[HIV-associated myelopathy: an uncommon indicator of AIDS]. / La myélopathie associée au VIH: un mode rare de révélation du sida.

INTRODUCTION: Spinal cord lesions are an uncommon mode of discovering acquired immunodeficiency syndrome because they usually appear at a later stage. EXEGESIS: We report a 58-year-old patient who had a spastic paraparesia and sphincter dysfunction. The spinal cord magnetic resonance imaging showed spontaneous hypersignals on T2-weighted images at the cervical and thoracic levels, enhanced with gadolinium, and without swelling. No cause was found. The HIV serology was positive and allowed us to consider an HIV-associated myelopathy. The antiretroviral therapy led to functional recovery. CONCLUSION: An HIV serology is suggested whenever an unexplained intramedullary lesion is discovered. Indeed, the diagnosis of HIV-associated myelopathy implies a specific therapeutic approach.

[Needle-tract seeding after ultrasound-guided puncture of hepatocellular carcinoma. A study of 150 patients]. / Essaimages tumoraux sur le trajet de ponctions écho-guidées de carcinomes hépatocellulaires. Etude de 150 malades.

OBJECTIVES: To study the frequency of tumor seeding after percutaneous biopsy of hepatocellular carcinoma and to evaluate the impact on long-term survival. METHODS: Records of 150 patients with cirrhosis who underwent ultrasound-guided aspiration biopsy for hepatocellular carcinoma between 1989 and 1996 were reviewed in June 1998. Liver transplantation was performed in 7 patients. One to three needle passes were performed with 18 to 20 gauge needles. Follow-up included regular clinical examinations and ultrasonography or computerized tomography. RESULTS: Four cases (2.66%) of subcutaneous metastasis were noted at the needle insertion site; none in transplanted patients. All patients had viral cirrhosis, Okuda class I. Nodules were detected 4, 12, 22 and 24 months after biopsy. The second patient is alive 24 months after tumor seeding. For other patients, survival time was 4, 24 and 60 months respectively, without local tumor extension after surgical resection or radiotherapy. During a mean 11.8 months of follow-up, 127 patients died without tumor seeding. Eleven patients are still being followed and have no signs of needle tract implantation of hepatocellular carcinoma (mean follow-up 34.7 months). CONCLUSION: The prevalence of tumoral seeding after percutaneous biopsy of hepatocellular carcinoma was 2.66%, which is higher than in previous studies. After liver transplantation, no evidence of needle tract seeding was identified. Survival did not seem to be influenced by local evolution.

[Pheochromocytoma manifesting as toe necrosis]. / Phéochromocytome révélé par une nécrose digitale.

BACKGROUND: Cutaneous manifestations of pheochromocytoma other than sweating, and facial pallor during paroxysmal episodes of hypertension are exceptional. CASE REPORT: We observed partial necrosis of the fourth toes which revealed pheochromocytoma. DISCUSSIONS: Signs of peripheral vascular disease are uncommon during the course of pheochromocytoma. Only four cases have been reported in the literature. Occurrence of distal necrosis in combination with hypertension and palpable pulses is suggestive of pheochromocytoma requiring assay of urinary catecholamines. The pathogenic mechanisms of necrosis would be vasospasm of cutaneous vessels due to excessive plasmatic catecholamine levels and thrombocytosis as an aggravating factor.

A phase II study of 5-fluorouracil, leucovorin and cisplatin (FLP) for metastatic gastric cancer.

The modulation of 5-fluorouracil (5-FU) with folinic acid (leucovorin, LV) is more efficacious than 5-FU alone in the treatment of metastatic colorectal cancer, and the combination of 5-FU with cisplatin is currently one of the most active regimens in advanced gastric cancer. A phase II study was therefore conducted to test the efficacy and toxicity of the combination of 5-FU, LV and cisplatin (FLP) in metastatic gastric cancer. 28 patients entered the study. Metastatic sites were observed in the liver (in 21 patients), the peritoneum (in 8), the lymph nodes (in 7) or the bones (in 1) and a local recurrence was noted in 4 cases. The performance status (using World Health Organisation criteria) was 0 for 13 patients and 1 or 2 for the others. Cycles of treatment were administered every 28 days and consisted of LV 200 mg/m2/day for 5 days followed by 5-FU 400 mg/m2/day for 5 days with cisplatin 100 mg/m2 on day 2. The response rate for the 27 evaluable patients was 51.8% (95% confidence interval (CI), 33-70.6%). There were four complete responses (14.8%) and 10 partial responses (37%). Median survival was 11 months and 4 patients were alive at 2 years. Both response rate and survival were better for patients with a good performance status. The overall toxicity was very low, except for 1 patient who died of dehydration and cardiac failure. In conclusion, the FLP protocol was effective and well tolerated in patients with metastatic gastric cancer.

[Syndrome of hemophagocytosis associated with infections]. / Syndrome d'hémophagocytose associé aux infections.

Infection-related hemophagocytic syndrome was originally described in viral processes by Risdall in 1979. Recent reports have suggested associations of this syndrome with bacterial, parasitic and fungal infections. It occurs generally in immunosuppressed patients. The clinical and biological manifestations are not specific. The diagnosis is based on morphologic examination of the bone marrow showing a benign proliferation of histiocytes with hemophagocytosis. Treatment is symptomatic, however when an infectious etiology is found a specific treatment must be applied. This pathology has a poor prognosis, with a fifty percent mortality rate. When evolution is favorable, relapses are exceptional. The precise pathophysiological mechanism has not yet been determined. A better understanding of the cytokines' role should permit to consider new therapeutic routes.

Spontaneous resolution of acquired factor X deficiency in amyloidosis.

We describe the case of a 51-year-old man with systemic amyloidosis in whom factor X activity was initially 6% of the normal. Amyloidosis was responsible for congestive heart failure and a nephrotic syndrome but there was no bleeding diathesis. A 12-month trial of melphalan and prednisone failed to improve cardiac and renal dysfunction; factor X levels remained low. Eighteen months after this treatment was stopped, factor X spontaneously normalized although renal insufficiency persisted. We suggest that the possibility of a spontaneous factor X recovery must be considered when evaluating efficacy of therapeutic agents in amyloidosis.

Diurnal profile of oxyntomodulin-like immunoreactivity in duodenal ulcer patients.

Plasma concentrations of oxyntomodulin-like immunoreactivity, a group of intestinal peptides capable of mediating an enterogastrone signal, were measured during a 24-h period in 6 duodenal ulcer patients and compared with those of 16 age-matched controls. Each subject was submitted to 18 oxyntomodulin-like immunoreactivity determinations. Four standardized meals were given during the test. Furthermore, each patient was evaluated for peak acid output after pentagastrin stimulation. The values of the duodenal ulcer subjects were predominantly within normal acid secretion limits. Fasting levels, meal-induced variations, and nocturnal production of oxyntomodulin-like immunoreactivity were similar in the two groups. A negative correlation was observed between peak acid output and oxyntomodulin-like immunoreactivity evaluated either as nocturnal production or as maximum nyctohemeral concentration. We conclude that, taken as a whole, duodenal ulcer disease is not caused by a defect in oxyntomodulin-like immunoreactivity secretion. However, this study does not rule out the possibility of a selective deficiency of these peptides in some duodenal ulcer subgroups such as hypersecretory patients.

[Oxyntomodulin, a new hormonal marker of intestinal malabsorption syndromes]. / L'oxyntomoduline, nouveau marqueur hormonal des syndromes de malabsorption intestinale.

Plasma oxyntomodulin-like immunoreactivity (OLI) concentrations were found to be significantly elevated in 6 patients with coeliac disease when compared with those observed in 38 healthy subjects. Furthermore, OLI hypersecretion is related to the degree of malabsorption. This marker could be used as a test for detection and follow-up of patients with malabsorptive disorders.

[Severe hypocalcemia complicating outbreaks of renal failure in 2 uremic patients]. / Hypocalcémie sévère compliquant une poussée d'insuffisance rénale chez deux urémiques.

Hypocalcemia has many causes of which several often occur in combination in intensive care unit patients. Two cases (a 78-year-old male and a 63-year-old female) of severe hypocalcemia (corrected serum calcium 1.2 mmol/l in both cases) in patients hospitalized for acute decompensation of chronic renal failure are reported herein. Both subjects had a history of chronic hypocalcemia due to vitamin-calcium deficiencies and chronic renal failure. The lack of adverse clinical consequences of the low serum calcium levels can be explained by the fact that both patients also had severe metabolic acidosis, a disorder which increased the ionized fraction of total serum calcium. Serum calcium returned to normal slowly and gradually despite parenteral administration of large amounts of calcium and vitamin D or vitamin D derivatives.