Solitary Intrathyroid Metastasis Occurring 23 Years after Resection of Renal Cell Carcinoma.

A case of solitary intrathyroid metastasis is described in a 60-year-old male patient. He had a history of renal cell carcinoma classified as T1b resected 23 years earlier. A mass was palpable in the right thyroid lobe. Ultrasound showed a hypoechoic polylobular nodule with intense vascularisation in the right lobe. Fine needle aspiration cytology was normal, but thyroidectomy was performed due to mass enlargement, the ultrasound pattern, and the oncological history. Histological examination revealed the presence of an intrathyroid metastasis of renal cell carcinoma. The bone scan and thoracoabdominal CT scan were normal. Postoperative care was uneventful.

Point-of-Care Ultrasound (POCUS) in the Field of Diabetology.

Ultrasound is increasingly used in daily clinical practice to improve the efficiency of the clinical examination. In this article, we reviewed its various possible uses in the field of diabetology. The ultrasonic evaluation of the carotid arteries (plaques and intima media thickness) allows improving the assessment of the cardiovascular risk. Steatosis can be detected relatively easily on liver ultrasound. Ultrasound also allows a more sensitive detection of lipohypertrophy resulting in glycemic fluctuations and thus increasing the risk of hypoglycemia than the clinical examination. Finally, muscle ultrasound appears to be a promising tool to assess the nutritional status and its consequences (e.g., falls).

[Unusual association between auto-immune hepatitis and pyoderma gangrenosum. A case report]. / Association inhabituelle entre une hépatite auto-immune et un pyoderma gangrenosum. A propos d'un cas.

Pyoderma gangrenosum is an uncommon neutrophilic dermatosis that presents as an inflammatory and ulcerative disorder of the skin. This entity is associated with systemic diseases and autoimmune diseases but exceptionally with autoimmune hepatitis. We report the case of a 40 year-old woman diagnosed with type 1 autoimmune hepatitis 12 years earlier and admitted for the appearance of an ulcerative lesion in the left leg. Histology confirmed pyoderma gangrenosum.

Le Pyoderma gangrenosum (PG) est une affection rare appartenant au groupe des dermatoses neutrophiliques. Cette entité est associée à l'existence de maladies systémiques et autoimmunes, mais exceptionnellement à une hépatite auto-immune. Nous rapportons l'observation d'une patiente âgée de 40 ans atteinte d'une hépatite auto-immune (HAI) de type 1 depuis 12 ans admise pour une lésion ulcéreuse du membre inférieur gauche. L'histologie confirmera l'existence d'un pyoderma gangrenosum.

Pseudopheochromocytoma Associated with Domestic Assault.

Pseudopheochromocytoma has a clinical presentation that is similar to pheochromocytoma. It manifests itself with paroxysmal hypertension crises, associated with various symptoms such as headaches, chest pain, nausea, palpitations, and dizziness. Patients are usually asymptomatic in between the crises. Unlike pheochromocytoma, there is no catecholamines overproduction in this pathology: hypertensive peaks are caused by a hyperactivation of the sympathetic nervous system, which is often triggered by a psychological trauma in the past. Treatment of pseudopheochromocytoma can be challenging due to normal blood pressure values in between the hypertensive peaks; it includes alpha- and beta-blockers for moderate crises and prevention and must be combined with psychopharmacologic agents such as anxiolytics or antidepressant drugs. Psychotherapy and dietetic treatment are also crucial in pseudopheochromocytoma management.

[A BANEFUL CUTANEOUS LESION]. / Un placard cutané funeste.

We report the case of a patient presenting meningeal carcinomatosis and cutanenous metastasis as first manifestation of gastric adenocarcinoma. A 57-year-old patient was hospitalized because of headache and diplopia. Clinical examination revealed VI cranial nerve paralysis and anterior neck infiltration. Cutaneous biopsy and umbar puncture showed signet ring-cells. Extensive work-up disclosed gastric adenocarcinoma. Cutaneous metastasis and carcinomatous metastasis are both present exceptionally as first manifestation of gastric adenocarcinoma. We discuss frequency, etiology and treatment of these manifestations.

Intravenous iron administration and hypophosphatemia in clinical practice.

Introduction. Parenteral iron formulations are frequently used to correct iron deficiency anemia (IDA) and iron deficiency (ID). Intravenous formulation efficacy on ferritin and hemoglobin level improvement is greater than that of oral formulations while they are associated with lower gastrointestinal side effects. Ferric carboxymaltose- (FCM-) related hypophosphatemia is frequent and appears without clinical significance. The aim of this study was to assess the prevalence, duration, and potential consequences of hypophosphatemia after iron injection. Patients and Methods. The medical records of all patients who underwent parenteral iron injection between 2012 and 2014 were retrospectively reviewed. Pre- and postinjection hemoglobin, ferritin, plasma phosphate, creatinine, and vitamin D levels were assessed. Patients who developed moderate (range: 0.32-0.80 mmol/L) or severe (<0.32 mmol/L) hypophosphatemia were questioned for symptoms. Results. During the study period, 234 patients received iron preparations but 104 were excluded because of missing data. Among the 130 patients included, 52 received iron sucrose (FS) and 78 FCM formulations. Among FS-treated patients, 22% developed hypophosphatemia versus 51% of FCM-treated patients, including 13% who developed profound hypophosphatemia. Hypophosphatemia severity correlated with the dose of FCM (p = 0.04) but not with the initial ferritin, hemoglobin, or vitamin D level. Mean hypophosphatemia duration was 6 months. No immediate clinical consequence was found except for persistent fatigue despite anemia correction in some patients. Conclusions. Hypophosphatemia is frequent after parenteral FCM injection and may have clinical consequences, including persistent fatigue. Further studies of chronic hypophosphatemia long-term consequences, especially bone assessments, are needed.

Evolution of Metabolic Abnormalities in Alcoholic Patients during Withdrawal.

Chronic alcohol intoxication is accompanied by metabolic abnormalities. Evolution during the early withdrawal period has been poorly investigated. The aim of this study was to determine the evolution of metabolic parameters during alcohol withdrawal. Patients and Methods. Thirty-three patients admitted in our department for alcohol withdrawal were prospectively included. Results. Baseline hypophosphatemia was found in 24% of cases. FEPO4 was reduced from 14.2 ± 9% at baseline to 7.3 ± 4.2% at day 3 (P < 0.01). FEPO4 inversely correlated with albuminemia (rs = -0.41, P = 0.01). CPK level was 124 ± 104 IU/L in men and 145 ± 85 IU/L in women (nl < 308 and <192 IU/L, resp.), 7% and 28% of patients having a CPK level >nl, respectively. No correlation was found between the sodium and CPK levels (P = 0.75) nor between the CPK level and the amount of alcohol ingested (rs = 0.084, P = 0.097). Baseline urate level was elevated and returned to normal after three days. Baseline magnesium concentration was normal and stable over time. Conclusion. Chronic alcohol intoxication was accompanied by phosphaturia, rapidly reversible after alcohol withdrawal and inversely correlated with albuminemia, slight hyponatremia, low levels of 25 hydroxy vitamin D, elevated CPK level in about 30% of women, and hyperuricemia with rapid normalization.

[Incomplete form of hypertrophc osteoarthropathy in a patient with breast cancer]. / LE CAS CLINIQUE DU MOIS. Ostéoarthropathie hypertrophique de forme incomplète chez une patiente présentant un cancer du sein.

Hypertrophic osteoarthropathy is sometimes the paraneoplasic manifestation of cancer of pulmonary origin. It is rarely present in case of breast cancer, even at a metastatic stage. In its complete form, this entity includes periostitis (predominantly bilateral and affecting upper and lower limbs), digital clubbing and, rarely, arthritis. We report the case of a female patient with metastatic breast cancer and an incomplete form of hypertrophic osteoarthropathy, clearly asymetric and without digital clubbing.

[Good practice and update in oral antidiabetic agents]. / Bonnes pratiques et actualisation des antidiabétiques oraux.

The epidemic of type 2 diabetes mellitus in our countries and the consequences of this disease on macro- and microvascular complications impose an early medical care and to consider it as a public health priority. The aim of this article is to dwell on oral antidiabetic drugs available for the treatment and to underscore the importance of lifestyle modifications, a key element, for decreasing diabetes-related complications.

Prevalence, aetiologies and significance of clubbing in a department of general internal medicine.

BACKGROUND: Clubbing remains an amazing clinical sign. Its strong association with serious disease is still a clinical enigma. Moreover, the significance of diagnosing clubbing is not well established. The aim of our study was to evaluate prevalence, aetiology and clinical significance of clubbing in a department of general internal medicine. PATIENTS AND METHODS: During one year (1511 admissions), all patients with digital clubbing assessed by determining ratio of the distal phalangeal depth (DPD) to the interphalangeal depth (IPD) and with the presence of Swamroth sign were included. Fifteen patients were diagnosed with clubbing (10 males and 5 females). They underwent complete physical examination, pulmonary CT-scan, bone scintigraphy, blood gas analysis and were compared with 86 matched controls. RESULTS: Aetiology were renal cell carcinoma, pulmonary arteriovenous malformation, AIDS, inflammatory pseudo-tumour of the lung, adenocarcinoma of unknown origin in one case and in one case, Pet-scan suspected neoplasia but histology was not obtained. In 9 cases, no aetiology was found. Bone scan was normal in 14 cases and revealed periostitis in one case (idiopathic clubbing). Compared to control group, there was no difference in blood gas analysis but emphysema was more often present in patients with clubbing (p<0.01). No patient without aetiology developed cancer in the one year follow-up. CONCLUSION: Clubbing is present in 1% of admission in a department of general internal medicine and is associated in nearly 40% with serious disease. In 60% of cases, aetiology is not identified but follow-up do not disclosed cancer.

[Drug of the month. Varenicline (Champix)]. / Le médicament du mois. La varénicline (Champix).

Smoking is responsible for 20,000 premature deaths per year in Belgium. Paradoxically, few drugs are efficient to induce tobacco cessation and to decrease relapse. Until a few weeks ago nicotin replacement therapy and bupropion only were validated in this indication. Varenicline (Champix), a partial agonist of nicotinic receptors, is a novel type of drugs currently also accepted for sale for smoking cessation. This article dwells on recent publications about efficacy of varenicline. Position, side-effects and advantages of the drug are discussed.

Positive octreotide scintigraphy and determination of lanreotide activity in Paget's disease of bone associated with phosphate diabetes: a case report.

A patient with Paget's disease developed phosphate diabetes (phosphate: 1.6 mg/dl (2.5-4.4 mg/dl), with 29 ml/min phosphate clearance (Nl<15ml/min) and a 65% phosphate reabsorption rate (Nl>85%). As previously demonstrated in tumor-induced osteomalacia, we hypothesized that osteoblasts might manifest somatostatin receptor activity. The patient underwent an octreotide scan which demonstrated increased uptake localized in affected bone. Under lanreotide treatment (40 mg i.m.), the patient's bone pain improved with a concomitant decrease in phosphate alkaline level. Phosphate clearance and tubular readsorption rate of phosphate did not change significantly. We reviewed previously reported cases of associated Paget's bone disease and phosphate diabetes.

[Review on hypertrophic osteoarthropathy and digital clubbing]. / Le point sur l'ostéoarthropathie hypertrophique et l'hippocratisme digital.

Clubbing was first described by Hippocrates more than 2.500 years ago. It may be seen alone or as part of an entity called hypertrophic osteoarthropathy which include periostitis, arthritis and sometimes thickening and edema of the skin around the affected joints. Pulmonary diseases such as cancer, abscess, empyema, bronchiectasis and cystic fibrosis are the major diseases known to be associate with hypertrophic osteoarthropathy. Digestive tract cancer, cyanogenic congenital heart disease are well known association. Many theories have attempted to explain the appearance of this sign but few have persisted. In this article, we review characteristics, relation with etiology and the basis of the pathophysiology of hypertrophic osteoarthropathy and particularly of clubbing.

Possible association between deep infection and hypertrophic osteoarthropathy. Report of three cases and review of the literature.

Hypertrophic Osteoarthropathy is classically associated with chronic pulmonary disease, cancer or inflammatory bowel disease. However, deep infection such as vascular graft infection is an etiology important to recognize because of the risk of life-threatening complication (aorto-enteric fistula). In this study, we reported two cases of aortic graft infection and one case of para-anal abscess associated with hypertrophic osteoarthropathy. The previously reported cases are reviewed.

[Bronchiolitis obliterans organizing pneumonia: eight cases and review of the literature]. / La bronchiolite oblitérante avec pneumopathie organisée: à propos de 8 cas et revue de la littérature.

Bronchiolitis obliterans and organizing pneumonia is characterized histologically by plugs of granulation tissue in terminal air spaces. Patients usually present with flu-like illness followed by cough, dyspnea and fever. The chest X-ray pattern is characterized by pneumonia like infiltrate which can migrate. Outcome is good with steroid treatment. The aim of this article is to define the clinical, biological, including bronchoalveolar lavage and radiological aspects of BOOP on the basis of 8 clinical cases. The pathophysiology, diagnosis methods and treatment of BOOP are also discussed.