[Mediastinal parathyroid adenomas on a 5th ectopic gland. 2 case reports]

Mediastinal parathyroid adenoma located on the 5th ectopic gland is rare. We report here two new cases diagnosed by scintigraphy. In one case the adenoma was found to be located in the mediastinum prior to cervicotomy. The modern imaging methods capable of locating parathyroid adenomas are evaluated.

Influence of age and sun exposure on the biophysical properties of the human skin: an in vivo study

The physical properties of the skin were measured by using noninvasive methods on 72 people displaying various levels of solar elastosis on the neck. The physical parameters measured were the skin extensibility, the elastic recovery, the skin colour, the skin thickness and the electrical conductance. The correlation between the above parameters, the clinical grades of elastosis and the chronological age of each subject were studied using two different statistical approaches. They both showed that elastotic skin is less elastic, dryer, darker, more erythematous and less yellowish than the nonexposed skin. The similarities and differences between the properties of elastotic skin and purely chronologically aged skin are discussed.

[Hepatitis caused by quinidine. Study of a case and review of the literature]

The authors report the case of a 63 year-old woman who developed high-grade fever with chills, nausea, diarrhea, severe pain in the right hypochondrium, and jaundice after one month's treatment with 300 mg of hydroquinidine hydrochloride daily. Serum bilirubin and aminotransferases were slightly increased, while alkaline phosphatases and gamma-glutamyl-transpeptidase serum activities were markedly raised. Histological examination of a liver specimen obtained by the transvenous route showed numerous epithelioid granulomas with giant cell formation and eosinophils in hepatic lobules and portal tracts. Symptoms disappeared three days after withdrawal of the drug, but hepatomegaly and a mild increase in serum gamma-glutamyl-transpeptidase persisted more than eighteen months. Quinidine-induced hepatitis is almost always associated with fever, and, in one-third of the cases, with a pseudo-cholangitis picture. Extrahepatic hypersensitivity manifestations are often present. Histological examination of the liver shows granulomatous or cytolytic hepatitis. Withdrawal of the drug is rapidly followed by a favorable outcome; readministration causes immediate relapse; progression to chronic liver disease has never been reported previously.

[Should thalidomide be rehabilitated?]

Thalidomide (alpha-N-phtalimido-glutarimide) was withdrawn from sale in 1961 since it was held responsible for the birth of hundreds of phocomelus children. Despite this teratogenic potential, thalidomide remains a useful tool in the treatment of erythema nodosum leprosum, as well as in discoid lupus erythematosus when antimalarial drugs are ineffective or contraindicated. In addition, good results have been reported in several diseases such as actinic prurigo, polymorphous light eruption, Behçet syndrome, Weber-Christian disease, prurigo nodularis, pyoderma gangrenosum and ulcerative colitis. The mechanism of action is under debate but it is likely that thalidomide has immunomodulating properties by controlling T-suppressor lymphocytes, and anti-inflammatory effects, particularly an inhibition of neutrophil chemotaxis. Several attempts at synthesis of effective thalidomide derivatives devoid of teratogenic effects are ongoing.

[Leprosy tests: diagnostic problems (apropos of 2 cases)]

Two cases of reactional leprosy leading to wrong diagnosis are reported. The first one concerns a reversal reaction predominantly neuritic, initially taken for polyarthritis. The second one concerns an erythema nodosum leprosum with extensive cutaneous necrosis (Lucio's phenomenon or ulcerative lazarine leprosy). Main aspects and mechanisms of leprosy reactional states are reviewed. It is emphasized that errors or delays in diagnosis are often caused by failing to recognize cutaneous or neuritic symptoms.

[Red grain mycetomas (A. pelletieri). Apropos of 20 new cases in Dakar]

20 cases of mycetoma A. pelletieri coming from Sénégal are reported. This series confirms the peculiar localisation, extension and severity of this type of mycetoma: 14 cases located outside the foot (buttock, perineum, scrotum, inguinocrural area, abdominal and chest wall); frequency of lymph node involvement; importance of superficial extension; surgical possibilities overreached in more than 1/3 of the cases. Effectiveness of sulfa-methoxy-trimethoprime in the medical management is outlined.

[Ecology of a focus of cutaneous leishmaniasis in the Thies region (Senegal, West Africa). 2. Epidemiological and clinical peculiarities of the human disease]

During their epidemiological survey of a cutaneous leishmaniasis focus, the authors study the epidemiological and clinical aspects of 60 proven human cases observed in the studied area (Thies region). The disease can occur at any age but is more frequently seen in the pre-adolescent (10-15 years), adolescent (15-20 years) and adult (20-40 years) age classes. During the year, 76.5% of the lesions appear between july and the end of november. The spontaneous evolution of the disease seems to have a one year duration. Less than 10 lesions are observed in the majority of the cases (91.5%). The lesions are mainly located on upper and/or lower limbs and are generally of humid ulcerated type, often covered by a deep scar; a lymphatic nodular dissemination from a lesion occurs in 25% of the cases.

[2d case of cutaneous leishmaniasis with mucous involvement in Senegal]

A 6 year-old-girl of a village along the Senegal River presented cutaneous lesions with a nasal nodule, both infected with Leishmania amastigotes. This is the second case of cutaneous leishmaniasis with mucosal involvement described in Senegal (West Africa).