Introduction. - Olmesartan is an angiotensin II receptor blocker, used to treat arterial hypertension. Severe digestive manifestations have been associated with olmesartan, including sprue-like enteropathy and lymphocytic colitis. Observations. - We report two cases of sprue-like enteropathy associated with olmesartan, leading to malabsorption syndrome related to villous atrophy. After olmesartan discontinuation, patients exhibited resolution of clinical digestive symptoms and disappearance of biochemical abnormalities. Conclusion. - Our case reports underscore that accurate questioning is crucial in diagnostic approach, allowing to make the diagnosis of sprue-like enteropathy related to olmesartan in our patients. Interestingly, particular attention has recently been drawn to the fact that sprue-like disease may be a class effect of angiotensin II receptor blockers; further investigations are warranted to confirm these latter data. (C) 2018 Societe Nationale Francaise de Medecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

L'olmésartan appartient à la famille des antagonistes sélectifs des récepteurs de l'angiotensine II ; il est indiqué dans le traitement de l'hypertension artérielle (HTA). Récemment, l'olmésartan a été rendu responsable de colite lymphocytaire et/ou d'atrophie villositaire. Nous rapportons deux nouvelles observations d'entéropathies sévères induites par ce traitement. Une patiente de 72 ans était hospitalisée pour une diarrhée fécale non glairo-sanglante et des douleurs abdominales évoluant depuis 5 semaines. Ses antécédents étaient marqués par une HTA traitée par olmésartan depuis 6 mois. L'examen clinique était normal, hormis un météorisme abdominal modéré. La biologie montrait une insuffisance rénale fonctionnelle (urée : 29 mmol/L, créatinine : 351 μmol/L), une hypokaliémie (à 2,7 mmol/L) et une albuminémie à 32 g/L ; les autres examens (numération formule sanguine, C-réactive protéine, bilan hépatique, coprocultures, examen parasitologique des selles) étaient normaux. La gastroscopie était normale ; les biopsies duodénales mettaient en évidence une atrophie villositaire. La recherche d'anticorps anti-transglutaminase était négative. Après arrêt du traitement par olmésartan, l'évolution était favorable, avec disparition des troubles digestifs et normalisation de la fonction rénale. Une patiente de 66 ans, traitée par olmésartan depuis 2 ans pour HTA, était hospitalisée pour une diarrhée, des douleurs abdominales et un amaigrissement (7 kg) évoluant depuis un an. La biologie révélait une insuffisance rénale fonctionnelle (urée : 16 mmol/L, créatinine : 156 μmol/L), une hypokaliémie (à 2,8 mmol/L) et une albuminémie à 27 g/L ; la numération formule sanguine, la C-réactive protéine, le bilan hépatique étaient normaux. La recherche d'anticorps anti-transglutaminase était négative. La gastroscopie était normale ; les biopsies duodénales objectivaient une atrophie villositaire. La tomodensitométrie abdominale et la coloscopie étaient normales. L'évolution clinique et biologique était rapidement favorable après interruption de l'olmésartan. Des cas d'entéropathies dues à l'olmésartan ont été décrits, leur prévalence étant estimée à 10/100 000. Elles peuvent survenir, comme chez nos patientes, plusieurs mois à années après le début du traitement. Nos observations ont l'intérêt de souligner que les entéropathies induites par l'olmésartan, représentent une entité anatomo-pathologique sévère à ne pas méconnaître et sur la nécessité d'interrompre ce traitement en cas de survenue de signes d'entéropathie.

La prise en charge des récidives des cancers de l'ovaire repose sur la chimiothérapie intraveineuse associée ou non à une chirurgie de cytoréduction. La chimiohyperthermie intrapéritonéale (CHIP) est parfois proposée en complément d'une chirurgie complète. Le but de cette étude est d'évaluer la faisabilité, la morbidité et la survie de la CHIP associée à une cytoréduction chirurgicale complète dans le cadre de la prise en charge de patientes présentant une première récidive d'un cancer de l'ovaire.Entre 2005 et 2010, 27 patientes ont été opérées pour une récidive d'un cancer de l'ovaire. Parmi elles, 17 patientes (63 %) ont bénéficié d'une CHIP.Seize patientes (94 %) étaient en résection complète en fin d'intervention. Aucune patiente n'est décédée en postopératoire. Deux patientes ont eu des complications peropératoires : une plaie vésicale et une section de l'uretère. Huit patientes ont présenté des complications postopératoire dont 3 de grade 3 ou supérieur (deux défaillances d'organe et une reprise chirurgicale). Quinze patientes ont présenté une récidive avec une médiane de survie sans progression de 11,9 mois (IC 95 % [5,4–32,9]) depuis la CHIP. La médiane de survie globale depuis le diagnostic était de 107,8 mois.Ces résultats montrent que l'association de la CHIP, à une cytoréduction complète pour les récidives de cancer de l'ovaire, présente une morbidité et une survie acceptables. Les résultats de l'étude française multicentrique en cours (CHIPOR) sont attendus afin de généraliser cette prise en charge.The management of recurrent ovarian cancer is based on intravenous chemotherapy with or without debulking surgery. The hyperthermic intraperitoneal chemotherapy (HIPEC) is sometimes proposed as a complement to complete surgery. The purpose of this study was to evaluate the feasibility, morbidity and survival of HIPEC associated with complete surgical cytoreduction in the management of patients with a first recurrence of ovarian cancer.Between 2005 and 2010, 27 patients underwent surgery for a recurrence of ovarian cancer. Among them, 17 patients (63%) have received HIPEC.Sixteen patients (94%) were completely resected after surgery. No patient died postoperatively. Two patients had intraoperative complications: a bladder injury and a section of the ureter. Eight patients had postoperative complications including 3 grade 3 or higher (two organ failure and one reoperation). Fifteen patients had a recurrence with a median DFS of 11.9 months (95% CI [5.4–32.9]) from the HIPEC. The median overall survival from diagnosis was 107.8 months.These results showed that the association of HIPEC with a complete cytoreduction for recurrent ovarian cancer presents acceptable morbidity and survival. The results of the ongoing French multicenter study (CHIPOR) are expected to generalize this support.

Introduction. - Diagnosis of neuroborreliosis may be difficult. Neuroborreliosis mainly results in lymphocytic meningitis and in meningoradiculitis (67-83% of cases).Case report. - We report the case of a patient who developed a sudden facial diplegia, revealing neuroborreliosis proved by positive blood and cerebrospinal fluid serology. The patient had no previous history of tick bite and migrans erythema. The patient was given ceftriaxone therapy (2 g/day for 21 days), leading to resolution of all clinical symptoms.Conclusion. - Our report underscores that neuroborreliosis should be considered in patients exhibiting facial diplegia. Thus, Lyme serology should be performed systematically in these patients. Altogether, early management is crucial, before the onset of neurological manifestations at late stage, leading to disabling sequelae despite antibiotic therapy. (C) 2014 Societe nationale francaise de medecine interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

Since the 2000s, there has been an increase in prevalence of neurosyphilis (NS) and ocular syphilis (OS). As data about symptomatic NS/OS is limited, this study aims to assess the characteristics of symptomatic NS/OS, according to HIV status.We compared the clinical and biological presentation of early symptomatic NS/OS and its outcome in HIV-positive and HIV-negative patients.Ninety-six patients (93% men, 49% HIV-positive) were included from 2000 to 2016 in two centers, with 67 (69%) having OS, 15 (16%) NS, and 14 (14%) both. HIV-positive patients were younger (P = 0.006) and more likely to be males having sex with males (P = 0.00048) or to have a history of syphilis (P = 0.01). Among 81 OS, there were 43 posterior uveitis (57%), and bilateral involvement was more common in HIV-positive patients (62% versus 38%, P = 0.045). Among 29 NS there were 21 cases of cranial nerve involvement (72%), seven meningitis (24%) and 11 paresthesia (38%). Involvement of the VIIIth cranial nerve was the most common (16 cases). Treponemal tests were more commonly found positive in cerebrospinal fluid in HIV-positive patients (88% versus 76%, P = 0.04). Visual acuity (VA) always improved after treatment (initial VA logMAR 0.8 ± 0.8 versus 0.1 ± 0.1 at 3 months), but 32% and 18% of the patients still had neurological or ocular impairment respectively six and 12 months after treatment. Non-treponemal serological reversion was observed in 43/50 patients (88%) at six months.HIV infection has no consequence on the outcome of NS and OS. Sequelae are common, emphasizing the importance of prevention, and screening, and questioning enhanced treatment.

L’examen morpho-constitutionnel d’un calcul est indispensable pour établir la concordance diagnostique des mécanismes lithogènes ayant engendré ce calcul. Ce typage morphologique comporte une analyse visuelle de la surface et la section du calcul. Le CLAFU propose une méthode d’apprentissage de la reconnaissance endoscopique des calculs rénaux.Un recueil des images de surface et de section des calculs rénaux traités par urétérorénoscopie numérique a été réalisé de juin 2015 à décembre 2016. Le typage morphologique endoscopique, microscopique et l’examen SPIR des calculs a été réalisé par deux experts (biologiste, urologue).Cette expertise a permis de valider les images des calculs purs (I à VI) et mixtes (IIb + Ia), (IIb + IVa1)c, (IIb + IVa1)i, IIIab + Ia.Le CLAFU met à disposition des urologues des planches validées d’aide à la reconnaissance endoscopique des calculs pour une meilleure prise en charge de la maladie lithiasique.The constitutional morphological examination of urinary stone is indispensable to establish the diagnostic agreement of the lithiasic mechanisms that have produced this stone. This morphological typing involves a visual analysis of the surface and the section of the stone. CLAFU proposes a method of learning the endoscopic recognition of kidney stones.A collection of surface and section images of renal stones treated by digital ureteroroscopy was carried out from June 2015 to December 2016. Endoscopic, microscopic morphological typing and FTIR examination of the stones was carried out by two experts (biologist, urologist).This expertise allowed to validate the images of the pure kidney stones (I to VI) and mixed (IIb + Ia), (IIb + IVa1) c, (IIb + IVa1) i, IIIab + Ia.The CLAFU provides urologists validated boards to aid in the endoscopic recognition of stones for better management of lithiasis.

Intravesical bacillus Calmette-Guérin (BCG) therapy-associated articular complications are uncommon, occurring in only 0.5 to 1% of the patients.We report two patients who were given intravesical BCG therapy for superficial bladder cancer. Both patients developed polyarthritis and fever related to intravesical BCG instillation. The outcome of articular manifestations was favorable after administration of nonsteroidal anti-inflammatory therapy.Intravesical BCG therapy-associated articular complications should not be overlooked, as they may result in high morbidity. Nevertheless, the diagnosis of intravesical BCG therapy-related reactive arthritis should be discussed after excluding infectious arthritis due to Mycobacterium bovis. Therefore, joint fluid microbiological tests (cultures, PCR) are required in the patients receiving intravesical BCG who develop arthritis.

Connaître les symptômes cliniques de la neuromyélite optique de Devic. Connaître les anomalies IRM (moelle, nerf optique) évocatrices de maladie de Devic. Comprendre le profil évolutif des lésions de cette maladie. Savoir dépister les rares lésions encéphaliques et comprendre leur siège particulier. La maladie de Devic présente des caractères cliniques et d’imagerie qui peuvent être confondus avec ceux de la sclérose en plaques. On décrit maintenant, à côté des atteintes médullaires et optiques typiques, des lésions encéphaliques. L’évolution des lésions se fait par poussées et le pronostic global de la maladie est très sévère. La lésion la plus spécifique de la maladie de Devic est un hypersignal T2 médullaire très étendu.

Skeletal muscle involvement is uncommon in lymphoma, occurring in less than 1.5% of patients. We report the original case of a 61-year-old man who presented with pseudotumoral muscle lesions of the lower limbs, revealing nonHodgkin T-cell lymphoma. In our patient, magnetic resonance imaging (MRI) was useful in clearly revealing the detailed anatomic extent of muscle change; indeed, MRI showed muscle enhancement after intravenous administration of gadolinium on T-1-weighted images as well as high-signal intensity on T-2-weighted images. Moreover, MRI was helpful in guiding the optimal site for muscle biopsy. (C) 2008 Elsevier Masson SAS. Tons droits reserves.

Bisphosphonates are effective in reducing hip and other fractures. However, concerns about atypical femur fractures (AFFs) have contributed to substantially decreased bisphosphonate use, and hip fracture rates may be increasing. Despite this impact, important uncertainties remain regarding AFF risks including the association between bisphosphonate use and other risk factors such as BMD, age, weight, and race.To address this evidence gap, a cohort study of 196,129 women ≥50 years of age in the Southern California Kaiser Permanente HMO women (with ≥1 bisphosphonate prescription) were studied; the primary outcome was radiographically-adjudicated AFF between 2007 and 2017. Risk factors including bisphosphonate use and race were obtained from electronic health records. Multivariable Cox models were used for analysis. Benefit-risk was modeled for 1–10 years of bisphosphonates to compare fractures prevented vs. AFFs associated. Among 196,129 women, 277 (0.1%) sustained AFFs. After multivariable adjustment, AFF risk increased with longer bisphosphonate duration: hazard ratio (HR) increased from HR = 8.9 (95%CI: 2.8,28) for 3–5 years to HR = 43.5 (13.7138.1) for >8 years. Hip BMD, surprisingly, was not associated with AFF risk. Other risk factors included Asian ancestry (HR = 4.8 (3.6, 6.6)), short stature, overweight, and glucocorticoid use. Bisphosphonate discontinuation was associated with rapid decrease in AFF risk. Decreases in osteoporotic and hip fractures risk during 1–10 years of bisphosphonates far outweighed the increase AFF risk in Caucasians, but less so in Asians. In Caucasians, after 3 years 149 hip fractures were prevented with 2 AFFs associated compared to 91 and 8 in Asians.The evidence for several potential mechanisms is summarized with femoral geometry being the most likely to explain AFF risk differences between Asians and Caucasians. The results from this new study add to the evidence base for AFF risk factors and will help inform clinical decision-making for individual patients about initiation and duration of bisphosphonate therapy and drug holidays.

Sir, Tonsillar tuberculosis is a rare presentation of extrapulmonary tuberculosis. Although tuberculosis of the tonsils is nowadays an uncommon finding, tonsillar granulomas are occasionally seen by histopathologists, and can sometimes contain tuberculous organisms. Occasionally, tonsillar tuberculosis may precede the diagnosis of pulmonary tuberculosis.1 We present the case of a 40-year-old patient admitted for evaluation of hoarseness and difficulty in swallowing, firstly diagnosed as recurrent angina. He had also had chronic bilateral cervical lymphadenopathy for the last three years. All preceding investigations were normal. Clinical examination was …

La migration du cathéter après la dérivation ventriculopéritonéale (DVP) d’une hydrocéphalie est une complication très rare. Elle est due à une déconnection ou rupture de ce cathéter. Cette migration peut aller jusqu’à l’extériorisation de ce dernier par l’anus ou la bouche. Notre travail rapporte un cas d’extériorisation du cathéter de dérivation d’une hydrocéphalie par le canal péritonéovaginal diagnostiqué en peropératoire au cours d’une cure d’hydrocèle chez un enfant qui avait subi une DVP pour son hydrocéphalie, il y a plus de deux ans. Les enfants dérivés pour hydrocéphalie nécessitent une surveillance régulière clinique et par des radiographies de contrôle du trajet de la valve, une fois par an.The catheter migration after ventriculoperitoneal shunt (VPS) for hydrocephalus is a very rare complication. It is caused by a disconnection or rupture of the catheter. Then, this one can be exteriorized through the anus or the mouth. We report here the case of catheter exteriorization after VPS through the peritoneovaginal duct diagnosed during the hydrocele surgical cure, two years after VPS insertion. The children with VPS require a regular clinical surveillance and a radiographic control of the hydrocephalus valve track, once per year.

Polyarteritis nodosa ( PAN) is a systemic necrotizing vasculitis that affects numerous organs, particularly the digestive tract ( 33 - 52% of cases). However, isolated ascites has rarely been described in patients with PAN. We observed a patient who had developed ascites revealing PAN, and because of suspected malignancy laparotomy and abdominal surgery were performed, including systematic total abdominal hysterectomy, bilateral salpingo- oophrectomy, submesocolic omontectomy and appendicectomy. Macroscopic examination revealed a nodule involving the left ovary, while histological examination of biopsy specimens demonstrated characteristic damage of necrotizing vasculitis involving the appendix, omentum, uterus, fallopian tubes and right ovary, consistent with PAN. The patient had a favourable outcome of clinical manifestations related to PAN after initiation of combined therapy of prednisone and cyclophosphamide. Our case report therefore reinforces the possibility of an unusual presentation of PAN. As ascites may precede other signs of PAN, we suggest that when unexplained ascites is noted an evaluation for misdiagnosed vasculitis should be carried out, including a search of the constitutional symptoms ( e. g. fever, weight loss). Patients undergoing laparoscopy for peritoneal involvement of unknown origin should also have tissue specimens taken for pathologic studies, notably to exclude an underlying vasculitis.

Introduction Spontaneous splenic hematomas are uncommon and frequently associated with infectious, hematologic, or neoplastic diseases. Presentation is typically acute but progressive forms have been described.Case We report the case of a 45-year-old man consulting for abdominal pain that was found to be due to a spontaneous splenic hematoma. No recent injuries, infections, or hematologic, neoplastic or gastrointestinal diseases were found, but the patient had had a minor injury 9 months earlier and had been treated with selective serotonin reuptake inhibitors (venlafaxine) for the past year. This history suggested that the drug might play a role.Discussion Although the likely cause of this splenic hematoma appears to be a minor injury 9 months before the onset of pain, we cannot rule out the possibility that selective serotonin reuptake inhibitor treatment was a predisposing factor.