Acrométastase du pied révélant un cancer bronchique: à propos d’un cas

Foot bone acrometastasis, as the first manifestation of an occult primary malignant tumor, is rarely reported in the literature, and delayed or inappropriate diagnosis is frequent. We report a case of arcometastasis at the head of the first metatarsus revealing an occult lung adenocarcinoma.     

Spondylarthropathie et fibrose rétropéritonéale. À propos d’un cas

Retroperitoneal fibrosis is an uncommon inflammatory condition in which the retroperitoneal tissue is transformed into a tight sheet of fibrous tissue. It can occur in association with various diseases, including rheumatic conditions. We report a new case in a 66-year-old man with spondyloarthropathy. Nine similar cases have been reported. Axial manifestations predominated, and half the patients carried the HLA-B27 antigen. The relation between retroperitoneal fibrosis and spondyloarthropathy remains controversial.     

Métastases osseuses d’un épendymome d’emblée de double localisation. À propos d’un cas

A case of cerebral and sacral ependymoma revealed by cerebellar syndrome and sciatica in a 68-year-old man is reported. Bone metastases were diagnosed seven months after surgical excision of the brain tumor.     

Comment mettre en place un plateau technique d’aphérèses

Many apheresis techniques can be performed in a blood-bank facility or a hemodialysis (HD) facility. However, it makes sense to perform apheresis in a hemodialysis facility as apheresis involves extra-corporeal circuits and because HD can be performed at the same time as apheresis (tandem procedure). Apheresis techniques comprise therapeutic plasma exchange, double-filtration plasmapheresis, and its derivative (rheopheresis and LDL-apheresis), and immunoadsorption (specific and semi-specific). We have setup an apheresis platform in our hospital that fulfills health recommendations. This process has involved financial investment and significant human resources, and has enabled us to network with different specialties (neurology, hematology, vascular medicine). We have setup protocols according to the type of pathology to be treated by apheresis, and to monitor clinical and biological data for each apheresis session. The main side effects of apheresis are a fall in blood pressure when a session is initiated, an increase in fluid overload, hypocalcemia, and the loss of some essential plasmatic factors. However, these side-effects are easily identified and can be properly managed in real time. Within two-years, we have performed 1845 apheresis sessions (134 patients). Of these, 66 received apheresis before and/or after kidney transplantation for ABO and/or HLA incompatibility (desensitization), for humoral rejection, or in the setting of relapsing focal-segmental glomerulosclerosis. Our patients’ outcomes have been similar to those reported in the literature. The other 68 patients had various conditions. Because our program is now well-established, we are currently forming a specialist center to train physicians and nurses in the various apheresis techniques/procedures.     

Repigmentation d’un vitiligo universalis déclenchée par l’hémodialyse

Vitiligo is an acquired depigmenting disorder. Vitiligo universalis is a rare form responsible for significant aesthetic damage. To date, the exact pathogenesis remains unknown. Its treatment, a real challenge, consists rather in removing the still pigmented areas. We report a case of a patient followed for stable vitiligo universalis from an early age who presented with repigmentation shortly after initiation of hemodialysis.     

RS3PE révélant la rechute d’un lymphome malin non hodgkinien

A patient meeting published criteria for RS3PE was found to have a synchronous recurrence of non-Hodgkin’s malignant lymphoma. Reported cases of RS3PE associated with hematological malignancies and other forms of cancer are reviewed.     

Atteinte des derniers nerfs crâniens révélatrice d’une métastase occipitovertébrale d’un cancer du col de l’utérus

A 37-year-old woman had a histologically documented occipitovertebral metastasis from an invasive epidermoid carcinoma of the uterine cervix. The metastasis was found three months after the primary and was treated by local radiation therapy followed by systemic chemotherapy. Radiation therapy was highly effective in relieving the pain but was not associated with changes in magnetic resonance imaging findings. Lymph node involvement and local extension occurred. The patient died one year after the diagnosis of the metastasis. Involvement of the occipitovertebral junction by uterine cervix carcinoma metastasis is exceedingly rare. The relevant literature is reviewed.     

Existe-t-il des critères prédictifs de la réalisation d’un geste radical au décours d’une hospitalisation pour lombosciatique ?

Objective. To determine predictive factors for radical  treatment (nucleolysis or surgery) after inhospital conservative management of low back pain with sciatica (LBPS). Patients and methods. A standardized form was used to collect data on 134 patients admitted for conservative treatment of LBPS. Subsequent radical procedures were recorded 11 to 24 months after discharge. Results. Forty-seven patients required radical treatment after discharge. Significant risk factors for radical treatment in the univariate analysis were taller stature, use of a lumbar support, more preadmission epidural injections, a positive straight leg-raising test, and a disk herniation diameter of at least 50% the spinal canal diameter. Protective factors were onset within the month preceding admission and normal range of motion of the lumbar spine. In the multivariate analysis, symptom  duration longer than one month, use of a lumbar support prior to admission, and a positive straight leg-raising test were associated with radical treatment. A positive straight leg-raising test was the only significant clinical risk factor in the subset of patients investigated by computed tomography (CT). When CT findings were added to the model, only size of the herniation was significant Conclusion. Sixty-five per cent of patients admitted for conservative treatment of LBPS do not receive radical treatment during a mean follow-up of 18 months. Several factors are associated with the likelihood of radical treatment.     

Techniques d’anastomoses iléoanales avec réservoir

Complete proctocolectomy with ileoanal pouch anastomosis is the gold standard for the treatment of familial adenomatous polyposis and ulcerative colitis. In Crohn’s disease, this technique may be considered for selected patients free of anal or small bowel lesions. The two main techniques used for ileoanal anastomosis are the manual anastomosis following mucosectomy (Parks’ procedure, the reference technique), and the stapled anastomosis, the most used procedure worldwide. A third technique exists also, consisting in rectal eversion with section on the dentate line (Hautefeuille procedure); this technique avoid conservation of the anal transitional zone in stapled ileoanal anastomosis, and the risk of incomplete mucosectomy associate with Parks’ procedure. Finally, it is possible today to perform this intervention by laparoscopic approach, provided the operating team has the required training.     

Insuffisance rénale aiguë et obstacle mycélien : à propos d’un cas

Fungus ball is rarely associated with acute renal failure (ARF). We report the case of a 65-year-old diabetic patient who has been admitted for a right kidney infection. Urinary exam showed a leucocyturia with a negative urine culture. Ultrasonography showed pelvicaliceal dilation. Nephroscopy revealed a fungal material in ureter. Culture of this material was positive for Candida tropicalis. After endoscopic and antifongic therapy, the serum creatinin decreased from 336 μmol/L to 150 μmol/L, indicating the good evolution of his renal function.     

Une cause rare d’hypertension artérielle avec hypokaliémie : un cas de réninome

Reninoma or juxtaglomerular cell tumor is a rare usually benign renal renin secreting tumor. We report the case of an 18-year old woman, without any medical history, investigated in our hospital's emergency department for a bilateral papilledema. Ambulatory ophthalmological investigations were performed because of a newly occurring blurry vision, associated with diffuse headaches. Cerebral mRI and lumbar puncture recommended by the ophthalmologist and neurologist excluded intra-cranial hypertension. The patient presented with severe hypertension. Laboratory values showed hypokalemia, compensated metabolic alkalosis and microalbuminuria. During the hospital stay, she developed AKIN 1 acute renal injury. Ultrasound revealed a tissular cystic lesion of the superior pole of the right kidney. Abdominal mRI confirmed the lesion and raised suspicion for a renal cell carcinoma without calicial or vascular invasion. Plasma renin value was >500 mUI/L with normal values for plasma aldosterone. Renal biopsy diagnosed a juxtaglomerular cell tumor. After an aggressive initial treatment, hypertension remained well controlled with spironolactone only, finally allowing for withdrawal of all antihypertensive medications. Robot-assisted laparoscopic partial nephrectomy was performed. Studies of the operative specimen confirmed the diagnosis of benign reninoma. Clinical follow-up showed complete resolution of clinical and biological parameters.