[Recurrent nerve palsy due to Lyme disease: report of two cases]. / Paralysie du nerf récurrent au cours d'une maladie de Lyme : à propos de deux observations.

INTRODUCTION: Neuroborreliosis can be a difficult diagnosis which requires epidemiologic, clinical and biologic arguments. CASE REPORTS: We report two patients who presented with a recurrent laryngeal nerve palsy with positive Lyme serology and favorable outcome after antibiotic therapy. In one case, a lymphocytic meningitis with intrathecal production of specific antibodies was evidenced. CONCLUSION: Recurrent laryngeal nerve palsy is an uncommon manifestation of neuroborreliosis. Lyme serology is an important tool when neurologic disorder occurs because of an atypical course of Lyme disease.

[Von Recklinghausen's disease associated with pancreatic somatostatinoma]. / Maladie de Von Recklinghausen associée à un somatostatinome pancréatique.

INTRODUCTION: Pancreatic somatostatinoma is a rare entity and its association with Von Recklinghausen's disease has only been described on two occasions. We report a new observation, with clinical and evolving status differing from those described in isolated cases of somatostatinoma. OBSERVATION: A 28 year-old man presenting with familial Von Recklinghausen's disease, had suffered for 10 years from paroxysmic abdominal pain. He was hospitalized for intense pain. Imaging revealed a retroperineal tumoral formation. Following duodenopancreatectomy, somatostatinoma was diagnosed. Diffuse metastatic miliary was revealed and multiple glandular metastases. DISCUSSION: Other than the rarity of the morbid association (pancreatic somatostatinoma and Von Recklinghausen's disease) described, this case is particular in that the patient was very young, symptomatology was unapparent and tumoral evolution was minimal.

[Acute disulfiram intoxication with severe neurological sequaelae and presenting misleading psychiatric deficiency]. / Intoxication aiguë au disulfirame avec séquelles neurologiques graves et présentation psychiatrique déficitaire trompeuse.

Disulfiram self poisoning is exceptional. The authors report on the case of such an intoxication related to the ingestion of a potentially lethal dose of this drug (30 g) and draw the attention on the following points: 1) The initial signs may be misleading because they include both psychiatrics and neurological signs such as phonation abnormalities, myoclonias and tetraparesia. 2) The evolution is unforseeable with the possible occurrence of severe psychological and motricity sequaelae, associated with bilateral and symetric injuries of the putamen, the palladium and the basal nuclei on CT-scan (or MRI). The pathophysiologic al mechanisms of theses signs are discussed, and the need for disulfiram in the care of alcoholic patients seeking for withdrawal as well.

[Budd-Chiari syndrome with inferior vena cava stenosis]. / Un syndrome de Budd-Chiari par sténose cave inférieure.

BACKGROUND: Stenosis of the inferior vena cava is a rare cause of Budd-Chiari's syndrome. We report on such a case related to a specific cause with a dramatic improvement after endovascular treatment. CASE REPORT: A 53-year old woman was admitted to hospital because she demonstrated circulatory collapse, inferior limbs edema and post-prandial epigastralgia. These signs were related to the occurrence of a stenosis of the sus-hepatic segment of the inferior vena cava related to the presence of the distal part of a catheter. An angioplasty with the insertion of a stent was followed by a total recovery with a one-year survey. CONCLUSION: Angioplasty with the insertion of a stent should be considered in a Budd-Chiari syndrome related to the stenosis of the inferior vena cava. This option should be evaluated with reference to classic surgical techniques.

[Campylobacter fetus meningitis in adults]. / Méningite à Campylobacter fetus chez l'adulte.

Campylobacter fetus is an uncommon cause of meningitis in the adult. We report a case observed in an 84-year-old man with alcoholic cirrhosis. The patient presented fever, jaundice and a state of mental confusion. Blood and cerebrospinal fluid cultures identified Campylobacter fetus sensitive to several antibiotics. Ciprofloxacine-ceftriaxone combination replaced the antibiotics prescribed empirically prior to identification and led to regression of the fever and normal mental status within 4 days. Spinal tap on day 7 showed 20 white cells, 85% lymphocytes and normal protein level. Unfortunately, the patient later developed edema and ascitis with major jaundice. Oligo-anuria could not be controlled and the patient died two weeks after admission. Campylobacter fetus meningitis is predominantly seen in men, mean age of onset 50 years. Clinical signs are not specific and diagnosis can only be obtained on the basis of cerebrospinal fluid results. Adapted antibiotics are required.

[Amiodarone-induced hypothyroidism followed by hyperthyroidism. Apropos of 2 new cases]. / Hypothyroïdie suivie d'une hyperthyroïdie et induite par l'amiodarone. A propos de deux nouvelles observations.

Amiodarone, an iodine-rich benzofuranic derivative, may often induce hyperthyroidism and hypothyroidism. We report two cases of complex dysthyroidism, in which hypothyroidism and then hyperthyroidism alternated: we recall five former observations found in the literature. Their nosologic position and pathophysiologic mechanisms are discussed.

[Yellow nail syndrome. Apropos of 2 cases. Review of the literature]. / Syndrome des ongles jaunes. A propos de deux cas. Revue de la littérature.

The yellow nail syndrome is a clinical syndrome without specific biological parameters. It is characterized by the following threesome of symptoms: nail abnormalities, primary lymphedema, and pleuropulmonary manifestations. In most cases lymphography shows abnormalities of the lymphatic vessels and spirometry shows a restrictive defect and rarely obstructive disorders. Pathogenesis of this syndrome is still unknown. It is, however, remarkable that the yellow nail syndrome may occur in association with other diseases, the most frequent of which are cancer affections and immune disorders. We report two cases of the yellow nail syndrome which were associated with cancer (neoplasm of the larynx and breast).

[Lyme disease disclosed by disabling amyotrophy]. / Maladie de Lyme révélée par une amyotrophie invalidante.

The Lyme disease, which was first found in Lyme, USA, in 1975 is an infectious multi-system disorder whose agent, the Borrelia Burgdorferi, was identified in 1983. Various disease manifestations have been reported since them. We report a case of Lyme disease manifestation in the muscle revealed by serious amyotrophy in the scapular muscles, in the neck and in the trunk with scapula alata accompanied by noctural lumbago which is resistant to non steroïd anti-inflammatory drugs. Electromyography showed patterns of the myogenic type in the serrate anterior and infraspinous muscles on both sides and patterns of the neurogenic peripheral type in the lower extremities. The histological, immunohistochemical and electron-microscopal studies of the muscle biopsy have been without any pathological result. Creatine kinase and aldolase proved normal. Serological antibodies were not significantly increased. A positive diagnosis was obtained by lumbar puncture which showed lymphocytic meningitis, by demonstrating specific antibodies in the cerebrospinal fluid and by Western Blot antibodies analysis. Efficacy of the antibiotic therapy has resulted in a rapid regression of the symptoms, which is a further confirmation of the previous diagnosis.

[Prognostic factors of decompensated chronic respiratory insufficiency. Apropos of a series of 272 cases]. / Facteurs pronostiques des insuffisances respiratoires chroniques décompensées. A propos d'une série de 272 observations.

Over a 6 years' period (1980-1986), 272 patients with chronic respiratory disease were admitted for respiratory failure to the same intensive care unit. The series was characterized by the high mean age of the patients (69.3 years) and by the high proportion of those who were ventilated (75%); 33.7% of the patients died within 1 month of discharge. The survival rate at 5 years estimated by the actuarial survival curve was 28%. Parameters measured during the acute decompensation phase were analyzed statistically. The main prognostic factors regarded as unfavourable were: old age and associated visceral failure particularly, important loss of weight and muscular atrophy, pre-existing neurological sequelae, left ventricular dysfunction, simplified Le Gall score above 15, presence of respiratory encephalopathy, stroke or viral infection as precipitating factors of decompensation, transfer from other hospital units after failure of medical treatment, and need for mechanical ventilation for more than 30 days.