[Pulmonary arterial hypertension revealing pseudolymphoma associated with Sjogren's syndrome]. / Hypertension arterielle pulmonaire revelant un syndrome de Gougerot-Sjorgen primitif dans sa forme pseudolymphomateuse.

INTRODUCTION: The authors related a right heart failure related to a primitive pulmonary arterial hypertension without past medical. METHODS AND RESULTS: This diagnosis has been noticed on the cardiac catheterism as well as the cardiac echography (no shunt). Two years later systemic anomalies such as polyarthritis and salivary glands disease were noticed. The Biopsy revelated a primitive Gougerot-Sjorgen pseudolymphomas syndrom. CONCLUSION: Three years under conventional treatment were a failure as the evolution of the disease resulted to death.

Conformation of corticotropin. An infrared spectrometry study of hydrogen exchange kinetics.

1H--2H exchange kinetics of the peptide hydrogens in corticotropin have been examined in 2H2O and CF3C2H2O2H solutions by means of infrared absorption measurements. In aqueous solution, around pH 3, the experimental data suggest a partially ordered structure, since in the two corticotropins 1--24 and 1--32 about 6 slowly exchanging peptide protons are numbered. These might belong to the N-terminal part of the molecule. The C-terminal 25--32 octapeptide segment appears to be unordered and slightly destabilizes the overall hormone conformation. For corticotropin1--24 in CF3C2H2O2H, the qualitative interpretation of infrared spectra and the quantitative analysis of exchange data give evidence of a strong stabilization: a predominantly alpha-helical structure is induced by trifluoroethanol.

Effects of the somatostatin analog BIM 23014 on the secretion of growth hormone, thyrotropin, and digestive peptides in normal men.

BIM 23014 (BIM) is a long-acting octapeptide somatostatin analog. We studied the effects of this analog on the secretion of GH, TSH, and gastroenteropancreatic hormones [secretin, motilin, and pancreatic polypeptide (PP)] in normal men. In the first protocol three BIM doses (125, 250, and 500 micrograms) and vehicle were administered sc in random order at 2000 h to eight normal young men. Plasma GH concentrations decreased during the first part of the night only after the highest dose (P less than 0.05). Plasma secretin levels did not change, while plasma motilin decreased after the 250- and 500-micrograms doses (P = 0.05 and P = 0.02, respectively), and plasma PP decreased after all three doses (P less than 0.05, P less than 0.01, and P less than 0.01, respectively) during the first part of the night. In the second protocol, eight men received BIM, administered by constant sc infusion during the night in a dose of 2 mg/12 h, or vehicle, either alone or in association with a 10 ng/kg.min iv GHRH or vehicle infusion. Nocturnal GH secretion was suppressed by the BIM infusion (P less than 0.001). GH secretion, stimulated by GHRH infusion (P less than 0.001), was reduced by concomitant BIM infusion (P less than 0.001) and was pulsatile during the combined infusions. BIM infusion suppressed the physiological nighttime rise in plasma TSH levels. Plasma motilin and PP levels were reduced by BIM, when administered either alone or in combination with GHRH. We conclude that: 1) BIM is capable of reducing GH secretion when administered sc in a dose of 500 micrograms and of abolishing nocturnal GH secretion when constantly infused at a dose of 2 mg/12 h; 2) BIM, constantly infused, reduces the nocturnal rise in TSH secretion; and 3) motilin and PP secretion are more sensitive than that of GH to BIM, as they are reduced by a lower dose.

[Endoluminal treatment of peripheral aneurysm with covered endoprosthesis]. / Traitement par voie endoluminale des anévrismes périphériques par endoprothèse couverte.

PURPOSE: To evaluate the feasibility and middle term patency results, for endovascular treatment of peripheral aneurysms, using covered stents. MATERIALS AND METHODS: Between December 1993 and may 2000 25 peripheral aneurysms on 24 patients, mean age 67.8 years (42-81), were treated with covered stents (Cragg EndoPro system or passenger, hemobahn, Word Medical). Aneurysm locations were: 17 iliac, 4 popliteal, 1 femoral, 1 subclavian, 1 carotid. The follow-up range from 1 to 75 months (mean 30.1 months). RESULTS: Successful aneurysm exclusion was achieved in all patients, while maintaining good lower extremity perfusion. All but one stent remained patent during the early follow-up period. At one year 94.4% stents were patent, at two years 90.2. CONCLUSION: Treatment of peripheral aneurysms with covered stents has a high rate of immediate procedural and clinical success. At middle term follow-up patency is encouraging except with popliteal procedure, however long term follow-up and larger series is warranted to assess the place of this procedure as an alternative to the surgery.

[Infectious crystalline keratopathy: a case report]. / Kératopathie cristalline infectieuse: à propos d'une observation.

We report a case of perforated infectious crystalline keratopathy in a 88-year-old woman. Corneal surgery like keratoplasty and topical corticosteroids are the main causative factors present in the rare reported cases. Clinically, the anterior layers of cornea exhibit slowly progressive stellate infiltrates. "Viridans streptococci" are the most common micro-organisms involved but their culture for identification is difficult. As compared to cultures, histologic examination is more sensitive for diagnosis, by showing clusters of bacteria in the corneal stroma with no inflammatory response.

[Right tracheal bronchus]. / Bronche trachéale droite.

We present 3 cases of tracheal bronchus. The right tracheal bronchus is an uncommon anomaly, more frequent however than on the left side. Two variations are knows, with or without real ectopy. The radiologist can recognize this abnormal bronchus on the CT slices. Most often it is a non-pathogenic finding (unlike the left-sided anomaly). One of the cases, however, had lung cancer in the segment ventilated by the anomalous right bronchus.

[Plasmacytoma and AIDS: unusual duodenal localization]. / Plasmocytome et SIDA: une localisation duodénale inhabituelle.

We report an uncommon presentation of plasmocytoma in an AIDS patient. AIDS is associated with an increased risk of neoplasms. The incidence of Plasma Cell tumors in HIV-positive patients is greater than in non-infected patients. Multiple factors contribute to B cell neoplasms development.

[Sociological aspects of identity disorders in the pathology of migration]. / Aspects sociologiques des troubles de l'identité dans la pathologie de la migration.

Many people think that mental pathology connected with maghrebian migration into France is coming from a psychopathology more or less specific to migration and maghrebian origin. But, the migrant worker, when sick, asks directly or not the question of his own identity. Authors insist on obligation to take in count the sociological, psychological and cultural characteristics of migrant's problems, and also the ways of changing concerning both his own imago and his relationship to others. The concept of identity gives us facility to integrate all these elements.

[Practical aspects of the care of immigrant patients in a psychiatric milieu]. / Aspects pratiques des soins en milieu psychiatrique chez les patients immigrés.

The institutional psychiatric treatment of migrant workers is difficult. But it is also necessary: the most dangerous evolutions happen when there is no intervention or during long breaks of therapy. From their own experience, authors ask themselves about what, in usual attitudes of psychiatrist, can drive into blind-alleys. The symptomatology shown by maghrebian migrant has implications in fields of sociology, culture and psychology, with wide extensions in politics, economics, etc. In front of symptoms (described there), different persons give different institutional answers, described too. Each pathological situation is either revelating of migrant's contradictions or origin of new contradictions.

Neumomediastino y neumotórax bilateral en paciente con fibrosis pulmonar idiopática / Pneumomediastinum and Bilateral Pneumothorax in Patients with Idiopathic Pulmonary Fibrosis

Los pacientes con fibrosis pulmonar idiopática (FPI) presentan un mayor riesgo de desarrollar complicaciones pulmonares agudas, incluyendo entre ellas el neumotórax y el neumomediastino. Describimos los hallazgos en la radiografía y el TAC de tórax en un paciente con diagnóstico de FPI. El examen radiológico realizado por dos radiólogos especialistas de tórax reveló hallazgos de aire extra alveolar. La disnea, disfagia, afonía y dolor torácico fueron los síntomas más llamativos que presentó el paciente. En la Rx de tórax se apreció neumotórax bilateral y neumomediastino. El paciente falleció a los 22 días de iniciado el deterioro clínico por insuficiencia respiratoria

Patients with idiopathic pulmonary fibrosis (IPF) have a higher risk of developing acute pulmonary complications, including pneumothorax and spontaneus pneumomediastinum. We describe the findings in the xray and CT scan of the thorax in a patient diagnosed with IPF. The radiography examination by two thoracic specialist radiologists revealed evidenced extravascular air in the thorax. Disnea, disphagia, aphonia, thoracic pain were the most concerning symptom presented in the patient. The thoracic radiology display air in the pleural cavity along bilateral pneumothorax and pneumomediastinum. The patient died 22 days after the start of clinical deterioration due to respiratory failure

[Randomised comparative study of early versus delayed surgery in hip-fracture patients on concomitant treatment with antiplatelet drugs. Determination of platelet aggregation, perioperative bleeding and a review of annual mortality]. / Estudio comparativo aleatorizado de la intervención quirúrgica temprana frente a la demorada en los pacientes con fractura de cadera tratados con antiagregantes plaquetarios. Determinación de la agregabilidad plaquetaria y el sangrado perioperatorio, y la revisión de la mortalidad al año.

OBJECTIVE: A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery (<48 h) versus delayed surgery (>5 days). Platelet aggregation was measured on admission and immediately before surgery in all patients included in the study PATIENTS AND METHODS: A total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients. The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood. RESULTS: Bleeding, transfusion requirements and analytical results showed no significant differences between groups. More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not. Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9-0.9) and number of transfusions (OR: 1.1-1.5). The average lenth of stay was 4.1 days greater in the delayed surgery group. CONCLUSION: Early surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay. The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation.

[Distal coronary thrombosis during L-asparaginase treatment for an acute lymphoblastic leukaemia]. / Thrombose coronaire distale compliquant une leucémie aiguë lymphoblastique traitée par asparaginase.

A 53-year-old man is treated by L-asparaginase for an acute lymphoblastic leukaemia. He received anti thrombin infusions. A systematic electrocardiogram showed an asymptomatic subepicardium ischemia without troponin elevation. Echocardiography and heart magnetic resonance imaging showed an apical thrombus facing a zone of myocardial necrosis. A thrombus regression was observed under anticoagulation. Atypical and asymptomatic coronary thrombosis may occur following L-asparaginase treatment. Regular electrocardiogram monitoring is proposed along this treatment. Arterial thrombosis associated with anti tumor chemotherapies are reviewed.