[Hemorrhagic shock revealing multiple digestive microaneurysms in a patient with systemic lupus erythematosus: Case report and literature review]. / Choc hémorragique révélant des micro-anévrismes digestifs au cours du lupus : cas clinique et revue de la littérature.

INTRODUCTION: The vascular disorders in systemic lupus erythematosus (SLE) result from various mechanisms and presentations (inflammatory disease or vasculitis, atherosclerosis). CASE REPORT: We report on a 34-year-old man with cutaneous, articular, neurological and nephrologic SLE. He presented with catastrophic haemorrhage on microaneurysm rupture of the left hepatic artery. After blood transfusions and immunosuppressive treatments, his condition improves. CONCLUSION: Uncommon complication in SLE patients, digestive vasculitis with microaneurysms may occur as in polyarteritis nodosa. In the literature, we identified 10 additional cases of hepatic microaneurysms in SLE patients. The main issue is an earlier diagnosis in order to give appropriate treatment and improve prognosis.

Botulinum toxin therapy for neurogenic detrusor hyperactivity versus augmentation enterocystoplasty: impact on the quality of life of patients with SCI.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To compare quality of life (QoL) in patients with spinal cord injury (SCI) who underwent overactive detrusor treatment by botulinum toxin (BT) versus augmentation cystoplasty (AC). SETTING: France. METHODS: Prospective and descriptive study: Patients with a refractory overactive bladder due to SCI treated by at least two successive injections of BT or by AC. QoL was assessed using Qualiveen-30 (Q30). Clinical data and urodynamic parameters were collected. RESULTS: Thirty patients were included between March 2013 and March 2014: 14 in arm 1 (BT injections) and 16 in arm 2 (AC). Mean postoperative time after AC was 9.94 years. Mean BT injections already performed was 6.36. Qol was significantly lower in arm 1-Q30 score 1.625 versus arm 2-Q30 score 1.077 (P=0.037). Continence control was significantly higher in arm 2. Fourteen patients were completely continent (87.5%) in arm 2, whereas only 6 (42.3%) were continent in arm 1 (P=0.0187). Urinary infection, reflux, diverticula and stones were almost at a similar occurrence level. CONCLUSIONS: QoL was found to be higher with an AC compared with BT injections. Long-time intervals between two injections and advantages specific to AC might explain in part these findings.

The Cognitive Assessment scale for Stroke Patients (CASP) vs. MMSE and MoCA in non-aphasic hemispheric stroke patients.

INTRODUCTION: CASP specifically assesses post-stroke cognitive impairments. Its items are visual and as such can be administered to patients with severe expressive aphasia. We have previously shown that the CASP was more suitable than the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in aphasic patients. Our objective was to compare the above scales in non-aphasic stroke patients, and assess to what extent the solely visual items of the CASP were problematic in cases of neurovisual impairments. METHODS: Fifty non-aphasic patients admitted to Physical Medicine and Rehabilitation (PM&R) units after a recent left- or right-hemisphere stroke were evaluated with the CASP, MMSE and MoCA. We compared these three scales in terms of feasibility, concordance, and influence of neurovisual impairments on the total score. RESULTS: Twenty-nine men and 21 women were included (mean age 63 ± 14). For three patients, the MoCa was impossible to administer. It took significantly less time to administer the CASP (10 ± 5 min) than the MoCA (11 ± 5 min, P=0.02), yet it still took more time than MMSE administration (7 ± 3 min, P<10(-6)). Neurovisual impairments affected equally the total scores of the three tests. Concordance between these scores was poor and only the CASP could specifically assess unilateral spatial neglect. CONCLUSION: The sole visual format of the CASP scale seems suitable for administration in post-stroke patients.

Feasibility of the cognitive assessment scale for stroke patients (CASP) vs. MMSE and MoCA in aphasic left hemispheric stroke patients.

INTRODUCTION: Post-stroke aphasia makes it difficult to assess cognitive deficiencies. We thus developed the CASP, which can be administered without using language. Our objective was to compare the feasibility of the CASP, the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) in aphasic stroke patients. MATERIAL AND METHODS: All aphasic patients consecutively admitted to seven French rehabilitation units during a 4-month period after a recent first left hemispheric stroke were assessed with CASP, MMSE and MoCA. We determined the proportion of patients in whom it was impossible to administer at least one item from these 3 scales, and compared their administration times. RESULTS: Forty-four patients were included (age 64±15, 26 males). The CASP was impossible to administer in eight of them (18%), compared with 16 for the MMSE (36%, P=0.05) and 13 for the MoCA (30%, P=0.21, NS). It was possible to administer the CASP in all of the patients with expressive aphasia, whereas the MMSE and the MoCA could not be administered. Administration times were longer for the CASP (13±4min) than for the MMSE (8±3min, P<10(-6)) and the MoCA (11±5min, P=0.23, NS). CONCLUSION: The CASP is more feasible than the MMSE and the MoCA in aphasic stroke patients.

[Kikuchi-Fujimoto disease in Gabon. Description of first 2 cases in Gabon]. / Maladie de Kikuchi-Fujimoto: 2 premiers cas au Gabon.

Kikuchi-Fujimoto disease is a rare disorder sometimes associated with systemic lupus. It has rarely been reported in the black African population. The purpose of this report is to describe the first two cases in Gabon. In patients presenting enlarged cervical lymph nodes, it is first necessary to rule out infectious disease. Histology can allow diagnosis by demonstrating necrotizing histiocyte lymphadenitis.

[Hysterectomies for benign pathology: is there a place for laparoscopic surgery?]. / Hystérectomies pour pathologie bénigne: y a-t-il une place pour la coeliochirurgie?

STUDY OBJECTIVE: To investigate the alternative routes for hysterectomy for benign disease and the appropriate role of laparoscopic surgery. DESIGN: Retrospective study of hysterectomies performed between August 1991 and July 1997. SETTING: University hospital. PATIENTS: Hysterectomy for benign disease without prolapse, pelvic floor relaxation. INTERVENTION: 359 hysterectomies: vaginal (n = 211), laparoscopically-assisted vaginal (n = 56), and abdominal (n = 92). MEASUREMENTS AND MAIN RESULTS: Uterine volume was the principal indication for laparotomy. Laparoscopy was required only in cases of adnexal disorders or when the vaginal access was limited or associated with extensive adhesions. The rate of laparotomies and laparoscopies dropped steadily over the six-year study period: during the last two years, 75% of all hysterectomies were vaginal, and 90% of those for patients without a previous vaginal birth. CONCLUSION: With experienced surgeons, the number of cases in which there appears to be poor vaginal accessibility experience decreases, and indications for vaginal hysterectomies increase.