[An unusual cause of hypertension]. / Une cause inhabituelle d'hypertension artérielle.

Secondary hypertension is relatively rare. Its etiologies are essentially renal or endocrine. The adrenocortical carcinoma, a rare malignant tumor, is one of the most exceptional causes of hypertension. We report the case of a young woman presenting with hypertension and ascites of great abundance. She had hypokalemia, hepatic cytolysis and cholestasis. Thoracic, abdominal and pelvic CT scans showed adrenal mass, liver and lung nodules, osteolytic lesions of the sacrum. The biopsy of liver nodules confirmed the diagnosis of a metastatic malignant adrenocortical carcinoma. The hormonal investigations revealed cortisol and testosterone hypersecretion. The evolution was quickly fatal, the patient passed out a few days after her hospitalization.

[Bilateral pulmonary embolism revealing granulomatosis with polyangiitis]. / Embolie pulmonaire bilatérale révélant une granulomatose avec polyangéite.

Granulomatosis with polyangiitis is a systemic small-vessels vasculitis. It is characterized by a granulomatous inflammatory reaction around the arterial wall and is, in most cases, accompanied by the presence of cytoplasmic - type anti-neutrophil cytoplasmic antibodies (ANCA) with anti-proteinase 3 specificity. The predominant clinical presentation is frequent involvement of the upper and lower respiratory tract and the kidneys. This vasculitis is rarely revealed by pulmonary embolism. We report the observation of a 47-year-old male who presented with acute dyspnea. Chest X-ray disclosed an excavated opacity. Pulmonary angioscan revealed bilateral pulmonary embolism. The absence of clinical improvement after anticoagulant therapy with antibiotics and the presence of extra-respiratory signs led to the suspicion of a systemic inflammatory disease. The etiological investigations concluded with the diagnosis of granulomatosis with polyangiitis.

A comparison of insulin lispro Mix25 and human insulin 30/70 in the treatment of type 2 diabetes during Ramadan.

OBJECTIVE: To compare insulin lispro Mix25 and human insulin 30/70 with regard to their effect on morning and evening postprandial glucose (PPG) control, and on average daily blood-glucose (BG), in patients with Type 2 diabetes who wish to fast during Ramadan. METHOD: Insulin lispro Mix25 and human insulin 30/70 were compared in an open-label, multicenter, randomised, crossover study involving 151 patients. Each treatment period had a duration of 14 days during which the patients self-monitored their BG before and 2 h after the main meals on any 3 days within the last 5 days of each treatment period. RESULTS: The 2 h PPG excursion following the main evening meal after sunset was significantly lower with insulin lispro Mix25 (3.4+/-2.9 mmol/l) compared with human insulin 30/70 (4.0+/-3.2 mmol/l, P=0.007). The evening pre-meal fasting BG values were also lower with insulin lispro Mix25 (7.1+/-2.2 mmol/l) versus human insulin 30/70 (7.5+/-2.6 mmol/l, P=0.034). The average daily BG concentration was 9.5+/-2.4 mmol/l during treatment with insulin lispro Mix25 versus 10.1+/-2.5 mmol/l with human insulin 30/70 given in identical doses (P=0.004). CONCLUSION: When compared with human insulin 30/70, treatment of insulin-requiring Type 2 patients with insulin lispro Mix25 during Ramadan resulted in better average daily glycaemia, and better BG control before and after the evening meal. Insulin lispro Mix25 should be considered as a therapeutic option during Ramadan.

[Fronto-temporal dementia: a clinical approach]. / Les démences fronto-temporales: approche clinique.

Although the existence of atrophy of the anterior part of the brain has been known for a long time (Pick, 1892), the interest for fronto-temporal dementias (DFT) is relatively recent. Several excellent reviews have been recently published on the topic (Gustafson, 1993; Neary and Snowden, 1996; Pasquier et al., 1998) and, for that reason, we only recall the main aspects of the disease to insist on some lesser known features, illustrated by original observations.

Sensitivity to semantic cuing: an index of episodic memory dysfunction in early Alzheimer disease.

Alzheimer disease (AD) is characterized by episodic memory impairment. This study was aimed at assessing various aspects of episodic memory, and particularly sensitivity to semantic cuing, in patients with various degrees of cognitive deterioration, compared with normal elderly subjects. One hundred thirty-one patients, subdivided into four subgroups as a function of their Mini-Mental State Examination score, were included. All subjects, including 20 normal elderly subject, were given an episodic memory test with controlled encoding and selective reminding. The subgroups of patients were homogeneous in terms of free recall and recognition, but differed in terms of responsiveness to cuing by semantic categories corresponding to the to-be-remembered items. The data confirmed that a severe amnesic syndrome occurs very early in AD, even in a subgroup of patients who did not meet the criteria for dementia. The data indicated that free recall performance, characterized in all subgroups by a floor effect, is not likely to be an appropriate index in pharmacological trials. By contrast, sensitivity to semantic cuing seemed relatively preserved in the early stages, and decreased with the progression of the disease. This index would be the most sensitive index of episodic memory in AD.

[Spinal cord compression in bone fluorosis. Apropos of 4 cases]. / Compressions médullaires au cours de la fluorose osseuse. A propos de quatre cas.

The authors report four cases of spinal cord compression (three at cervical level and one at dorsal level) due to vertebral osteosclerosis secondary to chronic fluoride intoxication. Roentgenograms showed typical diffuse densification of vertebral bodies, calcifications of bony insertions of many ligaments, discs and interosseous membranes. Urinary fluoride was markedly increased in two cases. In the other two cases the bone biopsy was suggestive of skeletal fluorosis. Spinal computed tomography showed severe cord compression due to posterior osteophytes. Good improvement was observed after surgical decompression in one case. Fluorosis was described as a consequence of endemic exposure to high fluoride content in soil and natural ground water in North Africa. Fluorotic myelopathy was due to bone excrescences mainly affecting the spine.