[Pulmonary histoplasmosis in an immunocompetent patient]

INTRODUCTION

Acute pulmonary histoplasmosis (APH) is rare in an immunocompetent patient. We report a case of APH diagnosed by culture of broncho-alveolar lavage (BAL) in a patient presenting a pseudo-tumoral form with nodules progressing to cavitation.

OBSERVATION

A 41 year-old male smoker was hospitalized with a persistent fever, dry cough and dyspnoea on exertion. The first CT scan showed a reticulo-nodular interstitial infiltrate with lymphadenopathy that progressed rapidly to multiple pulmonary nodules with central cavitation. Bronchial endoscopy, with BAL culture, provided the diagnosis of Histoplasma capsulatum, variety capsulatum. The infection may have occurred during work in a hangar in Guadeloupe that was scattered with bats' guano. After two months of treatment by itraconazole, the patient's condition improved clinically and radiologically with reduction of the nodules and their cavitation.

CONCLUSION

This case presents an immunocompetent patient with pulmonary histoplasmosis and multiple, radiologically atypical, nodules. The diagnosis was established by BAL culture.

[Meckel's diverticulum Diagnosed by CT-Enteroclysis]

The authors report the case of a 24 year old woman presenting with acute lower GI hemorrhage caused by a Meckel's diverticulum. Diagnosis was made by CT-enteroclysis and confirmed at surgery. This new imaging technique will be briefly described and compared to the other more traditional small bowel imaging techniques. The authors will then present the CT-enteroclysis imaging features of this congenital anomaly.

[Small bowel diverticulitis: the role of CT]

The authors report a case of small bowel diverticulitis diagnosed by computed tomography. They describe the CT findings and review its advantages for diagnosis of this uncommon entity that is rarely suspected at physical examination.

[Massive hemoperitoneum from rupture of an intra-peritoneal varix]

Rupture of an intra-abdominal varix in a patient with portal hypertension is a rare but severe cause of massive hemoperitoneum. The authors report the case of a patient with alcoholic cirrhosis that presented to the emergency department with hypovolemic shock. Imaging showed massive hemoperitoneum, severe portal hypertension and suggested the diagnosis of spontaneous rupture of an intra-abdominal varix, confirmed at laparotomy.

[Ultrasound guided alcohol ablation of the celiac plexus in oncology patients with abdominal pain]

PURPOSE

The authors report results of a retrospective study evaluating the efficacy of US-guided alcohol ablation of the celiac plexus in 26 patients with chronic cancer-related abdominal pain. They review the interest of this imaging technique for guidance.

PATIENTS AND METHODS

Thirty US-guided alcohol ablations were performed in 26 patients. Twenty-two of them had a prancreatic malignancy, 3 had a gastric cancer and 1 had an esophageal cancer.

RESULTS

72% of patients experienced significant pain relief with at least 50% decrease in morphine requirements for two months. Four patients underwent a second ablation because of persistent pain and 3 of them experienced relief.

CONCLUSION

Celiac plexus ablation is considered to be one of the most effective treatments for chronic cancer-related abdominal pain, often used as an adjuvant treatment in the pain management strategy. US guidance is advantageous because it is simple and accurate and enables quick needle placement.

[Capillary telangiectasis, angiographically occult vascular malformations. MRI symptomatology apropos of 7 cases]

OBJECTIVE

Describe the MRI findings in capillary telangiectasias.

MATERIALS AND METHODS

Between 1996 and 1999, we observed 9 cases of capillary telangiectasia in 7 patients explored 5 times for posterior fossa symptoms. In two cases capillary telangiectasia was a fortuitous discovery. All patients were explored by MRI with T1 sequences with and without gadolinium injections, turbo spin echo T2 coupled in 5 cases with a double echo gradient echo T2 sequence (TR: 970 ms, TE: 15 and 35 ms). Two patients also underwent vertebral angiography.

RESULTS

The telangiectasia gave a low intensity signal on T1 sequences in 2 of the 9 cases and a discretely high intensity signal on T2 sequences in all cases. After gadolinium injection, 9 telangiectasias showed homogeneous or speckled enhancement. The echo-gradient T2 images showed a very low intensity signal in 7 out of 7 cases on the second echo. At the first echo, 4 capillary telangiectasias were undetectable. The two vertebral angiographies were normal and the follow-up MRI in 5 patients showed lesion stability.

CONCLUSION

Pontile lesions with no mass effect showing enhancement after gadolinium injection and with or without a discrete T2 high intensity signal but with a frank echo-gradient T2 signal strongly suggest capillary telangiectasia.

Clinical and electrophysiological study in French-Canadian population with Charcot-Marie-tooth disease type 1A associated with 17p11.2 duplication

BACKGROUND

The aim of the present study was to examine the frequency and the phenotypic manifestations in a French-Canadian population with a chromosome 17p11.2 duplication (Charcot-Marie-Tooth type 1A, CMT-1A).

METHODS

Molecular analysis were performed by Southern blot using pVAW409R3a probe. Clinical evaluation was carried out according to the scale defined by the European HMSN Consortium.

RESULTS

The frequency of duplication was found to be similar in the adult (70.8%) and pediatric (72.7%) populations. Onset of symptoms occurred before 20 years of age in 85.7% of adult cases and before the age of 5 in 80% of the pediatric cases. The classical CMT syndrome was observed in 77% of the cases and the syndrome was associated with additional features in 15% of cases in the adult population. All the children presented with classical CMT syndrome with no additional features. There was a significant correlation between the disability score and the duration of the disease but no correlation was found between median nerve conduction velocity and the functional handicap, the age at onset or the duration of the disease. In one family, there was a very conspicuous anticipation over five observed generations.

CONCLUSION

This study reveals that the age at onset, the clinical and electrophysiological variability as well as the functional disability variations in a French-Canadian population did not differ from those reported in other populations.

Multiple tendon rupture at unusual sites in rheumatoid arthritis

A patient with seropositive nodular rheumatoid arthritis taking large doses of corticosteroids developed multiple tendon ruptures around weight bearing joints. The mechanisms underlying this rare complication are discussed.

Articular manifestations of familial hypercholesterolaemia

Familial hypercholesterolaemia is characterised by a decreased removal of low density lipoproteins and premature coronary artery disease. Tendinous xanthomata are a hallmark of the disease. The affected joints may also be the sites of inflammation and pain. Arthropathy has been associated mainly with the homozygous form of familial hypercholesterolaemia, but it is also known to occur in the heterozygous form. We report on the articular manifestations in 73 patients with heterozygous familial hypercholesterolaemia. About 40% of these patients had at least one episode of articular symptoms. The observed articular manifestations may be classified into four types: Achilles pain (18%), Achilles tendinitis (11%), oligoarticular arthritis (7%), polyarticular or rheumatic fever-like arthritis (4%). It is concluded that in heterozygous familial hypercholesterolaemia articular manifestations are frequent, diverse, and may be the first symptom of this metabolic disorder.

Psoriatic arthritis: risk factors for patients with psoriasis - a study based on histocompatibility antigen frequencies

Histocompatibility antigen frequencies were studied in a group of 100 patients with psoriatic arthritis (PSA) and were compared to a group of 80 patients whose psoriasis was restricted to skin lesions (PSC). The antigens B13, BW57 (17), CW6 were significantly increased in PSC while BW57 (17), BW39, CW6 and CW7 were increased in PSA. No DR or MT antigen was elevated in frequency when compared to normal controls. The significant information which results from this study includes: 1) a failure to confirm previous reports on HLA-DR antigen increased frequencies; 2) an association, in this population, of BW39 with PSA and not BW38; 3) finding of a closer link of PSC and PSA with HLA-C rather than HLA-B antigens; 4) an estimate of relative risk for patients with PSC to develop PSA.

[Juvenile rheumatoid arthritis and HLA-B27]

Forty children with juvenile rheumatoid arthritis were studied to determine the frequency of the histocompatibility antigen HLA [human leukocyte antigen)-B27 in this disease and to characterize the arthropathy associated with this antigen. HLA-B27 was detected in four patients (10%). Its presence was associated in a statistically significant manner with sacroiliitis demonstrated radiologically and with a greater age at the time symptoms in the joints first appeared; this age was, on average, 10 years, compared with 6.29 years for the children without HLA-B27.

[Inhibition of adjuvant arthritis by oxonate: influence of uricemia (author's transl)]

Adjuvant arthritis in rat is inhibited by an oxonate diet, which increases uricemia. The inhibition is proportional to blood uric acid level and not to oxonate concentration in the diet. Oxonate alone does not exert an inhibitory effect.