[Primary Neisseria meningitidis arthritis of the knee without meningitis: contribution of synovial fluid culture in blood-culture vial]. / Monoarthrite du genou à Neisseria meningitidis sans méningite: apport de la culture du liquide articulaire en flacon d'hémoculture.

INTRODUCTION: Primary meningococcal arthritis is a rare form of meningococcal disease. It occurs as an isolated acute purulent arthritis without meningitis, and presence of Neisseria meningitidis in articular fluid. We report a new case of typical primary meningococcal arthritis. EXEGESIS: A previously healthy 23-year-old female patient was admitted for purpuric lesions of the legs. At admission, conscience was normal and symptoms of meningitis were absent. During the 2nd day of hospitalisation, a warm and painful effusion in the right knee appeared. Aspiration from the right knee yielded a purulent fluid. N. meningitidis was isolated from a blood-culture vial inoculated with the synovial fluid, while blood cultures remained sterile. Anti-biotherapy was initiated as soon as microbiological diagnosis was established. The patient was symptom-free 1 month later. CONCLUSION: We emphasize the fact that agar cultures of the synovial fluid remained sterile, while N. meningitidis grew in a blood-culture vial. We suggest that diagnosis of primary meningococcal arthritis may be underestimated when inappropriate culture media are used.

[Activated C protein resistance manifested by cutaneous necrosis after interferon alpha injection: case report]. / Nécrose cutanée après injection d'interféron alpha révélant une résistance à la protéine C activée: rapport d'un cas.

INTRODUCTION: Cutaneous necrosis occurring in the course of treatment by alpha interferon is an uncommon side-effect. Its physiopathologic mechanism remains obscure. A local thrombotic action of interferon has been suggested to explain its occurrence. EXEGESIS: A 64-year-old male patient with human immunodeficiency virus-related cutaneous Kaposi's sarcoma presented cutaneous necrosis after a 9-month treatment by interferon alpha, while his resistance to activated protein C had already been demonstrated. To our knowledge, this is the first case ever described regarding the association of interferon-induced cutaneous necrosis with activated protein C resistance. CONCLUSION: This suggests that in case of interferon treatment-induced cutaneous necrosis coagulation disorders should be investigated and questions the existence of a particular "pro-coagulant profile" facilitating this side effect.

[Electrolyte abnormalities in elderly people. Prevalence and relation to drug treatment. Multicenter study of 631 subjects aged 70 years and over]. / Anomalies électrolytiques chez les personnes âgées. Prévalence et relation avec le traitement médicamenteux. Etude multicentrique chez 631 sujets de 70 ans et plus.

In order to assess the responsibility of medicinal drugs for the disorders in electrolytes observed in elderly people, the prevalence of abnormal natraemia and kalaemia was prospectively established in 631 subjects aged 70 or more on the first day of hospitalization. Among 337 subjects not taking drugs likely to create problems (diuretics, angiotensin-converting enzyme inhibitors, anti-inflammatory agents) 3.6 percent had hyponatraemia (below 130 mmol/l) and 12.2 percent had hypokalaemia (below 3.5 mmol/l). Subjects with normal renal function who were taking angiotensin-converting enzyme inhibitors or non-steroidal anti-inflammatory agents showed no more electrolytic abnormalities than those who did not take them. Conversely, subjects on thiazides were more frequently hyponatraemic (11.8 percent) or hypokalaemic (16.2 percent; 20 percent in the absence of associated distal diuretics). These abnormalities were more frequent in women than in men (21.7 and 13 percent). This, together with the fact that 68 percent of subjects taking thiazides were women accounts for the marked female predominance of electrolytic abnormalities reported in the literature.

[Anti-hypertensive drugs prescribed to the elderly. Multicenter study at the hospital admission of 631 patients aged 70 plus years]. / Les anti-hypertenseurs prescrits aux personnes âgées. Etude multicentrique lors de l'entrée à l'hôpital de 631 patients de 70 ans et plus.

The anti-hypertensive treatment of 631 patients 70 years old and over was evaluated at the time of their hospitalization in 12 Internal Medicine departments in the western Paris suburbs, in May and June 1990. 49.6 +/- 3.9% received no such therapy; 30.3 +/- 3.6% were being treated for hypertension (group 1); 8.7 +/- 2.2% were taking anti-hypertensive drugs for poorly specified reasons (group 2); 11.4 +/- 2.5% were under such treatment for another reason. In groups 1 or 1 + 2, the most frequently prescribed medications were, in decreasing order: diuretics, calcium channel blockers, converting enzyme inhibitors, beta-blockers or central inhibitors. In the oldest patients, the beta-blockers were prescribed less and converting enzyme inhibitors more. More than half of the patients in groups 1 + 2 were taking a single drug. The most frequently prescribed combined therapy was diuretic + converting enzyme inhibitor. Our results seem to indicate that the prescription modalities depended, for the most part, upon an associated or suspected pathology, notably cardiac insufficiency.

[Granulomatous hepatitis in cytomegalovirus infection in healthy adults]. / Les hépatites granulomateuses au cours des infections à cytomégalovirus chez l'adulte sain.

The authors report 16 cases of cytomegalovirus (CMV) disease in previously healthy adults. Constant features included pyrexia lasting 3 to 8 weeks and mononucleosis occurring 2-3 weeks after the onset of fever. Moderate hepatomegaly without jaundice, splenomegaly and morbilliform or petechial rush were observed in 30 to 50 p. 100 of cases. None had pharyngitis. Mild increase in serum transaminase activity (2 to 5 N) was present in 13 of the 16 patients, but increased alkaline phosphatase activity was observed in only 3 of them. Liver biopsy was obtained in 10 patients. Liver lesions were characterised by the association of intra lobular granuloma, abundant mononuclear cells in the sinusoids and hepatic peri-venous inflammation but hepatocellular necrosis was not prominent. Typical intracellular inclusions were not seen, either in hepatocytes or in cells of biliary ducts. The diagnosis was ascertained by positive viremia and or viruria and presence of IgM antibodies. The outcome was favourable although clinical and biological signs lasted for about 8 weeks. The authors conclude that adults with chronic pyrexia, no pharyngitis and sub-clinical hepatitis with mild increases in transaminase activity and histologic mononucleosis hepatitis showing mononuclear infiltrates and granuloma formation are likely to have CMV disease.

Pulmonary lymphangioleiomyomatosis and Bourneville's tuberous sclerosis with pulmonary involvement: the same disease?

The authors studied the ultrastructural morphology of the lung in one case of Bourneville's tuberous sclerosis with pulmonary involvement. The observations in this report are similar to those previously reported in pulmonary lymphangioleiomyomatosis and further emphasize the striking resemblance between the two diseases.

[Digestive manifestations of dermatomyositis (author's transl)]. / Manifestations digestives de la dermatomyosite.

The principal digestive anomalies detected by radiological examination in dermatomyositis are the motor and functional consequences of the smooth and striated muscle lesions in these tissues. Vascular changes cause ulcerations, located in any part of the digestive tract, but more frequently in the esophagus, duodenum, and small intestine. These ulcerations sometimes develop into pseudodiverticulae.

[Primary intestinal localisation of Hodgkin's disease. One case initially diagnosed as a benign eosinophilic granuloma of the small intestine (author's transl)]. / Localisation intestinale primitive de la maladie de Hodgkin. Un cas initialement interprété comme un granulome éosinophile bénin de l'intestin grêle.

Intestinal lesions in Hodgkin's disease remain relatively rare. Even rarer are forms in which intestinal lesions or mesenteric nodes remain the only manifestations of the disease for a number of years. In these cases, histological findings are usually less typical than in more usual sites and this explains the diagnostic hesitancy which sometimes occurs. In the case reported here, the diagnosis made and adhered to for four years and despite three successive operations was that of an eosinophilic granuloma of the small intestine.

[Scintigraphic appearance and particular arteriographic aspects intrahepatic cholestasis]. / Foies de cholostases. Aspects scintigraphiques et artériographiques particuliers.

Based on one case history, it is reviewed here that prolonged cases of obstructive jaundice can take on deceiving appearences, and all the more so when they fall within the framework of a "biological gap". Extensive distension of the extra and intrahepatic bile ducts are at the basis of images with multiple, radiating hilar gaps on scintigraphy, and of "chicken nests" and "Swiss cheese" at hepatographic times in selective hepatic arteriography. These rather uncommon images should lead to a diagnosis of a surgical cholestatic liver.

[Subacute cytosteatonecrosis of pancreatic origin. Surgical problem in 5 cases (author's transl)]. / La cytostéatonécrose sous-cutanée d'origine pancréatique. Le problème chirurgical à propos de 5 observations.

The authors report 5 cases of subcutaneous cytosteatonecrosis (Weber-Christian syndrome of pancreatic origin) and review 68 cases in the world literature. The skin, bone joint and general manifestations may appear without any clinical or radiological sign of pancreatitis. The rise in blood and urinary amylase and lipase, the skin lesions, the joint pleural and peritoneal effusions, orient the diagnosis towards the pancreas and suggest a full radiological arteriographic and echotomographic investigation. The pancreatic disease was pancreatitis in 50 cases, cancer in 18 cases. Too long a delay between the initial signs and the diagnosis may lead to early operation even in the absence of pancreatic signs. The cancer may still be limited and removable. The pancreatitis was in 18 cases a false cyst of the head in 2/3rds, whether obvious clinically or not. Operation led to its discovery usually but may miss the lesion which is then only discovered on autopsy. Removal or early by pass operations transform the prognosis which is otherwise fatal. Analysis of these cases illustrates well the problems of indication operative management and efficacy of surgery in a disease still relatively unfamiliar both to physicians and surgeons.