[Aortic thrombosis during acute endocarditis caused by Staphylococcus aureus]

The authors report a case of acute bacterial (Staphylococcus aureus) endocarditis in a 70-year-old woman, revealed by a febrile cerebral ischemic accident. Ultrasonography confirmed the presence of a large posterior mitral valve vegetation interfering with left ventricular filling. The sudden onset of complete paraplegia and acute ischemia of the lower limbs suggested thrombosis of the abdominal aorta, which was confirmed by aortography. These features indicated that a vegetation fragment had migrated, obstructing the aortic bifurcation and causing secondary thrombosis. This led in turn to involvement of the medullary arteries and the onset of paraplegia. Unfortunately, acute renal insufficiency and major left heart failure rapidly developed, and the patient died. Autopsy confirmed the diagnosis of aortic thrombosis with involvement of the renal arteries. Multiple visceral infarcts were noted as well as the large mitral vegetation. This case illustrates the potential severity of systemic embolism complicating endocarditis due to Staphylococcus aureus. The accident was remarkable because of the aortic acute occlusion and the association with paraplegia, an unusual neurologic complication.

[Arterial embolic manifestations in the legs revealing isolated aorto-iliac Takayasu's disease]

The authors report the case of a 30-year-old woman with Takayasu's disease revealed by acute leg ischemia and complicated by abortion during the fourth month of pregnancy. Clinically suspect lesions were confirmed by angiography showing a severe stenosis at the aorto-iliac bifurcation complicated by overlying mild ectasic lesions and a large thrombus. A total occlusion of embolic origin was noted in the right popliteal artery. An attempt to open up the thrombosis at the bifurcation led unfortunately to massive rethrombosis requiring implantation of an aorto-iliac prosthesis. Histopathological examination of the aortic surgical specimen indicated Takayasu's disease; the placenta showed multiple infarcts. The complete angiographic study revealed no arterial involvement in any other region. Five months after the initial operation, rapid development of claudication in both lower limbs suggested stenosis at the prosthesis implantation sites which was confirmed by angiography. Initiation of general corticosteroid therapy led to partial remission in less than two weeks. The unusual feature in this case was the revelation of the affection by distal arterial embolic manifestations, which have been reported only exceptionally in the literature. Moreover, isolated involvement of the aorto-iliac bifurcation constitutes a rare form of Takayasu's disease. With respect to therapy, the implantation of a prosthesis was complicated by severe stenoses of the junction zones, which is unfortunately an event in the course of this affection. The normality of biologic inflammation studies did not suggest an initial need for corticosteroid therapy, especially in the case of an isolated arterial manifestation.(ABSTRACT TRUNCATED AT 250 WORDS)

[The role of adrenal gland x-ray computed tomography and scintigraphy using radiolabelled norcholesterol in the etiological diagnosis of primary hyperaldosteronism]

The major etiologies of primary aldosteronism are aldosterone-producing adrenal adenoma, requiring a surgical treatment, and bilateral hyperplasia, usually managed with medical therapy. We only report a retrospective study on 22 patients with primary aldosteronism diagnosed by clinical and usual biochemical tests. All the patients were explored by computed tomography scan (CT) and iodomethyl-norcholesterol scintigraphy. The purpose of this study was to compare the capacity of the two methods to differentiate adrenal adenoma and hyperplasia. The CT scan was more sensitive (sensitivity: 88%) compare to scintigraphy (sensitivity: 64%) for the diagnosis of adrenal adenoma. However, the scintigraphy was a useful tool to detect asymmetric macronodular adrenal hyperplasia. Therefore, the catheterisation of adrenal venous would be only necessary for a few cases. We conclude from this study and the literature review that CT scan and iodomethyl-norcholesterol scintigraphy are complementary and both useful to increase diagnostic reliability of primary aldosteronism.

[Bone marrow necrosis in malignant hemopathies. 7 cases]

The authors report 7 cases of bone marrow necrosis during hematological malignant diseases:3 leukemia, 4 lymphoid malignancies. The main clinical features were bone pain and fever. The bone marrow aspiration and/or biopsy allow diagnosis. The prognosis was in all cases very poor.

Experimental venous thrombosis: what animal model?

A new experimental venous thrombosis model is described and its role relative to other models is defined. Previous models are not satisfactory for all types of investigation. Opposite, present model based on the three classic thrombogenic factors is suitable for venous scintigraphy and evaluation of different forms of therapy for venous thrombosis of the limbs. So this model permits research on diagnosis and therapy of thromboembolic disease.

Evaluation of indium-111-labeled antifibrin monoclonal antibody for the diagnosis of venous thrombotic disease

The potential advantage of using 111In-antifibrin (111In-AF) monoclonal antibody for the diagnosis of deep venous thrombosis (DVT) was studied in 44 patients with suspected DVT (27 underwent heparin therapy before 111In-AF injection). All patients had contrast venography (considered as the gold standard) and 111In-AF scintigraphy within 24 hr. Two to 3 mCi of 111In-AF were injected intravenously, and planar scintigraphy of the limbs was recorded within 10 min (17 times), 3 hr (44 times), and 18 hr (39 times). Indium-111-AF images were then interpreted without knowledge of the results of the other examinations. The DVT diagnostic accuracy of 111In-AF was greater when interpretation was based on images recorded at different time periods after injection. Indium-111-AF sensitivity for diagnosis of DVT was 85% (29/34) and was not apparently decreased by heparin therapy. None of the 10 patients with negative contrast venography had a positive 111In-AF scan. The results demonstrate the importance of recording serial images and the excellent accuracy of 111In-AF for diagnosing DVT.

[Reliability of pulmonary perfusion and ventilation scintigraphy compared with angiopneumography for the diagnosis of pulmonary embolism]

Fourty-six patients suspected clinically of having a pulmonary embolism (PE) were investigated by angiopneumography (AGP) and perfusion (99m-Tc aggregates) and ventilation (99m-Tc colloid) scintigraphy (SPV Tc). Findings were assessed under blind conditions. A positive diagnosis of pulmonary embolism was made in 19 patients. The SPV Tc was considered as positive if perfusional deficiencies were greater than ventilatory defects, and this was evaluated as such in 23 cases (19 true and 4 false positives). False negatives were not observed. The 4 false positive results corresponded to scintigraphic anomalies suggestive of pulmonary emboli subsegmental in size; true positives were either subsegmental (8), segmental (6) or lobar (5). Sensitivity of the SPV Tc wis therefore 100%; its specificity, all results considered was 76%, but was 100% if only images of lobar or segmental lesions are considered.

[Superior vena cava syndrome disclosing Behçet's disease]

While venous manifestations are common in Behçet disease and often occur as a presenting feature, thromboses of the vena cava are less frequent and usually occur several years after onset. We report the unusual case of a patient whose Behçet disease was revealed by vena cava thrombosis. Most authors underscore the difficulties encountered in ascribing vena cava thrombosis to Behçet disease and the frequent latency of inferior vena cava involvement. Pathological changes in these venous thromboses are identical to those found in other organs involved in Behçet disease: they consist in inflammation of the venous wall with perivascularitis and secondary thrombosis. Lastly, there is a general agreement as to the adverse prognostic significance of the venous involvement.

[Diagnosis of hematomas in the Retzius space during anticoagulant therapy. Prospective study (11 cases)]

During a three-year, prospective study carried out at the Saint Jacques Hospital, Nantes, France, in a group of 33 patients with echographically identified intra-abdominal hematoma, 11 cases of Retzius' space hematoma were detected in patients under anticoagulant treatment (heparin or antivitamin K). This suggests that the frequency of this complication is greater than supposed. The authors emphasize two aspects of Retzius' space hematoma: on one hand, clinical symptomatology, especially involving the urinary system (transient oliguria or oligoanuria in 7 of the 11 cases), on the other, ultrasonic diagnosis (slip-page of the intraperitoneal contents along the posterior surface of the hematoma, rupture sign, denoting diffusion of the hematoma immediately below the Douglas' arch). Ordinarily, the clinical course of this complication of rectus sheath hematoma is spontaneously favorable.

[Sterno-costo-clavicular hyperostosis (author's transl)]

The authors report two cases of sterno costo clavicular hyperostosis. Six cases have been described in previous reports by Köhler (five cases) and CAMUS (one case). This disease begins with sterno costo clavicular pain that develops with exacerbations over several years. Biologically, there is a no specific inflammatory syndrome. Radiologically, clavicles sternum and first ribs are enlarged and increased in density. There is also an ossification of the sterno clavicular and sterno costal junctions. Phlebography sometimes show subclavian veins occlusion. Histological finding is hyperostosis without osteoclast inclusions. The main differential diagnosis is the Paget's disease.