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The support provided at the Germaine-Revel medical center in the Rhône region involves assessing the patient as a whole, which is a key aspect of implementing personalized rehabilitation focused on one or more objectives. The team offers multidisciplinary and multimodal care, because the clinical symptoms of people with multiple sclerosis are very varied: they can include neuromotor, neurosensory, neurosensory and cognitive disorders, as well as bladder and bowel and genital disorders., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Purpose: Fluorodeoxyglucose positron emission tomography (FDG-PET) is a promising imaging technique that has already proven effective in modifying patient care in oncology. Fluorodeoxyglucose still remains the main radiopharmaceutical agent routinely used for PET imaging. A growing interest has recently lead to broaden PET research on benign disorders. The field of inflammatory or immune diseases and globally the field of internal medicine could also be impacted by FDG-PET., Main Points: Great vessels vasculitides and fever of unknown origin have both been studied by several teams and could become indications for PET. In addition, current indications now extend to paraneoplastic syndromes. It is thus possible to foresee that the clinical applications for PET will continue to expand in these patients., Perspectives and Projects: In the future, inflammatory arthritis, chronic inflammatory bowel diseases, systemic erythematous lupus, histiocytosis, or pulmonary and retroperitoneal fibrosis might benefit from PET even if, available data remains scarce to this day. Although PET will probably alter the landscape of patient management in internal medicine in the near future, additional clinical research is still needed to ascertain the exact role of PET.

Objectives: Risk factors for infectious complications of central venous catheters (CVC) were compared between CVC used for short and long periods to identify patients at risk., Patients and Methods: A prospective study was conducted over a 6 month period in two general intensive care units (87 patients with short duration CVC) and in 4 medical units (110 patients with cancer or HIV infection for whom long duration CVC was scheduled). The first CVC inserted was followed to withdrawal or for a minimal 3 months., Results: The mean duration of CVC use was 7.5 and 106 days for the short and long duration groups respectively. A CVC-related infection occurred in 6 patients in the short duration group and in 14 patients in the long duration group giving an incidence of 1.0/100 CVC days (95% CI: 0.4-2.0) for the short-duration CVC group and 0.13/100 CVC days (95% CI: 0.07-0.21) for the long-duration CVC group. Intensive care patients with a skin lesion far from the CVC insertion point had a higher incidence of CVC-related infection than patients without a skin infection. Taking into account the indications for CVC, patients with cancer or HIV infection had equivalent risk of infection. For both short and long duration CVC use, parenteral nutrition was found to be a major risk factor for infectious complications., Conclusion: Rigorous regular surveillance of nosocomial infections on central catheters should be centered on those inserted for parenteral nutrition.

The Valtrac ring is a biofragmentable ring used for gastrointestinal anastomoses. Over a two-year period, 15 anastomoses in 16 patients (mean age: 60 years) were performed with the Valtrac ring: 10 ileal, 4 ileocolonic, and 1 jejunojejunal anastomoses. One anastomosis could not be performed because of an excessively narrow ileal lumen. The mean stay in the intensive care unit was 3 days: gastric aspiration was maintained for an average of 1 week, as return of gastrointestinal motility was long, with first flatus on the 6th day and the first stools on the 7th day. Complications consisted of 2 cases of gastrointestinal fistula (11th and 13th days) one of which was fatal, evisceration on the 7th day, a transient partial bowel obstruction and one bowel obstruction treated medically on the 27th day, due to pancreatitis. Our results are not identical to those reported in the literature. It is often difficult to insert the current form of the Valtrac ring into a healthy ileum, as the smallest ring is often too large. In contrast with gastrointestinal surgery, the anastomoses performed in urology involve a non-thickened, non-distended small intestine.

High flow rate priapism was diagnosed in a 14-year-old adolescent 5 days after a fall onto the perineum. Highly selective embolization of the 2 internal pudendal arteries was performed with gelatin (SPONGEL). Rapid resolution of the priapism as well as return of normal erection were observed within 48 hours. Doppler ultrasound revealed a high flow rate and identified the side of the traumatized artery. Endovascular embolization allows effective treatment of traumatic arteriocavernous fistula.

Objectives: We evaluated the sensitivity and specificity of cervical ultrasonography for the detection of primary parathyroid adenomas., Methods: From January 1990 to May 1992, ultrasonography was performed before exploratory cervicotomy in 30 patients (10 males, 20 females, mean age 56.3 yr) whose diagnosis was primary hyperparathyroidism based on radioimmunoassay of parathyroid hormone. The same trained operator performed all the ultrasonographic examinations., Results: Twenty-six parathyroid tumours were detected in 23 of the 30 patients examined by ultrasonography. The four standard localizations and one ectopic tumour were visualized. At surgery 37 tumours were found in 30 patients. Among the 11 false negatives, the operator had identified an abnormal tumour incorrectly as a cervical lymph node in 2. Most of the false negatives occurred early in the study. The sensitivity of ultrasonography was thus 70 % with a 100% specificity., Conclusions: Cervical ultrasonography is a reliable, non-invasive and relatively inexpensive examination which should be used as a first-line test for the aetiological assessment of hyperparathyroidism.

The authors report a case of an ovarian abscess presenting as acute sciatica with pyrexia in a 36-years-old woman with an intrauterine contraceptive device. Imaging (plain X-ray of abdomen and CT scan) was clear-cut, showing an air pocket as a result of abscess formation and dental calcifications which enabled a preoperative diagnosis of dermoid cyst. The outcome was successful following appropriate surgical treatment and unilateral tubo-oophorectomy.

Somatomedin C/IGF I, dehydroepiandrosterone sulfate (DHAS), testosterone (T) or estradiol (E2) have been measured in 154 patients of a previous study in which growth hormone (GH) responses to classical pharmacologic stimuli and spontaneous growth hormone secretion during sleep were compared in short children before and at the beginning of puberty. Five groups were identified: Group I, normal growth hormone secreting children; group II, completely growth hormone deficient; group III, partially growth hormone deficient; group IV, with normal sleep secretion and low responses to stimuli; group V, with the reverse situation. The somatomedin C/IGF I levels were widely dispersed. In group I, the mean +/- SEM levels of somatomedin C/IGF I were 0.77 +/- 0.047 U/ml before puberty and 1.36 +/- 0.142 U/ml in early pubertal patients, with a relation to age (r = 0.52, p less than 0.001). The difference between prepubertal and pubertal patients was significant. In groups II to V, there was no pubertal rise of somatomedin C/IGF I. In group II, the mean IGF I level was 0.48 +/- 0.05 U/ml, significantly lower than in prepubertal patients of group I. In groups III, IV and V, it was 0.7 +/- 0.069 U/ml, 0.8 +/- 0.059 U/ml, and 0.73 +/- 0.059 U/ml respectively, not different from prepubertal patients of group I, but significantly lower than in early pubertal patients of the same group. In prepubertal patients, somatomedin C/IGF I was slightly but highly significantly correlated to growth hormone sleep secretion (r = 0.27, p less than 0.001) and to dehydroepiandrosterone sulfate (r = 0.36, p less than 0.001), but growth hormone and dehydroepiandrosterone sulfate were not correlated with each other.(ABSTRACT TRUNCATED AT 250 WORDS)

Somatomedin C/IGF I, dehydroepiandrosterone sulfate (DHAS), testosterone (T) or estradiol (E2) have been measured in 154 patients of a previous study in which growth hormone (GH) responses to classical pharmacologic stimuli and spontaneous growth hormone secretion during sleep were compared in short children before and at the beginning of puberty. Five groups were identified: Group I, normal growth hormone secreting children; group II, completely growth hormone deficient; group III, partially growth hormone deficient; group IV, with normal sleep secretion and low responses to stimuli; group V, with the reverse situation. The somatomedin C/IGF I levels were widely dispersed. In group I, the mean +/- SEM levels of somatomedin C/IGF I were 0.77 +/- 0.047 U/ml before puberty and 1.36 +/- 0.142 U/ml in early pubertal patients, with a relation to age (r = 0.52, p less than 0.001). The difference between prepubertal and pubertal patients was significant. In groups II to V, there was no pubertal rise of somatomedin C/IGF I. In group II, the mean IGF I level was 0.48 +/- 0.05 U/ml, significantly lower than in prepubertal patients of group I. In groups III, IV and V, it was 0.7 +/- 0.069 U/ml, 0.8 +/- 0.059 U/ml, and 0.73 +/- 0.059 U/ml respectively, not different from prepubertal patients of group I, but significantly lower than in early pubertal patients of the same group. In prepubertal patients, somatomedin C/IGFI was slightly but highly significantly correlated to the growth hormone sleep secretion (r = 0.27, p less than 0.001) and to dehydroepiandrosterone sulfate (r = 0.36, p less than 0.001), but growth hormone and dehydroepiandrosterone sulfate were not correlated together.(ABSTRACT TRUNCATED AT 250 WORDS)

Two normal boys, with no previous history, were referred at the onset of puberty for unilateral testicular hypertrophy. Radiological and biological investigations, and in one case testicular biopsy, ruled out cellular proliferation or tumor. Except for FSH level slightly above normal in one case, no endocrine abnormality was found. This is a rare, and probably non pathologic event.

Maximal response (peak) of growth hormone (GH) after conventional pharmacologic stimuli have been compared to maximal level reached during sleep in 215 children (123 prepubertal, 92 early pubertal) (group A). A weak correlation (r = 0.37, p less than 0.001) was observed. Five sub-groups of patients could be distinguished according to their GH pharmacologic or sleep peaks: 115 with normal secretion in both cases (I), 10 with complete deficiency (II), 27 with partial deficiency (III), 34 with normal GH sleep secretion and low responses to stimuli (IV) and 29 with the inverse situation (V). A second group (B) of 30 very short children (17 prepubertal and 13 early pubertal) had borderline or variable responses after several pharmacologic stimuli. hGH therapy was done to every patients of sub-group A II, 12 of sub-group A III, 9 of subgroup A IV, 5 of sub-group A V and every one of group B. A sharp rise of growth rate has been obtained with hGH in every patients of sub-groups A II and A III, in 10 out of 14 patients of sub-groups A IV and A V and in almost all patients of group B. A sharp rise of growth rate has been obtained with hGH in every patients of sub-groups A II and A III, in 10 out of 14 patients of sub-groups A IV and A V and in almost all patients of group B. hGH effect in the three last kinds of patients, with atypical GH secretion, was better in those who were in early puberty.(ABSTRACT TRUNCATED AT 250 WORDS)

The epidermolysis bullosa simplex (intraepidermal) disorders represent a heterogeneous group of bullous diseases all inherited in an autosomal dominant mode. The prognosis is usually good and the bullous lesions heal without scarring. We present here three patients affected with intraepidermal epidermolysis bullosa of the Dowling-Meara type with varying prognoses. Case n. 1. This 4-year-old girl was first seen at the age of 15 months for numerous bullous lesions distributed over her entire skin surface and on her oral mucosa. The blisters, first noted shortly after birth, showed an herpetiform distribution and a thick and hyperkeratotic roof. A yellowish palmoplantar keratoderma was also present. At the age of four the bullous eruption remained extremely severe. The family history revealed no similar cutaneous disorders. Histology showed focal intraepidermal separation and ultrastructural examination revealed that the split occurred above the dermoepidermal junction within the basal cell cytoplasm. Tonofilament clumping was observed. The dermoepidermal junction was normal with hemidesmosomes and anchoring fibrils showing no significant abnormalities. Case n. 2. This 8-year-old boy presented at the age of 5 with numerous bullous lesions involving most of the skin surface and mucosa. The family history was unremarkable. The blisters, present since birth, were numerous and were often circinate with central healing. Palmoplantar keratoderma was noted. Electron microscopy showed intraepidermal separation occurring in the basal cell layer with tonofilament clumping.(ABSTRACT TRUNCATED AT 250 WORDS)