Parisi E, Tortel MC, Chenard MP
… +3 more, Raby P, Mazurier I, Moskovtchenko P
Ann Med Interne (Paris)
· 2003 Sep · PMID 14593315
We report an observation of intravascular lymphoma occurring in a 69-year-old woman. This relatively rare disease presents polymorphic clinical features that render diagnosis difficult. Cutaneous and central nervous syst...We report an observation of intravascular lymphoma occurring in a 69-year-old woman. This relatively rare disease presents polymorphic clinical features that render diagnosis difficult. Cutaneous and central nervous system signs and symptoms are frequently observed and should be recognized as suggestive of intravascular lymphoma. However, they are not always observed, in our case only pancytopenia was present. Pronostic is generally unfavorable but good response to chemotherapy has been described with early diagnosis. A large number of pathogenic hypotheses have been put forward: abnormality of cellular receptor, role of Epstein-Barr virus or transformation from lymphoma. Intravascular lymphoma should be included in the differential diagnosis of pancytopenia to increase chances of good response.
Laurat E, Revest M, Djenidi M
… +2 more, Decaux O, Jego P
Ann Med Interne (Paris)
· 2003 Sep · PMID 14593314
We report two cases of constrictive pericarditis revealing neoplasia. Both patients underwent pericardiotomy with drainage and biopsy that did not disclose malignancy. Likewise, the initial radiologic were not suggestive...We report two cases of constrictive pericarditis revealing neoplasia. Both patients underwent pericardiotomy with drainage and biopsy that did not disclose malignancy. Likewise, the initial radiologic were not suggestive of cancer.
Ksouri H, Zitouni M, Achour W
… +2 more, Makni S, Ben Hassen A
Ann Med Interne (Paris)
· 2003 Sep · PMID 14593313
Progress in immunologic methods and diagnostic assays over the last two decades has led the description of an association between some cases of recurrent fetal loss and recurrent spontaneous abortion of unknown cause to...Progress in immunologic methods and diagnostic assays over the last two decades has led the description of an association between some cases of recurrent fetal loss and recurrent spontaneous abortion of unknown cause to immunological factors. Some causal immunological diseases or dysregulations have been identified in pregnant women. These abnormalities may precede or be triggered by the pregnancy, or occasionally result from an impairment of the mother's allogeneic response to the fetus. In this article we review the principal immunological factors and abnormalities implicated in recurrent pregnancy loss and focusing on those generally accepted by the majority of authors.
Aulagnier M, Limosin F, Verger P
… +1 more, Rouillon F
Ann Med Interne (Paris)
· 2003 Sep · PMID 14593312
A traumatic event (assault, traffic accident, bomb attack or war, disasters.) is often followed by a reaction of fear and anxiety which can evolve to a posttraumatic stress disorder (PTSD). Its severity and associated ha...A traumatic event (assault, traffic accident, bomb attack or war, disasters.) is often followed by a reaction of fear and anxiety which can evolve to a posttraumatic stress disorder (PTSD). Its severity and associated handicap justify treatment as early as possible. We present the various PTSD treatments and discuss their respective efficiency and limitations. Most of available treatments (cognitive and behavioral therapies, antidepressants.) are efficient on PTSD and co-morbid disorders. However, the efficiency of some therapies (eye movement desensitization) on the treatment of PTSD are controversial. Studies are necessary to evaluate various treatment strategies, optimal duration of antidepressant treatment and pediatric therapies.
Ann Med Interne (Paris)
· 2003 Sep · PMID 14593311
Back pain is a common and disabling condition; it afflicts young adults, and often pursues a chronic course--representing a major public health problem. The physical component of such pain is often overestimated. This pa...Back pain is a common and disabling condition; it afflicts young adults, and often pursues a chronic course--representing a major public health problem. The physical component of such pain is often overestimated. This paper describes five cases demonstrating how somatic factors can interact with psychological and psychiatric factors--i.e. the 'psychoaffective context'--to determine the degree of perceived pain. In a schema, we summarize the three ways in which the psychoaffective context may contribute to pain: i) physiologically, as a result of increased arousal, leading to muscle tension and perceptual hypervigilance, ii) emotionally, as a result of anxiety leading to stress and feeling of threat, and iii) cognitively, as a cognitive bias caused by increased attention to signals from the target region, and by an increased tendency to interpret these signals as aversive. Personality factors, autobiographical memory, and the place devoted to the body within the narcissistic equilibrium contribute to the degree of anxiety and cognitive bias. Moreover, anxiety and the cognitive bias are also exacerbated by the depressive syndrome that often accompany such pain. Collectively, these factors can lead to a somatization disorder and to chronic pain, even in response to an experience of minimal pain.
Godart N, Flament M, Curt F
… +9 more, Perdereau F, Lang F, Venisse JL, Halfon O, Bizouard P, Loas G, Corcos M, Jeammet P, Fermanian J
Ann Med Interne (Paris)
· 2003 Sep · PMID 14593310
OBJECTIVE: We designed a controlled study comparing referred women with an eating disorder (ED) to a matched normal control group to answer the following questions: what are the frequencies of anxiety disorders (AD) in a...OBJECTIVE: We designed a controlled study comparing referred women with an eating disorder (ED) to a matched normal control group to answer the following questions: what are the frequencies of anxiety disorders (AD) in anorexia nervosa (AN) and bulimia nervosa (BN), according to DSM-IV criteria? Are AD significantly more frequent among women with an ED than among women from the community? METHOD: We assessed frequencies of six specific AD among 271 women with a current diagnosis of AN or BN and 271 controls, using the Mini International Neuropsychiatric Interview (MINI), French DSM-IV version. RESULTS: Seventy-one percent of both the AN and the BN subjects had a lifetime comorbidity with at least one AD, significantly more (p<0.001) than the percentage of controls with an AD. Prevalence was significantly higher in the ED groups than in controls for most types of AD, and between 41.8% and 53.3% of comorbid cases had an AD preceding the onset of the ED. CONCLUSION: Evidence that AD are significantly more frequent in subjects with ED than in the community has important etiological and therapeutic implications.
Andreu M, Gordien E, Lhote F
… +3 more, André MH, Deny P, Guillevin L
Ann Med Interne (Paris)
· 2003 Sep · PMID 14593309
In polyarteritis nodosa (PAN) due to hepatitis B virus (HBV) infection, the insidious nature of the infection makes very difficult to establish the chronology which often remains unknown. PN occurs in the majority of pat...In polyarteritis nodosa (PAN) due to hepatitis B virus (HBV) infection, the insidious nature of the infection makes very difficult to establish the chronology which often remains unknown. PN occurs in the majority of patients during the year following infection. Simultaneous occurrence or occurrence immediately after infection with the HBV is exceptional. We report here three cases of this form of simultaneous HBV infection and PN and describe the particular clinical, virological and evolutive features of the disease.
Delbrel X, Le-Bougeant P, Etienne G
… +5 more, Blanco P, Beylot-Barry M, Amouretti M, Mercie P, Longy-Boursier M
Ann Med Interne (Paris)
· 2003 Sep · PMID 14593308
BACKGROUND: Celiac disease is an autoimmune disorder which may be associated with another autoimmune or systemic disease. OBJECTIVE: To determine the links between autoimmune diseases and celiac disease. PATIENTS AND MET...BACKGROUND: Celiac disease is an autoimmune disorder which may be associated with another autoimmune or systemic disease. OBJECTIVE: To determine the links between autoimmune diseases and celiac disease. PATIENTS AND METHODS: Among 31 patients with a celiac disease, we selected those who had another autoimmune or systemic disease. RESULTS: We report 6 patients with such disease association: 3 with autoimmune thyroiditis including one also with Grave's disease, 2 with systemic lupus erythematosus including one also with insulin-dependent diabetes mellitus, and 1 with temporal arteritis. CONCLUSION: The link between celiac disease and autoimmune thyroiditis or insulin-dependent diabetes mellitus seems to be real but many discrepancies are observed for the other autoimmune diseases. After a literature review, we suggest a summary of effective associations between celiac disease and autoimmune or systemic diseases.
Tonduangu KD, Jungfer F, Nahila M
… +6 more, Ranarivelo L, Mogylevsky A, Gaillard C, Adande P, Amarni N, Malaca R
Ann Med Interne (Paris)
· 2003 May · PMID 12910050
Cephalic tetanus is a rare form of tetanus defined as trismus plus paralysis of one or more cranial nerves. The seventh cranial nerve is most commonly involved. The process can remain localized, or become generalized. We...Cephalic tetanus is a rare form of tetanus defined as trismus plus paralysis of one or more cranial nerves. The seventh cranial nerve is most commonly involved. The process can remain localized, or become generalized. We describe the case of an elderly Caucasian man who developed cephalic tetanus after head trauma with a facial wound. Bell's palsy was inaugural.
Ann Med Interne (Paris)
· 2003 May · PMID 12910049
A 16-year-old girl from Guadeloup developed paresis of the flexors of the right foot, associated with edema and acute pain located in the upper anterior tibialis muscle. Electromyography confirmed mononeuritis of the rig...A 16-year-old girl from Guadeloup developed paresis of the flexors of the right foot, associated with edema and acute pain located in the upper anterior tibialis muscle. Electromyography confirmed mononeuritis of the right peroneal nerve, with severe reduction of potential amplitude. Computed tomography of the right leg showed a heterogeneous mass involving the upper segment of the anterior tibialis muscle, close to the location of peroneal nerve. Muscle biopsy confirmed pyomyositis. Muscle culture was negative. Paresis improved soon after antibiotic therapy was started.
Bauduceau O, De Revel T, Fogelman J
… +3 more, Amadou S, Souleau B, Nedellec G
Ann Med Interne (Paris)
· 2003 May · PMID 12910048
Spontaneous hematoma in the ilio-psoas muscle is an uncommon condition, usually observed as a complication of anticoagulation or hemophilia. Clinically, the onset is marked by violent pain in the territory of femoral ner...Spontaneous hematoma in the ilio-psoas muscle is an uncommon condition, usually observed as a complication of anticoagulation or hemophilia. Clinically, the onset is marked by violent pain in the territory of femoral nerve and/or psoitis. The diagnosis is confirmed by echography or CT-scan. The most serious complications are loss of self-sufficiency and neuro-muscular after-effect. Surgery is recommended in patients with neurological suffering, followed by early physiotherapy. We report the case of a 42-year-old man, with an ilio-psoas muscle hematoma, revealing chronic myeloid leukemia, without any hemostasis disorder.
Fradet G, Robin-Le Nechet A, Huguenin H
… +1 more, Chiffoleau A
Ann Med Interne (Paris)
· 2003 May · PMID 12910047
Celecoxib is a non-steroidal anti-inflammatory drug (NSAID) which acts via specific inhibition of cyclooxygenase-2 (synthesis of prostaglandins mediating pathological inflammation) but which preserves the homeostatic act...Celecoxib is a non-steroidal anti-inflammatory drug (NSAID) which acts via specific inhibition of cyclooxygenase-2 (synthesis of prostaglandins mediating pathological inflammation) but which preserves the homeostatic action of cyclooxygenase-1. The efficacy of celecoxib is similar to that of classical NSAIDs and its tolerance is comparable with that of placebo. We nevertheless observed one patient with hypersensitivity to celecoxib who developed fever, toxic skin reaction, and liver involvement.
Ann Med Interne (Paris)
· 2003 May · PMID 12910046
Drug-induced aseptic meningitis has been reported mainly with the use of nonsteroidal anti-inflammatory drugs, antibiotics, intravenous immunoglobulins and OKT3 antibodies. We describe today a very unusual reaction on in...Drug-induced aseptic meningitis has been reported mainly with the use of nonsteroidal anti-inflammatory drugs, antibiotics, intravenous immunoglobulins and OKT3 antibodies. We describe today a very unusual reaction on intravenous dexchlorpheniramine with this case of aseptic meningitis.
El Khattabi A, Tabache F, Baaj M
… +4 more, Abouzahir A, Ghafir D, Ohayon V, Archane MI
Ann Med Interne (Paris)
· 2003 May · PMID 12910045
PURPOSE: Gastrointestinal bleeding, an uncommon complication of polycythemia can be the inaugural sign in exceptional cases. CASE REPORT: A 35-year-old patient was hospitalized for upper gastrointestinal bleeding. Physic...PURPOSE: Gastrointestinal bleeding, an uncommon complication of polycythemia can be the inaugural sign in exceptional cases. CASE REPORT: A 35-year-old patient was hospitalized for upper gastrointestinal bleeding. Physical examination and laboratory tests led to the diagnosis of polycythemia (Vaquez disease). Gastroscopy showed an hemorrhagic bulber ulcer. Outcome was favorable after chemotherapy and antinuclear treatment. CONCLUSION: Based on this observation and data in the literature we propose that this unusual presentation would suggest a relationship between polycythemia and ulcer disease.
Ann Med Interne (Paris)
· 2003 May · PMID 12910044
In 1961, Stauffer first described a syndrome characterized by nonmetastatic intrahepatic cholestasis associated with undifferentiated renal adenocarcinoma. Since that time, this syndrome has been associated with other tu...In 1961, Stauffer first described a syndrome characterized by nonmetastatic intrahepatic cholestasis associated with undifferentiated renal adenocarcinoma. Since that time, this syndrome has been associated with other tumor diseases. We describe here a patient with lung adenocarcinoma which led to paraneoplastic cholestasis. We discuss the diagnosis and review the literature, emphasizing the pathophysiology of Stauffer's syndrome.
Labaye J, Duvic C, Sarret D
… +2 more, Dordain ML, Nedelec G
Ann Med Interne (Paris)
· 2003 May · PMID 12910043
We report the case of a patient with predominantly renal sarcoidosis. Renal failure responded well to systemic corticosteroid therapy. The clinical presentation was particular, notably the absence of lung involvement and...We report the case of a patient with predominantly renal sarcoidosis. Renal failure responded well to systemic corticosteroid therapy. The clinical presentation was particular, notably the absence of lung involvement and the presence of cutaneous lymphedema.
Ann Med Interne (Paris)
· 2003 May · PMID 12910042
Sjögren's syndrome (SS) is an excellent model for understanding the pathophysiology of autoimmune diseases and the relationships between autoimmunity and lymphoma. Recently discovered new elements probably play a role in...Sjögren's syndrome (SS) is an excellent model for understanding the pathophysiology of autoimmune diseases and the relationships between autoimmunity and lymphoma. Recently discovered new elements probably play a role in the pathogenesis of this multifactorial disease: genetic predisposition remains largely unknown, but there isa link between certain HLA molecules and the type of autoantibodies secreted; sometimes called autoimmune epithelitis, SS is associated with abnormal apoptosis activity in epithelial cells leading to an abnormal accumulation of degradation products of the cytoskeleton proteins such as alpha- and beta-fordrine and also to the presentation of numerous antinuclear autoantigens to the immune system; significant polyclonal activation of B lymphocytes is probably mediated, at least in part, by a major increase in molecules of the TNF family (e.g. BlyS or BAFF) which play an important role in the production of autoantibodies; cytokine inhibition of healthy glands or anti-muscarin receptor antibodies and abnormal function of certain water pumps such as aquaporine could explain the perturbed function of the remaining healthy glands; permanent stimulation of autoreactive B cells favors oncogenic events and could lead to the development of B lymphoma with autoantibody activity. The links between these different elements are progressively falling into place. A better understanding of the pathophysiology of SS can be expected to lead to the development of much needed new therapeutic tools.
Fournier JP, De Champlain AF, Benchimol D
… +15 more, Staccini P, Subhiyah R, Braun M, Kohler C, Guidet B, Claudepierre P, Prevel M, Scoles P, Holtzman K, Swanson D, Angelucci K, McGrenra C, Goldberg J, Rampal P, Melnick D
Ann Med Interne (Paris)
· 2003 May · PMID 12910041
Medical training is undergoing extensive revision in France. A nationwide comprehensive clinical competency examination will be administered for the first time in 2004, relying exclusively on essay-questions. Unfortunate...Medical training is undergoing extensive revision in France. A nationwide comprehensive clinical competency examination will be administered for the first time in 2004, relying exclusively on essay-questions. Unfortunately, these questions have psychometric shortcomings, particularly their typically low reliability. High score reliability is mandatory in a high-stakes context. The National Board of Medical Examiners-designed multiple choice-questions (MCQ) are well adapted to assess clinical competency with a high reliability score. The purpose of this study was to test the hypothesis that French medical students could take an American-designed and French-adapted comprehensive clinical knowledge examination with this MCQ format. Two hundred and eighty five French students, from four Medical Schools across France, took an examination composed of 200 MCQs under standardized conditions. Their scores were compared with those of American students. This examination was found assess French students' clinical knowledge with a high level of reliability. French students' scores were slightly lower than those of American students, mostly due to a lack of familiarity with this particular item format, and a lower motivational level. Another study is being designed, with a larger group, to address some of the shortcomings of the initial study. If these preliminary results are replicated, the MCQ format might be a more defendable and sensible alternative to the proposed essay questions.
Malliti M, Junot H, Fievet MH
… +4 more, Gabarre J, Taright N, Vernant JP, Thuillier A
Ann Med Interne (Paris)
· 2003 May · PMID 12910040
The monoclonal antibody rituximab, targeted against the CD20 antigen, has shown efficacy in patients with follicular lymphoma who relapse or fail to response to conventional chemotherapy. We evaluated the economic impact...The monoclonal antibody rituximab, targeted against the CD20 antigen, has shown efficacy in patients with follicular lymphoma who relapse or fail to response to conventional chemotherapy. We evaluated the economic impact of using rituximab for the treatment of non-Hodgkin's lymphoma (NLH) in comparison with conventional chemotherapy protocols (CHOP or CHVP). In this retrospective study conducted between 1998 and 2000, the direct costs of treating inpatients with NHL rituximab (n=20) or CHOP/CHVP (n=17) were compared. Results, including costs of administering chemotherapy and adverse events, showed that the average cost per patient was comparable for the two strategies (9700 euro for rituximab, versus 8487 euro for conventional chemotherapy). In the rituximab group, the cost was mostly due to drug purchases. In the conventional chemotherapy group, outlays were related to drug-induced toxicity and longer hospital stay. Our results were similar to others described in the literature. Prospective studies are nevertheless needed for confirmation. For first-line treatement, the difference in the cost-effectiveness-ratio between rituximab and conventional drugs might be smaller, but sound data are not yet available.