[Hepatosplenic localization of cat scratch disease: two cases in immunocompetent adult patients]. / Atteinte hépatosplénique de la maladie des griffes du chat : à propos de deux observations chez l'immunocompétent.

INTRODUCTION: Cat-Scratch Disease (CSD) is a well-recognized benign cause of localized lymphadenopathy, which often recovers spontaneously. However systemic clinical presentations are described in immunodeficient adults (bacillary angiomatosis, bacillary splenitis) and are less common in immunocompetent ones. EXEGESIS: We report two cases of disseminated CSD in immunocompetent patients, presenting hepatosplenic nodules, associated in the second case with an endocarditis. CONCLUSION: Bartonella serology must be achieved in case of hepatosplenic nodules with fever. Treatment of disseminated CSD in immunocompetent adults is still empirical and recovery can occur without antibiotherapy when endocarditis is not associated.

[Fire-eater's lung]. / Pneumopathie des cracheurs de feu.

INTRODUCTION: Fire-eaters use kerdan, a petroleum-derivative, during their performances. Its accidental inhalation produces respiratory symptoms known as fire-eater's lung. CASES: We report 8 cases of fire-eater's lung and compare their clinical and radiologic data and outcome with those of 44 cases from the French and English-language literature. Presentation is highly characteristic: i) occurrence in young inexperienced subjects; ii) immediate phase characterized by coughing and digestive symptoms; iii) after a latency period, pseudoinfectious lung disease frequently associated with extra-respiratory symptoms, usually digestive; iv) generally favorable clinical and radiological outcome, rarely complicated by pneumatocele or pneumothorax. CONCLUSION: Diagnosis of fire-eater's lung is based on history-taking and characteristic clinical and radiological presentation. Treatment is symptomatic. Prevention relies on educational campaigns about the risks of fire-eating.

Osteomalacia cured by surgery.

Oncogenic osteomalacia is an uncommon syndrome characterized by bone pain, proximal muscle weakness, hypophosphatemia, hyperphosphaturia, and a low concentration of 1,25-dihydroxyvitamin D. This syndrome is induced by a tumor, usually benign, of mesenchymal origin and resolves after its excision. We report a case of an oncogenic osteomalacia caused by a small mesenchymal tumor of the tendon sheath of the foot, a localized form of tenosynovial giant cell tumor.

[Pulmonary mucormycosis: benefit of aerosol amphotericin B?]. / Mucormycose pulmonaire: intérêt des aérosols d'amphotéricine B?

Mucormycosis is an opportunistic fungal infection usually observed in diabetic or neutropenic patients. Prognosis is serious with a high rate of mortality. Intravenous amphotericin B is the gold standard treatment. The main side effect is renal failure. Liposomal amphotericin B (AmBisome(R)) is not nephrotoxic and can be proposed as an alternative treatment although its cost is high. We report a case of mucormycosis in a diabetic woman who developed renal failure after intravenous amphotericin B treatment. AmBisome(R) could not be used for long-term treatment due to its high case. The patient was given nebulized amphotericin B and achieved recovery. This kind of treatment may provide a useful alternative to intravenous amphotericin B.

Value of Doppler ultrasound for the diagnosis of renal artery stenosis in children.

To evaluate the reliability of Doppler ultrasonography (US) in identifying children with renal artery stenosis (RAS) among those with hypertension, we compared Doppler US results in 22 hypertensive children (mean age 8.9 +/- 4.3 years), with (13 cases) and without RAS at angiography, and in 33 normotensive children (mean age 8.8 +/- 4.7 years). We observed 2 false-negatives and 2 false-positives with Doppler US. Of the 2 false-negative diagnoses, I had RAS on an accessory renal artery located behind a normal upper polar artery and the other was observed in a patient with bilateral multiple stenosis of the very distal segments of renal arteries. The 2 false-positive diagnoses were due to sinuous left renal artery and to technical reasons, respectively. In another patient, Doppler US showed a tight RAS, while arteriography was normal. RAS was subsequently confirmed by a second arteriography. Peak systolic velocity values of Doppler US were significantly higher in patients with proven angiographic RAS (3.44 +/- 0.66 m/s) than in hypertensive patients with normal renal arteries at angiography (0.99 +/- 0.35 m/s, P < 0.0001) and normotensive healthy children (1.04 +/- 0.23 m/s, P < 0.0001). With the use of multiple views, and the experience acquired with practice, false-negatives or false-positives due to the geometry of the renal artery can be avoided. Nevertheless, very distal stenosis can be missed by Doppler US.

Sequential echocardiographic study prior and during antihypertensive therapy in children with severe hypertension.

This study was performed to assess myocardial involvement in 18 children with severe hypertension (HT), using two dimensional (2D) guided M mode echocardiography, prior and during therapy. All patients but 2 had renal or renovascular disease. Septal diastolic thickness (SDT) was utilized as a serial marker. Except for one case, all patients had increased SDT initially (1.03 +/- .26 cm/m2, p less than .01 vs normal). Evolution under therapy allowed subdivision of patients: Group I: 12 patients showed left ventricular (LV) hypertrophy regression, within a follow-up period of 20 +/- 9 months (final SDT: .78 +/- .12 cm/m2 vs initial 1.09 +/- .28, p less than .01). Blood pressure (BP) was normalized in 9 patients, and borderline in 3. Therapy consisted on acebutolol (n = 10), captopril (n = 1), and renal artery surgery (n = 1). Group II: LV hypertrophy was unchanged (n = 3) or increased (n = 3), within a follow-up period of 19 +/- 8 months, with persistent severe (n = 3) or mild (n = 3) HT, under acebutolol (n = 5). Treatment was changed to captopril with subsequent normal BP and echocardiogram improvement (n = 3). In the overall population, final SDT was significantly correlated to the final BP (r = .69, p less than .01). In conclusion, echocardiographic follow-up allowed serial non invasive assessment of LV hypertrophy in our severely hypertensive pediatric population. At first echocardiogram, LV hypertrophy was present in all patients but one. Antihypertensive therapy allowed simultaneous decrease of BP and LV hypertrophy in 12 patients, 10 under acebutolol.