[Humoral hypercalcemia revealing a malignant non hodgkin lymphoma]. / Hypercalcémie humorale révélant un lymphome malin non hodgkinien.

INTRODUCTION: Hypercalcemia is a rare complication of non-Hodgkin lymphoma. Usually, hypercalcemia occurs late in the disease course, except for high-grade lymphoma. Most often hypercalcemia is related to excessive level of circulating PTH-rP or sometimes, 1,25(OH)2D3. Concomitant high plasmatic concentration of PTH-rP and 1,25(OH)2D3 is uncommon. EXEGESIS: We report the case of a 82-year-old man who presented with abdominal pain and weight loss, leading to the diagnosis of diffuse large-B-cell lymphoma (high-grade lymphoma) associated with symptomatic hypercalcemia (3.21mmol/l). PTH-rP and 1,25(OH)2D3 plasmatic levels were high. Calcium concentration was normalized with glucocorticoids and sequential chemotherapy. CONCLUSION: This case report confirms that hypercalcemia, as consequence of excessive plasmatic level of PTH-rP secreted by tumoral cells, can occur early in the course of high-grade lymphoma. Glucocorticoids and chemotherapy are the best treatment options.

[Hyponatremia due to tramadol]. / Hyponatrémie due au tramadol.

We reported a 92-year-old woman with hyponatremia (117 mmol/l) occurring three days after the introduction of tramadol. Diagnosis of inappropriate antidiuretic hormone secretion was based on blood and urinary analysis and dosage of antidiuretic hormone. Natremia became normal after tramadol cessation and fluid restriction. Natremia must be measured when neurological abnormality occurs with tramadol treatment.

[Waldenström's macroglobulinemia with an uncommon presentation]. / Macroglobulinémie de Waldenström: à propos d'une présentation clinicobiologique peu commune.

Waldenström's macroglobulinemia is a rare disease with an indolent clinical course. The median age of the affected patient is 65 years. Nevertheless, we report a case of Waldenström's macroglobulinemia revealed by a splenomegaly and severe pancytopenia, in a 51-year-old man without previous medical history. According to the recent consensus recommendations for the clinicopathological definition of Waldenström's macroglobulinemia, diagnosis was made through morphological and immunophenotypic data of medullary cells. The reduced survival of the patient is associated with the importance of the cytopenia.

[Gleich syndrome. A case report and review of the literature]. / Le syndrome de Gleich. Un cas et revue de la littérature.

INTRODUCTION: The Gleich syndrome associates episodic angioedema, hypereosinophilia and elevation of immunoglobulin M. It's a rare cause of nonallergic angioedema and is characterised by no organ involvement. EXEGESIS: We report a case of a 27-years-old african women, with five years history of recurrent angioedema of face and extremities, associated with a major hypereosinophilia. Serum IgM elevation, elimination of other etiologies and spectacular response to corticoid treatment permitted to retain diagnosis. CONCLUSION: The majority of cases of Gleich syndrome were reported in USA, Europe and Japan. The nonepisodic angioedema, which is not accompanied by elevation of immunoglobulin M, was described in Japan. There are currently no case reported in Africa where parasites are the principal cause of hypereosinophilia. The immunohistochemical studies permit to explain cytochemical disturbances responsible for the release of disease whose initial mechanism is unknown.

[Inflammatory pseudotumor of lymph node]. / Pseudotumeur inflammatoire ganglionnaire.

INTRODUCTION: Inflammatory pseudotumor of lymph node is a rare case in the etiology of fever of unknown origin. OBSERVATION: We report the observation of a woman, aged 40, hospitalized with intermittent fever revealing under-diaphragm adenopathy related to inflammatory pseudotumor of lymph node. CONCLUSION: Inflammatory pseudotumor of lymph node is a rare pathology whose nosological definition is unclear. It should probably be considered as belonging to a category different from the inflammatory pseudotumor of other organs. The diagnosis presents itself in case of isolated adenopathy or prolonged fever and is based on an anatomopathology that essentially calls to mind a lymphoma. The evolution of the condition is shown to be favorable : it can lead to a spontaneous remission, or call for a non-steroid anti-inflammatory treatment, or a steroid therapy.

[Hemolytic uremic syndrome as a complication of gemcitabine treatment: report of six cases and review of the literature]. / Syndrome hémolytique et urémique secondaire à la gemcitabine: à propos de six observations et revue de la littérature.

UNLABELLED: Hemolytic uremic syndrome is a rare condition during gemcitabine therapy. METHODS: We report six new cases of hemolytic uremic syndrome related to gemcitabine, three issued from a retrospective study of 136 consecutive patients treated with gemcitabine for which a systematic screening of this side effect has been performed and 29 cases with clinical data available identified in the literature in order to better characterised frequency and clinical presentation of this side effect. RESULTS: In our series, frequency of HUS is 2.2% and is higher than this previously reported (0.015%) or estimated with the data of clinical trials analysed (0.072 %). For 35 cases with clinical data available, the patients were always treated for a local advanced and/or metastatic disease. For our cases and for literature cases, at the time of diagnosis of hemolytic uremic syndrome, mean number of doses received (mean+/-standard deviation. Minimum/maximum)) (personal cases: 26.5+/-6.6. 16/36, literature cases: 21+/-11. 8/54), cumulative dose received (g/m2) (personal cases : 24.5+/-6.3. 16/31.6, literature cases: 21.7+/-12.4. 2.4/54) and duration of treatment (months) (personal cases: 8.2+/-1.9. 5.6/11, literature cases: 8.5+/-4.0. 3/18) are very closed and high individual variations observed for these factors are not consistent with a time and/or dose dependant toxicity. New-onset hypertension or exacerbation of underlying hypertension is the most common clinical manifestation, with mild anemia; thrombocytopenia is inconstant. The degree of severity of renal failure is highly variable. The existence of subacute clinical form with progressive worsening of the symptoms and biological form at the time of diagnosis suggest the interest of a systematic clinical and biological screening of this side effect, before each injection of gemcitabine. Early prognosis is linked to the evolution of hemolytic uremic syndrome and after hemolytic uremic syndrome healing, cancer progression. Treatment include gemcitabine discontinuation, antihypertensive drugs and if necessary fresh frozen plasma. CONCLUSIONS: Systematic clinical and biological screening of hemolytic uremic syndrome during gemcitabine therapy should allow to better know this complication, to recognize and treat it earlier with a potential positive impact for patients.

[Pancreatic peritoneal fistula with bisalbuminemia]. / Fistule pancréatico-péritonéale avec bisalbuminémie.

INTRODUCTION: Pancreatic fistulas are a complication that occur in 3 to 15% of cases during the progression of chronic or acute pancreatitis, usually alcohol-induced. Bisalbuminemia is characterised by two albumin fractions on serum protein electrophoresis. The presence of Bisalbuminemia is inconsistent and has only rarely been reported. OBSERVATION: A 42 year-old man, excessive drinker, developed pancreatic ascites related to a pancreatic-peritoneal fistula and associated with transitory bisalbuminemia. Treatment was medical with good short term results. DISCUSSION: Ascites was secondary to a pancreatic-peritoneal fistula. It can be constitutional or acquired and transitory, and secondary to prolonged treatment with b-lactamines in a patient with kidney failure or a pancreatic fistula.

Regional intravenous guanethidine blocks in algodystrophy.

Five-hundred-thirteen regional intravenous guanethidine blocks were carried out in 125 cases of algodystrophy (118 adults), after failure of other treatments in 120 cases (Group I) and without previous treatments in 5 (Group II). A positive result occurred in 85 cases of Group I (71%) and in the 5 cases of Group II, after 4.5 +/- 1.7 blocks. In Group I the results did not differ significantly between upper (33 cases) and lower (87 cases) limb or in regard to sex, age, duration of disease, nature of previous treatments. The presence of psychic disorders was accompanied by less frequent (p less than 0.02) positive results. The tolerance was satisfactory in 85.6% of cases: 22 moderate side effects authorized a continuation of the blocks, 22 serious ones indicated interruption, especially one case of thrombophlebitis and another one of very transitory acute ischaemia. The risk of intolerance was significantly raised (p less than 0.02) by age. The regional guanethidine blocks seemed to be a good treatment for algodystrophy after failure of other treatments.

[Yellow nail syndrome associated with intestinal lymphangiectasia]. / Syndrome des ongles jaunes associé à des lymphangiectasies intestinales.

The yellow nail syndrome, a combination of yellow discoloured nails, lymphedema and pleural effusions, is a rare clinical condition. We report a case of the yellow nail syndrome associated with intestinal lymphangiectasia revealed by chylous ascites and protein-losing gastroenteropathy. This association reported in only three cases in the literature leads us to discuss the relations between yellow nail syndrome, primitive intestinal lymphangiectasia and primary lymphatic disorders.

[Simultaneous hepatic cholangiocarcinoma and bone fibrosarcoma 45 years after ingestion of Thorotrast]. / Cholangiocarcinome hépatique et fibrosarcome osseux synchrones 45 ans après injection de Thorotrast.

This case of a 63 year old man reports the simultaneous development of hepatic cholangiocarcinoma and fibrosarcoma of the sacrum 45 years after the systemic injection of Thorotrast. The characteristic radiologic aspect was an important criteria for diagnosis. Biopsies have confirmed the histology of both tumors. We describe the way to thorotrastosis diagnosis and characteristic malignant tumors, especially cholangiocarcinoma, induced by Thorotrast.

[Autoimmune cholangitis successfully treated with corticotherapy. One case]. / Cholangite auto-immune traitée avec succés par corticothérapie. Un cas.

Autoimmune cholangitis is a rare cause of chronic liver disease which has recently been described and associates the clinical, biological, and histological patterns of primary biliary cirrhosis without serum anti-mitochondrial antibodies. We report a case of this disease in a 67-year-old female. The patient presented with jaundice and marked biological cholestasis associated with pulmonary fibrosis and salivary and lacrymal sicca syndrome. Serum anti-smooth muscle antibodies were found without anti-mitochondrial antibodies. Corticotherapy resulted in rapid improvement of clinical and hepatic abnormalities, as well as of pulmonary lesions. The patient was still healthy 18 months later, with low dose corticotherapy. This report emphasizes the possible effectiveness of corticotherapy in autoimmune cholangitis.

[Emergency coronary angioplasty following treatment with 5-fluorouracil]. / Angioplastie coronaire en urgence au décours d'une cure de 5-fluoro-uracile.

INTRODUCTION: The incidence of cardiac toxicity due to 5-fluorouracil (5-FU) ranges from 1.2 to 18%. Most complications occur at the time of the first cure. Their mechanisms have not yet been clearly defined. EXEGESIS: The authors report a case of unstable angina induced by 5-FU. A coronary angioplasty was performed on a previously ignored coronary lesion. CONCLUSION: Recent studies support the hypothesis that 5-FU has endothelial toxicity resulting in thrombogenic effect and release of vasoactive substances. Unstable angina pectoris would be related to plaque rupture caused by 5-FU. Patients with previous history of coronary disease are at significantly increased risk for 5-FU-induced cardiotoxicity. They probably would benefit from continuous electrocardiographic monitoring. Rechallenge with 5-FU after cardiotoxicity problems should include only those patients for whom there is no alternative treatment.

[Osteochondroplastic tracheobronchopathy: 5 cases]. / Trachéobronchopathie ostéochondroplastique: cinq observations.

Five new cases of tracheobronchopathia osteochondroplastica (TBOCP) are reported and clinical, radiological and pathological features are reviewed. TBOCP is a rare disease characterized by cartilaginous and bony nodules lining the mucosa of the trachea and major bronchi. The endoscopic features realize pathological evolution by stadiums. The prognosis is usually favourable. The etiology of TBOCP remains unknown, even though some cases were reported in association with amyloidosis.

[Spontaneous dissecting aneurysm of the internal carotid artery]. / Dissection spontanée de l'artère carotide interne.

INTRODUCTION: Dissecting aneurysms of the internal carotid artery are due to arterial wall dissection caused by hematoma. We report a case of spontaneous dissection. EXEGESIS: A 65-year-old man presented with painful Horner's syndrome and hypoglossal palsy, without a history of arterial traumatism. Magnetic resonance imaging showed carotid artery dissection. CONCLUSION: Distal and subadventicial dissection can induce compression of adjacent nerves without modifications of the arterial lumen. This type of wall hematoma may not be detected by ultrasonography and angiography. Magnetic resonance imaging proves to be the best method of investigation and should be primarily advocated. Anticoagulation treatment is necessary.

[Ifosfamide-related encephalopathy. Report of two cases]. / Encéphalopathie à l'ifosfamide. A propos de deux cas.

INTRODUCTION: Due to ifosfamide urotoxicity, encephalopathy is a frequent complication accompanying treatment with this drug. The various clinical, physiological and therapeutical aspects of ifosfamide-related encephalopathy are reviewed. We report two cases and review current literature. EXEGESIS: Ifosfamide-related encephalopathy has polymorphous and non-specific clinical picture. The disease severity is variable, as related deaths have been reported. Clinical signs disappear with treatment discontinuation. Routes of administration, doses, tumoral site and gender have been implicated in the disease physiopathology. Admittedly, metabolite mitochondrial toxicity would be the underlying mechanism. Treatment would be based on intravenous methylene blue. A clinical trial aimed at studying prophylaxis is in progress. A few number of patients have been cured until now. CONCLUSION: Further studies are required to confirm the involved physiopathological mechanisms and methylene blue effects.

[Malacoplakia. Apropos of a case of retroperitoneal site]. / Malacoplasie. A propos d'une observation avec localisation rétropéritonéale.

Malacoplakia is a granulomatous inflammatory disease caused by a disorder of macrophage bactericidal function. The disease, histologically characterized by the presence of Michaelis-Gutmann bodies, has a preference for the urogenital tract and less frequently affects the gastrointestinal tract and the retroperitoneal region. We report the unusual case of a male patient who presented with retroperitoneal pseudotumoral malacoplakia associated with vesical malacoplakia. The main pathophysiological, diagnostic and therapeutic aspects of this rare disease are described.

[Common variable immunodeficiency and total villous atrophy regressive after gluten-free diet]. / Déficit immunitaire commun variable et atrophie villositaire totale régressive après régime sans gluten.

A patient with a commun variable immunodeficiency (CVID) is hospitalized for chronic symptoms of malabsorption (weigh loss and diarrhea). The duodenal histology show a total villous atrophy. Investigations are negative and a gluten free diet is given. Symptoms of malabsorption disappear and improvement is histologically confirmed. Our observation suggest that the coincidence of gluten sensitive enteropathy and CVID is possible and clinicians should be aware of this association and should consider giving a gluten free diet. The sensitivity of serologic testing in this conditions is unknown.

[Panhypopituitarism disclosing empty sella turcica syndrome]. / Panhypopituitarisme révélant un syndrome de la selle turcique vide.

INTRODUCTION: Empty sella syndrome is sometimes associated with anterior pituitary insufficiency, the latter being mostly partial or dissociated. EXEGESIS: We report a case of a profound panhypopituitarism revealing an empty sella syndrome. This case shows that empty sella syndrome, although a generally benign and asymptomatic condition, can be associated with hypopituitarism. CONCLUSION: In case of empty sella syndrome, especially if an endocrine dysfunction is clinically suspected, minimal hormonal analysis must be requested.

[Small intestine bacterial overgrowth: six case reports and literature review]. / Colonisation bactérienne chronique de l'intestin grêle: présentation de six observations et mise au point.

INTRODUCTION: Small intestinal bacterial overgrowth syndrome (SIBOS) has various clinical and biological presentations. Six observations are described in this review which is aimed at reporting recent data on SIBOS and proposing diagnosis and therapeutic attitudes. CURRENT KNOWLEDGE AND KEY POINTS: Chronic diarrhea, malabsorption syndrome and exsudative enteropathy are the main criteria of diagnosis. Breath hydrogen testing is commonly performed to confirm diagnosis, with a 78% sensitivity and a 89% specificity. The aim of therapy is reparation of malabsorption consequences, reduction of intestinal bacterial overgrowth, and surgical correction of intestinal stasis. In the absence of consensus, norfloxacin or amoxicillin-clavulinic acid (administered for a mean of 7 to 15 days) seem the more appropriate antibiotics. When possible, surgery represents the primary treatment of SIBOS recurrences. FUTURE PROSPECTS AND PROJECTS: Diagnosis of small intestinal bacterial overgrowth syndrome must be evoked on the basis of either surgical or medical context, i.e., the existence of chronic diarrhea, malabsorption syndrome (complete or not), and exsudative enteropathy. This review reports essential factors for diagnosis and treatment.

[Non-Hodgkin's lymphoma and hepatitis C virus infection]. / Lymphomes non hodgkiniens et infection par le virus de l'hépatite C.

INTRODUCTION: The authors report four cases of non Hodgkin's lymphomas (NHL) among patients infected by the hepatitis C virus (HCV). They discuss the epidemiological, physiopathological and clinical features of this association. CURRENT KNOWLEDGE AND KEY POINTS: The role of the HCV in the development of B-cell NHL is probable but the reported frequency of the association with HCV infection is variable especially in different countries. Most of the reported cases are low-grade NHL with frequent extranodal involvement. FUTURE PROSPECTS AND PROJECTS: New studies will improve the understanding of the physiopathological mechanisms that might explain the occurrence of NHL in the course of HCV infection. The recent evidence that the antiviral treatment is effective in splenic lymphoma with villous lymphocytes leads to reconsider the relationship between HCV and NHL and to think about new therapeutic possibilities.