A case of giant cell arteritis associated with suspected cerebral angiitis.

We report the case of a patient with giant cell arteritis associated with cognitive dysfunction. Magnetic resonance imaging showed areas of subcortical increased signalling, suggesting intracerebral angiitis. Steroid and heparin therapy resulted in spectacular improvement in clinical status, and MRI abnormalities regressed almost completely. Intracranial localization of giant cell arteritis and the possible association of giant cell arteritis with primary angiitis of the central nervous system are discussed.

[Acute colonic pseudo-obstruction in internal medicine: etiology and prognosis, report of a retrospective study]. / Pseudo-obstructions coliques aiguës en médecine interne: circonstances étiologiques et pronostic, à propos d'une étude rétrospective.

PURPOSE: To analyze the context in which acute colonic pseudo-obstructions occur in a medical practice. METHOD: Retrospective study of patients with an acute colonic pseudo-obstruction hospitalized in an internal medicine department between November 1992 and December 1999. RESULTS: We found 12 patients including eight men (mean age: 80.2 years). All had abdominal pains. Seven patients presented an occlusive syndrome. A septic shock occurred in two subjects. The average diameter of the cecum was 10 cm. Distention involved the whole colon for nine patients, and only the left part for three. Six subjects were affected by a bronchopneumonia, three had a previous history of recent diarrhea, two had colonic diverticulitis, and two others had a diabetic neuropathy. Ogilvie's syndrome revealed hypothyroidism for one patient. Nine patients were taking one or more medications incriminated in the acute colonic pseudo-obstruction: calcium-channel blockers (n = 6), neuroleptics (n = 5), antidepressant agents (n = 4), dopaminergic drugs (n = 2) and opiates (n = 1). Five patients underwent a colonoscopic decompression. Surgical procedures were undertaken for three patients: one underwent a complete colectomy because of numerous perforation. Except for the colectomized patient, the outcome resulted in either recovery (n = 7), partial improvement (n = 3), or recurrence (n = 1). CONCLUSION: In a medical environment, acute colonic pseudo-obstruction is a pathology for elderly persons, namely with a masculine predominance and often associated with iatrogenic factors. The outcome is more often than not favorable, but it may result in invasive acts or significant complications at this age.

[Extra-ocular etiologic factors in retinal vein occlusion. Retrospective study of 24 patients]. / Facteurs étiologiques extraoculaires des occlusions veineuses rétiniennes. Etude rétrospective de 24 patients.

PURPOSE: Retinal vein occlusion has several causes. Cardiovascular risk factors, particularly systemic hypertension; as well as thrombophilia appear to be involved in the development of retinal vein occlusion. METHODS: In a retrospective study we analyzed these factors in 24 patients, admitted for retinal vein occlusion and isovolaemic hemodilution in an internal medicine unit. RESULTS: In patients over 50 years of age, cardiovascular risk factors predominate; while in patients under 50, one patient out of two has biological features indicating a risk for thrombosis. CONCLUSION: Serological abnormalities could be involved in the physiopathology of retinal vein occlusion in young patients.

[Rheumatoid purpura and intravenous immunoglobulins]. / Purpura rhumatoïde et immunoglobulines intraveineuses.

Henoch-Schönlein purpura is a vasculitis usually with a benign course. Abdominal symptoms occur in 70% of cases, with possible intussusception or intestinal perforation. There is no clear evidence of the efficacy of a treatment in complicated cases of Henoch-Schönlein purpura. Corticosteroids improve abdominal pain but they do not have any effect on renal involvement or prevention of relapses. Intravenous immunoglobulins have been efficient in some cases with recurrent abdominal symptoms or progressive renal lesions. We report the case of a 19-year-old patient with severe abdominal involvement and early renal manifestations of Henoch-Schönlein disease, rapid and sustained improvement was obtained by intravenous immunoglobulins given during 48 hours.

[Granulomatous mastitis, erythema nodosa and oligoarthritis. Apropos of a case]. / Mastite granulomateuse, érythème noueux et oligoarthrite. A propos d'une observation.

The authors report a case of granulomatous mastitis associated with erythema nodosum and oligoarthritis. The skin and joint symptoms improved with potassium iodide. The breast lesion clinically simulated a tumor of high malignant grade. Granulomatous mastitis is a benign and rare disease. Its interest lies in the possible association with systemic manifestations and in its steroid responsiveness. This condition has been recently described as a distinct entity. When associated with systemic manifestations, sarcoidosis should be considered.

[Magnetic resonance imaging in the diagnosis of agenesis of the pericardium]. / Apport de l'imagerie par résonance magnétique dans le diagnostic d'agénésie du péricarde.

The authors report a case where the diagnosis of complete pericardial agenesis was made by magnetic resonance imaging (MRI). This anomaly is rare, often asymptomatic (two-thirds of the cases) and its diagnosis may be evoked on a chest X-Ray and sonocardiography. MRI confirms the initial clinical impression and, besides, enables to completely rule out associated cardiac or pulmonary pathologies.

Medium-chain triglyceride-based fat emulsions: an alternative energy supply in stress and sepsis.

Medium-chain triglycerides (MCTs) and medium-chain fatty acids (MCFAs) have special physicochemical properties such as small molecular weight, small interfacial tension against water, and for the fatty acids, solubility in biological fluids. As a result the metabolic pathways followed by these fats in an organism are different and simpler, or identical but more rapid, than those followed by long-chain triglycerides (LCTs) and long-chain fatty acids (LCFAs). Consequently the MCTs have found numerous applications in oral or enteral nutrition and, more recently, in parenteral nutrition. The infusion of conventional fat emulsions in stress and sepsis is still controversial. A main question is whether an MCT supply can be beneficial for these patients. In this review, we will discuss different aspects of modified lipid and protein metabolism: exchanges between exogenous fat particles and lipoproteins; exogenous fat clearance, storage, and oxidation; reticuloendothelial system function; nitrogen balance; and hepatic function. For each of these perturbations, the MCT/LCT and structured lipid emulsions are theoretically capable to provide an appropriate solution. The efficiency of these emulsions has been demonstrated experimentally on animal models of stress and sepsis. However, the value of MCT-based fat emulsions for these pathological states has still to be ascertained by clinical studies.

[Renal manifestations in dermatomyositis and polymyositis]. / Les manifestations rénales au cours des dermatomyosites et des polymyosites.

Renal involvement is usually considered to be rare in dermatomyositis and polymyositis. The aim of this prospective study was to reevaluate the renal changes which may occur in these two conditions. Twenty patients, 12 with dermatomyositis and 8 with polymyositis of the adult type, were investigated to determine the incidence, the severity and course of renal disease. The 24 hour proteinuria was over 0.1 g in 14 cases and greater than 1 g/24 hours in 6 cases, including one patient with the nephrotic syndrome. Microscopic haematuria was noted in 3 cases and pyuria in 8 cases. Endogenous creatinine clearance was significantly decreased (p less than 0.001) in patients with dermatomyositis compared with a control group of subjects paired for age, sex, weight and serum creatinine concentration. Renal biopsy (5 cases) showed minimal glomerular lesions (2 cases), endocapillary proliferation and extramembranous glomerulonephritis (1 cases) and amyloid deposits (1 case). Although the proteinuria, haematuria and pyuria responded to steroid therapy (except in 1 case), the creatinine clearance remained decreased during the course of steroids.

Monoclonal antibodies defining a minor and a private idiotope on human rheumatoid factors.

Two mouse monoclonal antibodies (mAb A216-5 and L 49-3) with antiidiotypic activity against two human monoclonal IgM rheumatoid factors (IgM RFs) were defined. Each of these monoclonal antibodies (two mouse IgG 1K) reacted with an idiotope located on the heavy chain of the immunizing monoclonal IgM RF and was able to inhibit RF fixation to the antigen. These monoclonal antibodies did not react with other monoclonal IgM RFs from patients with macroglobulinemias or cryoglobulinemias and, therefore, did not recognize the known cross-reactive idiotopes of human monoclonal RFs. The presence of both 216-5 and 49-3 idiotopes on polyclonal IgM RFs from unrelated patients was undetectable by the inhibition assays. However, using a four-stage solid-phase radioimmunoassay, the 216-5 idiotope (minor), but not the 49-3 idiotope (private), was frequently present at a low concentration on polyclonal IgM RFs from patients suffering from rheumatoid arthritis, primary Sjögren syndromes, various infectious diseases, systemic vasculitis, and sarcoidosis and during aging. Interestingly, the 216-5 idiotope was undetectable among polyclonal IgM RFs of 12 normal adults. The main conclusions of these data are the following. The definition of minor and private idiotopes of human RFs requires the use of assays able to detect low amounts of antibodies among polyclonal Ig. The anti-IgG B cells which are sometimes clonally expanded during Waldenström diseases and cryoglobulinemias can also be activated during nonneoplastic diseases, among the other RF-secreting B cells.(ABSTRACT TRUNCATED AT 250 WORDS)

[Malignant diffuse peritoneal mesothelioma: clinical and therapeutic aspects. Apropos of a case with gelatinous ascites]. / Mésothéliome péritonéal malin diffus: aspects cliniques et thérapeutiques. A propos de 1 cas accompagné d'ascite gélatineuse.

Peritoneal mesothelioma ranks second in frequency after pleural mesothelioma. A well-established clinical entity since 1960, mesothelioma is increasingly frequent due to improvements in diagnostic methods and to the fairly wide industrial use of asbestos, a well-known carcinogenic substance for mesothelial cells. The diagnosis of malignant peritoneal mesothelioma rests on a corpus of convergent data. Treatment consists of surgery combined with radiotherapy and chemotherapy. The mean survival from the time of diagnosis is 8-10 months.

[Regression of IgA kappa monoclonal gammopathy in IgA lambda Kahler's disease]. / Régression d'une gammapathie monoclonale à IgA kappa lors du développement d'une maladie de Kahler à IgA lambda.

The authors report the case of a patient with a stable IgA kappa gammapathy over several years which finally evolved to an IgA lambda myeloma during which the initial gammapathy regressed. As the two gammapathies probably arose from two different cellular populations, the regression of the IgA kappa dysglobulinaemia is an additional argument in favour of the hypothesis that benign monoclonal gammapathies are the result of cellular hyperplasia.

[Bacteriologic surveillance of patients with infectious endocarditis. Value and limitations of the determination of minimal inhibitory concentration and serum bactericidal activity]. / Surveillance bactériologique des malades atteints d'endocardite infectieuse. Intérêt et limites des déterminations de la concentration minimale inhibitrice et du pouvoir bactéricide du sérum.

This is a retrospective study of the records of 17 patients who suffered from infectious endocarditis with positive blood cultures, and concerns the possibilities of predicting immediate infectious signs in patients:--by testing each of the antibiotics used for the minimal inhibitory concentration;--by determining the peak of the serum bactericidal activity of patients. All the patients were under observation, as outpatients, for more than a year and proved completely cured of their infectious endocarditis. A satisfactory minimal inhibitory concentration does not necessarily prevent an infectious evolution in the immediate future. The determination of the peak serum bactericidal activity does not reflect faithfully and instantaneously the anti-infectious action of the treatment; this is shown by the excellent and rapid evolution 13 times out 20 although serum bactericidal activity was considered insufficient (less than 1/8). This level of 1/8 is not a guarantee of therapeutic efficiency. Finally the antiinfectious treatment has been, in the majority of cases, determined by clinical signs and in very few cases by serum bactericidal activity results.

Abnormalities of in vitro responses to polyclonal activation of peripheral blood lymphocytes in patients with active sarcoidosis.

A variety of immunological abnormalities have been described in patients with sarcoïdosis. At the blood level, both hypo and hyper immune responsiveness seem to coexist and were related to abnormal T cell and macrophage functions by using allogenic cocultures and/or lymphocyte fractionation. We tested several components of cell mediated responses with two in vitro models: (a) the pokeweed mitogen activation of B cells which is T cells and macrophage dependent; (b) the Epstein-Barr virus (EBV) activation of B cells which is T cell- and macrophage-independent. We confirm previous data showing that PWM induced Ig Production of peripheral blood lymphocytes (PBL) of patients with sarcoïdosis is significantly reduced compared with normal PBL. However, this is associated with an increase of IgG, IgM synthesis of EBV-infected PBL in these sixteen patients. Thus, there is no evidence for a complete B cell defect in sarcoïd PBL. Furthermore, by using limiting dilution analysis of antibody secreting cells, there is an increase of precursor B cells EBV infectable in PBL of sarcoïd patients but T cells are effective in reducing EBV-induced B cell proliferation. Finally, these abnormalities are concomitant to the disease, disappear with it, and are apparently not correlated with the stage or the activity of sarcoïdosis.