Search

The internist has a role to play in the practical approach of HELLP syndrome, a disease which can differ according to its symptoms, course and causes. Any recent epigastric pain during the end of pregnancy must be considered as a symptom of HELLP syndrome. Liver disease together with thrombocytopenia may be present even without any renovascular involvement. The disease can be threatening for the mother and lead to the foetal death. It can be sometimes difficult to be distinguished from thrombotic microangiopathy. Treatment consists mainly in rapid discontinuation of pregnancy. Steroid therapy could allow to simplify anaesthesia procedures and to avoid blood transfusion. Early-onset HELLP syndrome could be a marker a chronic nephropathy or a thrombophilic disorder. The HELLP syndrome is a very demonstrative example of the help the internist can afford to the obstetrician in the management of pregnancy-associated disorders.

Resume Introduction. – Un grand nombre de tuberculoses actives en France sont liees a la reactivation d'une tuberculose latente. Il semble que la reactivation de tuberculoses latentes puisse etre favorisee pendant le post-partum par la restitution immunitaire. Exegese. – Nous rapportons trois observations d'infections osteo-articulaires a Mycobaterium tuberculosis (deux spondylodiscites et une arthrite sternoclaviculaire) survenues au cours du post-partum chez des femmes non infectees par le VIH. Deux patientes ont beneficie d'une prise en charge chirurgicale. L'evolution clinique a ete favorable pour toutes nos patientes avec un traitement anti-tuberculeux adapte. Conclusion. – Il faut savoir evoquer une possible tuberculose osteo-articulaire devant des douleurs osseuses ne faisant pas leur preuve pendant le post-partum. Nous rappelons les liens existants entre la tuberculose et le post-partum ainsi que les principes de prise en charge de la mere et de l'enfant. Des etudes epidemiologiques complementaires meriteraient d'etre realisees. Il parait de plus necessaire de renforcer en France les mesures de depistage de la tuberculose et notamment des formes latentes.

Resume Introduction. – La moitie des patients atteints d’hemochromatose genetique developpe des manifestations articulaires. Parmi celles-ci, deux sont consequentes : l’atteinte des petites articulations des mains, outil diagnostique precieux, et l’atteinte coxofemorale. La surcharge articulaire en fer semble etre a l’origine de la destruction du cartilage. Exegese. – Nous rapportons cinq observations d’hemochromatose avec atteinte de la hanche. La coxopathie a ete revelatrice dans un cas et est survenue malgre le blanchiment de l’hemochromatose chez un autre patient. Trois de nos cinq malades ont eu besoin d’une prothese totale de hanche. Conclusion. – L’hemochromatose genetique est une maladie chronique au cours de laquelle une coxopathie demeure un risque frequent (12,5 %), souvent meconnu, engageant le pronostic fonctionnel du patient.

Resume Introduction Les arthrites septiques a Neisseria gonorrhoeae sont mono- ou oligoarticulaires. Elles representent une cause non rare d'arthrite de l'adulte sexuellement actif. Il faut y penser meme en l'absence d'uretrite. Exegese Nous rapportons le cas d'une arthrite gonococcique sans uretrite chez un jeune homme, associee a des hemocultures steriles et des cultures positives du liquide articulaire. Conclusion Le diagnostic et le traitement precoce de cette pathologie permettent une guerison sans sequelles. L'existence de souches penicillines–resistantes a justifie les recommandations recentes concernant l'utilisation en premiere intention d'une cephalosporine de troisieme generation.

Introduction L’anemie ferriprive chez les femmes menopausees et les hommes doit conduire a des explorations digestives ; cependant, chez des patients fragiles, et particulierement en medecine interne, la realisation d’une coloscopie sous anesthesie generale est souvent difficile. Nous avons voulu faire l’etat des lieux de la pratique des explorations coliques tomodensitometriques (coloscanner) dans le bilan des carences martiales. Materiels et methodes Nous avons mene une etude retrospective monocentrique pendant 2 ans entre janvier 2013 et decembre 2014 au CHU de Clermont-Ferrand. Tous les patients ayant eu une exploration colique tomodensitometrique pour bilan d’anemie ferriprive pendant cette periode ont ete inclus. Les donnees biologiques initiales, les comorbidites et le resultat de l’examen radiologique ont ete recueillis, ainsi que le devenir des patients dans l’annee suivant l’examen. Resultats Cent cinquante-six patients ont beneficie d’un coloscanner sur la periode etudiee, dont 74 (47,4 %) pour bilan d’anemie ferriprive. Parmi les patients avec carence martiale, la majorite etait des femmes (59,5 %), l’âge moyen etait de 77 ans, plus eleve que pour les autres indications (65,5 ans, p Conclusion Les patients necessitant une exploration colique pour anemie ferriprive sont des patients âges ayant, pour la majorite d’entre eux, une cardiopathie. Le coloscanner est une alternative fiable et peu invasive pour la recherche de cancer chez ces patients, permettant ainsi de selectionner ceux pour qui le benefice d’une coloscopie classique devient superieur au risque de l’anesthesie generale.

Recent data show that the quality of anticoagulation evaluated in patients receiving vitamin K antagonists (VKA) is not optimal in France. The aim of this retrospective study was to estimate the performances of six French anticoagulant clinics that manage VKA treatments over a 3-year period, from 2009 to 2011.All clinics used the same rule based software. We determined the time spent in the therapeutic range (TTR), a surrogate end-point of quality of treatment with VKA.The overall duration of follow-up was 2755 patient-years concerning 2385 patients. The time spent in the therapeutic range 2 to 3 assigned for 89% of the patients, was 73%. On the other hand the time spent in the therapeutic range for the other two INR ranges (2.5-3.5 and 3-4.5) concerning 11% of patients with prosthetic heart valve was lower (63.7% and 68.8% respectively) with an imbalance in favour of the time below the range. In this study, warfarin (Coumadine(®)) and fluindione (Previscan(®)) allowed an equivalent quality of anticoagulation. The 1728 patients of age ranged from 60 to 100 years spent more time in TTR than the 651 younger patients. The percentage of time spent with an INR greater than 5 was extremely reduced which is a guarantee of safety.These results prove that anticoagulant clinics in France have the same good performances as their counterparts abroad. It can be assumed that a high TTR contributes to a low incidence of both bleedings and thrombosis.

The internist has a role to play in the practical approach of HELLP syndrome, a disease which can differ according to its symptoms, course and causes. Any recent epigastric pain during the end of pregnancy must be considered as a symptom of HELLP syndrome. Liver disease together with thrombocytopenia may be present even without any renovascular involvement. The disease can be threatening for the mother and lead to the foetal death. It can be sometimes difficult to be distinguished from thrombotic microangiopathy. Treatment consists mainly in rapid discontinuation of pregnancy. Steroid therapy could allow to simplify anaesthesia procedures and to avoid blood transfusion. Early-onset HELLP syndrome could be a marker a chronic nephropathy or a thrombophilic disorder. The HELLP syndrome is a very demonstrative example of the help the internist can afford to the obstetrician in the management of pregnancy-associated disorders.

Septic arthritis caused by Neisseria gonorrhoeae is mono or pauciarticular. They represent a nonrare cause of arthritis in sexually active adults. He is necessary to think of it even in the absence of urethritis.We report the case of gonococcal arthritis without urethritis in a young man associated with positive synovial fluid culture and negative blood cultures.Prompt recognition and treatment of this disease results in cure without aftereffects. The finding of penicillin-resistant organisms reinforces recent recommendations that advanced-generation cephalosporin must be used as initial therapy.

To investigate the frequency of main symptoms of Obstructive Sleep Apnea Syndrom (OSAS) and their relationship with Pregnancy Induced-Hypertension (PIH) as well as Intrauterine Growth Retardation (IGR) as suggested by recent studies.Four hundred (and) thirty-eight enquiry forms completed during post-partum period were analysed, after exclusion of multiple pregnancies. Collected data were demographic characteristics, obstetrical events, sleep disorders during last trimester, screening of snoring and vigilance troubles with an Epworth score.Forty-five percentages of the patients reported to have habitual snoring during pregnancy. Among these, 85% were non-snorers before pregnancy. Daytime somnolence concerned 84,5% of the population with an Epworth score significatively increased (P0,0001). The prevalence of PIH was found to be 4,5%, with two apparently independent risk factors: the body mass index (OR=1,1) and an association between snoring and increased vigilance trouble (OR=2,6). No statistical difference was found concerning IGR.SAS symptoms are frequent during pregnancy and snoring appears to be linked with PIH. However, polysomnographic data are not yet sufficient to explain pathophysiological mechanisms and find relevant diagnostic markers during pregnancy.

Most cases of active tuberculosis in France are due to a recurrence of latent tuberculosis. It seems that immunorestitution during the postpartum can contribute to the return of latent tuberculosis.We report three observations of Mycobacterium tuberculosis osteo-articular infections (two Pott's diseases and one sterno-clavicular arthritis) occurring during the postpartum of women non infected by HIV. Two patients need a surgical treatment. The response to standard tuberculous treatment was favourable and all patients were cured.One must consider osteo-articular tuberculosis when a patient is suffering from osseous pains not proving reliable during the postpartum. We must remind ourselves of the relationships between tuberculosis and postpartum as well as the necessity to the threat both mother and child. Additional epidemiological studies should be realised. It appears necessary to increase in France measures for tracking tuberculosis in particularly about the latent forms.

Half of the patients with genetic hemochromatosis will have arthritis. Two of these articular involvements are well-known: the arthropathy involving the phalangeal and the metacarpophalangeal joints of the hand, useful for diagnosis, and hip arthropathy. Iron deposits seem to be involved in articular cartilage destruction.We report five cases of patients with hemochromatosis hip involvement. Hip arthropathy revealed hemochromatosis in one case and appeared despite efficient phlebotomies in another case. Three of these patients required hip arthroplasty.Hip arthropathy remains a frequent but unknown event in genetic hemochromatosis (12.5%) and it involves the functional prognosis.

A case of persistently severe postpartum Hellp syndrome was treated with infusion of gammaglobulin, which was followed by a dramatic increase of the platelet count. These results suggest that Hellp syndrome could be a clinical form of thrombotic thrombocytopenic purpura.

The authors have reviewed 13 cases of hypertension of pregnancy associated with Hellp syndrome observed over a 7-year period. Pregnancy was interrupted in 11/13 cases. Six of the 13 children were eutrophic and 7 were hypothrophic (2 deaths). The mother rapidly improved and regular control examinations showed regression of all biological abnormalities. Two women subsequently had an uneventful pregnancy.