Search

1. L’OBSERVATION : Une femme, âgée de 64 ans, était hospitalisée à la fin du mois d’avril pour dyspnée évoluant depuis un mois. Dans ses antécédents, on notait un reflux gastro-œsophagien, une hypothyroïdie substituée, des migraines, une hypertension artérielle, une hypercholestérolémie et une arthrodèse lombaire. Elle était fonctionnaire, ne fumait pas et consommait de l’alcool de manière occasionnelle. Elle appréciait les balades en forêt. Son traitement comportait : propanolol 40 mg/j, oméprazole 20 mg/j, L-thyroxine 25 μg/j, acide folique 4 mg/j. Fin mars, après une chute de la 11e marche d’un escalier, elle présentait une fracture et une plaie du poignet, nécessitant une attelle plâtrée puis une chirurgie de l’extenseur de l’index droit. C’est en revoyant l’orthopédiste à la consultation de contrôle post-opératoire qu’elle mentionnait pour la première fois une dyspnée de grade 3, associée à des douleurs thoraciques d’effort. Elle était donc hospitalisée en cardiologie où un bilan était réalisé : ECG montrant des ondes T négatives de V1 à V3, échographie cardiaque retrouvant une discrète hypertension artérielle pulmonaire (HTAP), angioscanner pulmonaire négatif, coronarographie normale. Une anémie macrocytaire (hémoglobine : 7,2 g/L) était découverte. Le bilan biologique montrait également une carence en folate substituée. Une gastroscopie mettait en évidence une petite ulcération antrale traitée par oméprazole. Il existait un syndrome inflammatoire (CRP : 200 mg/L), pour lequel les prélèvements bactériologiques (hémocultures, culture urinaire) restaient stériles. [...] Titre en anglais : Dyspnea in a 64 year-old woman

Introduction The identification and treatment of latent tuberculosis infection (LTBI) among immigrants from high-incidence regions who move to low-incidence countries is generally considered an ineffective strategy because only ≈14% of them comply with the multiple steps of the ‘cascade of care’ and complete treatment. In the Estrie region of Canada, a refugee clinic was opened in 2009. One of its goals is LTBI management. Methods Key components of this intervention included: close collaboration with community organizations, integration within a comprehensive package of medical care for the whole family, timely delivery following arrival, shorter treatment through preferential use of rifampin, and risk-based selection of patients to be treated. Between 2009–2020, 5131 refugees were evaluated. To determine the efficacy and benefit-cost ratio of this intervention, records of refugees seen in 2010–14 (n = 1906) and 2018–19 (n = 1638) were reviewed. Cases of tuberculosis (TB) among our foreign-born population occurring before (1997–2008) and after (2009–2020) setting up the clinic were identified. All costs associated with TB or LTBI were measured. Results Out of 441 patients offered LTBI treatment, 374 (85%) were compliant. Adding other losses, overall compliance was 69%. To prevent one case of TB, 95.1 individuals had to be screened and 11.9 treated, at a cost of $16,056. After discounting, each case of TB averted represented $32,631, for a benefit-cost ratio of 2.03. Among nationals of the 20 countries where refugees came from, incidence of TB decreased from 68.2 (1997–2008) to 26.3 per 100,000 person-years (2009–2020). Incidence among foreign-born persons from all other countries not targeted by the intervention did not change. Conclusions Among refugees settling in our region, 69% completed the LTBI cascade of care, leading to a 61% reduction in TB incidence. This intervention was cost-beneficial. Current defeatism towards LTBI management among immigrants and refugees is misguided. Compliance can be enhanced through simple measures.

ispartof: JAAD Int vol:4 pages:15-17 ispartof: location:United States status: Published online

Schnitzler syndrome is an underdiagnosed clinical condition characterized by 2 major criteria: chronic recurrent urticarial eruption and monoclonal IgM gammopathy, as well as at least 2 of the following minor criteria: (1) recurrent fever, (2) high C-reactive protein (CRP) levels, (3) signs of abnormal bone remodeling with or without bone pain, and (4) neutrophilic infiltrates on skin biopsy.1 We report the case of a patient with history of hairy cell leukemia who exhibited atypical clinical presentation of chronic urticaria for 2 years before the final diagnosis of Schnitzler syndrome was established. To the best of our knowledge, this is the first reported case of Schnitzler syndrome associated with hairy cell leukemia.

We describe the case of four patients consulting for headache and tachycardia of brutal onset. Their biological data were compatible with primary hyperthyroidism with low TSH and high T4 serum levels. Serum thyroglobulin level was low and Tc-scintigraphy showed decreased uptake with a homogenous pattern. These results allowed to conclude a thyrotoxicosis caused by thyroid hormones intake. History taking revealed consumption of beef neck meat containing all or parts of the bovine thyroid gland. Evolution was favourable with beta-blockers. A literature review of « hamburger thyrotoxicosis » is presented.

Infection of costal cartilage is a rare observation. We report the case of a 43-year-old male patient without relevant history who presented with a progressive painful swelling of the left chest wall since 4 months. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated an abscess within the left ninth costal cartilage with surrounding reactive changes. A CT-guided biopsy was performed and the culture of the sample revealed the presence of Prevotella nigrescens. Musculoskeletal infections by Prevotella are rarely described in the literature, Prevotella oralis and Prevotella bivia being the most frequently observed pathogens. These infections usually originate from a hematogenous spread after thoracic surgery or dental procedure. In our patient, conservative treatment was chosen. A clinical improvement was noted after 1-month antibiotherapy, confirmed by short-term and 6-month imaging follow-up showing the complete disappearance of all previously observed abnormalities.

Angiotensin I-converting enzyme (ACE) is a well-known zinc-metallopeptidase that converts angiotensin I to the potent vasoconstrictor angiotensin II and degrades bradykinin , a powerful vasodilator , and as such plays a key role in the regulation of vascular tone and cardiac function. Increased circulating ACE (cACE) activity has been reported in multiple diseases, including but not limited to granulomatous disorders. Since 2001, genetic mutations leading to cACE elevation have also been described. This review takes advantage of the identification of a novel ACE mutation (25-IVS25 + 1G > A) in two Belgian pedigrees to summarize current knowledge about the differential diagnosis of cACE elevation, based on literature review and the experience of our centre. Furthermore, we propose a practical approach for the evaluation and management of patients with elevated cACE and discuss in which cases search for genetic mutations should be considered.

We report on a 75-year-old woman who presented with recurrent episodes of hypotension, anasarca, renal failure, hypoalbuminaemia without proteinuria, suggestive of systemic capillary leak syndrome (SCLS). Further investigations led to a diagnosis of diffuse large B-cell lymphoma. Secondary SCLS associated with non-Hodgkin lymphoma is reviewed.

A 75-year-old man was admitted to the Department of internal medicine because of a 2-month history of neurological deterioration. During the previous year, he complained of recurrent sinusitis, asthma, arthralgias, myalgias and asthenia. Later on, an oculomotor palsy, weakness and disturbance of the sensibility of the right upper limb appeared. Blood sample showed 6510 eosinophils per microlitre. The cerebral magnetic resonance demonstrated bilateral frontal and left parietal subcortical lesions from which the most voluminous presented large haemorrhagic areas. A cerebral biopsy showed small vessel's vasculitis, fibrinoid necrosis and extravascular eosinophilic encroachment. A diagnosis of oculomotor palsy secondary to eosinophilic granulomatosis with polyangeitis was then made, which was successfully treated with corticosteroids and cyclophosphamide.

This article focuses on the CD-R defects that cause digital errors when decoding the HF signal delivered by the optical pickup of a player. We often remark that the error rate is not correlated with any of the parameters currently used to qualify the HF signal. We develop a more precise analysis of the HF signal than those of the analysers, in order to explain how errors happen in this case. The information is obtained mainly from the complete histogram of the positions of the transitions. We also check particular signal segments such as the beginnings of data frames. Using these analysis tools, we highlight different kinds of defects on aged CD-R. One of them consists in micrometre-sized dark spots, which are localized on the dye layer. More generally, the defects due to ageing cannot be characterised only by the standard parameters given by analysers.

A 64-year-old woman developed progressively a neck pain with bilateral shoulder pain, followed after several weeks by a symmetrical bilateral proximal upper extremities weakness (1/5 strength in the deltoids and biceps) with amyotrophy. She was unable to elevate her arms. Biceps and brachio-radialis reflexes were absent, tricipital and cubito-pronator reflexes were weak. Sensory examination was normal. There was no headache or visual impairment. Her temporal arteries were pulsatile, painless and not thickened on palpation. A careful history revealed constitutional symptoms including weight loss, fatigue and diaphoresis. Fever (38–39 C) was observed during hospitalization. Blood pressure was 130/90 mmHg on both arms. Laboratory studies showed a high C-reactive protein level (25 mg/dl; nl\ 1.0 mg/dl) and cholestasis (GGT 337 UI/L; nl\ 50 UI/L). Electromyogram showed fibrillation potentials and reduced recruitment in biceps and deltoid muscles bilaterally, consistent with brachial plexopathy. MRI of cervical spine and brachial plexuses was normal. CSF was normal. PET/CT revealed increased 2-deoxy-2-[18F]fluoro-Dglucose (FDG) uptake (Fig. 1) in ascending, descending

We report the case of a 46-year-old woman who noticed a swelling of the left supraclavicular fossa of rapid onset soon after a Mycoplasma Pneumoniae upper respiratory infection. On the basis of clinical history, physical examination and imaging findings, a diagnosis of chyloma due to intense non-productive coughing bouts was made. The supraclavicular swelling progressively disappeared after a few days. This observation prompted us to briefly review the pathophysiology of chylomas.

PurposeThe purpose of this paper is to propose two simple tools for the kinematic characterization of hexapods. The paper also aims to share the experience of converting a popular commercial motion base (Stewart‐Gough platform, hexapod) to an industrial robot for use in heavy duty aerospace manufacturing processes.Design/methodology/approachThe complete workspace of a hexapod is a six‐dimensional entity that is impossible to visualize. Thus, nearly all hexapod manufacturers simply state the extrema of each of the six dimensions, which is very misleading. As a compromise, a special 3D subset of the complete workspace is proposed, an approximation of which can be readily obtained using a computer‐aided design (CAD)/computer‐aided manufacturing (CAM) software suite, such as computer‐aided 3D interactive application (CATIA). While calibration techniques for serial robots are readily available, there is still no generally agreed procedure for calibrating hexapods. The paper proposes a simple calibration method that relies on the use of a laser tracker and requires no programming at all. Instead, the design parameters of the hexapod are directly and individually measured and the few computations involved are performed in a CAD/CAM software such as CATIA.FindingsThe conventional octahedral hexapod design has a very limited workspace, though free of singularities. There are important deviations between the actual and the specified kinematic model in a commercial motion base.Practical implicationsA commercial motion base can be used as a precision positioning device with its controller retrofitted with state‐of‐the‐art motion control technology with accurate workspace and geometric characteristics.Originality/valueA novel geometric approach for obtaining meaningful measures of the workspace is proposed. A novel, systematic procedure for the calibration of a hexapod is outlined. Finally, experimental results are presented and discussed.

Introduction : La granulomatose de Wegener (GW) est une vascularite necrosante systemique associee a la presence d’auto-anticorps de type c-ANCA. L’atteinte du systeme nerveux central dans la GW est rare et correspond a une vascularite intraparenchymateuse, a la formation in situ de granulomes cerebromeninges ou a une extension par contiguite au depart de la sphere ORL. Observation : Nous rapportons ici le cas d’une GW nasosinusienne severe compliquee d’une extension intracrânienne pseudotumorale, confirmee par l’examen histologique. Conclusion : L’apport de la tomographie par emission de positons, dans notre observation, est un nouvel exemple de l’interet de cette imagerie fonctionnelle dans le bilan d’activite et d’extension, voire le suivi de la GW.

We report a case of pauci-immune proliferative necrotizing and crescentic glomerulonephritis in a patient with systemic lupus erythematosus (SLE) who presented with a nephrotic syndrome, while SLE was clinically and serologically quiescent. Immunofluorescence and electron microscopy examination of the kidney biopsy failed to reveal any significant deposit of immunoglobulins as well as of complement C3 and C1q, excluding lupus nephritis as the determinant of crescentic glomerulonephritis. Anti-myeloperoxydase (MPO) as well as anti-proteinase 3 (PR3) antibodies were absent in the serum. An immunosuppressive regimen including corticosteroids and IV cyclophosphamide led to a dramatic decrease of proteinuria. We conclude that necrotizing glomerulonephritis unrelated to lupus nephritis may occur in a patient with quiescent SLE. An underlying dysfunction of cell-mediated immunity might explain the association of pauci-immune crescentic glomerulonephritis and SLE.

Although the thrombotic risk of heparin-induced thrombocytopaenia (HIT) is well recognized and may affect any vascular bed, the involvement of adrenal veins has been less commonly described. We report the case of a 86-year-old woman who developed bilateral massive adrenal haematoma associated with HIT, resulting in acute adrenal insufficiency. After immediate discontinuation of heparin and starting therapy with danaparoid and hydrocortisone, the clinical evolution was favourable, although adrenal failure was irreversible. When abdominal pain, hypotension and fever occur during heparin therapy, associated with a drop in platelet count, acute adrenal insufficiency secondary to HIT should be considered, as early diagnosis is essential for the treatment of this life-threatening complication.

In this randomized, double-blind, multicenter study, patients whose blood pressure (BP) was uncontrolled by monotherapy were switched directly to amlodipine/valsartan 5/160 mg (n=443) or 10/160 mg (n=451). After 16 weeks, BP control (levels

Introduction La CA 19.9 est reconnu comme etant le marqueur serologique le plus specifique de l’adenocarcinome pancreatique. Les taux seriques du CA 19.9 peuvent cependant s’elever dans diverses affections non neoplasiques, en particulier respiratoires. Une augmentation du CA 19.9 serique associee a des bronchectasies demeure exceptionnelle. Observation Nous rapportons le cas d’une patiente de 67 ans chez qui on decouvre fortuitement un taux serique de CA 19.9 superieur a 1 500 U/ml (valeurs normales Conclusion Ce cas rappelle l’inutilite du dosage d’un marqueur tumoral dans un but de depistage et qu’une elevation du CA 19.9 serique jusqu’a 50 fois normale peut s’observer dans des affections respiratoires benignes comme les bronchectasies.

Background: A 57-year-old patient was admitted for high-grade fever, asthenia, sweating, dry cough and diffuse arthro-myalgias. Two years earlier, elevated titers of anticytoplasmic antibodies (ANCA) of anti-proteinase 3 specificity and renal biopsy led to a diagnosis of granulomatosis with polyangiitis (GPA) with lung and renal involvement. GPA was treated by steroids, cyclophosphamide and rituximab with subsequent clinical and biological remission. The current chest CT scan was performed for a lung opacity that eventually was proved to be an organising pneumonia. CT also showed an unsuspected pattern of the spleen that was compared with a previous chest CT.

Adrenal hemorrhage is a rare disease associated with various conditions. We report a case of a 68-year-old woman with abdominal and back pain. The diagnostic work-up showed a left adrenal gland infarction associated with essential thrombocythemia. Treatment consisted in painkillers and treating the underlying condition in order to prevent further thrombotic events.

We report the case of a 57-year-old woman presenting with persistent cough, weight loss, and fever. An extensive work-up revealed laboratory signs of inflammation and a mild thickening of the aortic wall on computed tomographic scan of the thorax. These findings raised the suspicion of large vessel vasculitis that was elegantly confirmed by fluorodeoxyglucose positron emission tomography. Persistent cough as the inaugural symptom and involvement of large vessels in Horton's disease are also discussed.

Resume Nous rapportons l'observation d'un patient de 47 ans opere pour l'ablation de materiel d'osteosynthese a la cheville. A l'occasion de la pose de la voie d'abord veineuse en salle d'operation, apparurent et disparurent spontanement en trois minutes des salves de tachycardie ventriculaire. On decida de poursuivre la preparation de l'intervention. Trente minutes apres une rachianesthesie survint une asystolie. La prise en charge immediate a permis la reprise quasi instantanee de l'activite cardiaque, sans consequence clinique pour le patient. Le sujet presentait un antecedent cardiaque rythmologique de type « tachycardie ventriculaire idiopathique benigne » integree dans une entite nosologique appelee syndrome de Gallavardin. Les causes d'asystole apres une rachianesthesie sont bien connues et ne sont donc pas reprises ici. En revanche, bien que dans ce cas, l'origine de l'asystole ne soit pas precisement definie, nous revenons sur ce syndrome peu connu pour lequel il n'y a pas lieu d'evaluation preoperatoire longue et couteuse.

Adipose tissue secretes a large number of physiologically active peptides that often share structural properties with cytokines, and are therefore collectively referred to as "adipocytokines". Some of these are almost exclusively secreted by adipose tissue. Leptin, adiponectin and resistin are specific fat-derived hormones that affect fuel homeostasis and insulin action, and may also be involved in hematopoiesis and immune functions. Anorexia nervosa is characterized by chronic self-starvation and severe weight loss, mainly at the expense of adipose tissue. Starvation-induced depletion of fat stores is accompanied by alterations of circulating adipocytokines. Plasma leptin and likely resistin levels are decreased in anorectic patients, while plasma adiponectin levels are increased. These alterations may have potential repercussions in the pathophysiology of anorexia nervosa. Thus, low leptin and high adiponectin may separately or in concert contribute to altered hematopoiesis and immunity, enhanced insulin sensitivity, neuroendocrine disturbances or osteopenia in anorexia nervosa.

OBJECTIVE: Adiponectin (ApN) is a fat-derived hormone that enhances insulin sensitivity, controls body weight, prevents atherosclerosis and negatively regulates haematopoiesis and immune functions. In contrast to many proteins secreted by adipose tissue, the circulating level of ApN falls in obesity and insulin resistance states. The influence of starvation-induced depletion of fat stores on ApN concentrations is yet unknown. We therefore investigated plasma ApN in anorexia nervosa (AN). PATIENTS AND DESIGN: We measured plasma ApN in 26 female anorectic patients and examined its relationships to several anthropometric or metabolic parameters. Twenty-four age-matched healthy female controls (C) were also studied. RESULTS: Body mass index (BMI) and fat mass were markedly decreased in AN. However, plasma ApN levels were 30% higher in anorectic than in control subjects (P < 0.01), while a reverse pattern was observed for leptin concentrations. When normalized for fatness, ApN values almost doubled in AN. ApN levels were negatively correlated with BMI and fat mass (P < 0.05 in the combined population, AN + C). Insulin sensitivity tended to be 40% higher in AN (n = 7) than in C (n = 12) subjects, and plasma ApN levels were positively correlated with insulin sensitivity (P < 0.05 in AN + C subgroups). Total and low density lipoprotein (LDL)-cholesterol were higher, or tended to be higher, in AN, but there were no correlations between plasma ApN and plasma lipids. By contrast, ApN was related to the lipid profile, in a manner consistent with its antiatherogenic role, in healthy controls [i.e. negatively correlated with triglycerides, total and LDL-cholesterol and total/high density lipoprotein (HDL) cholesterol; P < 0.05 or less for each parameter]. In a multiple regression analysis, BMI and insulin sensitivity in AN were independent determinants for ApN levels, explaining up to approximately 80% of the variance in this measure. CONCLUSIONS: Plasma adiponectin levels are increased in anorexia nervosa. This may, at least in part, be due to the lack of negative feedback exerted by fat mass on adiponectin production and/or to enhanced insulin sensitivity. We speculate that hyperadiponectinaemia could, in turn, contribute to maintain a state of enhanced insulin sensitivity and possibly exacerbate haematological and infectious complications of anorexia nervosa.

We report a case of Charcot spinal arthropathy in a diabetic patient and emphasize the clinical reasoning leading to the diagnosis, discuss the differential diagnosis, and insist on the crucial role of the radiologist and pathologist which allows the distinction between Charcot spinal arthropathy and infectious or tumoural disorders of the spine.

A 78-year-old man presented with a history of fever and night sweats of 1-month duration. His relevant medical history was a transitional-cell bladder cancer treated with intravesical instillation ...

Background: Septic arthritis (SA) is a rheumatological emergency that can lead to rapid joint destruction and irreversible loss of function. The most common pathogen causing SA is Staphylococcus aureus which is responsible for 37–65% of cases. Streptococcus pneumoniae is traditionally described as an uncommon cause of SA of a native joint. The objective of our study was to analyse clinical characteristics, treatment, and outcome of all cases of pneumococcal septic arthritis treated in our institution, and to compare them with other series published in the literature. Materials and methods: We conducted a retrospective study of pneumococcal SA identified among all cases of SA diagnosed in a teaching hospital of one thousand beds between 2004 and 2009. Diagnosis was based on culture of joint liquid or by the presence of pneumococcal bacteraemia and purulent (more than 50 000/mm3 white blood cells with more than 90% neutrophils) joint fluid aspiration. Results: Among 266 cases of SA, nine patients (3·3%) were diagnosed as having pneumococcal SA. The median age was 75 years. The main affected joint was the knee (7/9). No patient had more than one joint involved. Four patients suffered from concomitant pneumonia. Joint culture and blood cultures were positive in 7/9 and 5/9, respectively. Median (range) length of stay was 18 days (3–47 days). One patient with associated pneumococcal bacteraemia died 19 days after admission. Seven patients recovered completely. Conclusions: Streptococcus pneumoniae is now being increasingly recognized as a common agent of SA. This organism is frequently associated with pneumococcal pneumonia or bacteraemia, particularly in patients with advanced age and comorbidities. Direct inoculation of joint fluid into blood culture medium BACTEC system increases the probability of microbiological diagnosis. The prognosis is usually favourable if the disease is promptly recognized and treated (antibiotic therapy combined with joint drainage).