Synchronous association of ileal carcinoid and colorectal carcinoma. A case report

BACKGROUND: Multiple primary malignant neoplasms in a single patient have been well documented in the literature. The lesions can be limited to a single organ or involve multiple organ systems and can be synchronous or metachronous. AiM: Report of a new case. CASE REPORT: We report the case of a 63 year old women with a rectocolonic carcinoma; during surgery an ileal nodule was discovered also as liver metastasis. The final pathologic report on the specimen revealed an adenocarcinoma of the colon and a carcinoid tumor of the small bowel with liver metastasis. Tumoral association is relatively common for patients with small intetinal carcinoids. CONCLUSION: The association carcinoide of hail with primitive tumour not carcinoide is reported primarily with carcinomes of the digestive tract in particulary recto colics carcinoma.     

Trouble anxiété généralisée chez une patiente atteinte de sclérose en plaques : prise en charge par thérapie cognitivo-comportementale et émotionnelle

BackgroundThe social, personal and financial costs of anxiety disorders in multiple sclerosis patients are considerable. A properly managed anxiety disorder in these patients can reduce the morbidity associated with this debilitating disease. Among the therapeutic means proposed for anxiety disorders, cognitive and behavioral therapies have a proven anxiolytic effect. The current study aimed to describe the cognitive and behavioral management of a female patient with severe generalized anxiety disorder comorbid with multiple sclerosis.MethodsThe clinical case presented in this study concerned a 42-year-old woman followed since 2007 at the Outpatient clinic department, National Institute of Neurology of Tunis, for a severe relapsing-remitting multiple sclerosis. In March 2018 she was diagnosed with generalized anxiety disorder. The therapy took place over fifteen 45-minute weekly sessions (From February 8th to May 24th, 2018). Initial, intermediate and final evaluations included the “Penn State Worry Questionnaire” and the “Hamilton Anxiety Scale”.ResultsDuring the course of the therapy, we observed a clinical improvement in the patient's symptoms such a decreased of anxiety intensity and frequency of worries and an improvement in somatic complaints. The final evaluation showed that the objectives formulated with the patient were achieved and that there was an important improvement of the different scales of evaluation.ConclusionAccording to the available data, the follow-up of our patient showed that cognitive and behavioral therapy is an interesting option in the treatment of generalized anxiety disorder, including its severe and comorbid form with a disabling neurological disease such as multiple sclerosis.     

Magnetoencephalography is feasible for infant assessment of auditory discrimination

Magnetoencephalography (MEG) detects the brain's magnetic fields as generated by neuronal electric currents arising from synaptic ion flow. It is noninvasive, has excellent temporal resolution, and it can localize neuronal activity with good precision. For these reasons, many scientists interested in the localization of brain functions have turned to MEG. The technique, however, is not without its drawbacks. Those reluctant to employ it cite its relative awkwardness among pediatric populations because MEG requires subjects to be fairly still during experiments. Due to these methodological challenges, infant MEG studies are not commonly pursued. In the present study, MEG was employed to study auditory discrimination in infants. We had two goals: first, to determine whether reliable results could be obtained from infants despite their movements; and second, to improve MEG data analysis methods. To get more reliable results from infants we employed novel hardware (real-time head-position tracking system) and software (signal space separation method, SSS) solutions to better deal with noise and movement. With these solutions, the location and orientation of the head can be tracked in real time and we were able to reduce noise and artifacts originating outside the helmet significantly. In the present study, these new methods were used to study the biomagnetic equivalents of event-related potentials (ERPs) in response to duration changes in harmonic tones in sleeping, healthy, full-term newborns. Our findings indicate that with the use of these new analysis routines, MEG will prove to be a very useful and more accessible experimental technique among pediatric populations.     

Increased distractibility in closed head injury as revealed by event-related potentials

The present study demonstrates that event-related potentials (ERPs) may be used to reveal increased distractibility as a physiologically measurable condition after chronic closed head injury (CHI). ERPs were recorded from 17 chronic CHI subjects and from 17 healthy age-matched controls. Auditory stimuli consisted of variants of vowel /o/ (standards) occasionally replaced by an /e/ vowel (deviant). Subjects were instructed to ignore auditory stimuli while watching a silent movie. In the constant-standard condition, the vowel /o/ served as the standard and vowel /e/ as the deviant. In the roving-standard condition, four variants of the vowel /o/ were randomly used as standards in the same stimulus block. None of the stimuli were prototypes in the subjects' mother tongues. Deviant stimuli elicited significant MMNs in both groups in both conditions, which were significantly smaller in the roving-standard than in the constant-standard condition. CHI victims showed significantly larger P3a amplitudes than controls in both conditions, apparently reflecting their enhanced involuntary sifting of attention and thus their increased distractibility.     

Giant cell lichenoid dermatitis in a patient with baboon syndrome

Giant cell lichenoid dermatitis is a recently described pathological entity, which can be seen as an unusual lichenoid drug eruption, a manifestation of sarcoidosis or within herpes zoster scars. Histopathological findings include focal vacuolar alteration of the basal layer with cytoid bodies, dermal and intraepidermal multinucleated giant cells and a mixed chronic inflammatory infiltrate with a lichenoid pattern consisting of lymphocytes, histiocytes, eosinophils and plasma cells. Here, we report a giant cell lichenoid dermatitis in a 41-year-old male patient who developed, 3 days after intravenous treatment with amoxicillin-clavulanic acid for erysipelas of the left leg, a clinical picture suggesting a baboon syndrome characterized by an erythematous and pruritic eruption on the axillary, inguinal and popliteal areas and the anterior side of elbows. This is the first reported case of giant cell lichenoid dermatitis in a patient with baboon syndrome.     

Primary atrophic solitary morphea profunda

Solitary morphea profunda (SMP) is a distinct form of localized scleroderma, a cutaneous disorder of unknown origin. Here, we describe a patient presenting with noninflammatory cupuliform depressed plaques, without any significant skin induration, pigmentation or texture change, that appeared on the left shoulder at a site of previous intramuscular vaccination. Light microscopy studies revealed excessive dermal collagen deposition with thickened hyalinized collagen bundles. Magnetic resonance imaging studies demonstrated tissue fibrosis with thinning of the subcutaneous fat tissue and involvement of the adjacent deltoid muscle, which was confirmed by electromyographic tests. Borrelia serology was negative. Our observation of SMP differed from previously described cases, since it mimicked localized lipoatrophy. Our observation highlights the wide spectrum of clinical presentations of localized scleroderma. The latter should be considered in the presence of lipoatrophy-like lesions for proper workup and therapy.     

Septic oligoarthritis as a complication of rhumatoid arthritis--a case report

We present the case a 53-year-old patient followed-up since 1999, for erosive AR treated with methotrexate and glucocorticoids. In April 2000, he had an arthritis of the right knee. The identification of an enterobacter in blood culture, and synovial biopsy results permitted the diagnosis of septic arthritis. After 23 days of antibioterapy treatment, the patient had an arthritis of the left knee. The infectious origin was confirmed by synovial biopsy. The course was better after adaptation of the antibiotics. Septic arthritis is then a serious complication of AR. It requires a fast and multidisciplinary management. It can be threatenig in fragile and immunocompromised patients. The functional prognosis is especially compromised in polyarticular septic arthritis.     

Articular manifestations of adult Still's disease

Adult onset Still's disease is a rare systemic disorder of unknown etiology occuring in young adults. The diagnosis is difficult and based upon Yamaguchi's criteria after exclusion of infectious diseases, hemotologic process or autoimmune diseases. Clinical manifestations are various. Functional prognosis depends essentially on articular involvement. We report a retrospective and multicenter study of 26 cases of adult still's disease collected during 10 years. Arthralgia are constant and arthritis are observed in third of the cases. Radiologic joint alterations are found in five cases. A literature review was done with emphasis on clinical and radiological characteristics of articular manifestations.     

Thyrotoxicosis revelated by bilateral hip fracture

Hyperthyroidism is an important cause of secondary osteoporosis and therefore of fractures. Nevertheless, facing an osteoporotic fracture, we do not systematically seek after such thyroid disorder in our daily practice. In this purpose, we report the case of 73 year old women, presented with a bilateral pathological femoral neck fracture. Investigations find a hyperthyroid related osteoporosis. Beyond orthopaedic treatment, radioiodine and bisphosphonate drugs were prescribed.