Post-menopausal endometrial tuberculosis mimicking carcinoma: an important differential diagnosis to consider

We report the case of a menopausal 74-year-old patient who presents pyorrhoea for 6 months. We suspect initially a carcinoma process, but the anatomopathological examination takings obtained by biopsy curettage of the endometrial under hysteroscopy is in favor of an inflammatory infiltrate with epithelioid and giant cells of type Langhans and type Muller without caseous necrosis. The bacteriological direct examination after coloring of Gram, Ziehl-Neelsen and Sabouraud was negative. The bacteriological culture in the L"ewenstein and Coletsos environment identified Mycobacterium tuberculosis. The searches for another source of the infection was negative both at the pulmonary and urinary levels. An antituberculous quadritherapy allows the fast clinical improvement. The tuberculosis remains frequent but rarely genital. It is especially the case of young women, from non industrialized countries, consulting for infertility. It is necessary to know how to evoke it front in pelvic symptoms, whatever the age is and to realize easily mycobacteriological examinations

Effects of isotretinoin on bone turnover markers and bone mineral density in women with acne vulgaris and vitamin D deficiency: a preliminary study.

The prolonged use of retinoids is associated with changes in bone turnover markers and toxic skeletal effects. Although the effect of short-term oral isotretinoin therapy on bone loss is not well established, caution is recommended when it is used in patients with metabolic bone disease. We examined prospectively the effect of short-term oral isotretinoin therapy on bone turnover markers and bone mineral density [BMD] in women affected by severe acne and vitamin D deficiency. Serum bone Tartrate-resistant Acid Phosphatase [TRACP], bone specific alkaline phosphatase [Bone ALP], calcium, phosphorus, parathyroid hormone [PTH] and 25-hydroxyvitamin D [25[OH]D] were measured in 10 women at baseline, 6 weeks, and end of isotretinoin treatment. BMD was measured in 5 subjects at baseline and end of treatment. Mean serum 25[OH]D at baseline was 16.3 +/- 7.5 nmol/L. Mean TRACP and Bone ALP increased at end of treatment but this was only statistically significant for TRACP [1.18, 1.13, 1.64 U/L; P < 0.001]. Mean calcium decreased slightly at end of treatment but no significant changes occurred in PTH, 25[OH]D and phosphorus. BMD decreased in all studied patients at the femur [range -2.5 to -7.6%], and in all but one patient at the lumbar spine [range +3.2 to -6.8%]. Mean BMD decreased at all measured sites but this was statistically significant only for the femur [-5.3 +/- 1.9%; P=0.002]. Our preliminary study suggests that short-term oral isotretinoin therapy in women with vitamin D deficiency is likely associated with increased bone resorption and decreased BMD. Correction of vitamin D deficiency may be necessary before starting isotretinoin therapy

Uterine inversion; a case report

The puerperal uterine inversion is a rare and severe complication occurring in the third stage of labour. The mechanisms are not completely known. However, extrinsic factors such as oxytocic arrests after a prolonged labour, umbilical cord traction or abdominal expression are pointed. Other intrinsic factors such as primiparity, uterine hypotonia, various placental localizations, fundic myoma or short umbilical cord were also reported. The diagnosis of the uterine inversion is mainly supported by clinical symptoms. It is based on three elements: haemorrhage, shock and a strong pelvic pain. The immediate treatment of the uterine inversion is required. It is based on a medical reanimation associated with firstly a manual reduction then surgical treatment using various techniques. We report an observation of a 25 years old grand multiparous patient with a subacute uterine inversion after delivery at home

Acanthosis nigricans, hyperinsulinaemia and risk factors for cardiovascular disease

We examined the association between acanthosis nigricans, hyperinsulinaemia and other risk factors for cardiovascular disease in patients from the United Arab Emirates. Height, weight and sitting blood pressure were recorded in 122 patients with acanthosis nigricans, and blood samples were obtained for measuring fasting cholesterol, high-density lipoprotein cholesterol, triglyceride and uric acid levels. In addition, a glucose tolerance test was performed and blood was sampled for insulin and glucose. Our results indicate that the patients with acanthosis nigricans had a high prevalence of abnormal glucose tolerance and hyperinsulinaemia. In addition, euglycaemic patients with hyperinsulinaemia had a cluster of risk factors for cardiovascular disease