Hypercalcémie sévère de cause inhabituelle, à la recherche du coupable : cas clinique et revue de la littérature

IntroductionHypercalcemia is not a rare event and can lead to severe consequences. Its main etiologies are primary hyperparathyroidism and neoplasic conditions. The iatrogenic etiology by vitamin D intoxication is more rarely found.Case presentationA 76-year-old finish woman comes to the emergency room for chest pain. Her medical history is impossible to specify due to the language barrier and initial confusion. She has severe hypercalcaemia (4.14 mmol/L), renal insufficiency, cardiac arrhythmia later complicated by an ischemic cardiac episode. Clinic and biologic examinations initially guided the research towards a hematological and neoplasic pathology. The iatrogenic etiology will be permitted by the contribution of details on its medical history and treatment learnt secondly. She was treated for post-surgical hypoparathyroidism by dihydrotachysterol, a vitamin D derivative. The cessation of substitution, treatment with hydration and biphosphonates allowed the rapid correction of hypercalcemia.DiscussionDihydrotachysterol intoxication is a rare etiology of hypercalcemia. Because of the longer half-life of this molecule, the risk of hypercalcemia seems to be greater than with other vitamin D derivatives. This molecule, withdrawn from the French market in 1982, is not detected by the dosage of 25 and 1.25 OH vitamin D.ConclusionWe report an original case of intoxication by dihydrotachysterol. The risk of hypercalcemia encountered with this molecule must be known. The close medical follow-up recommended in case of hypoparathyroidism seems to be particularly necessary in case of supplementation by this molecule.     

Ostéopœcilie : un cas clinique et revue de la littérature

Osteopoikilosis is an uncommon benign sclerosing bone dysplasia. Herein we present a case of osteopoikilosis with characteristic roentgenographic findings and clinical findings of cervical myelopathy. The importance of the differential diagnosis in symptomatic cases of osteopoikilosis is emphasized with the review of the literature.     

Schwannome du nerf oculomoteur chez l’enfant : cas clinique et revue de la littérature

An isolated schwannoma of the oculomotor nerve is rare in children without an associated neurofibromatosis. A 13-year-old girl, with a previous medical history of migraine, was admitted for disabling ophthalmic migraine with oblique diplopia. The clinical examination showed a right incomplete ophthalmoplegia with reduced ipsilateral visual acuity (8/10). There was no particular skin reaction. The MRI revealed a right (isosignal-T1 and isosignal-T2) nodular schwannoma located within the cisternal segment of the oculomotor nerve. The angio-CT performed later confirmed the absence of any vascular malformation. The treatment consisted of analgesics and corticotherapy, with complete regression of symptoms three weeks later and a normal MRI follow-up. Therefore, radiosurgery was not performed.     

Lipome géant de la main : présentation d’un cas clinique et revue de la littérature

Giant lipoma of the hand is rare. The diagnosis is based on a clinical tumor and acroparesthesia from compression of the median and ulnar nerves. The MRI is the best exam to study local extension. Fibrolipoma of the median nerve and low-grade liposarcoma are the principal differential diagnoses.     

Le syndrome du marteau hypothénarien : analyse de la littérature et cas clinique

Hypothenar hammer syndrome is a rare disease first described by Conn et al. in 1970. It groups together symptoms of chronic microtraumatism to the ulnar artery or its superficial palmar branch against the hamate. Manual workers using vibrating tools are the most affected by this. Diagnosis is made by echodoppler, while arteriography is the gold standard for establishing the treatment plan. Hypothenar hammer syndrome may lead to severe complications secondary to ischemia and to embolic events resulting from delayed diagnosis or maltreatment. There is no real consensus as to the place of medical or surgical treatments. Medical treatment consists of eliminating favorizing factors and long-term antiplatelet aggregation treatment. Surgical treatment depends on the vascular lesions: simple arterial ligation, resection of the thrombosed arterial segment and end-to-end anastomosis, or revascularization using a pontage venous or arterial graft. Some authors suggested an associated thoracic sympathectomy. The diagnosis must be made early; the choice of treatment must be targeted at preventing serious embolic complications.     

L'uvéite : une complication peu connue du pamidronate à propos d'un cas et revue de la littérature

Uveitis, an underrecognized adverse effect of pamidronate. Case-report and literature review. Ophthalmologic adverse effects of bisphosphonate therapy are infrequent and of unclear pathogenesis. The most common has been anterior uveitis, of which 18 cases have been reported concerning especially pamidronate. Onset was within 24 to 48 hours after infusion initiation, and both eyes were affected in most patients. The outcome was favorable within a few days after bisphosphonate discontinuation and topical glucocorticoid therapy, although rechallenge was frequently followed by a recurrence. Bisphosphonates are being used successfully in an increasingly broad range of disorders. We report a case of pamidronate-induced anterior uveitis and present a review of the relevant literature.     

Paragangliomes de la queue de cheval : à propos de six cas et revue de la littérature

Background and purposeParagangliomas of the cauda equina are rare tumors. The standard treatment is surgical resection. Our study aims to compare our clinical, radiological, prognostic data to the literature and to offer management and follow-up recommendations.MethodsIn this retrospective study, six patients with paraganglioma of the cauda equina region were treated. Symptoms included radicular nerve pain and low back pain with occasional sphincter dysfunction and motor deficit. MRI showed well-circumscribed lesions with homogeneous enhancement following gadolinium injection. Treatment involved complete surgical resection of the tumor under electrophysiological control. In addition to the characteristics of the tumor, we assessed operating results as well as postoperative morbidity and follow-up.ResultsAll patients had complete removal of the tumor, which required in most cases the resection of the carrying root. The intervention allowed a regression of the initial symptoms, with possible postoperative regressive sphincter disorders. Clinical and radiological follow-up (19 months on average), showed no tumor recurrence.ConclusionsThe reference treatment of these tumors is complete surgical resection, usually requiring the sacrifice of the carrying nerve root. Intra-operative nerve roots stimulation is recommended to reduce the risk of motor deficit linked to this radical treatment. A long-term clinical and radiological follow-up is recommended.     

Monoarthrite secondaire à une métastase articulaire : à propos de deux cas et revue de la littérature

Synovial metastasis of neoplasms are uncommon. We report two cases of monoarthritis of the knee due to articular metastasis. The diagnosis was performed by cytologic evaluation of the synovial fluid. The first case was an epidermoid carcinoma of the ureter with a metastasis to the left knee joint. The second was a chronic monoarthritis of the left knee unresponsive to classical treatment and found to have bony metastases of the distal femur from lung adenocarcinoma. Only 28 cases of synovial metastasis of solid tumor have been reported in the literature. The knee joint is the most commonly affected. Lung is the main localization of the primary neoplasm (12 cases) and histologic type is preferentially adenocarcinoma (12 cases). Articular metastasis has usually a poor prognosis with an average survival lower than 5 months.     

Métastases cutanées après une cystoprostatectomie: à propos d’un cas et revue de la littérature

Cutaneous metastases are an unusual location of a bladder tumor. We report through this observation the case of a patient with cutaneous metastases two years after cystoprostatectomy with bilateral cutaneous ureterostomy.     

Néphropathie associée à une vascularite urticarienne hypocomplémentémique : présentation d’un cas clinique et revue de la littérature

Hypocomplementemic urticarial vasculitis is a rare systemic vasculitis, affecting small vessels, characterised by chronicle urticaria, hypocomplementemia, and systemic manifestations. Renal involvement, whose prevalence varies between 9% and 60%, is mainly glomerular. We here report the case of a 59 years old woman presenting kidney failure, associated with chronicle urticaria and arthralgias. Laboratory investigation showed haematuria, proteinuria, hypocomplementemia and anti-SSa antibody positivity. A percutaneous kidney biopsy revealed focal and segmental glomerulonephritis associated with an acute interstitial nephritis. Hypocomplementemic urticarial vasculitis diagnosis was established after identifying anti-C1q antibodies. The lack of a dry syndrome, the negativity of a Schirmer test and the lack of sialadenitis on a salivary gland biopsy excluded an associated Gougerot–Sjögren Syndrome. The patient was treated with hydroxychloroquine and low-dose steroids, enabling a clinical and biological recovery. Of the 82 cases in the literature describing hypocomplementemic urticarial vasculitis associated nephropathies, 72 (88%) were a glomerular impairment, most frequently secondary to membranoproliferative glomerulonephritis. Only 6 (7%) tubulo-interstitial nephritis have been reported, 4 of them being associated with a glomerulonephritis. Patients were more likely to be women, aged in their third decade. The most frequent renal manifestations were haematuria (60%), and proteinuria (52%). Kidney failure was rarely observed (22%), with a fairly good renal prognosis. Hypocomplementemic urticarial vasculitis was associated with a systemic disease in 11 (13%) patients. In the absence of recommendations, the treatment strategy remains to be defined.     

Les fistules uro-génitales iatrogènes: À propos de 62 cas et revue de la littérature

ObjectivesTo identify types of iatrogenic genitourinary fistula, their circumstances of occurrence, diagnostic tools and to assess the surgical treatment outcomes.Patients and MethodsThis prospective study conducted from January 2009 to July 2014 in the Urology department at Lamordé national hospital and the national referral centre for obstetric fistula (CNRFO) is based on 62 cases of iatrogenic fistulae. The main variables are fistula types, circumstances of occurrence, diagnostic tools and management outcomes.ResultsThe following fistulae have been registered: vesico-uterine (40 cases), trigono-vaginal (3 cases), uretero-vaginal (14 cases) and urethro-vaginal (5 cases).The contexts of occurrence are C-section, hysterectomy, instrumental delivery and “yankan gishiri” procedure. Gynecologic exam, methylene blue test, intravenous indigo carmine and cystoscopy using a condom are specific tips that help confirm diagnosis. All cases except one have been successfully treated surgically.ConclusionIatrogenic genitourinary fistulae are becoming a relative frequent complication in developing countries like Niger. Despite high success rate of surgical treatment, special emphasis should be put on improving training in surgery and the practice of qualified emergency obstetric care.     

Le prolapsus muqueux de l'urètre chez la fillette: A propos de 22 cas colligés en dix ans et une revue de la littérature

ObjectiveTo report our experience in managing 22 cases of urethral prolapse.Matérial/Patients and méthodsThis is a retrospective study conducted at Urology Department of Lamordé national hospital in a ten years period (2002-2011) and based on 22 cases of urethral prolapsed in young girls.ResultsIn the last ten years, 22 cases of urethral prolapse have been recorded. The mean age of patients was 6 ± 3,3 years (ranges 3-10 years). The main reason for consultation was mild genital haemorrhage in 18 cases and 4 cases related to suspicious sexual abuse raising medico legal problems. The treatment combined psychological and medico surgical approaches. In all the cases a surgical excision of the prolapsed mucosa was performed followed by muco-mucosal stitching around indwelling Foley catheter for 72 hours. Post operative period was uneventful except one case of acute urinary retention managed by drainage and anti-inflammatory drug.ConclusionUrethral prolapse is a rare disease that affects pre-menarcheal girls in low social and economic context. Surgical treatment gives good clinical and esthetic results.