[Pourfour du Petit syndrome: a rare aetiology of unilateral exophtalmos with mydriasis and lid retraction]. / Le syndrome de Pourfour du Petit : une cause rare d'exophtalmie unilatérale avec mydriase et élargissement de la fente palpébrale.

INTRODUCTION: Pourfour du Petit syndrome, rarely reported, is the opposite of Claude Bernard-Horner syndrome. EXEGESES: A 67 years old female is hospitalised for dysphagia, allowing the discovery of oesophagus carcinoma with mediastinal, pleural and costal extension. The discovery of left unilateral mydriasis associated with exophthalmos and eyelid retraction suggest Pourfour du Petit syndrome; this diagnosis is confirmed by CT-scan, finding pedicular lysis of high dorsal vertebras and intra-canalar tumoral extension. CONCLUSION: Pourfour du Petit syndrome has the same localisation value and the same aetiologies as Claude Bernard-Horner syndrome, but its mechanism proceeds byan exciting lesion of cervical sympathetic nervous system. The recognition of this entity can allow the diagnosis of pathologies that need emergency treatment.

[Crowned dens syndrome: three new cases]. / Syndrome de la dent couronnée : à propos de trois nouveaux cas.

INTRODUCTION: Crowned dens syndrome is due to a microcrystalline infringement (hydroxyapatite or calcium pyrophosphate) of the retro-odontoidal ligament of atlas, often leading to the erroneous diagnosis of meningitis or spondylitis. We report on three new cases diagnosed from 1996 to 1999. EXEGESIS: The patients complained of cervicalgies, headaches or fever. The initially evoked diagnoses were meningitis, spondylodiscitis or endocarditis. Clinical exam found meningism and an inflammatory syndrome in all patients. Analysis of the cerebro-spinal fluid realised in two cases was normal. The diagnosis of crowned dens syndrome was assessed in two cases by cervical CT scan of C1/C2. In the third case, chondrocalcinosis of a wrist allowed this diagnosis. We report a probably non fortuitous case of crowned dens syndrome associated with genetic hemochromatosis. A non steroidal anti-inflammatory treatment allowed a dramatic regression of clinical symptoms. CONCLUSION: This entity should be better known; it can mimick numerous diagnosis and be responsible for fever in the long course.

[What vasoactive agent should be chosen in rupture of esophageal varices in cirrhosis?]. / Quelle substance vaso-active choisir dans la rupture de varices oesophagiennes de la cirrhose?

Variceal esophageal bleeding is a frequent and severe complication of portal hypertension. Balloon compression was the standard therapy for many years. Currently, endoscopic hemostasis with sclerosis or ligation appears to be more effective but requires an experienced operator who is not always present at emergency situations. Parenteral administration of vasoactive agents is one therapeutic option offering new perspectives for the future. Data in the literature suggest that terlipressin or somatostatin would be the preferential choice because of the adverse effects of vasopressin. Data is insufficient concerning sandostatin. Currently, the trend is to administer vasoactive agents as soon as possible, prior to hospitalization and, perhaps, in association with endoscopic hemostasis. Treatment should be maintained for several days although the cost/benefit ratio remains a question of debate.

[Acute cerebellar syndrome after treatment with 5-fluorouracil]. / Syndrome cérébelleux aigu après traitement par le 5-fluorouracile.

We report on a case of 5-fluorouracil induced neurotoxicity during 5-fluorouracil cisplatin combination chemotherapy for advanced head and neck squamous cell carcinoma. The initial manifestations included an acute cerebellar syndrome and peripheral neuropathy. Computed tomography of the brain was normal. The results of nerve-conduction studies were compatible with the diagnosis of distal sensory neuropathy. The patient experienced improvement, without treatment, four weeks after cessation of chemotherapy. The role of cisplatin and alcohol abuse in this neurotoxic episode, can not yet completely be excluded.

[Para-septal emphysema]. / Emphysème paraseptal.

Paraseptal emphysema is characterised by a sub-pleural distribution of the lesions along the interlobular septa. It is most often clinically silent and chest radiography is neither sensitive nor specific. Pulmonary function tests are normal or show simple bronchial obstruction. The diagnosis is often made following a complication (pneumothorax or development of a compression bulla) or on computed tomography.

Raynaud's phenomenon in chain saw users. Hot and cold finger systolic pressures and nailfold capillary findings.

To gain insight into the physiopathology of Raynaud's phenomenon of occupational origin, finger systolic pressures under heat and cold, and results of nailfold capillary microscopy, were examined in 29 lumberjacks with Raynaud's phenomenon vibration syndrome (pathological group) and 24 lumberjacks without it (non-pathological group), and compared with the same values in 26 healthy matched manual workers not using a vibrating tool (controls). Vibration syndrome physiopathology seemed multifactorial, combining 5 features: a rise in brachial diastolic and systolic pressures in the pathological group compared with the two other groups. In lumberjacks with Raynaud's phenomenon, these rises seemed to be acquired, since they were not found when the workers were engaged; a reduction in the number of nailfold capillaries (9.4 +/- 2 per mm in the pathological group vs 11 +/- 2.5 in the controls, P less than 0.025); a rise in the brachial digital systolic gradient (P less than 0.025) in the pathological versus the non-pathological lumberjack group abnormal cold vascular tone, since at 15 degrees C finger systolic pressures in the pathological group were lower than pressures in both the control and non-pathological groups (P less than 0.05 and P less than 0.01, respectively), and at 10 degrees C, they were lower in the pathological than in the control group (P less than 0.01); Within the pathological group, individual paired comparisons between the most and least symptomatic finger revealed a rise in the cold vascular tone, and a reduction in the number of nailfold capillaries in the most symptomatic finger compared to the least symptomatic finger.(ABSTRACT TRUNCATED AT 250 WORDS)

[Tuberculosis in the immunodepressed patient]. / La tuberculose chez l'immunodéprimé.

Tuberculosis is one of the opportunist infections which may complicate the course of many immunodepressive conditions generally those affecting cell-mediated immunity as the Koch bacillus is an organism which develops intracellularly provoking the activation of the cellular type of defence reaction. Recently, patients with malignant disease and immunosuppressive therapy have been joined by those with the acquired immunodepressive syndrome. It is important to understand that the frequency of tuberculosis in immunodepression is a reflection of the frequency of the disease in the general population. In addition, the diagnosis of atypical forms of tuberculosis can be difficult: the presenting signs are not specific and extrapulmonary forms are common. Therefore, tuberculosis should be suspected whenever immunodepressed patients develop unexplained symptoms. All practical means of confirming the diagnosis should be employed and the patient given a course of antituberculous drugs if there is any doubt as early treatment is an important prognostic factor.

[Several aspects of osteoarticular aging of the hand]. / Etude sur quelques aspects du vieillissement ostéo-articulaire de la main.

The articular amplitudes (abduction of the thumb, flexion/extension of the digital joints), arthritic localizations and the mineralization of the bones of the hand were studied in 155 subjects of both genders and classified by decades from 20 to 90 or more years old. There was a significant decrease in articular amplitudes with age and a considerable increase of arthritis especially after 70 years. Arthritic changes were seen most frequently in the distal interphalangeal joints, then with an equal prevalence, arthritis was encountered in the metacarpophalangeal and in the proximal interphalangeal joints. Articular chondrocalcinosis had a prevalence of 15 p. cent in subjects over 60 years and was always associated with arthritic changes in subjects over 80. The cortical index of the second metacarpal bone, which was chosen to express osteopenia, diminishes significantly with age only in female subjects.

[Raynaud's syndrome, Dupuytren's disease, force of prehension and sensitivity of the hand. Study of age-related changes]. / Syndrome de Raynaud, maladie de Dupuytren, force de préhension et sensibilité de la main. Etude des variations avec l'âge.

The prevalence of Raynaud's syndrome, of arterial calcifications and of Dupuytren's contracture was studied in 155 subjects of both sexes, decade by decade from 20 to 90 years. Moreover the force of prehension and two-point discrimination were measured separately. The prevalence of Raynaud's syndrome was 9% independent of variations in age or of sex. The prevalence of Dupuytren's contracture was equally 9% but only subjects over 60 years old (and one woman) were affected. The force of prehension diminished significantly with age, more in women than in men, and more in older patients presenting arthritis. Lastly, tactile sensibility decreased with age but individual variations were important.