[Association of renovascular hypertension and primary aldosteronism]. / Association d'une hypertension artérielle rénovasculaire et d'un hyperaldostéronisme primaire.

INTRODUCTION: Renal artery stenosis is rarely associated with Conn adenoma. CASE REPORT: We report a 27-year-old male patient who presented in 2001 with a severe high blood pressure associated with hypokaliemia. Radiologic investigations showed a left renal artery stenosis with agenesis of left kidney. A left nephrectomy was performed and blood pressure returned to normal with a single antihypertensive drug. Five years later, the patient again presented with severe high blood pressure. Laboratory studies revealed a low serum potassium level at 2.8 mmol/L associated with high urinary potassium excretion (84 mmol/24h) and a very high aldosterone/renin ratio (>462). Abdominal CT scan demonstrated a right adrenal mass. The patient underwent a right adrenalectomy (adenoma). Blood pressure returned to normal with a single antihypertensive. Serum potassium levels as well as aldosterone/renin ratio normalized. CONCLUSION: We discussed whether the association between these two entities is merely fortuitous or conversely based on a causal relationship.

[CRP and micro-albumin: new markers of cardiovascular risk in type 2 diabetes]. / CRP et micro-albuminurie : nouveaux marqueurs du risque cardiovasculaire chez les diabétiques de type 2.

INTRODUCTION: Type 2 diabetes is a chronic disease associated to the presence of multiple risk factors. Among recently studied factors we cite PCR and micro-albumin. OBJECTIVE: In the present study we intend to determine the correlation between urine albumin excretion rate, CRP levels and type of vascular complications in type 2 diabetes. PATIENTS AND METHODS: We recruited 48 type 2 diabetic subjects subdivided into three groups according to the type of vascular complications (GI: type 2 diabetics without complications, GII: type 2 diabetics with microvascular complications and GIII: type 2 diabetics with macrovascular complications). RESULTS: We found a significant elevated levels of CRP and micro-albumin (P<0.05) when we compared diabetics with vascular complications to those without any complications. Diabetics with macrovascular complications have the highest levels of CRP and micro-albumin. Significant positive correlation was found between CRP and micro-albumin levels in a total group of diabetics (r=0.32; P<0.05). CONCLUSION: The determination of CRP and microalbumin levels represents an interest in the screening of cardiovascular disease in type 2 diabetics.

[Consequences of insulin resistance on lipid profile in type2 diabetics group: study of 118 cases]. / Conséquences de l'insulinorésistance sur le bilan lipidique chez un groupe de diabétiques de type 2: à propos de 118 cas.

Insulin is a hormone which has an essential role in lipids metabolism by modulating the activity of many key enzymes and by its intervention on the production and the catabolism of lipoproteins. The aim of this study was to determine the influence of insulin resistance on lipid profile in a diabetic group. The study group consists of 118 diabetic patients. We assayed for each patient total cholesterol, high density lipoprotein cholesterol, triglycerides and insulin. Insulin resistance was determined by HOMA index. Insulin was found correlated to body mass index, triglycerides, waist circumference, and glycated haemoglobin. Triglycerides and glycated haemoglobin were significantly more elevated in insulin resistant group than in insulin sensitive group. Insulin resistance may be the initial anomaly in type 2 diabetes and incite us to search on molecular anomalies in the insulin action.

[Prevalence and clinical aspects of superficial mycosis in hospitalized diabetic patients in Tunisia]. / Prevalence et aspects cliniques des mycoses superficielles chez le diabétique tunisien en milieu hospitalier.

OBJECTIVES: The prevalence of mycotic infection seems to be higher among diabetic patients than in the non-diabetic population. The aims of this study were to determine the frequency of mycosis and to compare clinical and fungal results. PATIENTS AND METHODS: This transversal study included 307 type 1 and 2 diabetic patients admitted between January 1998 and January 2000. A dermatologist examined all patients. The mean age was 44 +/- 17 years and the duration of diabetes 8 +/- 6 years. Patients with suspected lesions underwent mycological examination. RESULTS: Clinical signs of presumed fungal infection were found in 61% of patients, but mycosis was confirmed only in 30%. Fungal foot infection accounted 38% of the patients, mostly due to dermatophytes (94%). The commonest localizations of dermatophytes were interdigital (60%) followed by onychomycosis (30%). The main fungal agent was Trichophyton rubrum. The main risk factors for fungal infections were the age of patients (P = 0.0003) and duration of diabetes (P < 0.05). Interdigital foot localization of dermatophytes was correlated to age (P < 0.0001) and to the male gender (P < 0.01). The frequency of dermatophytes in nails was higher in type 2 diabetic patients (P < 0.01). Vulvovaginal candidosis and interdigital dermatophytes were more frequent in obese than in non-obese patients. The accuracy and specificity of direct examination were respectively 85% and 79%. CONCLUSION: The high frequency of mycosis in diabetic patients at hospital is demonstrated. The main risk factors were age, male gender and obesity.

[Hypopituitarism and antiphospholipid syndrome]. / Hypopituitarisme et syndrome des antiphospholipides.

Endocrine disorders seen in antiphospholipid syndrome are rare. To date, these disorders have generally involved Addison's disease. Recently reports have appeared of a few cases of primary or secondary hypopituitarism associated with primary antiphospholipid syndrome. We report the case of a young female patient who presented neuroendocrine symptoms during the postpartum period associated with an antiphospholipid syndrome. Hormone assessment showed complete anterior hypopituitarism and antiphospholipid antibodies were positive. We discuss the clinical, biological and radiological features observed in our patient and compare results with cases reported in the literature. This case illustrates the importance of screening for antiphospholipid syndrome in the etiological work-up of hypopituitarism associated with a history of recurrent thrombosis.

[Diaphragmatic bronchogenic cyst: a rare case report]. / Kyste bronchogénique du diaphragme : à propos d'un cas rare.

Retroperitoneal bronchogenic cysts are rare and those located in the diaphragm are exceptional. We describe an additional case of bronchogenic cyst of the left crus of diaphragm. Diagnosis of a diaphragmatic lesion was confirmed during laparotomy and complete resection was successful. Final diagnosis was done on pathology.

Efficacy and safety of bromocriptine in the treatment of macroprolactinomas.

To assess the effectiveness of bromocriptine (BRC) as primary therapy in reducing the size of PRL-secreting macroadenomas with extra-sellar extension, we conducted a multicenter study in 29 patients without prior radiotherapy. Clinical presentation, response to medical treatment and long term follow-up of 29 patients with macroprolactinoma (pituitary mass more than 10 mm in diameter) were analysed. There were 19 women for 10 men. Mean age was 33 years. An hypogonadism was present in 94% of women vs 57% for men. Headaches and or visual abnormalities were present in 68% of women vs 90% of men. The mean basal serum prolactin level before treatment was 1 501 ng/ml: 202 ng/ml for women (range: 70-478 ng/ml) and 3 870 ng/ml for men (range: 100-20 476 ng/ml) and was correlated to tumoral size. 25 patients were treated with BRC as primary therapy with a mean dose of 9,7 mg/day (13 mg/day in men and 8 mg/day in women). BRC no malized serum PRL levels in all men and in 17/19 women over a mean period of 6 months, ranging from 3 to 72 months in both sexes. Tumor size was reduced by more than 50% in 18/29 patients (62%) with secondary empty sella in 5 patients and by less than 50% in 11 patients. Visual field improved in most of the patients in whom it was initially abnormal. Reduction in size was quite fast in most of patients but slower in some of them. The cumulative radiological response to BRC increased with time. Therefore, it appears that prolonged medical therapy is effective and safe in macroprolactinomas.

[Extra-adrenal gland pheochromocytoma. Apropos of 3 cases and review of the literature]. / Le phéochromocytome extrasurrénalien. A propos de trois observations et revue de la littérature.

The authors report three new cases of ectopic pheochromocytoma: latero-aortic, bladder and near the kidney. From the review of the literature, they propose a diagnostic and therapeutic strategy for the management of ectopic localisation of pheochromocytoma.

[Encapsulated papillary carcinoma of the thyroid gland. Particular histological aspect of a case with review of the literature]. / Le carcinome papillaire encapsulé de la thyroïde. Aspect histologique particulier d'une observation avec revue de la littérature.

The authors report a case of encapsulated papillary neoplasm in the right lobe of the thyroid of a 36-year-old woman. This neoplasm was a papillary encapsulated carcinoma with variable histologic patterns not properly described in the literature. In the light of a review of the literature, the authors stress the macroscopic and histologic aspects of this tumor and they discuss the prognosis and therapeutic tools used to cure this neoplasm.

[Adrenal myelolipoma]. / Le myélolipome surrénalien.

The authors report a case of myelolipoma discovered in a 57 year-old woman by ultrasonography and computed tomography. The tumour was 10 cm in diameter and weighed 350 grams. This case is discussed in the light of a review of the literature.

[Melanotic schwannoma. A case with review of the literature]. / Le schwannome mélanotique. Une observation avec revue de la littérature.

The authors report a case of melanotic schwannoma in a 46-year-old man after 2 years of bilateral sciatica. Surgical removal was incomplete, because of the posterior site of the tumor. The patient was alive and well, 2 years after surgical removal, with some surgical sequelae. The authors stress the diagnostic difficulties of this melanotic and review the previously reported cases in a comparative study.

[Bladder pheochromocytoma and pregnancy. A case report]. / Phéochromocytome vésical et grossesse. Une observation.

The authors report the case of a 31-year old patient who successfully completed a pregnancy despite unsuspected bladder pheochromocytoma. After delivery, the patient required care post-partum due to serious hemodynamic problems. Hypertension had been attributed to toxemia of pregnancy. The authors recall the diagnostic difficulties of tumors of this type, and the means which can be used for topographical diagnosis and the precautions to be taken before this tumor can be treated surgically.

[A case of bladder pheochromocytoma]. / A propos d'une observation de phéochromocytome vésical.

Phaeochromocytoma is an endocrine neuroectodermal tumour usually located in the adrenal gland, but occasionally arising in other organs. The authors report a case of a vesical phaeochromocytoma presenting with haematuria. Radiological and endoscopic investigations revealed a right laterovesical submucosal tumour. Partial cystectomy was performed. The normality of the postoperative endocrine survey suggested disappearance of the tumour and absence of any other sites.

[Gastric xanthelasma. Apropos of 2 of our cases]. / Le xanthélasma gastrique. A propos de deux observations personnelles.

On the basis of two personal cases and a review of the literature, we have attempted to define endoscopic and histologic features in gastric xanthelasma. The various etiopathogenic hypotheses published in the literature are reviewed and others are suggested. Attention is drawn to the differential diagnosis with mucus-secreting cell carcinoma. Use of stains for mucus in such lesions is recommended to confirm the diagnosis.