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We report 4 cases of chronic diarrhoea in patients treated with Cylclo 3 fort. This side-effect was not mentioned in the French list of therapeutic drugs until 1992. The diarrhoea was without faeces and without glairy mucus or blood. Symptomatic treatments were totally ineffective. The diarrhoea itself was well tolerated, but 3 patients lost weight, with hypokalaemia in 2 of them, and 1 had regressive acute renal failure. The time elapsed between the first dose of Cyclo 3 fort and the diarrhoea ranged from 1 to 3 months, and it took 5 months to make the aetiological diagnosis. Two patients were hospitalized. Withdrawal of the drug always resulted in cure. One patient taking enemas developed a regressive subocclusion of the bowel. The physiopathological mechanism of this diarrhoea is unknown. These cases are similar to the 5 other cases reported in the literature.

The term "chronic fatigue syndrome" (CFS) applies to a condition of unknown aetiology characterized clinically by an association of subjective symptoms, the most constant being an invalidating tiredness. The diagnostic criteria in current use do not permit to isolate an homogeneous subgroup among patients consulting for chronic asthenia. In the present state of research no infectious or immunological cause has been demonstrated conclusively, although a persistent enterovirus or herpesvirus type 6 infection or a state of chronic immune activation seem to play a role in some cases. Patients who fulfill the criteria of CFS present with psychiatric overmorbidity, essentially depressive, and in 50% of the cases with the mental disorders preceding CFS. The various theoretical models linking CFS to psychopathology are discussed, and finally the syndrome is regarded as a social construction reproducing or renovating the neurasthenia of the late 19th century. There is no specific treatment of CFS, but antidepressants, cognitive-behavioural therapy and perhaps certain immuno-modulators can be useful. The future lines of research should endeavour to isolate a subgroup of patients with prolonged asthenia after a recognized episode of infection and to identify the immunological, psychological and behavioral characteristics of this particular group as well as their reciprocal interactions.

We report on 9 cases of systemic mastocytosis which underline the frequency and the potential severity of this disease. All patients had intercritical signs (usually urticaria). Seven patients had also typical crises with flush and vascular collapses are observed together, doctors should measure histamine blood level and perform correct biopsy.

The authors report 11 cases of multiple autoimmune syndromes. Autoimmune thyroid disorders and Sjogren's syndrome seem to be non-randomly associated and might share a genetic predisposition linked to HLA phenotype B8 DR3 and B12 DR4.

We report 9 cases of enteroviral infection associated with systemic inflammatory disease (including 4 cases of vasculitis, 1 case of periarteritis nodosa, 1 case of Sharp's syndrome). We then reviewed 36 cases of enteroviral infection with persistent IgM antibodies diagnosed in the virology laboratory in a 6-year period: among them 11 cases were found to present with subacute or chronic inflammatory disease. We conclude that enteroviruses might be important triggers of systemic inflammatory disease.

Two new cases of eosinophilic ascites and a brief review of 40 cases found in the literature are presented. In three quarters of the cases eosinophilic ascites affects women aged 40 years on average. Because the patients present with a history of allergy (55%), blood hypereosinophilia (69%), associated pleural effusion (11%), gastrointestinal disorders and, above all, eosinophilic infiltrations in the walls of the digestive tract or the serous membranes (63%), this pathology may be regarded as a clinical form or eosinophilic gastroenteritis. The outcome is favourable in 90% of the cases; relapses occur in 26%. Is eosinophilic gastroenteritis and independent pathological entity, or should it be considered a minor clinical form of Chusid's idiopathic hypereosinophilic syndrome? The lack of decisive arguments precludes a firm conclusion.

To ascertain the responsibility of renal artery thrombosis for the genesis of arterial hypertension, the methods available are not sufficiently sensitive and reproducible, and the residual revascularization maintained by a vicarious arterial network is not easy to demonstrate. Renal scintigraphy with technetium 99m-labelled mercaptoacetyltriglycine (MAG3) was performed in 4 old and severely hypertensive male patients with chronic thrombosis of one renal artery. With this tracer the thrombotic kidney was detected lately and weakly at the vascular and nephrographic stages. When the functions of both kidneys were compared, that of the affected kidney was always estimated at less than 5%. At the excretory stage a residual activity could be detected in the kidney with renal artery thrombosis. Owing to the specific biophysical behaviour of the tracer, MAG3 scintigraphy coupled with arteriography and assays of plasma renin activity in the veins contribute to the decision concerning nephrectomy.

A case of facial hemiatrophy and homolateral cervical band of scleroderma, complicated by hypothyroidism is reported. This case raises two problems: one is the problem of distinction between Romberg's disease and facial hemiatrophy due to a genuine localized scleroderma; the other concerns the relationship between localized scleroderma and dysthyroidism. The generalized scleroderma-dysthyroidism association has now been recognized, but the coexistence of thyroid disease and localized scleroderma has not yet been reported. Several pathogenetic hypotheses on this association are discussed.

TSH values performed by immunoradiometric method were compared with chemiluminescent method in 28 hyperthyroid patients with negative TRH-test. This last method gives a better sensitivity (0.020 mUI/L vs. 0.050 mUI/L) and reproducibility (5% V.C. vs. 40%). The measure of undetectable TSH by immunoradiometric assay becomes possible with chemiluminescence. Due to this increase of sensitivity, the TRH-test needs to be reconsidered and allows to discriminate various degrees of TSH suppression.

Background Fever of unknown origin (FUO) still remains a diagnostic challenge, while diagnosis may remain obscure for several weeks or months. The role of tissue biopsy is crucial in the diagnostic approach. We report a series of 130 consecutive patients with FUO who had undergone a bone marrow biopsy (BMB). Methods Among 280 consecutive nonimmunocompromised patients hospitalized between 1995 and 2005 for a febrile illness of uncertain cause, lasting at least 3 weeks, with no diagnosis after an appropriate minimal diagnostic workup, 130 underwent BMB. Results Overall, a specific diagnosis was achieved by BMB and histological examination in 31 cases (diagnostic yield, 23.7%). Three types of diseases were found: hematological malignant diseases in 25 cases, including 19 patients with malignant lymphoma, 4 with acute leukemia, 1 with hairy cell leukemia, and 1 with multiple myeloma; infectious diseases in 3 cases; systemic mastocytosis in 2 cases; and disseminated granulomatosis in 1 case. Thrombocytopenia (odds ratio, 4.9; 95% confidence interval, 1.04-9.30) and anemia (odds ratio, 3.24; 95% CI, 1.13-9.34) were the most reliable predictive factors regarding the usefulness of BMB. Bone marrow cultures had very limited value in our cohort. Finally, corticosteroid use did not seem to affect the yield of BMB. Conclusions Bone marrow biopsy is a useful technique for the diagnosis of prolonged fever in immunocompetent patients. Thrombocytopenia and anemia seem to be correlated with the value of this test.

Several epidemiological studies as well as clinicians' experience indicate that during the last four decades anorexia nervosa, perfectly described in the 19th century, has become increasingly frequent in industrial societies. In contrast, the disease is said to be extremely rare in traditional societies where it appears only when the life style has been "occidentalized". As a pathology of starvation in a society of abundance, anorexia nervosa lies at the cross-roads of biology and society by referring to two sectors with strong cultural determinations: the ideal body shape and the moral value of food. In a more subtle way, the ever growing incidence of the disease might also coincide with the expansion of such occidental moral values as self-control and individualism and with changes in family structure. Anorexia nervosa may be regarded as a culturally determined illness that "shapes" in a stereotyped mould psychological or even neuroendocrine disorders which vary from one patient to another. This brings it very close to the "culture-bound syndromes" or "ethnic disorders" described by ethnopsychiatrists.

Acute systemic lupus erythematosus (SLE) is characterized by a variety of manifestations and by the almost constant presence of anti-nuclear antibodies. In order to distinguish it from other systemic diseases, eleven diagnostic criteria have been laid down, four of which at least must be present. In 50 p. 100 of the cases the disease is revealed by a non-destructive inflammatory polyarthritis which is highly suggestive when associated with a "butterfly" facial erythema. The main prognostic criteria are renal lesions and their histological type. Nervous system involvement seems to be less frequent and less severe nowadays, but it may leave sequelae. Pleuropericarditis and vascular thrombosis are commonly part of the clinical set up. Antinuclear antibodies are detected by immunofluorescence in more than 95 p. 100 of the patients, but they are not specific to SLE. Their absence in the initial phase of the disease may throw doubts on the diagnosis. Antibodies to DNA and Sm are more specific but inconstant. SLE is a chronic disease with intermittent flare-ups: 30 p. 100 of the patients may hope for a prolonged complete remission. At present, the survival rate at 10 and 20 years is higher than 80 p. 100 and 70 p. 100 respectively at the cost of a very close supervision but also of iatrogenic complications in increasing numbers.

Fourteen cases of drug fever due to fipexide were reported by a retrospective survey of a National Network of French Pharmacovigilance. 8 women, 6 men (mean age, 52 years), presented a sudden fever with a mean onset delay of 7 days after the first cure (range 2-12 days). In five cases, drug fever was the only manifestation; in other cases, it was associated with systemic or cutaneous signs. Eosinophilia was frequent (8 cases) and once, a chest picture showed an interstitial pneumonitis. Fever disappeared promptly after discontinuation of the drug and for ten patients, the rechallenge was positive within a short time. The clinical picture and laboratory tests are discussed and suggest an hypersensitivity reaction.

Among the thrombotic events associated with a circulating anticoagulant of the antiprothrombinase type, myocardial infarction is exceptionally reported, which justifies the presentation of two cases. In both patients, myocardial necrosis occurred some time after the antiprothrombinase was discovered, and there was nothing special in its clinical features. No obvious atherosclerotic lesion and no image suggestive of vasculitis were found at coronary arteriography, which suggested that the antiprothrombinase played a predominant role in the genesis of infarction. Relationships between antiprothrombinase, arterial thrombosis (particularly of the coronary arteries) and the presence or absence of systemic lupus erythematosus (SLE) are discussed. As observed in thrombosis of other arteries, it is not certain that the presence of SLE constitutes an additional risk factor, except in cases with unquestionable vasculitis or if the treatment of SLE requires prolonged corticosteroid therapy. On the other hand, the appearance of an antibody directed against phospholipids is not necessarily related to the presence of SLE; in fact, this antibody itself might be a risk factor of myocardial infarction, as has recently been suggested.

The authors report two cases of hypercalcemia which occurred in hypoparathyroid women treated with vitamin D and calcium. A recent literature review suggests a major role for parathyroid hormone-related protein (PTH-rP), secreted by the mammary tissue, in this phenomenon with obvious implications for clinical practice.

Objectifs Presenter les anomalies IRM inhabituelles en T1 et en sequence de diffusion d’un cas de MCJ et faire une revue de la litterature. Materiels et methodes Patiente de 79 ans presentant un syndrome cerebelleux associe a des troubles des fonctions superieures apparus en quelques semaines et s’aggravant rapidement. EEG non contributif. L’augmentation de la proteine 14-3-3 avec une neopterine basse dans le LCR fait suspecter une MCJ confirmee par autopsie. Resultats L’IRM cerebrale realisee precocement montre un hypersignal T1 des noyaux gris centraux predominant sur le systeme putamino-caude. La sequence de diffusion montre un discret hypersignal asymetrique des noyaux caudes et symetrique des putamens. Le CDA est augmente. La sequence en SET2 est normale. Pas d’anomalie corticale. Dans la litterature, les hypersignaux T1 sont rares et concernent principalement le pallidum. L’hypersignal classique en T2 et en diffusion des pulvinars et des noyaux mediaux des thalamus (« hockey stick sign ») serait lie a la variante plus qu’a la forme sporadique de la MCJ. Conclusion Un hypersignal T1 putamino-caude avec des anomalies en diffusion doit faire evoquer parmi les diagnostics differentiels la MCJ.