[Atypical localization of a glomus tumor]. / Une tumeur glomique de localisation atypique.

Glomous tumors are rare and benign, generally affecting the fingers. Other localizations have nevertheless been described. We report the case of a patient who presented a supra-patellar glomous tumor provoking a pain-induced limp. Magnetic resonance imaging confirmed the diagnosis. The patient underwent complete surgical resection of the tumor followed by total resolution of the pain. Glomous tumors in an atypical localization may go unnoticed, with the risk of late or erroneous diagnosis. Symptoms are easily resolved with simple resection.

[Ebola virus disease: Clinical presentation, prognosis and treatment]. / Maladie à virus Ebola : présentation clinique, aspects pronostiques et principes thérapeutiques.

The clinical spectrum of Ebola virus disease (EVD) ranges from very serious forms with organ failure and death within days to paucisymptomatic forms and perhaps even asymptomatic. The authors propose a focus on the clinical manifestations of EVD, on prognosis and on therapeutic aspects (excluding resuscitation). This work extracts from the literature the main data gathered during the 2014-2015 epidemic that raged in Guinea Conakry and Sierra Leone. These two countries, even if they are separated by a border, are one and the same population base. The characteristics of the epidemic in Liberia have not been analyzed. The authors have treated EVD patients in the health workers treatment center of Conakry and enrich this work about their personal experience.

Transient myocarditis associated with acute Zika virus infection.

Zika virus outbreak is spreading in America. This emerging infection is associated with neurological complication. We report the first travel-acquired Zika acute infection complicated with myocarditis imported in Mainland France. We recommand an electrocardiogram and an troponin if any cardiac symptoms are present in a patient with acute Zika infection.

[Global management of patients with ebola viral disease, experience of the Healthcare workers Treatment of Conakry, Guinea]. / Prise en charge globale du patient contaminé par le virus Ebola, expérience du Centre de traitement des soignants de Conakry, Guinée.

The Healthcare Workers Treatment Center of Conakry, Guinea, was inaugurated in january 2015. It is dedicated to the diagnosis and the treatment of healthcare workers with probable or confirmed Ebola viral disease. It is staffed by the french army medical service. The french military team may reconcile their medical practice and the ethno-cultural imperatives to optimise the patient adherence during his hospitalization.

[Current treatment of rheumatoid arthritis]. / Traitement actuel de la polyarthrite rhumatoïde.

Over the past 10 years, the management of rheumatoid arthritis has been revolutionized. Early diagnosis is essential and should allow an early initiation of disease modifying anti-rheumatic drugs (DMARD), if possible within the first 3 three months after disease onset, aiming at disease remission and the best long-term prognosis. Recommendations for the prescription of synthetic and biologic DMARD (mainly anti-TNFalpha agents) are available since September 2007 [6] by HAS in France. The great efficacy of these drugs has been established from many clinical trials including tens of thousands of patients. However, severe adverse side effects may occur (allergy, tuberculosis, opportunistic infections, demyelination) and rheumatologists should remain vigilant. Global care of the patient includes prescription of pharmacologic and non-pharmacologic treatments (education, physical treatment, ergotherapy, psychotherapy, surgery). A good coordination between all specialists is required. Screening and treatment of extra-articular manifestations, prevention of infections, osteoporosis and cardiovascular complications are essential to allow a better long-term prognosis, and reduce disability and mortality of rheumatoid arthritis.

[Oedematous polyarthritis and myopericarditis as presenting features of periarteritis nodosa]. / Polyarthrite oedémateuse et myopéricardite révélatrices d'une périartérite noueuse.

Remitting symmetrical seronegative synovitis with pitting edema (RS3PE) syndrome is a rare type of seronegative polyarthritis occurring in the elderly. It can be associated to various diseases. We report a case of RS3PE syndrome associated with myopericarditis, leading to the diagnosis of polyarteritis nodosa in a 71-year-old patient admitted to the hospital for a febrile acute polyarthritis with pitting edema of the hands associated with a marked inflammatory syndrome. On second day of hospitalization, a sustained chest pain led to the diagnosis of myopericarditis. Muscular biopsy showed necrotizing vasculitis, characteristic of polyarteritis nodosa. The coexistence of RS3PE and myopericarditis has never been described in the literature. Its association with polyarteritis nodosa is also very rare and only one case has been previously reported.

[Right ventricular failure as the presenting manifestation of a carcinoid syndrome]. / Atteinte cardiaque droite révélatrice d'un syndrome carcinoïde.

We report a 75-year-old woman with a severe and symptomatic valvular tricuspid dysfunction, revealing a carcinoid syndrome, confirmed by an octreotid scan and liver biopsy. Carcinoid heart disease is a common complication of carcinoid syndrome associated with poor prognosis. Despite new pharmacological treatment, valve replacement surgery is the only curative treatment. Early diagnosis and multidisciplinary management could improve prognosis and quality of life of these patients.

[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.

[Favorable outcome of gemcitabine-induced acute respiratory distress syndrome]. / Syndrome de détresse respiratoire aiguë à la gemcitabine d'évolution favorable.

Gemcitabine is a new important drug used to treat solid tumors including non-small cell lung cancer, pancreatic, bladder and breast cancers. Myelosuppression is the most common adverse effect. Pulmonary toxicity is rare and usually mild and self-limiting with acute dyspnea. Severe pneumonitis and potentially fatal acute respiratory distress syndrome (ARDS) have been described in patients treated for a non-small cell lung cancer. We report a case of gemcitabine-induced ARDS in a 72-year old patient treated with gemcitabine and cisplatin for a bladder cancer without lung metastasis. Administration of high doses of corticosteroids led to a prompt symptomatic improvement.

[Venous thromboembolism and cancer]. / Maladie veineuse thromboembolique et cancer.

OBJECTIVES: The risk of venous thrombosis during cancer is largely increased especially in case of chemotherapy, surgery, advanced stage disease, coagulation abnormalities. Survival of patients with cancer experiencing venous thrombosis seems to be worse. Although thrombosis may be a presenting feature of occult malignancy, there are insufficient data to support a more extensive screening than comprehensive medical history, physical examination, routine laboratory tests and chest radiography. CURRENT KNOWLEDGE AND KEY POINTS: Pathophysiology of venous thrombosis during cancer is unspecific: venous stasis, vessel wall damage, hypercoagulability). Other factors like platelet abnormalities or the direct responsibility of chemotherapy or hormonotherapy have recently been though to play a causative role. Treatment of cancer-associated thrombosis usually requires at least 6 months of low-molecular-weight heparin therapy rather than oral anticoagulant. Inferior vena cava filters are not indicated. Primary prophylaxis of thrombosis during cancer could safely been achieved with low-molecular-weight heparin. Central venous catheters can be associated with thrombotic complications. Many risks factors have been identified: catheter's type, modalities of catheter's implantation, type of perfusion, bulky mediastinal mass... Prophylactic anticoagulation is not routinely recommended. FUTURE PROSPECTS AND PROJECTS: Knew oral anticoagulants could facilitate the treatment of venous thrombosis occurring during cancer in the next years.

Activity and distribution of protein kinase C in liver during the acute-phase response.

Activity and subcellular distribution of protein kinase C were estimated in liver cytosol and membrane fractions of rats carrying a turpentine-induced inflammation. Protein kinase C activity increases significantly 8 h after treatment in the membrane fraction, with concurrent reduction in the cytosol; 10 h after treatment the membrane-associated activity returns to normal, without concomitant recovery of that detected in the cytosol. The specific binding of phorbol dibutyrate to the liver membrane fraction increases but overall the effect is less evident and delayed in time. The changes are associated to alterations in the phosphorylation pattern of some liver proteins. Liver protein kinase C activity and intracellular distribution seem to be affected by a treatment which is known to induce an acute-phase response in the liver cells.

Liver albumin synthesis increases in free ribosomes during the acute-phase reaction.

Albumin concentration in the blood, and its synthesis by the liver, decrease in the rat during the acute-phase response to inflammation. In this paper we show that 24 hours after turpentine treatment free ribosomes from rat liver double their albumin synthesis and release preproalbumin in the cytosol. albumin mRNA from free polysomes, tested in reconstructed systems in vitro, directs the synthesis of preproalbumin which is correctly processed in the presence of microsomal membranes. Albumin mRNA in the free ribosomal fraction decreases in amount, but it is mainly associated with the heavier polysomal fraction. These data favor the hypothesis of a more, efficient utilization of the reduced amount of albumin mRNA, concurrent with failure of translational arrest of the nascent chain and with the release of unprocessed product in the cytosol.

Prostaglandin synthesis and early biochemical events in the liver cells during the acute-phase response.

Acetylsalicic acid and indomethacin suppress the increase of alpha-amanitin sensitive RNA synthesis (pre-mRNA), but not that of alpha-amanitin resistant RNA synthesis (pre-rRNA), which occur in liver nuclei a few hours after the start of turpentine-induced inflammation in the skin. The inflammation-associated increase in activity of nuclear ATP-ase is also prevented. Synthesis of prostaglandins PGE2 and PGE2 alpha by liver microsomes from turpentine-treated rats is enhanced within 90 min. from treatment. The results suggest an important role of intracellular prostaglandins as mediators of the early nuclear events occurring in the liver at the beginning of the acute-phase response to inflammation.