[Pet scan in internal medicine]

The nuclear medicine techniques represent an important role in infections and inflammation's evaluation. 18-fluorode soxyglucose [18F-FDG] is a tracer of glucose metabolism, recently produced in Morocco, which provides functional sensitive and high resolution images thanks to Positron Emission tomography [PET]. The indications of FDG-PET in internal medicine include the diagnosis management of certain inflammatory diseases, vasculitis of large vessels, such as temporal arteritis, especially in its systemic presentation, and Takyasu's arteritis. It is also useful for staging sarcoidosis, for differential diagnosis and the therapeutic's evaluation in multiple myeloma. The 18-FDG PET is the most effective for the diagnosis of paraneoplastic syndromes, or carcinomas of unknown primary. In case of fever of unknown origin, it facilitates the identification of the site of the infection and guides investigations conducting to the confirmation of the diagnosis. All, situations frequently found in internal medicine. This article will focus on the role of 18-FDG PET in the pathology specific to internal medicine. However, large scale prospective studies are needed before incorporating FDG-PET in clinical routine, because it is expensive and not available in our country

[News flow about A, H1N1 influenza]

2009 H1N1 is a new influenza virus causing illness in people. The first cases detected were in Mexico and in the United States in April 2009. This virus is a variant of influenza virus A, coming from triple human restocking, aviaire and porcine. The first cases were discerned in Mexico and in USA joined in April, 2009. In the date of February 17th 2010, 17208 cases of influenza A, H1N1 was confirmed in Africa and including 167 deceases. The virus has an interhuman transmission across the world, probably according to the same mode of transmission as the seasonal virus influenza. The state of pandemic was signaled by the worldwide organization of health on June 11th, 2009 and is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. On June 11, 2009, the World Health Organization signaled that a pandemic of 2009 H1N1 flu was underway. H1N1 a virus affect particularly young patient [20-40] at the difference to the seasonal influenza virus. The principal risk factors to the development of serious complications were: the young age, pregnancy and the presence of a chronic medical illness. The main clinical demonstrations of this virus are: fever, evil of throat, tiredness, aches and/or digestive disturbances with type of diarrheas and sometimes vomiting. The treatment consists of the seriousness of this influenza and the necessity of installation of appropriate prophylactic measurements [individual hygiene, vaccination and precautionary antiviral treatment in case of exhibition] to restrict the transmission of this infection and reduce total mortality. The aim of this study is to put a full stop on the clinical aspects, therapeutic measurements and the efficient means of prevention against this influenza

[Management of chronic lymphocytic leukemia]

Lymphoide chronic leukemia [LLC] is characterized by a heterogeneous evolution introduced classficiations around thirty years ago by RAI and Binet, having based on clinical signs and biological parameters allowed of license to differentiate three groups of patients having distinct forecasts. These classifications allowed guiding therapeutic strategy. However, they do not allow predicting the evolution of illness precisely, particularly at the patients having a weak risk. Since a dozen years, the taking care of lymphoide chronic leukemia was transformed by progress accomplished in the understanding of the physiopathology of illness, the identification of new markers with value prognosticates and the advent of new therapeutic tools. The aim of this review is to report, the actualities in the management of lymphoid chronic leukemia

[Reactive macrophage syndrome]

It is also known as hemophagocyticc syndrome, defined as pathology group characterized in common by the proliferation and the accumulation of macrophages in the bone marrow and the lymphoid system, leading to an abnormal phagocytosis of the blood cells and the production of proinflammatory cytokines. It has a non specific clinical picture as well as a perturbed laboratory findings. We differentiate the hereditary primary forms and the secondary related to several etiologies. Its pathophysiology is not yet clear the treatment remains poorly codified. It is a serious like-threatening disease but recent advances in the comprehension of its physiopathologic mechanisms will allow for a better adapted treatment and improve the survival rate of these patients

[Management of bone density abnormalities in inflammatory bowel diseases]

Osteoporosis is a common and life-threatening problem in patient with inflammatory bowel diseases. Its management is so very important and must be systematically investigated. The incomplete comprehension of pathogenesis and physiopathology of osteopenia in IBD is source of big difficulties in the treatment of this abnormality. Many advances had been realized last years in the management of osteopenia of IBD. This paper is a review of the physiopathology of low mineral density in patients with IBD and its implications on treatment

Hypercalcemi in elderly patient

Hypercalcemia is not rare among elderly patients. Hyperparathyroidism and neoplasia are the most frequent causes of hypercalcemia in old patients. Symptoms due to hypercalcemia are usually non specific in old subjects, leading to consider easily this diagnosis and to measure plasma calcium level. Biological diagnosis of hypercalcemia is not always obvious in old patients because of frequently decreased plasma albumin levels leading to lower plasma total calcium level. Thus, it is always necessary to calculate plasma total calcium level corrected by albumin. The symptomatic treatment of hypercalcemia rests on the intravenous administration of isotonic saline and the use of the bisphosphonates which currently represent the therapeutic of choice. Specific treatment depends on the etiology. The short-term risk of hypercalcemia is acute hypercalcemia, which may be lifethreatening. The long-term risk of hypercalcemia is renal failure

[ leptospirosis: clinical, biological and therapeutic study]

The Leptospirosis is an obligatory declared infectious disease, caused by a bacteria type spirochaete

Objectives: Analyse the clinical, biological and therapeutical characteristics of cases of leptospiral infection in the department of the internal medicine at CHU Ibn Sina, Rabat

Patients and Method: It was a retrospective study that begins in january 2000 still décember 2004.The inclusive criterions based on the epidemic circumstances orientated to the leptospirosis and the clinical and biological evokating arguments

Results: Seventeen cases were studied. Average age of the patients is 38 years old [28 years to 64 years] sex ratio of 7, 5 with predominance masculine. Contamination is related to of profession or exposure in a public bath in all the cases. The diagnostic period was 7-8 days. Clinically; icterus appears as a constant symptom, fever founded in 88% of the cases and hepatic cytolysis in 70% of the cases [transaminases are 2 times superior then the normal]. Renal insufficiency and thrombocytopenia are noted respectively in 58, 8% and 47% of the patients On the therapeutic plan; all patients benefited from parenteral rehydration. Thirteen patients benefited from a therapy based on Penicillin G; four patients were treated by Ampicillin parenteraly. One patient had presented with a mucocutaneous allergic reaction from Penicillin G at a 4 of the treatment so he had put on Cyclins. The average duration of hospitalization is 12, 5 days. Evolution was favourable in all patients

Conclusion: The diagnosis of leptospirosis must be evoked in all common cold [acute coryza] accompanied by hepatic cytolysis, renal insufficiency without thrombocytopenia. In the absence of serological proof, the clinical polymorphism of this disease makes the diagnosis sometimes difficult

[Periarteritis nodosa: experience of medecine interne]

Periartritis nodosa is a rare necrotic type of systemic vasculitis [angiitis] characterized by a multivisceral affection. Diagnosis is essentially histological. The prognosis has been improved, as a result of the therapeutic progress and the early management of this disease in the specialized centers. We report the experience of the internal medicine unit in the management of this disease depending on the new therapeutic strategies. It is a retrospective study carried out in the internal medicine unit of Ibn Sina hospital of Rabat through a period of 16 years between 1987 and 2003 responding to the clinico-biological criteria of the American College of Rheumatology [ACR] 1990- A series of twenty four cases 12 male and 12 female aged between 17 and 74 years with an age average of 45 years. Several parameters were evaluated: clinical manifistations, biological! [sedimentation rate-blood picture creatininemia], bacteriologically [B-C] serology], electromyographical and mainly neuromascular and or cutenous biopsy which assures the certitude of the diagnosis and also therapeutically [evaluation of the treatment]. Neuromuscular and or cutaneous biopsy showed lesions in favour of periarteritis nodosa in 12 patients, the other patients diagnosis was made according to the ACR criteria. As for the treatment, all patients were put under corticosteroid therapy, four severe form were treated by an association of cyclophosphamide and corticoides. Evolution was favourable in 15 patients, with recurrence in 3 cases, death of one case and 5 other patients were lost of sight. The prognosis of periartitis nodosa can be radically modified by the early diagnosis in the specialized centers

[Chronic diarrhea with difficult diagnosis during HIV infection]

Diarrhea is a frequent symptom related to HIV infection. It may impose diagnostical and therapeutical problems. We reported an observation of two HIV patients presenting with chronic diarrhea. It concerns two patients, a female aged 43 years and a male of 27 years old who had diarrhea related to HIV-AIDS infection. Parasitological stool analysis and colonoscopy examinations were necessary in the aetiological researches for both of them. The founded aetiology of the first case was a cryptosporidisis associated with cytomegalovirus colitis, while the second case diagnosed as an indetermined origin colitis. The evolution of diarrhea was favourable in the first case by a treatment composed of an association of antiretroviral and Ganciclovir therapy, while only a tritherapy was needed for the second patient. HIV - related chronic diarrhea imposes rigourous parasitological and endoscopical researches in order to get an effective therapy against the eventually opportunist infection

[Laryngeal amyloidosis]

Laryngeal amyloidosis is a rare cause of dysphonia. We report cases of 4 patients with laryngeal amyloidosis diagnosed in internal medicine department in Rabat. It is about 2 female and 2 male patients. The mean age is 53 years. Dysphonia and laryngeal dyspnea were the most frequent symptoms. Laryngeal endoscopy showed pseudotumoral lesion in all cases. The research of other localizations and of plasmocytic proliferation was negative. Two patients had chirurgical treatment and all patients had medical treatment. The outcome was good in the 4 cases. Laryngeal amyloidosis is a rare condition. The prognosis is better than in systemic amyloidosis. However, early diagnosis and appropriate management are essential for good evolution without complication

Urticarial vasculitis revealing a lupus like syndrome

We report the case of a 38 years old woman with urticarial cutaneous lesions associated with multiple systemic involvemernt including arthralgias, myalgias, muscular weakness, persistant hypocomplementemia is noted. A biopsy of the urticaria demonstrated a leucocytoclasic vasculitis, the immunofluorescence study of the skin biopsy showed IgM, C3 and C1q deposits in the dermo epidermal junction and along the capillary wall. Antinuclear antibodies, anti DNA are present. The syndrome recognized in this patient and those few observations reported previously constitue a lupus like syndrome

macrophage hyperactivation syndrome with hemophagocytosis

The hemophagocytic syndrome is a benign systemic histiocytic proliferation which may be caused by several etiologies: infections, autoimmune diseases, hemopathy; << solid >> cancers, immunity deficits. The inadequatee activation of the loop << macrophage - lymphocyte >> with hypercytokinemia explain in the large proportion the physiopathological, clinical and biological features. This syndrome includes: fever, organomegaly, cytopenia, hypertriglyceridemia, hyperferritinemia and clotting disorders. The diagnosis is based on clinical, biological and especially histopathological criteria: with tissue and/or medullary histiocytic infiltration. We report two cases of hemophagocytic syndrome in which the etiology had remained undetermined and the evolution had been fatal