[Aortic involvement in giant cell arteritis. A prospective follow-up of 11 patients using computed tomography]. / Aortite inflammatoire et maladie de Horton. A propos du suivi évolutif scanographique prospectif d'une série de 11 patients.

PURPOSE: To determine clinical and radiological features, using computed tomography (CT-scan) in patients with aortic involvement related to giant cell arteritis (GCA), and to assess both clinical and CT-scan outcome after therapy institution. METHODS: Aortic involvement due to GCA was investigated in all patients, using CT-scan at diagnosis, and at 3, 6 and 12 months follow-up after therapy institution. RESULTS: The 11 consecutive patients consisted of 4 men and 7 women with mean age of 64.5 years. Patients exhibited: constitutional symptoms (N=9; 82%), dorsalgia (N=3; 27%), clinical signs of GCA (N=3; 27%) and of upper limb large vessel impairment (N=6; 55%). CT-scan showed aortitis involving both thoracic and abdominal aorta (N=6; 55%), abdominal (N=2; 18%) or thoracic aorta (N=2; 18%) and thoracic aortic aneurysm (N=1; 9%). At one-year follow-up, CT-scan revealed: complete resolution (N=7; 64%) and improvement (N=3; 27%) of aortic damage; the patient, who had thoracic aortic aneurysm, underwent surgical treatment, as aortic lesion remained unchanged on CT-scan. CONCLUSION: Our study underlines that CT-scan is a helpful test in diagnosis and follow-up of aortic involvement in patients with GCA.

[Indications for angiographic study of renal arteries in elderly hypertensive subjects]. / Indications de l'exploration angiographique des artères rénales chez le sujet âgé hypertendu.

During a 30 months period, 70 patients (60-84 years old) underwent a renal artery angiographic investigation, either by combined intravenous angiography and pyelography, either by intravenous or intra-arterial digital angiography. Thirty-nine were males, 31 were females. All patients were hypertensive. Thirty-three had a normal renal function and 37 had a renal insufficiency arbitrarily definite as creatinine clearance lower than 60 ml/min (m = 33 +/- 15 ml/min). Eight aortic anevrysms were discovered. Thirteen patients (18.6%) had atherosclerotic renovascular disease. Criteria which led to undertake these investigations and results are listed in the following table. [table; see text] Transluminal percutaneous angioplasty and surgical treatment were performed 7 and 3 times respectively. In one case, nephrectomy was done. In all these patients but one, improvement of hypertension and/or renal function occurred. In patients with renal impairment, difference in size between the two kidneys detected by echography or plain abdominal X-rays were noted in 8 among the 9 patients with renovascular disease; six among them had proteinuria less than 0.5 g/day. In conclusion, in hypertensive patients older than 60, criteria for detection of renovascular disease are the same as in younger patients. When renal function is decreased, difference in size between the two kidneys requires an angiographic evaluation. Proteinuria does not exclude renovascular pathology.

[Thrombophlebitis and cancer: evaluation of the diagnostic value of abdominal ultrasonography in the acute phase of a deep venous thrombosis. Report of 148 consecutive examinations]. / Thrombophlébite et cancer: évaluation de la rentabilité diagnostique de l'échographie abdominale systématique à la phase aiguë d'une thrombose veineuse profonde. A propos de 148 examens consécutifs.

If an association between venous thromboembolism and malignancy is now well established, there is no consensus about the investigations which should be performed to detect occult malignancy after deep vein thrombosis episode. We investigated the usefulness of systematic abdomino-pelvic ultrasonography in 148 consecutive patients older than 40 with deep vein thrombosis and or pulmonary embolism. Ultrasonography was abnormal in 8 patients (5.4%) and detected only 6 cancers. In 5 cases, clinical examination and laboratory tests were sufficient to suggest malignancy. Our results suggest that ultrasonography should not be systematically performed in patients with deep vein thrombosis. Decisions to performed additional diagnostic tests can be based on the finding of the initial clinical examination, that includes medical history, physical examination, routine laboratory tests and chest-x-ray.

[Lumbar interapophyseal septic arthritis. Apropos of 3 cases]. / Arthrite septique interapophysaire lombaire. A propos de 3 cas.

Septic arthritis of spinal apophyseal joint, seldom described, mainly concern the lumbar spine. We report three cases. Inflammatory lesions of the paravertebral soft tissues were associated in each case; an epidural abscess was present twice. Our three cases were due to Staphylococcus aureus. The initial clinical features were consistent with a spondylodiscitis. Imaging led to the correct diagnosis in all cases. According to our observations and several others of the literature: facet joint lesions are visible too late on plain films. Bone scintigraphy is sensitive, but not specific. CT scan and MRI are the most contributive investigations. A pathologic aspect of the paravertebral soft tissues is visible less than one week after the beginning of the symptoms on CT scan and MRI. Lesions of the facet joint are detectable as soon as the first week on MRI, and after 15 days of clinical course on CT scan. Epidural abscess, when present, is best shown by MRI as early as the first week. CT scan can guide percutaneous needle biopsies of the paravertebral abscesses or of the concerned facet joint.

[Late manifestation of congenital intrahepatic portacaval shunt in a healthy liver]. / Révélation tardive d'une communication portocave intrahépatique congénitale sur foie sain.

We report the discovery of a congenital intrahepatic portocaval shunt during heart failure in a 68 year-old woman, without cirrhosis or portal hypertension. She had hepatic encephalopathy. Only 17 such cases have been reported. Their physiopathology remains unclear. Reasons for late revelation are debated. Color doppler imaging is very useful for diagnosis following and treatment of these shunts. Therapeutic options are presented.

[Pulmonary lymphangioleiomyomatosis: an often fortuitous diagnosis. A case report]. / Lymphangioléïomyomatose pulmonaire: une découverte souvent fortuite. A propos d'une observation.

INTRODUCTION: Lymphangioleiomyomatosis is an uncommon disorder of unknown origin, which exclusively occurs in women of reproductive age. The condition is characterized by proliferation of immature smooth muscle cells throughout the lungs, i.e., in the peribronchial, perilymphatic, and perivascular areas. This results in obliteration of the respiratory tract and in the development of cysts. Lymphangioleiomyomatosis has a poor prognosis due to both numerous lung complications and progression of the disease to respiratory failure. EXEGESIS: We report the case of a patient in whom lymphangioleiomyomatosis was fortuitously diagnosed from chest CT scan, itself performed for the diagnosis of pulmonary embolism. This case is therefore of particular interest. CONCLUSION: Our results suggest that the prevalence of lymphangioleiomyomatosis is probably underestimated due to its clinical latency and the absence of specific laboratory tests. Therefore, the development of non-invasive radiological methods should permit early diagnosis of the disease.

[X-ray computed tomographic aspects of benign mesotheliomas. Apropos of 4 cases]. / Aspect tomodensitométrique des mésothéliomes bénins. A propos de 4 cas.

Localized pleural mesothelioma or benign mesothelioma is a rare tumor and it has a good prognosis. The value of computed tomography (CT) in the evaluation of pleural disease is now well recognized. However, little information has been written regarding the value of CT in localized pleural mesothelioma. We describe four cases. CT findings include sharply delineated, smoothly contoured masses, often with homogeneous soft tissue density. Angles with the chest wall are obtuse or acute. In case of acute angles, a smoothly tapering margin may be encountered.

[Treatment by arterial embolization of a case of Wirsung's duct hemorrhage]. / Traitement par embolisation artérielle d'un cas de wirsungorragie.

A 49 years old patient was hospitalized following a eight days episode of gastro intestinal bleeding. Medical history revealed a chronic pancreatitis for more than three years. Physical examination upon admission was unremarkable. Acute oesophago-gastro-duodenoscopy showed red blood issue from the papilla. Echotomographic examination revealed no pancreatic pseudo cyst. A coeliac angiogram showed an extravasation of contrast material. Subselective pancreatico duodenal angiogram revealed the extravasation and the instantaneous opacification of the pancreatic duct with flow into the duodenum. Arterial embolization was chosen for treatment and stopped the bleeding. The patient has now been followed for three years and has had no recurrence of gastro intestinal bleeding.

Interstitial lung disease in anti-Jo-1 patients with antisynthetase syndrome.

OBJECTIVE: To assess the outcome of interstitial lung disease (ILD) in anti-Jo-1 patients with antisynthetase syndrome, determine predictive variables of ILD deterioration in these patients, and compare features of anti-Jo-1 patients with and without ILD. METHODS: Ninety-one anti-Jo-1 patients were identified by medical records search in 4 medical centers. All of these patients had undergone pulmonary function tests (PFTs) and high-resolution computed tomography (HRCT) scans. RESULTS: Sixty-six patients (72.5%) had ILD. Patients could be divided into 3 groups according to their presenting lung manifestations: acute onset of lung disease (n = 12), progressive onset of lung signs (n = 35), and asymptomatic patients exhibiting abnormalities consistent with ILD on PFTs and HRCT scans (n = 19). Sixteen patients had resolution of ILD; 39 and 11 patients experienced improvement and deterioration of ILD, respectively. ILD led to decreased functional status, since 29.8% of patients exhibited a marked reduction of activities due to ILD and 13.6% had respiratory insufficiency requiring oxygen therapy; 5 of 6 patients died due to ILD complications. Predictive parameters of ILD deterioration were HRCT scan pattern of usual interstitial pneumonia, respiratory muscle involvement, and age ≥55 years. Furthermore, anti-Jo-1 patients with ILD, compared with those without, more frequently exhibited mechanic's hands and lower creatine kinase levels. CONCLUSION: Our findings confirm that ILD is a frequent complication in anti-Jo-1 patients, resulting in high morbidity. We suggest that patients with predictive factors of ILD deterioration may require more aggressive therapy. Finally, anti-Jo-1 patients with ILD, compared with those without, may exhibit a particular clinical phenotype.

Rituximab therapy for refractory interstitial lung disease related to antisynthetase syndrome.

OBJECTIVE: To report our experience using rituximab as therapy for refractory antisynthetase syndrome (ASS)-associated interstitial lung disease. METHODS: We retrospectively evaluated the medical records of 7 ASS patients with refractory interstitial lung disease, which had previously failed to respond to prednisone and/or other cytotoxic drugs. All 7 patients received rituximab therapy, i.e.: 1 g at days 0 and 14 and at 6-month follow-up. Data on pulmonary symptoms, pulmonary function tests and high resolution computed tomography (HRCT) scan of the lungs were collected: (1) before rituximab initiation; and (2) at 6-month and one-year follow-up after the first infusion of rituximab. RESULTS: At one-year follow-up, ASS patients had resolution (n = 2) or improvement of pulmonary clinical manifestations. Patients also exhibited significant improvement of interstitial lung disease parameters: 1) on pulmonary function tests: FVC (p = 0.03) and DLCO (p = 2 × 10(-5)); 2) and HRCT-scan of the lungs. Due to clinical resolution/improvement of interstitial lung disease, the median daily dose of oral prednisone could be reduced in these 7 ASS patients at one-year follow-up, compared with baseline (20 mg/day vs. 9 mg/day; p = 0.015). CONCLUSION: Our findings suggest that rituximab may be a helpful therapy for refractory interstitial lung disease in patients with ASS.

[Renal sarcoidosis: a series of five patients]. / Sarcoïdose rénale: à propos d'une série de cinq patients.

INTRODUCTION: Renal involvement is uncommon in sarcoidosis, occurring in less than 5% of the patients. Diagnostic delay should be minimal to improve the outcome. METHODS: From 1996 to 2009, 78 patients were seen for sarcoidosis in the Department of Internal Medicine of Rouen University hospital. RESULTS: Five patients (6.4%) had renal involvement. Diagnosis of renal involvement and sarcoidosis were concomitant in two patients while in the three remaining patients, renal manifestations occurred during the course of sarcoidosis. The five patients with renal manifestations exhibited: isolated sarcoid granulomatous interstitial nephritis (n=2), sarcoid granulomatous interstitial nephritis and nephrocalcinosis (n=2), renal failure due to hypercalcemia (n=1). CONCLUSION: This series underlines that renal function tests should be performed systematically both during initial evaluation and the follow-up of patients with sarcoidosis.

Internal jugular vein thrombosis: outcome and risk factors.

INTRODUCTION: The aims of this study were to analyse the characteristics of patients with internal jugular venous thrombosis. We compared the characteristics of patients with internal jugular venous thrombosis with those of patients exhibiting upper extremity deep venous thrombosis (UEDVT) without internal jugular vein involvement. PATIENTS: From 1998 to 2007, 1948 consecutive patients were referred to our Department of Internal Medicine for deep venous thrombosis. RESULTS: Sixty-four patients exhibited UEDVT. Internal jugular venous thrombosis was diagnosed in 29 patients. Twenty-three patients had secondary thrombosis mainly due to cancer, central venous catheter and ovarian hyperstimulation syndrome; three of the four patients with bilateral DVT exhibited cancer. Six patients had primary internal jugular vein thrombosis. Complications of internal jugular vein thrombosis were pulmonary embolism (10.3%) and post-thrombotic syndrome (41.4%). Under multivariate analysis, significant factors for internal jugular vein thrombosis were older patients (P = 0.0008), female gender (P = 0.0035) and ovarian hyperstimulation syndrome (P = 0.0093). CONCLUSION: Our study underscores that the most common causes of internal jugular vein thrombosis are cancer, central venous catheter and ovarian hyperstimulation syndrome; it also underlines that bilateral internal jugular vein thrombosis is a significant risk indicator of malignancy Thrombosis led to high morbidity related to pulmonary embolism and post-thrombotic syndrome, principally in patients with secondary DVT. The knowledge of predictive factors of internal jugular vein thrombosis seems to be of utmost importance to improve patients' management.

[Traumatic pseudoaneurysm of the superficial temporal artery: a case report]. / Faux anévrisme post-traumatique de l'artère temporale superficielle : à propos d'un cas.

We report a case of traumatic pseudoaneurysm of the superficial temporal artery (STA) in an 87-year-old man. Surgical treatment was undertaken after failure of ultrasound-guided compression. In this report, we review briefly the pathogenic mechanism, presentation, diagnosis and treatment of this type of aneurysm. Traumatic pseudoaneurysms of the STA are rare injuries, generally occurring after a recent (weeks to months) episode of blunt head injury, and primarily in a young to middle-aged (60 %) male (80 %) population. Clinical diagnosis is straightforward when the patient presents with a pulsating painful mass in the STA area and a history of trauma. Doppler ultrasound, CT scan and MRI are useful to confirm diagnosis and exclude the other possible diagnoses (i.e. hematoma, abscess, lipoma, cyst, meningocele, etc.). Surgery remains the treatment of choice for these lesions, however, other treatments have been proposed: endovascular coil embolization, percutaneous thrombin embolization or ultrasound-guided compression.

[Infectious aortic aneurysms. A case series of 10 patients]. / Anévrismes infectieux de l'aorte. A propos d'une série de dix patients.

PURPOSE: Infectious aortic aneurysms are rare, being responsible of less than 3% of aortic aneurysms. In this study, we report the clinical characteristics and the outcome of patients presenting with infectious aortic aneurysms in an internal medicine unit. METHODS: Diagnosis of infection-related aortic aneurysm was obtained using: computed tomographic scan; and blood cultures, cultures and molecular biology testing of aortic wall and intra-aneurismal thrombus. RESULTS: The 10 consecutive patients included in this study consisted in eight men and two women with a mean age of 61.7 years. Patients presented with fever (n=9), asthenia (n=2), abdominal (n=4) or chest pain (n=1), lumbar pain (n=3). Computed tomographic scan showed aneurysm involving both thoracic and abdominal aorta (n=1), abdominal (n=8) or thoracic aorta (n=1). Isolated microorganisms were: positive Gram cocci (70%) and negative Gram bacilli (30%). All patients underwent both medical and surgical therapy. Outcome was favorable in nine patients; the remaining patient died from aneurismal aortic rupture. CONCLUSION: Clinical manifestations revealing infectious aortic aneurysms are variable, including aneurysm rupture as well as atypical abdominal pain with inflammatory syndrome. These latter presentations are more common in patients, who are hospitalized in internal medicine. Our study underlines that this clinical pattern should not be ignored, in order to avoid both diagnostic and therapeutic delay that could lead to life-threatening complications and poor prognosis.