ABSTRACT
We discuss the diagnostic workup of a 62 year old woman without any significant past medical history. We take this opportunity to point out three aspects : 1. The necessary contextualization of the whole process allowing to avoid unrealistic differentials; 2. The requirement to prioritize the diagnostic tests as a function of their expected contribution to the diagnosis, their invasive characteristic and their availability, including their cost and 3. The evolving character of the diagnostic process that, if needed, has to be reconsidered to integrate the information obtained from the first diagnostic tests and the evolution of the patient.
Nous discutons la démarche sémiologique et diagnostique d'un cas d'ataxie chez une patiente de 62 ans, indemne de tout antécédent médical significatif. A l'occasion de cette vignette diagnostique, nous insistons sur trois aspects : 1. La nécessité de contextualiser la démarche pour éviter d'évoquer des diagnostics différentiels irréalistes; 2. La nécessité de choisir les examens complémentaires pertinents en les hiérarchisant en fonction de la probabilité de contribuer au diagnostic, de leur invasivité et de leur disponibilité, y compris de leur coût et 3. Le caractère évolutif de la démarche diagnostique qu'il faut pouvoir remettre en question au fil des informations que fournissent l'évolution du patient et les résultats des investigations.
Subject(s)
Accidental Falls , Ataxia , Ataxia/diagnosis , Ataxia/etiology , Diagnosis, Differential , Female , Humans , Middle AgedABSTRACT
Cervical dystonia is one of the most frequent form of focal dystonia. However, there's a great lack of awareness of this condition : a long delay to diagnosis is quite common and misdiagnosis is often seen. Nevertheless, this pathology is invalidating and improving diagnosis could have an impact on the treatment and the patient's quality of life.
Trop souvent méconnue, la dystonie cervicale (parfois appelée torticolis spasmodique) est pourtant une des formes les plus fréquentes de dystonie focale. Les errances diagnostiques sont fréquentes et le délai pour établir le bon diagnostic est souvent long. Il s'agit pourtant d'une pathologie invalidante pour laquelle un traitement est envisageable et susceptible de soulager le patient.
Subject(s)
Neuromuscular Agents , Torticollis , Humans , Neuromuscular Agents/therapeutic use , Quality of Life , Torticollis/complications , Torticollis/diagnosis , Torticollis/drug therapyABSTRACT
Considering its strong symbolic connotations and its rich history, syphilis could be regarded as the perfect example of venerian disease. It could also be seen as a representative disease of the whole medical history and the evolution of both medical ways of thinking and curing. In this work we will briefly discuss the history of the syphilitic disease and try to show how this condition has affected the life and works of some of the most famous artists of the 19th century. Moreover, we shall try to evoke the complex relationship between art and pathology.
Par ses connotations historiques et symboliques, la syphilis constitue la maladie vénérienne par excellence. Elle peut également être considérée à plus d'un titre comme une maladie représentative de l'histoire de la médecine et paradigmatique de l'évolution de la pensée médicale. Au travers de ce petit historique, nous tenterons de dresser une brève histoire de la maladie et de son traitement avant d'envisager la façon dont elle a pu influencer le parcours créatif de plusieurs figures artistiques majeures du XIXème siècle. Plus encore, nous discuterons brièvement des liens complexes que peuvent entretenir l'art et la maladie.
Subject(s)
Medicine in the Arts , Syphilis , Art/history , History, 15th Century , History, 16th Century , History, 18th Century , History, 19th Century , History, 20th Century , Humans , Medicine in the Arts/history , Syphilis/diagnosis , Syphilis/history , Syphilis, Congenital/diagnosis , Syphilis, Congenital/historyABSTRACT
Light pollution is defined as the abnormal and disturbing nocturnal presence of light, its adverse consequences on flora, fauna, and, ecosystems, and its suspected or proven effects on human health. Light pollution is a quite recent and increasing phenomenon within our society; it leads to a major environmental damage not only on wildlife, but also on human health (cancers, obesity, fatigue, depression...). The solutions to this problem are however simple, efficient and, de facto, inexpensive because they involve a substantial energy saving.
Subject(s)
Circadian Rhythm , Health Status , Light/adverse effects , Photoperiod , Environment , HumansABSTRACT
Gigantism and acromegaly, usually caused by a pituitary adenoma linked inappropriate secretion of growth hormone (GH), are generally considered as very rare diseases, even if, according to some authors, their cumulative prevalence is about 1/5000. Starting from the historical case of a giant from Liège we shall describe the different types of GH pituitary adenomas and their pathophysiology. We shall particularly discuss rare forms of inherited GH secreting pituitary adenomas like the FIPA (familial inherited isolated pituitary adenomas) and the X-LAG (X linked acrogigantism), both described for the first time in Liège, in 2000 and 2014, respectively.
Subject(s)
Acromegaly/genetics , Gigantism/genetics , Belgium , Carney Complex/genetics , Chromosomes, Human, X , Fibrous Dysplasia, Polyostotic/genetics , Gigantism/history , Growth Hormone-Secreting Pituitary Adenoma/epidemiology , Growth Hormone-Secreting Pituitary Adenoma/genetics , History, 19th Century , Humans , Multiple Endocrine Neoplasia Type 1/genetics , MutationABSTRACT
Capgras delusion is characterized by the misidentification of people and by the delusional belief that the misidentified persons have been replaced by impostors, generally perceived as persecutors. Since little is known regarding the neural correlates of Capgras syndrome, the cerebral metabolic pattern of a patient with probable Alzheimer's disease (AD) and Capgras syndrome was compared with those of 24-healthy elderly participants and 26 patients with AD without delusional syndrome. Comparing the healthy group with the AD group, the patient with AD had significant hypometabolism in frontal and posterior midline structures. In the light of current neural models of face perception, our patients with Capgras syndrome may be related to impaired recognition of a familiar face, subserved by the posterior cingulate/precuneus cortex, and impaired reflection about personally relevant knowledge related to a face, subserved by the dorsomedial prefrontal cortex.
Subject(s)
Alzheimer Disease/physiopathology , Brain/physiopathology , Capgras Syndrome/physiopathology , Delusions/physiopathology , Aged , Alzheimer Disease/complications , Alzheimer Disease/diagnosis , Capgras Syndrome/diagnosis , Capgras Syndrome/etiology , Delusions/etiology , Diagnosis, Differential , Female , Humans , Male , Neuropsychological Tests , Positron-Emission Tomography/methodsABSTRACT
The hypothalamo pituitary axis, as the true conductor of the endocrine orchestra, is frequently involved in a large variety of pathological conditions such as acromegaly, behavioral disorders, obesity or dwarfism. It is paradoxical to note that, in spite of its importance, this system has been almost ignored by the physiologists of the late centuries. From the physiological conceptions of the physicians and philosophers of antiquity to the theories of the medieval and of the Renaissance physiologists, we will try to understand why the role of pituitary remained so long unrecognized.
Subject(s)
Endocrinology/history , Pituitary Gland/anatomy & histology , Pituitary Gland/physiology , History, 15th Century , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, Ancient , History, Medieval , HumansABSTRACT
Alzheimer's disease is the most common neurodegenerative disease encountered in patients over 60 years. By its prevalence and the consequent individual and social loss of function Alzheimer's disease is a major public health problem. With the presentation of a clinical story of Alzheimer's disease in an elderly patient, we propose a diagnostic and therapeutic discussion on this clinical problem. We must adjust the treatment for each patient and overall not omit the non pharmacological therapeutic approaches.
Subject(s)
Alzheimer Disease/diagnosis , Alzheimer Disease/drug therapy , Aged , Alzheimer Disease/psychology , Antioxidants/therapeutic use , Cholinesterase Inhibitors/therapeutic use , Cognition Disorders/diagnosis , Cognition Disorders/drug therapy , Cognitive Behavioral Therapy , Diagnosis, Differential , Dopamine Agents/therapeutic use , Drug Therapy, Combination , Geriatric Assessment , Humans , Male , Psychiatric Status Rating Scales , Risk Factors , Severity of Illness Index , Social SupportABSTRACT
Since their inception in the 1970's, monoclonal antibody therapies became increasingly efficient and common in numerous medical conditions and their use in neurology has been boosted during the last couple of years with the rise of natalizumab (Tysabri). Furthermore, if most monoclonal antibodies currently assessed in neurologic conditions remain considered as experimental, they may soon become first-line approved treatments in a broad range of neuromuscular and demyelinating diseases. Since the introduction of new therapies is likely to unravel specific adverse events and sui generis iatrogenic disorders, it is important to be able to recognize the side-effects of monoclonal antibodies delivered for neurological or non-neurological diseases.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Nervous System Diseases/drug therapy , Neuroprotective Agents/therapeutic use , Alemtuzumab , Antibodies, Monoclonal, Humanized , Antibodies, Monoclonal, Murine-Derived , Antibodies, Neoplasm/therapeutic use , Daclizumab , Etanercept , Humans , Immunoglobulin G/therapeutic use , Infliximab , Natalizumab , Receptors, Tumor Necrosis Factor/therapeutic use , RituximabABSTRACT
The case of a 19-month-old girl with visceral leishmaniasis and unusual skin manifestations is reported. Emphasis is put on the fact that such manifestations are unusual in Mediterranean infantile leishmaniasis. The clinical features, parasitology, histology, and course of these skin lesions are discussed.
Subject(s)
Leishmaniasis, Visceral/complications , Female , Humans , Infant , Leishmaniasis, Visceral/parasitology , Leishmaniasis, Visceral/pathology , Skin Diseases, Parasitic/parasitology , Skin Diseases, Parasitic/pathologyABSTRACT
Insulin-dependent diabetes mellitus is common in Tunisia. Eighty-six pediatric cases managed at the diabetes clinic of a department of pediatrics in Tunis from 1979 through 1989 were studied. Relevant clinical and biological findings were abstracted from case-records. Admissions of patients with diabetes mellitus accounted for approximately 0.44% of admissions to the pediatric ward during the study period. Mean age of patients was 7 years. Sex ratio was 0.89. Polyuria with polydipsia and ketoacidosis were the two most common presenting manifestations. Mean blood glucose level at diagnosis was 22.44 mmol/l. Rate of consanguinity was 48%. HLA typing studies demonstrated a high prevalence of DR3 and DR4 alleles and especially of simultaneous expression of both these alleles. Several factors are incriminated in the development of childhood insulin-dependent diabetes mellitus.
Subject(s)
Diabetes Mellitus, Type 1/epidemiology , Adolescent , Child , Child, Preschool , Diabetes Mellitus, Type 1/genetics , Diabetes Mellitus, Type 1/immunology , Diabetic Coma/epidemiology , Female , HLA-DR Antigens/analysis , Hospital Departments/statistics & numerical data , Humans , Infant , Male , Pediatrics/statistics & numerical data , Polyuria/epidemiology , Prediabetic State/epidemiology , Thirst , Tunisia/epidemiologyABSTRACT
8 healthy subjects have eaten in the morning, after an overnight fast, in two separated occasions and in a randomised order 50 gr of CHO as pasta or couscous. Blood glucose after pasta ingestion was lower at 30 mn (p less than 0.05) at 45 mn (p less than 0.01) and at 60 mn (p less than 0.05). Area under the curve after pasta was significantly reduced (p less than 0.01). In a second time 6 IDDM patients have eaten in a randomised order a meal made of pasta with tomato sauce (P = 11%, F = 30%, G = 59%) or couscous with vegetables and sauce (P = 10%, F = 37%, G = 53%). Blood glucose after the pasta was lower than couscous at 90 mn (p less than 0.05) the area under the curve after the pasta ingestion was reduced of 38% but did'nt reach significance. In conclusion couscous has a higher glycemic effect than pasta although it has a similar composition. This phenomenon is still observed when the cereal products are mixed with other foods and ingested by IDDM patients.
Subject(s)
Blood Glucose/metabolism , Diabetes Mellitus, Type 1/blood , Dietary Carbohydrates , Edible Grain , Energy Intake , Humans , Random Allocation , Reference ValuesSubject(s)
Hyperlipoproteinemia Type II , Hyperlipoproteinemia Type I , Hyperlipoproteinemias , Adolescent , Child , Female , Humans , MaleABSTRACT
Ketoacidosis is still a frequent complication as far as our diabetic patients are concerned. The insulin regimen during this acute diabetic ketoacidosis was, until October 1981, administered at the start, half intravenously and half intramuscularly, then discontinuously every four hours, subcutaneously, according to the rate of glucose and acetoacetate. Since then, a new method has been used for the treatment of diabetic ketoacidosis providing a continuous perfusion without pumps, of insulin, glucose and electrolytes. The authors describe their experience, using this technique on ten children admitted to hospital because of severe diabetic ketoacidosis. A certain number of parameters and the evolution were studied. The glycemia graph shows a more harmonious and regular normalisation, urinary ketosis disappears within 8 and 24 hours (with an average of 16,22 h). The next step that consists in administering mixed insulin is taken between the 16th and 48th hours (with an average of 25,42 h). Two hypoglycemia have been reported contrary to the statements of other authors. Furthermore, these parameters were compared to those of 10 children submitted to the classical regimen. The authors conclude that a continuous perfusion presents a better method with approximately similar results, and its use is much simpler both for the patient and for the staff.
