Search

A case is reported of a 49 years-old man who presented with cutaneous and muscular manifestations revealing periarteritis nodosa. Two years after detection of this disease occured a preleukemic condition and four years later a chronic lymphocytic leukaemia is discovered. In clinical course appeared a tuberous infiltration of the face and a sudden bilateral deafness. Regression of these two abnormalities is obtained after administration of prednisolone. The patient died of generalized infectious process postoperatively. From these clinical and pathological findings relations between periarteritis and CLL, occurence of deafness and cutaneous lesions are discussed. The relationship between the development of CLL and the immunosuppressive treatment is considered.

Gamma scintigraphy plays an important role in the topographic diagnosis of focalized cerebrovascular insufficiency. Furthermore, sequential imaging allows a comparative study of arterial distribution while studying the "transit time" of the radioactive tracer. In this work, the authors attempted to quantify transit time in patients with chronic cerebrovascular insufficiency while comparing the radioactivity in the hemispheres with that of the various arterial territories. The study of the arca and slope of the various arterial territories. The study of the area and slope of the tracer profile indirectly gives information about the cerebro-correlation between cerebrovascular resistance and the clinical state, there was, however, an interesting relation during vasodilator treatment (ifenprodil tartrate) in which promising clinical results were preceded by an increase in the arterial inflow component of the radioactivity curve.

A forty-two-year-old man presented with erythema nodosum of undeterminated etiology and pancytopenia. A bone marrow biopsy revealed extensive hairy-cell infiltration. Four months later, the diagnosis of pulmonary tuberculosis was suggested by the appearance of a pulmonary infiltrate in the left upper lobe. Despite antituberculous chemotherapy, the patient died. Post-mortem bacteriologic confirmation was given by sputum culture.

We used intravenous synthetic somatostatin to stem severe bleeding from oesophagites and oesophageal ulcer associated with renal failure hyponatremia and mental confusion. The ability of somatostatin to reduce splanchnic blood flow and portal pressure and to inhibit both gastrin release and the pentagastrin-stimulated secretion of gastric acid and pepsin provides its therapeutic use in multiple alimentary bleeding. When patients is considered poor candidate for surgery, somatostatin may prove a particularly valuable alternative to conventional medical treatments. We observed no side effects, with somatostatin, during a 72 h period of treatment. Since cimetidine give rise to mental confusion in ureamia or hyponatremia, somatostatin should be looked upon with particular interest in cases of gastro-intestinal bleeding associated with renal insufficiency.

The authors report on two patients in whom Hodgkin disease was revealed by renal complications: nephrotic syndrome in one patient and renal failure with enlarged kidneys secondary to malignant infiltration in the other. In comparison to other lymphomas, renal infiltration is infrequent in Hodgkin disease. Clinical manifestations of renal infiltration are delayed. Renal failure with enlarged kidneys, which is very uncommon, carries a poor prognosis and is often associated with involvement of the lungs. Nephrotic syndrome in Hodgkin disease may be secondary to one of the three following causes: renal vein compression, renal amyloïdosis, or a paraneoplastic syndrome. The latter is the most common cause and is probably ascribable to immunologic disturbances. Among the other complications, infection and the renal consequences of metabolic disorders are mentioned.

Prolymphocytic leukaemia (PL) is a rare variant of lympho-proliferative disorder, defined by Galton [21], which differs clearly from CLL by clinical, haematological and immunological features. Nevertheless like CLL, PL appears to represent predominantly a B cells monoclonal proliferation and cases of T-PL are rare. We report about another case of PL which was found to have T-lymphocyte characteristics and some clinical and immunological particularities.

Two cases of biliary peritonitis by perforation of intra-hepatic biliary ducts are presented. In both cases there is a perforation from a gallstone. In the first case the perforation is located at the proximal part of the left hepatic bile duct, in the second case it is at the proximal and distal portion of the third segment bile duct. Those peritonitis are rare and their diagnosis is difficult. Gallstone is the main cause. Removing bile duct obstruction is the treatment.

The unusual occurrence of microcytic anemia with hypochromia, high iron blood levels and excess of sideroblasts in the bone marrow, observed during the treatment of tuberculosis with isoniazid and rifampicine is reported. Three particularities were noted. First, in our experience, the occurrence of this type of anemia has never been noted previously as a result of these two drugs. Secondly, the improvement of the blood abnormalities was obtained by the combined use of vitamin B6 and vitamin C. Thirdly, the anemia was associated with neuropathy, characterized by areflexia and dysesthesia, which improved with vitamin B6 therapy (but not with vitamin C). Some mechanisms are discussed as being possibly the origin of this kind of anemia, particularly a lack of vitamin B6 resulting from a massive urinary loss of pyridoxal induced by isoniazid as well as both a tissue depletion and an overconsumption of this vitamin. The anemia may be the consequence of a deficiency of hemoglobin synthesis involving probably the first step of the biosynthesis of heme.

The authors report on a patient with hereditary osteo-onychodysplasia (HOOD). Osteoporosis was demonstrated upon histomorphologic bone examination. HOOD is a rare inherited disorder. Typical features include dysplasia of the nails, patellae, elbows and ilium. Nephropathy occurs in 48% of patients. Numerous renal histologic studies have led to the concept that the nail-patella syndrome is an inherited metabolic disorder affecting the connective tissue. Our findings from histomorphologic bone assessment bring further evidence in support of this hypothesis.

The authors report the case of an 18 year old girl with nocturnal tetraplegia. There was a family history of Westphal periodic paralysis, and a past history of transient paralysis two years previously. The serum potassium was 2.3 mEq/l. The patient was cured by intravenous drip of potassium chloride. There was a reactionary hyperinsulinism. The red cell potassium was lowered. There was a fall in the exchangeable and total potassium pool. The E.C.G. changes; observed during the acute attack of paralysis, persisted afterwards, which is unusual.

The authors report a case of Ph 1 positive chronic myelocytic leukemia associated with cutaneous mastocytosis, occuring lately in a 75 years old man. 12 similar cases (associations mastocytosis chronic or acute leukemia) are described in the literature.