Graves' ophthalmopathy after total thyroidectomy for papillary carcinoma.

We report the case of a 53-year-old woman who underwent two-phase total thyroidectomy (June and December 2001) for a multinodular goiter with incidental discovery at the first procedure of a multicentric papillary carcinoma of the right thyroid lobe. Thyroidectomy was followed by an ablative dose of 131-radioiodine because of the presence of residual tissue in the neck. The various elements of the follow-up are reassuring: no residual tissue was detected at the ultrasonography of the neck and thyroglobulin was undetectable in the absence of antithyroglobulin autoantibodies. In April 2006, the patient developed unilateral Graves' ophthalmopathy with the appearance of antithyrotropin receptor autoantibodies (TRAb). Ophthalmopathy progressively improved, in parallel to the decrease of TRAb. The parallel trend of TRAb and the ophthalmopathy supports the major role of TRAb in the pathogenesis of thyroid-associated ophthalmopathy. This observation also shows the possibility of developing autoantibodies in the absence of detectable thyroid tissue.

Dropped head syndrome. Three case-reports.

Dropped head syndrome is characterized by gradual forward sagging of the head due to weakness of the neck extensor muscles. We report three cases in elderly patients seen by rheumatologists at our institution. There was some evidence suggestive of a neurogenic process, whereas most reported cases of dropped head syndrome have been ascribed to myopathy. Dropped head syndrome can probably be produced by multiple causes. The close ties between dropped head syndrome and acquired camptocormia in adults are discussed.

Unusual longitudinal stress fractures of the femoral diaphysis: report of five cases.

We present five cases of a distinctive type of longitudinal stress fracture of the upper femoral shaft in which the fracture line is parallel to the outer surface of the bone, in contrast to the perpendicular orientation to the cortical surface in previously reported cases of diaphyseal stress fractures. In two cases the fracture recurred after 15 and 18 months, respectively.

[Malignant peritoneal mesothelioma occurring in periodic disease: apropos of a case]. / Mésothéliome péritonéal malin survenant au cours d'une maladie périodique: à propos d'un cas.

INTRODUCTION: Peritoneal mesothelioma is a rare malignant neoplasm that might be linked to chronic peritoneal inflammation. As well, the association peritoneal mesothelioma-familial Mediterranean fever is uncommon. EXEGESIS: We report the case of a 60-year-old man who presented for 30 years with standard periodic familial Mediterranean fever accompanied by acute abdominal episodes, sensitive to colchicine. Between 1988 and 1995, acute abdominal episodes were accompanied by more and more profuse recurrent ascites, partially resolving under colchicine treatment. In 1995, the last episode was severe (with loss of weight and inability to tolerate feeding) and conducted to the patient's death due to peritoneal mesothelioma, as confirmed by the biopsy. CONCLUSION: Profuse and recurrent ascites is unusual in standard periodic familial Mediterranean fever. Asbestos exposure at the origin of peritoneal mesothelioma is not well documented. Furthermore, the disease clinical and paraclinical features are misleading, and the diagnosis is based on histology. The prognosis is severe, and treatment is usually disappointing. Our observation clearly demonstrates the interconnection between an unusual form of profuse and relapsing ascites that occurred in the course of a periodic disease and peritoneal mesothelioma. The potential role of recurrent peritonitis related to familial Mediterranean fever in the pathogenesis of the tumor is discussed.

[A one-year prospective study of disodium etidronate versus 17 beta estradiol in the prevention of postmenopausal osteoporosis]. / Etude prospective versus 17 beta estradiol de l'étidronate disodique en prévention de l'ostéoporose post-ménopausique. Etude sur un an.

This prospective, controlled, nonrandomized, one-year trial in women included less than ten years after menopause was designed to compare the preventive efficacy on postmenopausal bone loss of replacement percutaneous 17 beta estradiol versus intermittent disodium etidronate. Twenty-five patients took oral disodium etidronate in a daily dosage of 200 mg in two-month courses separated by two-month intervals, with 1 g/day elemental calcium. Twenty-three patients used percutaneous 17 beta estradiol in daily dosage of 1.5 mg for the first twenty days of each month, then 20 mg oral dydrogesterone for the remaining ten days. At baseline the two groups were comparable as concerns age, mean time since menopause (5.1 versus 4.3 years), weight, height, and lumbar bone mineral density as measured by dual-photon X-ray absorptiometry. After one year of treatment, in both groups, bone mineral density was unchanged as compared with baseline, whereas serum alkaline phosphatase levels were significantly reduced. In the estrogen group, biochemical markers for bone turnover showed no significant changes, where as in the etidronate group urinary calcium and urinary hydroxyproline were significantly reduced. These data suggest that disodium etidronate is a satisfactory alternative to estrogens for the short-term prevention of postmenopausal bone loss when hormone replacement therapy is contraindicated or refused by the patient and when preventive therapy is warranted on the basis of measurable risk markers.

[Efficiency of cyclophosphamide bolus in Still's disease in adults. A case]. / Efficacité des bolus de cyclophosphamide dans la maladie de Still de l'adulte. Une observation.

The value of monthly intravenous injections of cyclophosphamide in adults with steroid-dependent Still's disease is documented by the report of a case. In the short term and perhaps also in the long term, this regimen reduces the amount of prednisone needed.

[Subacute edematous polyarthritis in the elderly. 9 cases]. / Polyarthrite subaiguë oedémateuse bénigne du sujet âgé. Neuf observations.

We report 9 cases of a recently described syndrome: subacute oedematous polyarthritis of the elderly. The condition is characterized by its sudden onset and by the presence of important oedema of the four limbs, symmetrical polyarthritis, marked inflammatory syndrome and negative serological test for the rheumatoid factor. Men are predominantly affected, and many of them are carrying the HLA B7 antigen. The illness subsides within a few months without sequelae. It seems that this syndrome should be clearly distinguished from late onset rheumatoid arthritis and polymyalgia rheumatica.

[The role of an immunologic survey prior to using collagen implants. Theoretical aspects and practical methods]. / Place de l'enquête immunologique avant l'utilisation d'implants de collagène. Aspects théoriques et modalités pratiques.

Collagen implants (Zyderm and Zyplast) are effective and well tolerated. However, certain inflammatory reactions may occur. The immunological mechanisms responsible for such reactions are analysed: cell-mediated reactions, humoral reactions (specific antibodies) and the role--certainly major--of the genetic predisposition which modulates the expression of these reactions. The practical consequences are logically derived from the histological and serological findings observed, i.e. strict respect of the systemic contraindications (auto-immune diseases, severe atopy); rigorous conduct of a preoperative skin test to detect the great majority of reactive subjects; lastly, consideration, in the evaluation of the potential risk, of individual dysimmune susceptibility (family history, personal clinical or laboratory elements) in a very small proportion of patients.

[Benign acute edematous polyarthritis in the elderly. Apropos of 4 cases]. / Polyarthrite aiguë oedémateuse bénigne du sujet âgé. A propos de 4 observations.

Four retrospective cases of acute, benign, edematous polyarthritis are reported in elderly patients. These cases have in common a sudden onset of distal edema of the 4 extremities, which is severe, associated with primary or secondary joint pain and an inflammatory syndrome. A picture of symmetrical polyarthritis similar to rheumatoid polyarthritis develops secondarily. This polyarthritis is sero-negative. In less than 2 years, it spontaneously evolves into a complete cure without any clinical or radiological sequelae. This picture appears to be a specific entity in the elderly, different from rheumatoid polyarthritis. Ten identical cases have been reported by McCarty under the name of RS3PE syndrome. The onset with edema, sero-negativity and the spontaneous cure are the main characteristics. The nosology of this disease among "polyarthritis of the elderly", is discussed here.