[Analysis of complications of thyroid surgery: recurrent paralysis et hypoparathyroidism. On a series of 588 cases]. / Analyse des complications de la chirurgie thyroïdienne: paralysie récurrentielle et hypoparathyroidie. Sur une série de 588 cas.

The purpose of this report is to study the incidence of two main complications in thyroid surgery without systematic search for recurrent laryngeal nerve, by intracapsular thyroidectomy: temporary and chronic laryngeal recurrent paralysis (after six months), temporary hypoparathyroidism and chronic hypoparathyroidism (unrecovering normal function after six months). We have retrospectively analysed 588 patients from 1981 to 1994. There were 247 total or subtotal thyroidectomies and 341 loboisthmectomies (isolated thyroid nodules). We obtained over this 588 cases 0.3% of chronic laryngeal paralysis and 1.4% of chronic hypoparathyroidism. If the cost of surgery for thyroid nodules is low (0.3% of chronic recurrent paralysis and 0% of chronic hypoparathyroidism), it is more important for total or subtotal thyroidectomies (respectively 1.2% and 3.2%). We conclude that in thyroid surgery, there is no higher risk for the recurrent nerve without dissection of this one, but we note that, without obvious explanation, rates of permanent hypoparathyroidism are not better than in others publications.

[Isolated fetal tachycardia, a diagnostic event of Basedow's disease. Apropos of a case]. / Tachycardie foetale isolée, circonstance de découverte d'une maladie de basedow. A propos d'une observation.

Two of thousand pregnancies are complicated by a Graves' disease. The circumstances of diagnosis are usually maternal disorders (tachycardia, exophthalmia, loss of weight...), also fetal disorders (tachycardia, intra-uterine growth retardation, stillborn...). The discovery of fetal tachycardia (160 beats per minute), and maternal tachycardia (120 beats per minute) associated with high blood pressure, allowed us to suspect, in this case, a Graves' disease, responsible of fetal hyperthyroidism by autoantibodies crossing the placenta. The measuring of T3, T4, TSH and autoantibodies confirmed the diagnosis. The drug of choice is the PTU (propylthiouracil). It prevents synthesis of thyroid hormones and inhibits peripheral deiodination of T4 to T3. It treats simultaneously mother and fetus; the surveillance must allow us to adjust treatment to avoid fetal hypothyroidism, maternal thyrotoxicosis of peripartum and neonatal thyrotoxicosis.

[Autoimmune dysthyroidism induced by alpha interferon in two female patients with chronic non-A, non-B hepatitis]. / Dysthyroïdies auto-immunes induites par l'interféron alpha chez 2 femmes atteintes d'hépatite chronique non-A, non-B.

We report two cases of autoimmune thyroid disorders which appeared after 6 months of recombinant alpha interferon therapy given for chronic non-A, non-B hepatitis. There was no family or personal history of thyroid disease, or had the patients taken any hepatic or thyroid toxic drugs. The other causes of hepatic and thyroid diseases were ruled out. The first case concerned a 33-year-old woman with sporadic hepatitis C. Therapy was complicated by the appearance of antimicrosomal thyroid antibodies and hypothyroidism. At 22 months, substitutive therapy was still necessary in one case. The second case involved a 37-year-old woman with post-transfusional non-A, non-B hepatitis which was complicated by transient hypothyroidism preceding thyrotoxicosis (with TSH-receptor antibodies). We observed a return to euthyroidism and loss of associated antibodies after withdrawal of interferon and institution of hormonal therapy.

[Deep venous thromboses in erysipelas of the leg. A prospective study of 40 cases]. / Thromboses veineuses profondes au cours des érysipèles de jambe. Etude prospective de 40 observations.

The treatment of lover limb erysipelas rests on antibiotic therapy directed against streptococci, but the necessity of prescribing a concomitant anticoagulant treatment has not yet been established. The incidence of deep vein thrombosis in patients with erysipelas of the leg in unknown. In a prospective study of 40 patients presenting with this type of skin disease, we looked for deep vein thrombosis, using systematically pulsed Doppler vein exploration combined with ultrasonography and, if necessary, a second Doppler examination and a phlebography. Six cases of deep vein thrombosis were diagnosed. This complication was observed in 5 patients at high risk for deep venous thrombosis; it had never been foreseen at clinical examination.

[Retrospective study of 594 HIV-1 seropositive patients seen in 8 hospitals of western Paris]. / Etude rétrospective de 594 patients séropositifs VIH 1 vus dans huit hôpitaux de l'quest Parisien.

This multicenter retrospective study concerns 594 cases of HIV-1 positive patients. The majority were asymptomatic. Some had Aids-related complex and some had AIDS. They were all seen in seven hospitals of the western outskirts of Paris and in one Paris hospital between 1983 and 1988. There was a predominance of homosexuals and of cases of AIDS in the center of Paris. Intravenous (IV) drug users and asymptomatic cases were more numerous in the city outskirts, a reflection of the populations at risk around each hospital. The proportion of cases of AIDS was lower among IV drug users than among homosexuals or bisexuals probably due to the fact that the viral infection was discovered at an earlier stage in a population contaminated at a later date or to the tendency to ask for the test "systematically" in drug addicts. 22% of the cases were women with a sex ratio of 3.5. HIV infection was attributed to use of intravenous drugs in 51% and to heterosexual transmission in 18% of the women. But the incidence of heterosexual transmission increased significantly, essentially in women. Overall, the incidence of infection by the HIV 1 has decreased since 1986. A number of recent publications seem to indicate the same tendency. But this fundamental observation remains to be validated by further studies. The yearly incidence of AIDS increases. The 5 year calculated actuarial rate of probability of remaining asymptomatic decreased to 40% in 385 initially asymptomatic patients.

[Colonic endoscopic screening and familial antecedent of sporadic rectocolonic cancer. Controlled prospective study]. / Dépistage endoscopique colique et antécédent familial de cancer rectocolique sporadique. Etude prospective contrôlée.

We searched for colorectal tumors in asymptomatic patients older than 40 years with family history of sporadic colorectal cancer (only first degree relatives). One hundred and four patients at risk had a left-sided (n = 60) or a total colonoscopy (n = 44) and were compared to 104 control patients, matched for age, sex and type of colonic investigation. Three cancers were detected in the group at risk, 1 in the control group (NS). One or more adenomas without carcinoma were found in 10 percent of the patients at risk and in 9 percent of the controls (NS). There was no difference between groups in the number, size, histologic type, degree of dysplasia, or location of adenoma in the colon. These results do not exclude a family predisposition to sporadic colorectal cancer or adenoma. Because of the low rate of adenoma detection, relatives of patients with sporadic colorectal carcinoma but without personal risk factors cannot be considered as a high risk group for colorectal endoscopic screening.

[Value of molluscum pendulum in the diagnosis of colorectal neoplastic lesions]. / Valeur du "molluscum pendulum" pour le diagnostic des lésions néoplasiques colorectales.

A routine search for skin tags was made before performing colonoscopy in 220 patients, whose mean age was 61.8 years. Sixty-one p. 100 of patients were male. The reasons for colonoscopy were digestive symptoms (95 cases), past history of malignant disease of the colon (MDC) or rectum (67 cases) or other symptoms (58 cases). Eighty-five patients had one or more skin tags, while 78 patients had one or more MDC. MDC in patients with skin tags was more frequent than in patients without skin tags (43.5 p. 100 vs. 30.4 p. 100 respectively, p less than 0.05). However this relationship was age-dependent. No significant relationship was found between the discovery of skin tags and the number of MDC, the carcinomatous nature of the lesion or not, or its degree of dysplasia. In 153 patients without personal history of MDC there was no significant relationship between the existence of skin tags and the discovery of colorectal lesions at colonoscopy. In this series of 220 patients, the sensitivity and specificity of skin tags associated with MDC on colonoscopy was poor (0.47 and 0.66 respectively).

[Icterus disclosing pancreatic involvement in idiopathic hypereosinophilic syndrome]. / Ictère révélant une atteinte pancréatique au cours d'un syndrome hyperéosinophilique idiopathique.

We report herein what we think is the first case of an idiopathic hypereosinophilic syndrome in which jaundice (caused by eosinophilic pancreatitis) was the first major symptom. The duodenum and an antral polyp were also infiltrated by eosinophils. In our case, diagnosis was based upon the classic three fold criteria: a) persistent eosinophilia (greater than or equal to 1,500/mm3, b) lack of evidence for any other recognized cause of eosinophilia, c) multiple organ systemic involvement: skin, lymph nodes, heart (detected by routine echocardiography), nerves (discovered on electromyography), and later, arthritis and pleural effusion. Biological signs included increased plasmatic IgE levels (3,500 UI/ml), circulating immune complexes and absence of leukemic markers. This case emphasizes the difficulty in classifying eosinophilic infiltrations of the gut and the possibility of transitional forms between eosinophilic granuloma, eosinophilic gastroenteritis and the hypereosinophilic syndrome.

[Cholestatic hepatitis. Presumptive role of ticlopidine]. / Hépatite cholestatique: rôle vraisemblable de la ticlopidine.

A seventy-one-year-old woman presented with jaundice (total bilirubinemia 91 microM, conjugated bilirubinemia 76 microM) and cytolysis (ALAT greater than 6 N) after ten days of pentoxifylline-ticlopidine combination therapy. Blood count was normal excepting transient anemia. Protein electrophoresis was normal. Jaundice resolved 10 days after both drugs had been discontinued. Viral serology (B, A, nonA-nonB, mononucleosis, cytomegalovirus, herpes simplex virus) was negative. Ultrasonography and cholecystography were normal. Responsibility of a drug is therefore likely and we are inclined to incriminate ticlopidine as two similar cases have previously been observed.

[Celiac disease, dermatitis herpetiformis and erosive jejunoileitis]. / Maladie coeliaque, dermatite herpétiforme et jéjuno-iléite érosive.

A 21-year-old man with coeliac disease and dermatitis herpetiformis presented successively with erosive ileitis (warranting surgical resection) and erosive jejunitis (proven by jejunoscopy). Discontinuous antibiotic therapy was associated with a gluten-free diet and evolution was favorable as judged with five years follow-up. Malabsorption with mucosal ulcerations can be due to: a) chronic ulcerative duodeno-jejuno-ileitis or Jeffries' disease; b) coeliac disease which may be classified as possible, probable, or certain according to the strictness of criteria. Our case is the fourth in which a villous response was proven after gluten-free diet. It is also particular in that the erosions were superficial; c) malignant lymphoma which can reasonably be excluded here. This observation confirms that a gluten-free diet may be effective after surgical resection of the ulcerated segment in complicated coeliac disease and shows that antibiotics may be an useful adjuvant to therapy.

[Gastric eosinophilic granuloma : value of endoscopic polypectomy. Apropos of 2 cases]. / Le granulome éosinophile gastrique : intérêt de la polypectomie endoscopique. A propos de deux observations.

Two ulcerated, sessile, gastric eosinophilic granulomas, measuring 5 and 10 mm in diameter, were diagnosed by endoscopic polypectomy (accurate prior forceps biopsy had not established accurate diagnosis). The patients, aged 76 and 74 years, had anemia and epigastric pain respectively. None of the usual etiologies (parasitic, chemical, traumatic and ulcerous) were found. Survival, clinical symptoms and location were similar to data reported in the literature, which are briefly reviewed. The value of endoscopic polypectomy is emphasized. With this procedure, pedunculated forms can be treated and sessile forms diagnosed, thus avoiding a useless gastrectomy and its hazards in these elderly patients.