-
La Revue de Médecine Interne 01/2013; · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: INTRODUCTION: Fever happens frequently in colon cancer but it is rarely the presenting manifestation. PATIENTS AND METHODS: We report a case series of patients with colon cancer revealed by fever in the three military hospitals in Paris. RESULTS: Of the 11 patients studied, seven were men and four were women, and their mean age was 70 years. Cancer was localized in the sigmoid colon (n=6), left colon (n=3) and right colon (n=2). Cancer staging (UICC TNM classification 2002) was respectively pTis (n=1), I (n=4), II (n=3) and III (n=3). Fever was the only reason for admission and two patients had a recurrent fever of unknown origin. All patients but one had bacterial infection. Blood cultures grew up in six cases, Escherichia coli (n=3), Streptococcus gallolyticus (ex bovis) (n=2) and anaerobic bacteria (n=1). There was one case of infective endocarditis caused by S. gallolyticus. Imaging showed a liver abscess (n=3) and a colon cancer complicated by an abscess (n=3). In seven patients, a familial history of colon cancer and symptoms of underlying colic disease were present (neglected rectal bleeding, iron deficiency anaemia, clinical evidence of an abdominal mass). CONCLUSIONS: Fever may reveal colon cancer at an early stage. Its main cause is a bacterial infection, such as bacteremia or abscess. Fever of unknown origin is a rare presentation. Detailed history, careful clinical examination and analysis of imaging contribute to recommend the prescription of colonoscopy.
La Revue de Médecine Interne 10/2012; · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: INTRODUCTION: Campylobacter fetus is a rare Gram-negative bacteria affecting especially elderly and immunocompromised patients, and that is responsible of vascular and cutaneous involvement. OBSERVATIONS: We report two cases of C. fetus infection in two diabetic male patients, aged 75 and 85years. The first patient was admitted for chronic fever. First-line examinations were inconclusive. Combined positron emission tomography and computed imaging tomography (PET-CT) diagnosed an infection of a previously operated popliteal aneurysm. The patient underwent surgery, and per-operative samples were positive for C. fetus. The second patient was admitted for a leg cellulitis. Blood cultures were positive for C. fetus. PET-CT found a septic superficial thrombophlebitis. The outcome was favorable for both patients with prolonged antibiotic therapy. CONCLUSION: Vascular involvement should be suspected in the presence of C. fetus infections. PET-CT may be useful, as other imaging modalities are not always contributive.
La Revue de Médecine Interne 09/2012; · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: La localisation duodénale des lymphomes folliculaires est considérée comme rare, mais l’incidence de ces tumeurs est en augmentation.
Nous rapportons une observation de lymphome primitif du duodénum, montrant la similitude des données endoscopiques avec celles
de la papulose lymphomateuse des lymphomes du manteau. Les techniques immunohistochimiques et cytogénétiques aident à différencier
ces deux tumeurs. Il est essentiel de les différencier car leur pronostic et les modalités de traitement sont différents.
The duodenal localization of follicular lymphoma is considered to be rare, but the incidence of these tumors is rising. We
report a case of a primary follicular lymphoma of the duodenum, showing that the endoscopic findings are often similar to
those found in lymphomatous polyposis associated with mantle-cell lymphomas. The immunohistochemical and cytogenetic techniques
help differentiate between these two conditions. It is essential to differentiate between these two forms of non-Hodgkin lymphomas,
as they do not carry the same prognosis and the therapeutic protocols.
Acta Endoscopica 04/2012; 35(3):395-400. · 0.09 Impact Factor
-
S Bonnefoy,
A Chauvin,
C Galéano-Cassaz,
S Camilleri-Broet,
S-F Jacquet,
T Carmoi,
G Perrot,
H Blondon,
S Lecoules,
A Cambon, J-P Algayres
[show abstract]
[hide abstract]
ABSTRACT: Tropical sprue is a postinfective malabsorption syndrome that occurs in some tropical endemic areas.
A 65-year-old Caucasian patient, with no significant past medical history, living in Cambodia for 10 years, presented with a 23 kg weight loss and chronic diarrhea. Clinical examination was unremarkable. Laboratory tests showed a moderate nutritional deficiency syndrome. The upper gastrointestinal endoscopy showed duodenal villous atrophy and histological analysis confirmed subtotal villous atrophy with important intraepithelial lymphocytosis. The diagnosis of tropical sprue was considered on the epidemiological, clinical and biological context, and the absence of other cause of villous atrophy. A three-month duration treatment with antibiotics, folic acid and vitamin B12 was initiated. The clinical course was favorable with disappearance of diarrhea in 15 days. One year later, the patient had resumed his usual weight, and laboratory tests and duodenal biopsies were normal.
The diagnosis of tropical sprue should be systematically discussed in any malabsorption syndrome with villous atrophy in a patient living or having lived in the tropics.
La Revue de Médecine Interne 03/2012; 33(5):284-7. · 0.61 Impact Factor
-
La Revue de Médecine Interne 11/2011; 32 Suppl 2:S201-2. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: FDG-PET, now hybrid positron emission tomography/computed tomography (PET-CT), has become an established diagnostic tool in oncology. Fluorodesoxyglucose ((18)F-FDG) is not specific for malignant lesions, as uptake of the tracer depends on its accumulation in cells with an increased glucose metabolism as it is also the case in infectious and inflammatory lesions, like sarcoidosis. Thus, FDG-PET has been proposed for internal medicine indications, one of whom is sarcoidosis. The main characteristics of FDG-PET are its better sensitivity compared to (67)Ga scintigraphy and its ability to be used as an earlier marker of therapeutic response as compared with anatomy-based and conventional scintigraphic imaging. However, FDG-PET should be used in atypical or advanced stage of the disease. Future prospective studies should be awaited before integrating FDG-PET in clinical routine for treatment outcome and disease activity assessment in sarcoidosis. New radiopharmaceutical probes are under development and will improve the performance of PET.
La Revue de Médecine Interne 02/2011; 32(2):101-8. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Early studies on prolonged fever date back to the 1960s. Fifty years later, prolonged unexplained fever remains a diagnostic challenge to the general internists. Although the aetiologies of prolonged fevers have not changed much in the general population, the distribution between the various causes is not the same anymore. A regular decrease in infectious and neoplastic causes is noticed whatever the age. Prolonged fevers related to inflammatory disorders and fevers that remain of unknown origin still represent approximately 30 to 50% of the cases. In the young adult population, as in the older patients, prolonged fevers can be attributed to four groups: infection, inflammation, neoplasic and other aetiologies (including drug-related fevers). In the young adult population, the management of prolonged fever presents some specific issues that are the purpose of this review coupled with our own experience. The prognosis of undiagnosed prolonged fever is usually favourable, as a life-threatening aetiology is exceptionally diagnosed during the follow-up if the initial management was complete and accurate.
La Revue de Médecine Interne 12/2010; 31(12):838-45. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The search of JAK2 V617F mutation is a useful tool for the diagnosis of myeloproliferative disorders (MPD). This case report highlights the potential usefulness of this testing in recurrent deep venous thrombosis (DVT) of lower limb. We report a 73-year-old man who presented with three spontaneous episodes of lower limb DVT. The third episode occured while he was receiving fluindione. MPD was suspected because of an increased hematocrit (55 %) and hemoglobin (17g/dl) level. Red cell blood volume was increased and a JAK2 V617F mutation was detected confirming the diagnosis of polycythemia vera. The usefulness of JAK2 mutation for the diagnosis of MPD has been widely demonstrated. Also, some studies confirmed its usefulness in apparently idiopathic abdominal venous thrombosis. This report highlights the possible interest of JAK2 mutation in unexplained recurrent lower limb DVT, especially when it occurs under anticoagulant therapy.
La Revue de Médecine Interne 03/2010; 31(7):e1-3. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Esophageal adenocarcinoma and its precursor Barrett's esophagus are increasing in incidence in western populations. Gastroesophageal reflux and high body mass index (BMI) are known risk factors. Studies about Barrett's esophagus in obese patients have emphasised the role of central adiposity as a stronger risk factor than BMI in the development of specialized intestinal metaplasia and subsequently esophagus adenocarcinoma. The proinflammatory impact of adipocytokines of the abdominal fat associated with the metabolic syndrome is also relevant. Except cardiovascular diseases, type 2 diabetes and non alcoholic steatohepatitis, abdominal obesity and metabolic syndrome are responsible of an increase of prevalence of esophageal adenocarcinoma, but also other cancer sites. In this review, we study the up to date main epidemiologic and physiopathologic data concerning this association that could be important in future for a preventive action in obese patients, especially when metabolic syndrome is present.
Gastroentérologie Clinique et Biologique 03/2009; 33(3):155-66. · 0.80 Impact Factor
-
Gastroentérologie Clinique et Biologique 02/2009; 33(1 Pt 1):85-7. · 0.80 Impact Factor
-
Gastroenterologie Clinique Et Biologique - GASTROEN CLIN BIOL. 01/2009; 33(3):155-166.
-
[show abstract]
[hide abstract]
ABSTRACT: The association of microscopic colitis with celiac disease is rare. A case of microscopic colitis associated with celiac disease and following administration of venlafaxine in a 67-year-old patient is described. The pathophysiologic hypotheses of such an association are discussed.
Revue De Medecine Interne - REV MED INTERNE. 01/2009; 30(1):74-77.
-
Y Sekkach,
H Baizri,
J Mounach,
H Qacif,
N El Omri,
H Chahdi,
F Rkiouak,
G Belmejdoub,
D Ghafir,
V Ohayon, J-P Algayres
[show abstract]
[hide abstract]
ABSTRACT: We report a historical case of hyperparathyroidism in a young patient hospitalized for an array of osteolytic foci and incomplete fracture associated with a swollen neck, revealing a very special form of a metastatic parathyroid carcinoma with unusual multiple locations and exceptional medullary flooding. Carcinoma of the parathyroid gland produces a malignant hypersecreting tumor particularly difficult to diagnose. Treatment of this rare tumor is primarily surgical. The preoperative syndrome is unusually severe primary hyperparathyroidism. Intraoperatively, the size of the tumor and its local extension to surrounding tissue are highly suggestive. Confirmation requires pathological analysis of the operative specimens and can be further supported by the clinical course of local recurrence or metastasic spread. Specific immunohistochemical techniques have recently been shown to be contributive. The diagnosis is strengthened in the presence of associated Schantz and Castelman criteria. Foci of local extension can be identified preoperatively with ultrasound, (99m)Tc-sestamibi scintigraphy and MRI of the neck and mediastinum. The prognosis depends mainly on the possibility of achieving complete resection at the initial surgery. In some cases, very aggressive complementary postoperative radiotherapy is likely to improve locoregional control of the tumor. Chemotherapy alone or in combination with radiation has not demonstrated its effectiveness. The disease course and control can be monitored by regular assay of serum calcium and the parathormone.
Annales d Endocrinologie 11/2008; 70(1):64-70. · 0.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: G6PD deficiency is very frequent with almost 400 millions of patients worldwide in Asia, Africa and Mediterranean. G6PD deficiency is involved in mild or severe haemolysis and the precipitating factor is usually a drug. More than 100 drugs have been implicated and fluoroquinolones are one of the more classic. However, the literature review shows that only a few observations have been clearly documented.
La Revue de Médecine Interne 10/2008; 30(4):355-7. · 0.61 Impact Factor
-
La Revue de Médecine Interne 08/2008; 29(7):577-8. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We report a case of acute renal insufficiency in a 77 year-old patient who took flurbiprofen as antiplatelet therapy. This is an important observation because it illustrates the potential risk of acute renal insufficiency, when using flurbiprofen before invasive medical examination or surgery in patients receiving long-term treatment with angiotensin converting enzyme inhibitors or angiotensin II inhibitors. This risk is probably underestimated in usual clinical practice.
La Revue de Médecine Interne 08/2008; 29(7):593-5. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Sporadic colonic juvenile polyps are uncommon in adults. We report three cases for which clinical manifestations were presence of occult blood in the stool, rectal bleeding or chronic diarrhea. Two of these polyps occurred in the caecum which is an uncommon localisation. Endoscopic characteristics of these polyps were indistinguishable from adenomas. Endoscopic resection was complicated in one case by bleeding.
Gastroentérologie Clinique et Biologique 08/2008; 33(1 Pt 1):88-91. · 0.80 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The association of microscopic colitis with celiac disease is rare. A case of microscopic colitis associated with celiac disease and following administration of venlafaxine in a 67-year-old patient is described. The pathophysiologic hypotheses of such an association are discussed.
La Revue de Médecine Interne 06/2008; 30(1):74-7. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Our aim is to describe the skeletal manifestations of Behcet's disease (BD) among young adults in a military population.
We conducted a retrospective study of 176 patients with BD who were followed between 1980 and 2005. All the patients fulfilled the international study group on Behcet's disease diagnostic criteria.
Rheumatic manifestations were noticed in 79 out of 176 patients (45%), ranking second after the skin and mucosal manifestations of the disease. Articular manifestations were the first disease manifestation in 16.5% of the patients. Inflammatory arthralgias were the most common manifestation and observed in 81%, interesting mainly the large lower limb joints. Disease course was acute in most of the patients. Arthritis was less common: oligoarthritis (7.5%), monoarthritis (6.5%) and polyarthritis (5%). Axial involvement was also noted: spine pain in 29%, isolated sacroiliitis in 7.5%, and definite ankylosing spondylitis in 5%.
Joint involvement is common in BD and could be the first manifestation of the disease. Most of the patients present with inflammatory arthralgias of the large lower limb joints. Disease course is usually favourable, spontaneously or with treatment. However, in our study population, skeletal manifestations were responsible for significant disability.
La Revue de Médecine Interne 05/2008; 29(4):277-82. · 0.61 Impact Factor
