[Positron emission tomography in internal medicine]. / Tomographie par émission de positons en médecine interne.

FDG-PET is now an established diagnostic tool in oncology. Fluorodeoxyglucose is not a specific tracer for malignant lesions but rather for elevated glucose metabolism, present not only in cancer but also in inflammatory and infectious lesions. FDG-PET has thus been suggested for diagnosis of fevers of unknown origin, deep bone or visceral infectious foci, inflammatory vasculitis or sarcoidosis and unknown primary tumors, all frequent situation in internal medicine. The main characteristics of FDG-PET are its ability to rule out focal inflammation or infection with a high degree of certainty when the examination is negative because of its good negative predictive value and its usefulness as an early marker of therapeutic response, compared with anatomy-based or conventional scintigraphic imaging. Large-scale prospective studies are necessary, however, before FDG-PET is integrated into routine clinical use. It should be compared with different techniques already validated (biology, radiology, conventional scintigraphic imaging) and its cost-effectiveness should be evaluated.

[Accelerated atheroma with prednisone and clopidogrel]. / Athérome accéléré lors d'un traitement par prednisone et clopidogrel.

INTRODUCTION: Several mechanisms may explain the aggravation of atheroma lesions in patients receiving corticosteroid treatments. CASE: This 68-year-old man, a smoker with high cholesterol levels and a history of two transient ischemic attacks, also had severe Horton disease (giant cell arteritis) requiring treatment by corticosteroids and azathioprine. After a new transient ischemic accident, clopidogrel treatment was initiated. Ten months later, severe carotid stenosis was observed. Endarterectomy removed a recent thrombus and the pathology examination showed necrotic lesions complicated by hemorrhage with inflammatory infiltrate. DISCUSSIONS: This patient's atheromatous disease was aggravated by intraplaque hemorrhage, caused by several factors include his corticosteroid therapy and platelet aggregation inhibition treatment.

[Rofecoxib-related cutaneous vasculitis]. / Vascularite cutanée liée au rofécoxib.

INTRODUCTION: Drugs are at the origin of around 10% of the cases of vasculitis involving the small vessels. Recent cases report vasculitis related to the administration of nonsteroidal antiinflammatory selective inhibitors of cyclo-oxygenase 2. CASE: Vasculitis associated with ketoprofen appeared in a 76 year-old man: the symptoms disappeared when treatment stopped. A few weeks later, during treatment with rofecoxib, a relapse appeared, including purpura. The diagnosis of rofecoxib-induced cutaneous vasculitis was confirmed by regression of all symptoms when treatment stopped. DISCUSSION: Coxibs, like other nonsteroidal antiinflammatory drugs, may cause vasculitis, at an as-yet undetermined frequency.

[Rectal endocrine intermediate-cell carcinoma]. / Carcinome endocrine à grandes cellules du rectum.

An 82-year-old patient complained of diarrhea due to a rectal endocrine intermediate-cell carcinoma. Histology displayed a neuron-specific enolase and CD56 immunoreactive tumor. Hepatic metastases developed rapidly and the tumor was briefly reactive to radiotherapy and chemotherapy. These tumors are rare and have a poor prognosis. We focus on the recent classification of gastrointestinal endocrine tumors.