Mediterranean spotted fever: clinical, laboratory and epidemiological features of 199 cases.

Most previous studies of Mediterranean spotted fever (MSF) have included cases that either were not laboratory-confirmed or were confirmed by the Weil-Felix test. The authors report the detailed clinical, laboratory and epidemiological features of 199 serologically-confirmed cases of MSF (by microimmunofluorescence). This work demonstrates that the disease is difficult to diagnose, especially at the beginning; that it can be fatal (2.5% of cases); and that a rapid and specific diagnosis is necessary to identify atypical cases. Epidemiological features such as season (summer essentially), presence of a dog, and travel in an endemic area (the Mediterranean Basin) are important in the diagnosis. In such cases fever associated with rash have to be considered and treated as MSF.

[Spondylodiscitis disclosing endocarditis on the endocavitary electrodes of cardiac pacemakers]. / Spondylodiscites révélatrices d'endocardite sur électrodes endocavitaires de stimulateurs cardiaques.

Permanent pacemaker electrode infection is rare but can be fatal. The authors report two cases presenting with spondylodiscitis, a previously described mode of presentation of valve endocarditis but not previously reported in this context. In one case, recurrent courses of antibiotics did not prevent repeated episodes of bacteraemia. In the second, the relapse of infection occurred at different sites of the vertebral column until surgical removal of the electrodes: the usual features of this pathology were observed: frequent but not constant infection at the site of the pacemaker implantation, making the diagnosis more difficult; delayed signs of spondylodiscitis after implantation of the pacemaker; recurrence of infection when antibiotic therapy alone was prescribed and, therefore, the need for surgical ablation of all implanted material. The authors underline the diagnostic value of transoesophageal echocardiography.

[Acute myocarditis in non-typhoid Salmonella infection]. / Myocardite aiguë au cours d'une salmonellose non typhique.

The authors report a case of myocarditis secondary to a Salmonella Virchow infection in a 20 year old non-immunodeficient man without a previous medical history. The outcome was favourable after treatment with fluoroquinolone. The features of this rare complication of non-typhic salmonella infection are discussed with respect to this and four other recently published cases.

[Gouty encephalopathy: myth or reality?]. / L/encéphalopathie goutteuse: mythe ou réalité?

Case report is a 75-year old woman who presented an unexplained febrile encephalopathy with diffuse myoclonic jerks and a gout's polyarthritis. None of these etiologies was found: infectious, toxic, vascular, metabolic, hormonal, immunologic. The spectacular effect on neurologic symptoms of a treatment by colchicine alone lead us to consider that gout encephalopathy probably exists.

[Meningoencephalitis after vaccination against yellow fever with the 17 D strain: 2 cases]. / Méningo-encéphalite après vaccination anti-amarile par la souche 17 D: deux observations.

The authors report two cases of meningoencephalitis consecutive to immunization with the 17 D yellow fever virus in adults. This complication is exceptional; the rare cases previously reported usually occurred in children. The meningoencephalitis had no particular clinical features; it was more severe in our second case but nevertheless followed a favourable course, as usually described in the literature. The pathogenesis of these central nervous system reactions is unclear. In our two cases the vaccine seems to have acted synergistically with another neurotropic virus (adenovirus in the first case, unknown virus in the second) which was either pre-existing and latent or occurring de novo.

[Giant esophageal fibrovascular polyp. Apropos of a case]. / Polype fibrovasculaire géant oesophagien. A propos d'une observation.

Fibrovascular polyps, together with eleiomyomas, constitute the great majority of rare benign tumors of the oesophagus. Their size and their frequently high level of attachment sometimes give them a spectacular clinical presentation. The hazards involved in the interpretation of radiological and endoscopic data account for frequent mistakes in their diagnosis. The determination of the pedicle site defines the choice of the surgical approach. A diagnostic error and the choice of an incorrect approach are the two main causes of therapeutic difficulties.

[Deficits of the layer of retinal nerve fibers and glaucoma. Comparison with campimetry and control of the course]. / Déficits de la couche des fibres nerveuses rétiniennes et glaucome. Confrontation à la campimétrie et contrôle de l'évolution.

Photographic study of retinal nerve fiber layer try to show early defects in case of glaucoma or ocular hypertension. Among the recent techniques trying to indicate the first marks of glaucoma, this method appears easy, reproducible, objective, and uses a very common equipment. We describe the equipment and the technic used, and present the main physiological and pathological aspects. Our series includes 49 eyes (30 patients) and, for 30 among them (17 patients), a control of the evolution has been done within an average period of thirty months. In each case, visual field was studied, principally with the programs of early detection of glaucomatous damage available on the Octopus 2000 R (prog. No 31, 33 and G1). We explore and comment upon the results obtained by the confrontation between these exams.

[Results of a double-blind study comparing the effects of timolol and pilocarpine in 110 patients with chronic open-angle glaucoma]. / Résultats d'une étude en double observateur comparant le timolol à la pilocarpine chez 110 patients atteints de glaucome chronique à angle ouvert.

Following a seventeen weeks study including 110 patients with open-angle glaucoma, 81,8% of the patients treated by timolol, administered twice a day, had a satisfactory control of their intraocular pressure, against only 41,8% of those patients treated by pilocarpine, administered four times a day. The side effects liable to timolol are clinically reduced, in a osit with pilocarpine which is followed by a series of well-known subjective and objective signs often causing discomfort to the patients.

[Neurocysticercosis of spinal manifestation. Apropos of a case]. / Neurocysticercose à révélation spinale. A propos d'un cas.

A case of spinal extramedullary cysticercosis with location in basal cisterns is reported. It was revealed by a severe sciatalgia and studied with MR imaging which is precious for the diagnosis and the follow-up. Cerebral cisternal arachnoiditis is the main problem in this racemose form where long medical treatment is necessary.

[An observational, retrospective two-year cost study in primary open-angle glaucoma and ocular hypertension in newly diagnosed patients]. / Etude observationnelle rétrospective de coûts des deux premières années de traitement dans le glaucome primitif à angle ouvert et l'hypertension oculaire en France.

PURPOSE: To investigate the different treatment strategies in France and the direct costs for patients with newly diagnosed primary open-angle glaucoma or ocular hypertension who have started treatment with beta-blockers, and to estimate the total direct cost for two years of treat. MATERIAL: and methods: We analyzed 225 medical charts retrospective in eleven academically and office-based centers in France over the first two years after diagnosis. Standard costs for each resource in current medical practice were determined from the French Social Security perspective. RESULTS: The vast majority of patients (90%) had a diagnosis of primary, open-angle glaucoma or ocular hypertension in both eyes. In 60% of the patients we found a moderate or severe defect in their visual field or optic nerve. Intraocular pressure before treatment was 23.9+4.7mmHg and 17.5+4.2mmHg after two years of treatment. Over the first two years, 25% of visits led to a change in therapy (medical or surgical), involving 64% of the patients. Two-thirds of the changes occurred during the first year of treatment and in around 80% of cases for low intraocular pressure at check-up. Laser surgery or surgical intervention was performed in 25% of the patients. Total direct costs for two years were 5698F.F. The intraocular pressure before treatment was positively correlated (p<0.01) with treatment costs, while the initial intraocular pressure-lowering effects of treatment were negatively correlated with two-year costs. CONCLUSION: After two years of treatment, the mean intraocular pressure decreased from 24 to 17.5mmHg. The higher the basal intraocular pressures is, the more intensive the treatment and the higher the costs. The more efficient the treatment to decrease baseline intraocular pressure is, the earlier the costs will be reduced.

[Sodium cromoglycate eyewash in allergic conjunctivitis. Multicentric controlled double-blind study. Review of the literature]. / Cromoglycate de sodium en collyre dans les conjonctivites allergiques. Etude contrôlée multicentrique à double insu. Revue de la littérature.

A randomized double-blind trial was conducted in 143 out-patients with allergic conjunctivitis (281 eyes). Active sodium cromoglycate collyre was compared with placebo in parallel groups over a four-week period. Highly significant advantage for active drug was demonstrated for subjective and objective symptoms as well as for overall assessment by patients and physicians. Results were compared with international data concerning this well-known anti-allergic compound.

[Unstable angina and single vessel stenosis of the anterior interventricular artery. Evaluation of the threatened myocardium. Therapeutic implications]. / Angor instable et sténose monotronculaire de l'artère interventriculaire antérieure. Appréciation du myocarde menacé. Implications thérapeutiques.

The authors report a special cases of precise evaluation of threatened myocardium during coronaro-ventriculography. Two elements provided this evaluation: 1) spasm in the tight stenosis of the middle part of the anterior interventricular artery with immediate left ventricular dyskinesia (EF: 37%, EDP/EVD: 1.74; EDV: 98 cc/m2). 2) Complete instantaneous recovery after injection of 2 mg of trinitrine into the left ventricle (EF: 69%, EDP/EVD: 4.33; EDV: 28 cc/m2). This loss, in the order of 50%, in the left ventricular function led us to perform an angioplasty (ACT) with success. A further clinical and angiographic stenosis, three months later, in this 72 years old patient with arteritis, led us to perform an aorto-coronary graft, rather than another ACT.

[Vectorcardiography in the diagnosis of the association of inferior necrosis--left intraventricular conduction disorders]. / Apport du vectocardiogramme au diagnostic de l'association nécrose inférieure--troubles de conduction intraventriculaire gauche.

The authors study 53 vectorcardiograms (VCG) which demonstrate the association of inferior myocardial necrosis with left intraventricular conduction disturbances (LIVCD) consisting of 44 left anterior hemi-blocks (LAHB), 2 left posterior hemi-blocks (LPHB) and 7 complete left branch blocks (CLBB). In the presence of LAHB, the ECG and VCG diagnosis concur in 37 cases, with a more obvious appearance on the VCG in 16 cases. In 7 cases, only the VCG provided the diagnosis of this association. In the presence of LPHB, the ECG, in one case, only showed signs of necrosis and only the VCG revealed the hemi-block; in the other case, the ECG showed signs of LPHB, but the Q waves did not present the criteria of necrosis. Once again, only the VCG provided the diagnosis of the association. Finally, in the presence of CLBB, the diagnosis were in agreement in only 3 cases. In two cases, only the VCG revealed the necrosis, in one case, the ECG was superior and in the remaining case, the ECG and the VCG were equally ineffective in confirming the inferior necrosis which was nevertheless definitely present. On the basis of these findings, the authors discuss the ECG criteria of the association of inferior necrosis and LIVCD.

[Inflammatory rheumatism and celiac disease in adults. Coincidence or pathogenic relationship?]. / Rhumatisme inflammatoire et maladie coeliaque de l'adulte. Coïncidence ou lien pathogénique?

Five adults had inflammatory rheumatic disorders 6 to 20 years before the diagnosis of coeliac disease. It is known that joint inflammation occurs in certain patients with adult coeliac sprue who develop either a specific inflammatory rheumatic disease or an atypical progressive polyarthropathy, sometimes as the first manifestation of the intestinal disorder. The diagnosis of adult coeliac sprue should be entertained in these cases even in absence of major digestive disorders or malabsorption. IgA anti-reticulin antibodies and atrophy of the duodenojejunal villosities are the best indicators for diagnosis. There are two important reasons for making the diagnosis of "asymptomatic adult coeliac sprue". First a gluten-free diet can improve or even cure the inflammatory joint disease, a rare situation which emphasizes the causal relationship between these two diseases. Second, the risk of developing lymphoma (especially in the small bowel) is apparently lower in patients on gluten-free diet. Pathogenesis is unclear. Frequently the two autoimmune disorders simply appear to coincide in the same patient; more rarely, arthritis is a symptom of coeliac disease. The immunological mechanisms probably begin when antigens cross an excessively permeable intestinal mucosa.

[Isolation of viruses in the cerebrospinal fluid in a case of acute varicella meningo-encephalitis]. / Isolement du virus dans le liquide céphalo-rachidien dans un cas de méningo-encéphalite aiguë de la varicelle.

The authors report a case of severe, life-threatening, meningo-encephalitis occurring in a young nonimmunodepressed adult with varicella. The demonstration of a cytopathogenetic effect of his cerebrospinal fluid and of immunoglobulins M specific to the varicella-zoster virus was in favour of an acute, directly viral-dependent encephalitis rather than an immune-mediated leucoencephalitis, as used to be commonly admitted. This is an incitement to use acyclovir in such cases, the effect of which contributes to reinforce this pathogenic hypothesis.

[Malignant adrenocortical tumor as a part of Wermer's syndrome. Apropos of a case]. / Corticosurrénalome malin dans le cadre d'un syndrome de Wermer. A propos d'une observation.

The authors report a case of malignant adrenal carcinoma associated with nodular adrenal hyperplasia as part of Wermer (N.E.M.I.) type pathological polyendocrinopathy syndrome. They stress the prognostic importance of the glandular degeneration and the type of adrenal involvement in these "multiple endocrine neoplasia".

[Travelers' diarrhea]. / Diarrhées du voyageur.

Up to fifty per cent of travellers going from temperate countries to tropical or subtropical countries present a diarrhoea. Enterotoxigenic Escherichia coli remain the most frequent bacterial cause, being identified in 40 to 70% of cases. Laboratory investigations are reserved to grave or protracted cases or those which resist to empirical therapy. Careful selection of food and beverage can limit its incidence. In adults at high risk of complications (sick or aged people) or who cannot suffer an interruption of their activity, one can prefer to a chemoprophylaxis with possible occurrence of adverse effects the early administration of a fluoroquinolone, which besides is a first-choice treatment of serious cases.