[Influence of age on presentation and prognosis of tuberculosis in internal medicine]. / Effets de l'âge sur la présentation et le pronostic de la tuberculose en médecine interne.

OBJECTIVES: To compare the clinical, biochemical, radiological features and the outcome of elderly and young patients with tuberculosis. METHODS: Between 1980 and 1997, 83 patients diagnosed as having tuberculosis were treated in two departments of Internal Medicine and Geriatrics. They were divided into 42 young (< 65 years) and 41 elderly (> or = 65 years) patients and differences in presentation between the two groups were analysed. RESULTS: A past history of tuberculosis was found in 10% of young and in 18% of elderly patients (p = 0.43). Cancer was more often associated with tuberculosis in elderly patients (2% vs 15%, p = 0.09). The sites of disease were similar in both groups with 2/3 of pulmonary infection. Comparison of the presenting symptoms showed no significant difference for weight loss (52% vs 66%, p = 0.31), fever (52% vs 56%, p = 0.90) and cough (33% vs 32%, p = 1). The skin testing was positive for the majority of the young adults (84% vs 58%, p = 0.11). The commonly observed biochemical abnormalities in elderly patients were an increased erythrocyte sedimentation rate (49 vs 69 mm/h: p = 0.03) and lymphocytopenia (1724 vs 1059/microliter, p < 0.01). There was no significant difference in radiographic findings between both groups with miliary tuberculosis in about 10% of patients. During the first three months of treatment, the mortality was especially high (22%) for the elderly patients. CONCLUSIONS: Comparison of the clinical and radiological features of tuberculosis in internal medicine showed no significant difference in young and elderly patients.

[Adult Still's disease: an unrecognized cause of acute febrile hepatic cytolysis. Study of twelve patients]. / Maladie de Still de l'adulte: une cause méconnue de cytolyse hépatique aiguë fébrile.

OBJECTIVE: Certain liver test abnormalities have been described in adult Still's disease. The objective of the present study was to analyze their type and frequency. PATIENTS: In a 10 year retrospective study, patients were included if they fulfilled Kahn's and/or Yamaguchi's diagnostic criteria (median follow-up: 6.5 years). RESULTS: Twelve patients were selected. The median age was 25 years old and the sex ratio H/F was 2.7. Fever was present in 100% of patients and hepatomegaly in 41%. Liver test abnormalities were identified in 92% of patients: moderate cytolysis (level of transaminases between 2 and 5 N) (83%), severe cytolysis (level of transaminases > 5 N) (17%), cholestasis (elevated levels of GGT and/or alkaline phosphatase) (75%), and an increase in the LDH level (41%). All these liver abnormalities resolved spontaneously or during treatment (83%), within a median of 18 days. CONCLUSION: Our study confirms the high frequency of liver test abnormalities (> 2/3 of the patients) in adult Still's disease. These abnormalities are generally moderate and asymptomatic (3/4 of the cases), but severe cytolysis may exist. This emphasizes the need to consider a diagnosis of adult Still's disease in the presence of fever and elevated transaminase activity.

[Veno-occlusive disease of the liver and POEMS syndrome]. / Maladie veino-occlusive du foie et syndrome POEMS.

BACKGROUND: Veno-occlusive disease of the liver is a common cause of morbidity and mortality after chemotherapy and/or radiotherapy and bone marrow transplantation. Non thrombotic hepatic venous obstruction is characteristic, but pathogenesis of this disease remains unknown. CASE REPORT: In june 1993, a 58-year-old man was treated by cyclophosphamide and steroid for a POEMS syndrome. In november 1996, he developed hepatalgia, edema, ascitis and jaundice. The diagnosis of hepatic veno-occlusive disease was obtained by hepatic biopsy. Refractory ascitis was treated by transjugular intrahepatic portosystemic shunt. Gradual improvement in clinical status was observed after this therapy. CONCLUSION: This observation offers three original types of information: there has been no prior report of an association between veno-occlusive disease and POEMS syndrome, the role of low dose cyclophosphamide in hepatic veno-occlusive disease was certain, transjugular intrahepatic portosystemic shunt is an interesting therapy with one years remission.

[Diffuse digestive tract B-cell lymphoma manifesting as exudative enteropathy]. / Entéropathie exsudative révélant un lymphome digestif B diffus.

BACKGROUND: Early manifestations of primary lymphomas of the digestive tract generally include general signs and abdominal pain. Diarrhea is uncommon and may result from several mechanisms. We report a case of primary lymphoma of the digestive tract in a patient presenting exsudative enteropathy. CASE REPORT: A 68-year-old woman was hospitalized for profuse diarrhea of 15 days duration. Laboratory tests showed major hypoalbuminemia. Malabsorption could not be evidenced and no infectious foyer was found. Biopsies at different levels of the digestive tract showed mucosal invasion by MALT type B-cell lymphoma. The clinical course was initially favorable after chemotherapy. DISCUSSION: Classification of digestive tract lymphomas differentiates MALT type B-cell lymphoma (the most frequently encountered type in western countries), Mediterranean lymphomas, and T-cell lymphomas generally complicating coeliac disease. MALT type lymphomas may occur in association with Helicobacter pylori infection, usually in a gastric localization. Multiple localizations are uncommon and diffuse involvement of the digestive tract as in our observation appears exceptional. This extension would explain the exsudative enteropathy which regressed with chemotherapy.

[Late manifestation of common variable immunodeficiency by Biermer's disease]. / Hypogammaglobulinémie commune variable révélée tardivement par une maladie de Biermer.

BACKGROUND: Common variable immunodeficiency (CVI) is a heterogeneous disorder characterized by decreased production of antibodies. Clinical presentation of CVI is generally that of recurrent pyogenic infections. Autoimmune diseases can also occur. The age of onset of symptoms shows two peaks at 1-5 and 16-20 years. CASE REPORT: A 77-year-old man was admitted in hospital for pernicious anemia. We discovered hypogammaglobulinemia with low levels of immunoglobulin G, A and M, but normal T-cell levels. We diagnosed common variable immunodeficiency. This patient had not had recurrent pyogenic infections. DISCUSSION: This case shows that common variable immunodeficiency can be revealed late by an autoimmune disease. The pathogenesis of autoimmune diseases in this immunodeficiency remains unknown despite several possible explanations.

Regulation of uveal sympathetic neurotransmission by peroxides.

PURPOSE: To investigate the effect of naturally occurring and synthetic peroxides on norepinephrine release from isolated iris-ciliary bodies of several mammalian species. METHODS: Hemiirides (bovine) and iris-ciliary bodies (human, rabbit, and rat) were incubated in Krebs solution containing [3H]-norepinephrine ([3H]NE) for 60 minutes. After incubation, tissues were set up for studies of [3H]NE release using the superfusion method. Release of [3H]NE was elicited through electrical field stimulation. RESULTS: In bovine irides, hydrogen peroxide (H2O2), cumene hydroperoxide (cuOOH), and tert-butyl hydroperoxide (buOOH) caused a concentration-dependent potentiation of field-stimulated [3H]NE release with the following rank order of potency: cuOOH > H2O2 > buOOH. Furthermore, the free radical scavenger, melatonin (2 mM), prevented the enhancement of evoked [3H]NE overflow elicited by H2O2 and cuOOH. At equimolar concentrations, H2O2 (1 mM) increased stimulated [3H]NE release from rabbit, human (mean age, 29.7; range, 15 to 48 years), and Fischer 344 rat (4 months old) iris-ciliary bodies by 98%, 50%, and 40%, respectively. However, H2O2 (1 mM) caused a 9% increase in evoked [3H]NE release in tissue from aged Fischer 344 rats (30 months old) and a 5% decrease in neurotransmitter release in tissue from old human donors (mean age, 72.3 years; range, 69 to 74 years). CONCLUSIONS: Peroxides such as H2O2 can potentiate sympathetic neurotransmission in the anterior uvea of several mammalian species. In bovine irides, H2O2-induced enhancement of neurotransmitter release can be mimicked by synthetic peroxides and may involve the generation of reactive oxygen species.

[Muscular metastases disclosing adenocarcinoma]. / Métastases musculaires révélatrices d'un adénocarcinome.

The authors report the case of a 67-year old man, with no particular medical history, presenting a large swelling of the left thigh. Investigations conclude to metastases located in muscles of the left thigh and of the pelvis, secondary to an adenocarcinoma of presumed pancreatic origin. With reference to this case, features of muscular metastases are reviewed. Muscular metastases seldom occur during the course of a cancer and are exceptionally the first manifestation of a neoplastic process. They are usually described as a painful mass, but symptoms can be misleading and delay diagnosis. Images obtained by ultrasonography, tomodensitometry and magnetic resonance imaging are not specific and histological examination is necessary to confirm the diagnosis.

[POEMS syndrome: role and value of interleukin-6]. / Syndrome POEMS: rôles et intérêts de l'interleukine 6.

POEMS syndrome is a systemic disorder with peripheral neuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes. The association of POEMS syndrome with lympho-proliferative disorder is very commun. The pathogenesis remains poorly understood but implication of cytokines (interleukins 1 and 6) is suspected. We report a case of a classic POEMS syndrome (with polyneuropathy, hepatomegaly, diabetes melitus, hyperpigmentation, monoclonal IgG lambda, anasarca and solitary plasmocytoma), associated with high serum levels of interleukin 6.