[Non-diseases: another field for the specialist of internal medicine]. / Les non-maladies: un autre domaine de linterniste.

PURPOSE: Non-diseases are a heterogeneous group of symptoms, preoccupations or phenomenon that are felt or interpreted as pathological and so justifiable of medical intervention. Most doctors easily recognize illnesses that require no medical act. However, as a result of a medical misinterpretation or wrong reasoning, physicians may diagnose a non-disease and prescribe a non adapted treatment. KEY POINTS: This non exhaustive literature review, gives examples of anatomical, clinical, investigational, iatrogenic, psychiatric and collective non-diseases. Health education of the population, initial and continuing education of general and specialist practitioners and continuous assessment of advertising by the pharmaceutical industry are probably useful to limit the provision of medical care of non-pathological problems, which excessively request the physicians. CONCLUSION: The specialist of internal medicine, because of a wide knowledge of the medical specialities, has to recognize and learn the frequent traps of non-diseases.

[Interest of careful blood film observation in haemolytic anaemia diagnosis]. / L'intérêt de l'examen attentif du frottis sanguin dans le diagnostic des anémies hémolytiques.

The discovery of anaemia raises the question of its aetiology. If many causes can easily be established, some remain without any accurate diagnosis. The mere issue is that their causes can be rare or mechanisms interlinked. A blood film examination by the biologist provides helpful elements to guide the diagnosis, it can be improved if it is orientated by the physician who prescribed it. Two cases of late discovery of haemolytic anaemia, in relation with red cell membrane disorders, are reported. They illustrate the interest of a good collaboration between the physician and the biologist that lead to diagnosis. The first case is about a band-3 protein defect, the second deals with an hereditary dehydrated stomatocytosis.

[Recurrence of thromboembolic disease after splenectomy for hereditary xerocytosis]. / Maladie thromboembolique récidivante après splénectomie pour stomatocytose héréditaire.

CASE REPORT: The diagnosis of hereditary xerocytosis is made in a 57 year old woman splenectomized 30 years ago for a chronic hemolytic anemia. In following, she developed many thrombophlebitis of lower limbs and portal vein. DISCUSSION: The methods of diagnosis of this rare hereditary stomatocytosis are recalled, and the mechanisms of thrombotic tendency after splenectomy are discussed. This case underlines the fact that splenectomy is banned in the treatment of hereditary stomatocytosis, and that the serious consequences of iron overload, which is very frequent in this disease, must be prevented.

[Prostatic actinomycosis in a diabetic patient]. / Actinomycose prostatique chez un patient diabétique.

INTRODUCTION: Prostatic localization of actinomycosis is unusual. CASE REPORT: We report the case of a 59 years-old diabetic man, hospitalised for a prostatic actinomycosis spontaneously fistulised in the rectum. Two species of Actinomyces were found in blood culture and in pus of the fistula. DISCUSSION: Therapeutic management including surgical treatment of the fistula and a specific antibiotherapy led to cure the prostatic infection due to Actinomyces.

[Diabetes insipidus revealing chronic myelomonocytic leukemia]. / Diabète insipide central inaugural d'une leucémie myélomonocytaire chronique.

INTRODUCTION: Central diabetes insipidus is most frequently reported to occur after a trauma from surgery or accident. However, between 30 and 50% of cases are considered idiopathic. It's a rare complication of myelodysplastic syndrome. CASE REPORT: A 61-year-old patient presented central diabetes insipidus revealing, 17 months before, chronic myelomonocytic leukemia. Cytogenetics studies revealed monosomy 7. Acute myeloid leukemia appears 3 months after training rapid patient's death. DISCUSSION: Blood examination is necessary before to conclude idiopathic central diabetes insipidus. The discovery of chronic myelomonocytic leukemia implicates a rapid managing before its possible acute myeloid leukemia transformation. Indeed, prognosis of central diabetes insipidus and acute myeloid leukemia associated, in presence of monosomy 7, is very poor.

[Acquired, non-amyloid related factor X deficiency: A first case associated with atypical chronic lymphocytic leukemia and literature review]. / Déficit non amyloïde acquis en facteur X : un premier cas satellite d'une leucémie lymphoïde chronique atypique et revue de la littérature.

INTRODUCTION: Acquired factor X deficiency is in most cases associated with AL amyloidosis. Acquired non-amyloid related factor X deficiency (DNAA-FX) has been exceptionally reported in the literature. CASE REPORT: We report the first case of acquired, non-amyloid related factor X deficiency associated with atypical chronic lymphoid leukemia in a 66-year-old patient with spontaneous hematomas. After therapeutic failure with polyclonal intravenous immunoglobulins, specific lymphoid malignancy treatment allowed symptoms and coagulation disorder resolution. CONCLUSION: DNAA-FX should be considered in case of bleeding events or coagulation disorders during low-grade hematological malignancies. Its occurrence can be considered as a treatment indication to prevent potentially fatal bleeding complications.

[Early myocardial infarction associated with chemotherapy for testicular cancer]. / Infarctus du myocarde précoce après chimiothérapie pour tumeur testiculaire.

INTRODUCTION: In long-term survivors of testicular cancer, a greater risk of developing cardiovascular disease is reported. On the other hand, acute vascular event during chemotherapy is uncommon. CASE REPORT: We report on a case of acute myocardial infarction in a young man receiving chemotherapy (BEP) for testicular cancer. DISCUSSION: We suggest a causal association between chemotherapy and early myocardial infarction. The physiopathological mechanisms are discussed here.

[Acute abdominal pain in a 8-year-old girl with Epstein-Barr infection]. / Douleur abdominale aiguë au cours d'une primo-infection par le virus d'Epstein-Barr.

Abdominal pain is uncommon in patient with Epstein-Barr infection and is usually attributed to an enlargement of the liver or spleen. We report on an 8-year-old girl with a pseudoperitonitis due to a mesenteric lymphadenitis associated with Epstein-Barr infection. Outcome was favourable without surgery. We review the different causes of abdominal pain occurring during Epstein-Barr infection.

[Bing-Neel syndrome: Report of 4 cases and literature review]. / Syndrome de Bing et Neel : à propos de 4 cas et revue de la littérature.

INTRODUCTION: Neurological manifestations during Waldenstrom disease are common and are usually related to immune peripheral neuropathy or serum hyperviscosity syndrome. The infiltration of the central nervous system by the lymphoproliferative syndrome is known as the Bing-Neel syndrome. This extremely rare entity remains poorly described in the literature. CASE REPORTS: We report on 4 cases of patients for whom central neurological disorders led to the diagnosis of a Bing and Neel syndrome. These four cases illustrate different clinical presentations, diagnosis, therapeutic options, and outcome in this syndrome. Based on our literature review, we discuss about these differences. CONCLUSION: The polymorphic clinical manifestations of Bing and Neel syndrome can mimic many diagnoses. However, it may be necessary to consider this diagnosis. Cerebrospinal fluid analysis and MRI may allow rapid diagnosis or guide a biopsy. Prolonged remissions are possible with appropriate treatment.

[Infectious endocarditis. A study of 50 patients in a non-university hospital]. / Endocardite infectieuse. A propos de 50 patients consécutifs d'un hôpital non universitaire.

The authors report the results of a single centre study of 50 consecutive patients (average age 66 +/- 14 years; 36 men), admitted between 1992 and 2001 to a peripheral hospital for infectious endocarditis (IE). The median interval to diagnosis was 57 days. There was an underlying cardiac disease in 52% of cases, usually valvular (42%). The site of the IE was the mitral valve in 21 cases, the aortic valve in 19 cases, mitro-aortic valves in 5 cases, native tricuspid valves in 2 cases and pacing catheters in 4 cases (associated with valvular endocarditis in one patient). The causal organism was usually a streptococcus (60%, including 28% of streptococcus bovis), or a staphylococcus (22%): no organism could be found in 7 patients. The average follow-up was 33 +/- 30 months: surgery was indicated in half the patients and 3 patients were turned down because of their poor general condition. In all, 34% of patients died (24% of their IE) in a median interval of 6 months, mainly from infectious or haemodynamic complications. Poor prognostic factors were: age > 70 years, "blind" antibiotic therapy, large-sized vegetations, embolism and renal failure. These data, comparable to the results observed in large series in the literature, underline the importance of multi-disciplinary management of IE and strict prophylaxis.

[Left atrial thrombus in multiple myeloma treated with thalidomide]. / Thrombus de l'oreillette gauche au cours d'un myélome multiple traité par thalidomide.

The occurrence of a left atrial thrombus without a haemodynamic predisposing factor (arrhythmia, mitral valvulopathy, severe left ventricular dysfunction) is a rare event. We report a case during the progression of refractory myeloma, four months after stopping treatment with thalidomide. The promoting haemodynamic factors for left atrial thrombosis in sinus rhythm, described in the literature, had been excluded. In our case the potential role of thalidomide is debatable, in the light of recent publications about venous and arterial thromboses observed with this treatment.

[Youthful popliteal aneurysm]. / Anévrisme poplité juvénile.

Popliteal artery aneurysms are not so clinically frequent but are the most common site of peripheral aneurysms. They usually affect men aged over sixty and are caused by atherosclerosis. Whenever they concern younger men, other more unusual aetiologies such trauma, infection, inflammatory arteritis or popliteal entrapment are responsible. The authors report the first written observation of small size popliteal aneurysm, revealed by intermittent claudication in a 33 years old subject, of which the origin is accelerated atherosclerosis. The evolution after resection of the popliteal aneurysm and end-to-end anastomosis with saphenous vein was favorable. This observation reminds us of various popliteal aneurysm aetiologies, not excluding atherosclerosis due to young age and also underlines that the small size of these aneurysms does not protect against embolism risk.

[Acute complication of a composite graft replacement of the aortic root]. / Complication aiguë d'une prothèse de l'aorte ascendante.

A 78-year old man operated for an acute aortic dissection 8 years ago was hospitalized for an unusual clinical presentation with acute cor pulmonale and superior vena caval syndrome. He had poorly controlled high blood pressure, and coronary artery disease with aorto-coronary by-pass 10 years ago. He underwent Bentall procedure 2 years later for type I acute aortic dissection, with vein graft reimplantation on the valvular conduit. A pseudoaneurysm was noted in the post-operative period, which remained stable at 45 mm during the follow-up. Thoracic CT-scan highlighted a 14.5 cm diameter pseudoaneurysm compressing the superior vena cava and right pulmonary artery. Detached right aorto-coronary by-pass, suspected on transesophageal echocardiography, was confirmed peri-operatively; the aortic anastomosis blood in the peri-prosthetic space, explaining the acute clinical picture. The severity of the lesions did not permit surgical repair and the patient died during operation. This observation evidences the complications observed after aortic root replacement and favors echographic and radiological follow-ups (J Mal Vasc 1999; 24: 381-383).

[Meningoradiculitis revealing an occult medulloblastoma-PNET in an adult]. / Méningo-radiculite révélant un médulloblastome-PNET occulte de l'adulte.

Neoplastic meningitis as the presentation of occult primitive neuroectodermal tumor (PNET) is occasionally described in children. We report the case of an 64 year old-man who presented a meningo-radiculopathy with progressive injury of the cauda equina and then the ocular motor nerves, revealing an occult medulloblastoma-PNET.

[Cutaneous metastatic Crohn disease. Apropos of a case]. / Maladie de Crohn cutanée métastatique. A propos d'une observation.

The authors report the case of a 54-year old man suffering from facial papulonodular eruption. He has Crohn's disease which was diagnosed 36 years ago. There were no clinical symptoms of the disease when the cutaneous manifestations occurred. The biopsy of a cutaneous lesion showed cutaneous granuloma at skin's level. Having no other etiology, we shall diagnose it as a cutaneous metastatic Crohn's disease. Derived sulfasalazine (Pentasa) healed all lesions in 1 month. This observation reminded us to that it is essential to biopsy all atypical cutaneous lesions occurring in a Crohn's disease case.

[Leishmaniasis and human immunodeficiency virus: an emerging co-infection?]. / Leishmaniose et virus de l'immunodéficience humaine: une co-infection en émergence?

Although not considered as indicative of AIDS, leishmaniasis presents a number of epidemiologic and clinical features that promote opportunistic infection in HIV patients. Accurate assessment of the incidence of this type of co-infection is difficult due to underestimation in endemic areas such as Africa and Asia. In these areas the WHO estimates that 2 to 9 p. 100 of HIV patients will develop leishmaniasis/HIV co-infection which could become a major concern. The characteristics of this co-infection have been documented. It is observed in adults between 20 and 40 years of age with a strong male sex bias. The visceral form is most frequent. Manifestations are similar to those observed in immunocompetent subjects but with the possibility of asymptomatic and low-grade forms (10 p. 100) and unusual locations suggesting multiorgan spreading in absence of host immune response. In addition to the time-tested standard procedures for diagnosis of parasitic disease, new serologic tests and genomic amplification are now available. Pentavalent antimonials have long been considered as the treatment of choice but they are not always effective and can have untoward effects. Amphotericine B especially in the liposomal form is a good alternative. The particularly high incidence of recurrence suggests that follow-up may be indicated but the modalities of prophylaxis have yet to be defined.

[Can we prevent or cure infection-related cancers?]. / Peut-on prévenir ou guérir les cancers d'origine infectieuse?

Infections are an important cause of cancer in the world, representing approximately 16% of the neoplasia. Ten infectious agents have been classified as carcinogens of group I. Four of these pathogens (Helicobacter pylori, hepatitis B and C viruses, and some human papillomavirus) are responsible for 95% of cases of infection-related cancers. The carcinogenesis mechanisms are multiple, either direct via certain proteins from these microorganisms, or more often indirect through chronic inflammation. This allowed to consider prevention of certain cancers, for example with a prophylactic vaccine strategy. Advances were also made in the curative field. However, efforts remain to be done to discover new infectious causes of cancer and refine the understanding of the mechanisms of carcinogenesis, for a better targeting of anticancer therapeutics.

[Myelodysplastic syndrome with erythroblastopenia]. / Syndromes myélodysplasiques érythroblastopéniques.

Myelodysplastic syndrome with erythroid hypoplasia or erythroblastopenia has not yet been clearly defined, and in most patients it is mistaken for acquired pure red cell aplasia. Including one additional patient reported in this article, a literature review revealed only 50 cases over the last 20 years. These patients were predominantly elderly males, all required regular packed red cell transfusions, and they had a poor prognosis, mainly because of acute transformation. The mechanisms of erythroid aplasia remain unclear. However, recent data suggest the association of an intrinsic stem cell defect with immunological implication.