[Cushing's syndrome due to a pulmonary carcinoid]. / Syndrome de Cushing révélateur d'un carcinoïde pulmonaire.

Cushing paraneoplasic syndrome is a rare cause of hypercorticism. We report a case of 35 year-old man presenting with Cushing's syndrome characterized by severe signs of hypercorticism and hypokalemia. Endocrine investigations were suggestive of an hypercortisolism linked to an ectopic adrenocorticotropic (ACTH) secretion, both at baseline (mean ACTH levels=275 pg/ml, urinary free cortisol excretion=3.898 mmol/24 h) and after pharmacodynamic testing (lack of inhibition of ACTH by dexamethasone). Thoracic tomodensitometric examination revealed a 15 mm tumor corresponding to a neuroendocrine pulmonary carcinoid with positive immunostaining for chromogranin A. Postoperative ACTH measurement was undetectable, plasma cortisol and free urinary cortisol were also decreased after tumor resection suggesting complete tumor removal. This case report illustrates the characteristics of paraneoplasic Cushing syndrome due to ACTH secreting pulmonary neuroendocrine carcinoid.

[Tuberculous osteoarthritis of the foot in the diabetic: not unrecognize this diagnostic trap. About one case]. / Ostéoarthrite tuberculeuse du pied chez le diabétique : piège diagnostique à ne pas méconnaître. A propos d'une observation.

Osteoarticular tuberculosis is the fourth leading extrapulmonary localization of tuberculosis. The disease has a progressive course and is often diagnosed in the stage of bone destruction, causing an important diagnostic problem in diabetics with nervous osteoarthropathy. We report the case of a 23-year-old patient with multicomplicated diabetes type 1, treated for pulmonary tuberculosis who consulted after a trauma distended the left ankle. Bone biopsy was performed because of the diagnostic doubt between diabetes and infectious osteoarthropathy. Pathology reported active tuberculosis. Osteoarticular tuberculosis is still a severe disease because of the functional prognosis that requires early diagnosis, a difficult task in some conditions particularly in the diabetic where the disease may mimic nervous osteoarthropathy. Bone biopsy should be performed if there is a doubt.

[Primary lymphoma of the thyroid gland]. / Lymphome malin primitif de la thyroïde.

Malignant primary lymphoma of the thyroid gland is a rare disease generally occurring women in the 6(th) or 7(th) decade of life. The principal clinical sign is giant goiter rapidly leading to sings of compression, raising the question of differential diagnosis with anaplastic cancer. The radiological findings in our patient were suggestive of malignancy due to the locoregional invasion. Immunohistochemistry study of the surgical specimen was required to reach the definitive diagnosis of thyroid gland primary lymphoma. Diagnosis of malignant primary lymphoma of the thyroid gland made at the stage of extensive locoregional extension compromises prognosis. Our patient died after one session of chemotherapy.

[Incidence of factors favoring recurrent foot ulcers in diabetic patients]. / Etude de la fréquence et des facteurs favorisant les récidives des ulcères de pied chez les patients diabétiques.

BACKGROUND: Patients with foot ulcers have a high risk of relapse and amputation. Several studies have reported that 28 to 51% of amputated diabetics will have a second amputation of the lower limb within five years of the first amputation. The purpose of this study was to assess the incidence of factors favoring relapse within two years. MATERIAL AND METHODS: One hundred ten diabetic patients were treated for foot lesions in the Casablanca Ibn Rochd university hospital between 1997 and 2000. Ninety of these patients attended review consultations. RESULTS: There were 42 cases of relapse (46.6%). Male gender predominated in the relapse patients with a sex ratio of 3.2. Mean age at relapse was 55 years; 71.5% of the patients had type 2 diabetes. Lesions observed were neuropathic ulcer (n=23), arterial ulcer (n=6), infected wounds (n=13). Revealing factors were burns and wounds. The main risk factors were neuropathy (n=23, 52%), neuroarteriopathy (n=12, 31%), peur arteriopathy (n=6, 12%). Patients who relapsed (n=42) were significantly different from patients who did not relapse (n=48) for gender, presence or absence of neuropathy, and presence or absence of arteriopathy. DISCUSSION: Secondary preventive measures against these risk factors, medical care, and specialized follow-up were satisfactory in these patients. our findings illustrate the importance of specialized management of diabetic patients with foot lesions. Adequate care of the lesions and preventive measures against risk factors are needed.

Comparison of NovoPen 3 and syringes/vials in the acceptance of insulin therapy in NIDDM patients with secondary failure to oral hypoglycaemic agents.

This open, randomised, cross-over study compared the acceptance and safety of NovoPen 3 with that of conventional syringes and vials when initiating insulin treatment in 96 NIDDM patients with secondary failure to oral hypoglycaemic agents. These patients had not previously been treated with insulin. All patients used each insulin administration system for 12 weeks. Group A started therapy using NovoPen 3 and crossed over to syringe/vial administration; Group B started with syringe/vial administration followed by NovoPen 3. In total, 78 patients completed the study. Most patients in Group A initially found the insulin injections very easy or easy and many of those who found injections easy at first found them very easy by the end of week 12. During the first period, patients in Group B found insulin administration more difficult than those in Group A. Injection pain was significantly lower with NovoPen 3 than with syringes and vials (P = 0.0018). Patients in Group B reported a significantly lower level of injection pain after the switch to using NovoPen 3 (P = 0.0003). Acceptance of insulin injections was significantly higher by patients using NovoPen 3 than by those using syringes and vials (P = 0.0059). Setting and drawing up the dose of insulin was also easier for patients using NovoPen 3 (P = 0.0490). At the end of the study, most patients (89.5% (68/76 replies)) said that they preferred NovoPen 3 to syringes and vials. Glycaemic control improved compared with baseline after starting insulin therapy, with no differences between Groups A and B, or between the two injection systems. The number of reported hypoglycaemic episodes was very low and was not significantly different between Groups A and B, or between the two administration systems. No treatment-related adverse events were reported. We conclude that use of NovoPen 3 provides better acceptance of insulin injection than use of conventional syringes and vials during initiation of insulin therapy in NIDDM patients with secondary failure to treatment with oral hypoglycaemic agents.

[Parathyroid cancer]. / Cancer parathyroïdien.

The study of one case of parathyroid cancer and a literary review permitted to state the following characteristics: it is a rare but not exceptional tumor. The endocrine syndrome represented by a hypercalcemia is frequently severe present. The tumor syndrome is often associated with locoregional invasion or metastasis. Clinical signs of malignity are as important as the anatomopathologic data. The surgical treatment is essential after a mecal hypocalcemic preparation. Thus, the prognosis may be good if the carcinologic rules are respected.

[Hydatid cyst of the thyroid. Apropos of 2 cases]. / Kyste hydatique de la thyroïde. A propos de deux cas.

Two cases of hydatid cyst of the thyroid are reported and the rare cases in the literature reviewed. Hydatidosis located in the thyroid is an infrequent finding, even in endemic countries. Finding on clinical examination are usually those of a cold thyroid nodule, and diagnosis is by detection of other sites for the lesion, positive results of immunologic tests, or often only after histology of an operative specimen. The spontaneous course of the affection may be interrupted by complications due either to the size of the lesion or the parasite itself. Treatment is surgical, usually by a hemithyroidectomy.