[Ocular syphilis, a re-emergent pathology: Series of 12 patients in one Hospital, 2017]. / La syphilis oculaire, une pathologie ré-émergente : série de 12 patients au CHU de Marseille en 2017.

INTRODUCTION: Syphilis is a sexually transmitted disease. All organs might be affected, but ocular syphilis only occurs in 0.6 percent of patients. We collected all cases of ocular syphilis requiring hospitalization at the University Hospital Center (UHC) in Marseille in 2017. PATIENTS AND METHODS: This was a retrospective monocentric study. The diagnosis of ocular syphilis was based on the combination of ocular inflammation with a positive syphilitic serology. For each patient, sex, age, HIV status, ocular and extraocular symptoms, initial visual acuity, syphilis serology, cerebrospinal fluid (CSF) analysis if done, treatment and clinical response were collected. RESULTS: Ten men and two women, aged 28 to 86 years, were hospitalized. Two patients were HIV-positive. Ophtalmological lesions were heterogeneous the posterior structures were most affected. Anterior uveitis was isolated in one patient. Five patients had extraocular signs with cutaneous and/or mucosal involvement. No patient had neurological symptoms. Diagnosis of neurosyphilis through CSF analysis was definite for one patient, probable for 5 patients and ruled out for 2 patients. Six patients received treatment with penicillin G and six with ceftriaxone. Visual acuity improved in all cases. DISCUSSION: Ophtalmic cases of syphilis have become more frequent over the past few years in France. The diagnosis should be suspected in cases of eye inflammation even in the absence of favourable clinical presentation or anamnesis. Search for HIV co-infection should be systematic. Our study shows that ceftriaxone remains an effective alternative to penicillin G.

[Systemic sclerosis and macrovascular involvement: Status of the issue in 2019]. / Atteintes macrovasculaires de la sclérodermie : état de la question en 2019.

Systemic sclerosis (SSc) is a rare immune disease leading to fibrosis of the skin and internal organs. Microvasculopathy is a hallmark of SSc. However, some patients have severe macrovascular complications as affecting cerebral, cardiac or peripheral vessels. To date, macrovascular involvement in SSc remains a matter of debate. Many studies have shown an increased prevalence of macrovascular involvement in SSc in comparison with controlled subjects with similar cardiovascular risk factors. Various methods were used: ankle brachial pressure index, intima media thickness, imagery, coronary calcium score, pulse wave velocity, or flow mediated dilation. The pathophysiology of macrovascular involvement remains unknown and is probably multifactorial: accelerated atherosclerosis, endothelial dysfunction, or reflected wave of microvessel obliteration. The aim of this study was to perform a comprehensible review of the literature, through the study of different types of involved vessels. Results of the main studies are summarized in tables according to the method of investigation used.

[Eosinophilia heralding the diagnosis of eosinophilic fasciitis (Shulman's disease)]. / Hyperéosinophilie isolée précédant le diagnostic d'une fasciite à éosinophiles (maladie de Shulman).

INTRODUCTION: Eosinophilic fasciitis or Shulman's disease is characterized, in its typical form, by palpable thickening of the skin and soft tissues, blood hypereosinophilia and fascia lesions. We hereby report a case of eosinophilic fasciitis in which hypereosinophilia preceded for several months the clinical signs of fasciitis. CASE REPORT: A 64-year-old woman, with a history of Little's syndrome with motor disability, was admitted in internal medicine for eosinophilia. For almost three months, no origin to the eosinophilia was found. The secondary onset of an edema and pain located on four limbs led to the diagnosis of eosinophilic fasciitis. Muscle magnetic resonance imaging was supportive and the muscle histological analysis confirmed the diagnosis of eosinophilic fasciitis. Treatment with steroids induced a rapid normalization of the eosinophilia and edema. CONCLUSION: In this case report, eosinophilia was preceding the clinical cutaneous signs that led to the diagnosis of eosinophilic fasciitis. It is likely to believe that myalgias, frequently found in the onset of eosinophilic fasciitis, may have been hidden by the history of infantile encephalopathy. The diagnosis of eosinophilic fasciitis must be kept in mind of physicians in the investigation of an eosinophilia, even though cutaneous signs are lacking.

[Cannabinoid hyperemesis syndrome: about 6 cases]. / Syndrome d'hyperémèse cannabique : à propos de 6 cas.

INTRODUCTION: The cannabinoid hyperemesis syndrome (CHS) is characterized by cyclic episodes of nausea, vomiting, and abdominal pain, and occurs in young adults with long-term cannabis use. The feature of this syndrome is the relief of symptoms with hot showers. We report here six cases report. CASE REPORTS: Three women and 3 men, chronic consumers of cannabis, presented with typical features of the CHS, but the syndrome remained undiagnosed until then: nausea, vomiting, abdominal pain with morning ascendancy and loss of weight occurring in adult's of less than 50 years. The symptoms were improved by taking repeated hot showers. The medical investigations were negative. After addictologist care and cannabis weaning, digestive symptoms disappeared. CONCLUSION: The CHS is based on a clinical diagnosis. When undiagnosed, clinical presentation leads to a medical wandering and to the realization of repeated, expensive, and sometimes invasive exams. The physiopathology is not clear. The treatment relies on the definitive cannabis weaning.

[Watermelon stomach: a rare cause of iron deficiency anemia, surgically treatable; a new case with review of the literature]. / L'estomac pastèque : une cause rare d'anémie ferriprive, de traitement chirurgical; un nouveau cas et revue de la littérature.

The authors report a new case of water-melon stomach, without portal hypertension, and responsible for a iron deficiency anemia cured by antrectomy. Water-melon stomach is a particular form of gastric antral vascular ectasia, characterized by a specific and striking endoscopic aspect. The diagnostic, histologic, pathogenic and therapeutic aspects are reviewed.

Clinically significant drug interactions.

A large number of drugs are introduced every year, and new interactions between medications are increasingly reported. Consequently, it is no longer practical for physicians to rely on memory alone to avoid potential drug interactions. Multiple drug regimens carry the risk of adverse interactions. Precipitant drugs modify the object drug's absorption, distribution, metabolism, excretion or actual clinical effect. Nonsteroidal anti-inflammatory drugs, antibiotics and, in particular, rifampin are common precipitant drugs prescribed in primary care practice. Drugs with a narrow therapeutic range or low therapeutic index are more likely to be the objects for serious drug interactions. Object drugs in common use include warfarin, fluoroquinolones, antiepileptic drugs, oral contraceptives, cisapride and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. Many other drugs, act as precipitants or objects, and a number of drugs act as both. Regularly updated manuals of drug interactions and CD-ROM-formatted programs are useful office references.

Pediatric admissions by family physicians and pediatricians in a semirural environment: implications for residency training.

BACKGROUND: The 3-year family practice residency curriculum includes longitudinal care of children in the family health center and a 4-month experience dedicated to the care of children. This study was designed to compare the diseases of hospitalized children cared for by family physicians and pediatricians and to examine the use of pediatricians as consultants by family physicians. METHODS: The study included all patients younger than 18 years who were discharged by a family physician or a pediatrician from this semirural hospital during a 3-year period. The primary discharge diagnosis, physician, consultations, and transfer status were recorded. RESULTS: Family physicians cared for 37 percent of the 4169 pediatric patients discharged during the study. Infectious diseases and their complications were the most common conditions for patients who were discharged beyond the newborn period. The 15 most frequent discharge diagnoses were identical for family physicians and pediatricians, accounting for about 86 percent of all discharge diagnoses. Pediatricians, however, cared for 86 percent of the newborns with major complications and were responsible for 80 percent of the infants and children who were transferred. The overall inpatient consultation rate of pediatricians by family physicians was 8 percent, whereas the consultation rate for nonneonatal-related discharges was 20 percent. CONCLUSION: In this semirural environment, family physicians and pediatricians care for a very similar mix of hospitalized pediatric patients. Pediatricians, however, care for a greater proportion of newborns with major complications.

Relationships between endosonographic appearan e and clinical or manometric features in patients with achalasia.

BACKGROUND: The existence of endosonographic abnormalities of the oesophagus in achalasia is discussed. The place of endoscopic ultrasonography (EUS) needs to be clarified. PATIENTS: Thirty five untreated patients suffering from achalasia and 28 controls without oesophageal disease were prospectively enrolled since 1993. Pseudoachalasia was diagnosed in two patients. METHODS: EUS measurements were performed at two opposite sites at the level of the cardia, and 5 cm and 10 cm proximally, avoiding compression by the water filled balloon. RESULTS: The oesophageal wall and the fourth hypoechoic layer were significantly thicker at the level of the cardia and 5 cm above, with mean differences between patients and controls of 0.37/0.42 mm and 0.16/0.23 mm respectively. No statistically significant correlation could be demonstrated between the thickness of the oesophageal wall or of the fourth hypoechoic layer and weight loss, or the average pressure of the lower oesophageal sphincter. However, a significant inverse relationship was demonstrated between the duration of symptoms and the thickness of the fourth hypoechoic layer. The thickness of the fourth hypoechoic layer was also increased in patients who required only one pneumatic dilatation (P < 0.01). CONCLUSION: The thickness of the oesophageal wall and of the fourth hypoechoic layer appeared to be significantly increased in achalasia patients. However, the slight increase of the mean size (< 0.5 mm) of the muscularis propria suggests that EUS is not helpful in the diagnosis of achalasia. The physiopathological basis of advanced achalasia has to be reconsidered as we demonstrated an inverse relationship between the duration of symptoms and the thickness of the muscularis propria.

Newborn hepatitis B immunization rates in primary care practices.

OBJECTIVES: To assess the hepatitis B immunization rate and to identify the reasons for an incomplete immunization series in newborns and infants seen in primary care practices. DESIGN: An inception cohort study enrolling newborns and infants and assessing their hepatitis B immunization status at 9 and 18 months of age. SETTING: Six primary care offices, most in rural environments. PATIENTS: All newborns and infants seen at 1 of 6 offices. INTERVENTION: Infants born between January 1, 1993, and September 30, 1994, were followed up through June 30, 1995. Hepatitis B immunization status and the reasons for an incomplete status were recorded at each visit. MAIN OUTCOME MEASURES: Hepatitis B immunization rates at 9 and 18 months of age, and the reasons for immunization failure. RESULTS: The immunization rates of infants aged 9 and 18 months were 60% and 77%, respectively. The most common reasons for inadequate immunization of the 247 infants followed up through age 18 months were patient transfer (7%), failing to return for a scheduled visit (4%), and guardians refusing the immunization (4%). Failure to return for a scheduled visit was the reason for the incomplete immunization in 13% of the 9-month-old infants. Immunization of these patients was the most important factor in the higher immunization rate at 18 months of age. By the age of 18 months, 95% of all infants had received at least 2 doses of the hepatitis B immunization. CONCLUSIONS: A hepatitis B newborn immunization rate of 77% by age 18 months was achieved in a primary care office setting. Barriers to complete immunization by the age of 18 months include patient transfer, patient failure to return, and parental refusal of immunization.

[Palliative treatment of esophageal neoplastic stenosis using bipolar electrocoagulation probe]. / Traitement palliatif des sténoses néoplasiques oesophagiennes par sonde d'électrocoagulation bipolaire (BICAP).

OBJECTIVE, PATIENTS AND METHODS: The objective of this study was to evaluate the results of palliative bipolar electrocoagulation probe (BICAP) treatment in 26 patients with non surgical, obstructive esophageal cancer. The mean tumor length was 7.2 cm. The strictures were located as follows: 3 in the cervical esophagus, 8 in the thoracic esophagus, 13 in the distal third of the esophagus and 2 involved both the cervical and thoracic esophagus. Most lesions were circumferential (73% versus 27% non circumferential) and exophytic (78% versus 22% sub mucosal). Coagulation was carried out under direct endoscopic control in the forward direction. The success of treatment was evaluated on the basis of the degree of reopening achieved (easy passage of an endoscope 12 mm in diameter) and good functional results (improvement of dysphagia, scored from 0 to 4 using a standard grading scale, for more than 15 days). RESULTS: Twenty-six patients underwent a total of 45 BICAP treatments (31 initial sessions, 14 repeated sessions). Reopening was achieved in 92% of cases and good functional results were obtained in 85% (mean dysphagia score: 3.2 before treatment versus 1.1 after treatment). The improvement of dysphagia resulted in a significant improvement of general performance status and stabilization or weight improvement in 21 patients. The mean number of sessions necessary for good initial results was 1.2 +/- 0.4. After the initial treatment by BICAP, radiotherapy or radiochemotherapy were respectively associated in 4 and 10 patients. The median duration of improvement was significantly longer in patients who underwent radiochemotherapy as compared with patients treated by BICAP alone (22 weeks versus 4 weeks). During the follow-up, 9 patients required several BICAP treatments and at the end of their disease, 12 patients underwent other palliative procedures. Major complications occurred in 4 cases (2 esotracheal fistulas, 1 hemorrhage, and 1 aspiration pneumonia) and mortality related to the procedure was 8%. CONCLUSIONS: Palliative BICAP treatment of obstructing esophageal and cardial cancer provide quick relief of dysphagia but repeated treatment sessions are necessary to maintain initial improvement. The procedure requires a short hospitalization stay and can be easily accomplished in all cases regardless of the tumor features.

Enoxaparin in the prevention of deep venous thrombosis.

Enoxaparin, a low-molecular-weigth heparin, has recently been approved for use in the prevention of deep venous thrombosis following elective hip replacement surgery. Clinical trials have demonstrated enoxaparin to be superior to placebo, dextran and unfractionated heparin in deep venous thrombosis prophylaxis. However, no published studies have compared the efficacy of enoxaparin with that of warfarin in the prevention of deep venous thrombosis. Advantages of enoxaparin include less frequent dosing, reduced need for laboratory monitoring and a lower incidence of adverse effects, including hemorrhage. Although enoxaparin is more expensive than unfractionated heparin, its potential benefits may offset its higher cost.

[Endoscopic retrograde cholangiopancreatography in children and adolescents]. / Cholangio-pancréatographie rétrograde endoscopique chez l'enfant et l'adolescent.

Nineteen children and adolescents, mean age 9.6 +/- 1.2 years, underwent endoscopic retrograde cholangiopancreatography (ERCP). Indications for ERCP were cholestasis in 11 cases, suspected pancreatic disease or trauma in 8 cases. Equipment and technique used for papilla catheterisation were similar to those routinely used in adults. Bile duct or pancreatic opacification were successfully obtained in all cases. Transient acute pancreatitis following the procedure was observed in one patient, and resolved spontaneously. ERCP confirmed diagnosis suspected after ultrasound study and abdominal CT scan in 9 patients. In the remaining 10 cases, diagnosis was only made by ERCP. Twelve patients were operated based on ERCP results. We conclude that ERCP is rarely performed in children, but remains as useful as in adults in biliary and pancreatic examination.

Common chronic disease in Vietnam-era veterans and nonveterans.

Little research has been conducted investigating the general experience of military service during Vietnam and its long-term relation to common nonpsychiatric problems. The relationship between Vietnam-era veteran status and common chronic disease was examined using data from the 1987 National Health Interview Survey. Compared to a cohort of nonveterans, Vietnam-era veterans were not more likely to have common chronic disease. Moreover, veterans were not significantly more likely than nonveterans to have limitations in activity. The findings indicate that military service during the Vietnam conflict does not place veterans at greater risk for common chronic disease.

Patient and physician characteristics associated with perceived quality of care.

This study was undertaken to describe patient and physician sociodemographic characteristics that might be associated with the patient's perception of the quality of care rendered by his or her physician. A random telephone survey of 685 adult Kentucky residents showed that self-health assessment correlated positively, while patient education correlated negatively, with perceived quality of care. Perceived physician origin was related to the respondent's perceptions of quality of care, with native-born physicians perceived as supplying higher quality of care than their foreign-born counterparts. Cultural and communication issues might explain differences in perceived quality of care.