement was made. Futhermore, no adverse effects on blood respiratory functions were noted in these patients who had blood hypoxia before treatment, but the removal of ascitic fluid produced no improvement in arterial gasometric parameters which is contrary to what one would expect.

Changes in cerebrospinal fluid monoamine metabolites, tryptophan, and gamma-aminobutyric acid during the 1st year of life in normal infants. comparison with victims of sudden infant death syndrome.

Cerebrospinal fluid (CSF) levels of 3-methoxy-4-hydroxyphenylglycol, 5-hydroxyindoleacetic acid, homovanillic acid, tryptophan, and gamma-aminobutyric acid were measured using high-performance liquid chromatography in 102 infants during the 1st year of life (preterm and term neonates included). CSF levels are expressed versus corrected age (postnatal days - preterm days) which reflects the stage of maturity of the central nervous system. These results are compared to those obtained in CSF of 53 victims of sudden infant death syndrome (SIDS). All components were significantly higher in SIDS than in the age-matched control group. This increase does not seem to be an artefact related to death. Indeed, under the same conditions concerning postmortem time interval before CSF sampling and analysis, the levels are not significantly higher in infants who died from a known pathology than in living infants. Moreover, in living infants as regards a pathology such as asphyxia or hypoventilation in comparison with SIDS, similar profiles are observed in some neurotransmitters or metabolites. Other studies are necessary to explore further neurotransmission systems in SIDS.

[Endemic goiter in the Man region (Ivory Coast)]. / Le goitre endémique dans la région de Man (Côte-d'Ivoire).

An epidemiological study involving 616 subjects carried out in the Man region, Côte-d'Ivoire, showed endemic goitre in 54,4% of the group overall and in 80 % of females. Thyroid function of subjects chosen at random in the goitrous and nongoitrous group (105 G and 71 NG respectively) was identical. Compared with a French control group T4 was significantly lower but T3 and TSH were higher, which represents a high TBG level with low iodine elimination. High levels of TSH are not necessarily associated with low T3 or T4 levels, or with clinical signs of a hypothyroid condition. They are probably the result of a transient reaction. T4-TSH and T3-TSH correlations for NG subjects were (--0,40) but the T3-TSH correlation for the G subjects was significantly lower (--0,23). These differences could be explained by the simultaneous high levels of T3 and TSH more frequently encountered in G subjects and by the fact that serious hypothyroid conditions are more frequent in the NG group (6 out of 9). The percentage of hypothyroid conditions is high in both clinical and biological investigations. No anti-thyroglobulin antibodies were found in any of the hypothyroid cases with goitre. The histograms illustrate the clinical and biological heterogeneity of a homogeneous non-medicalised population.

Isolation of human T-lymphotropic retrovirus (LAV) from Zairian married couple, one with AIDS, one with prodromes.

A Zairian married couple had been living in France since 1981. The man had acquired immunodeficiency syndrome (AIDS) and his wife had prodromes of the disorder. Infection with a human T-lymphotropic retrovirus (lymphadenopathy-associated virus) was demonstrated in both by isolation of the virus from their cultured lymphocytes and the detection of specific antibodies in serum samples. Since this virus has been isolated from patients in other AIDS risk categories, the finding of the virus in AIDS patients from the African group adds further support to the hypothesis that this human retrovirus is the AIDS aetiological agent.

Necrobiotic xanthogranuloma with myeloma. A case report.

Necrobiotic xanthogranuloma is a newly recognized cutaneous manifestation associated with paraproteinemia. Necrobiotic xanthogranuloma is distinctive clinically by yellowish-red nodular lesions, often ulcerated, with predilection for the periorbital area and ocular involvement. Histologically, it is characterized by the combination of inflammatory xanthogranulomas together with areas of necrobiosis. These skin lesions are associated with a dysglobulinemia and preceded the development of an IgG lambda myeloma in a previous patient. Hyperlipidemia may be found in some patients. A case of necrobiotic xanthogranuloma is reported, occurring in a 46-year-old man and associated with an IgG kappa myeloma.