Adrenal hemorrhage is a rare disease associated with various conditions. We report a case of a 68-year-old woman with abdominal and back pain. The diagnostic work-up showed a left adrenal gland infarction associated with essential thrombocythemia. Treatment consisted in painkillers and treating the underlying condition in order to prevent further thrombotic events.

BACKGROUNDA 57-year-old patient was admitted for high-grade fever, asthenia, sweating, dry cough and diffuse arthro-myalgias. Two years earlier, elevated titers of anticytoplasmic antibodies (ANCA) of anti-proteinase 3 specificity and renal biopsy led to a diagnosis of granulomatosis with polyangiitis (GPA) with lung and renal involvement. GPA was treated by steroids, cyclophosphamide and rituximab with subsequent clinical and biological remission. The current chest CT scan was performed for a lung opacity that eventually was proved to be an organising pneumonia. CT also showed an unsuspected pattern of the spleen that was compared with a previous chest CT.

A 78-year-old man presented with a history of fever and night sweats of 1-month duration. His relevant medical history was a transitional-cell bladder cancer treated with intravesical instillation of bacillus Calmette–Guérin (BCG) 5 months previously. Abdominal palpation revealed a pulsatile mass in the left lower quadrant. Laboratory tests only showed an elevated C-reactive protein at 5.7 mg/dl. Contrast-enhanced CT scan of the abdomen demonstrated a saccular aneurysm of the infra-renal aorta (Fig. 1) suggestive of mycotic aneurysm. An aneurysmal resection was then performed. Aerobic and anaerobic culture of the aortic tissue remained negative but a Ziehl–Nielsen stain was positive consistent with a mycobacterial infection. Acid-fast culture and PCR were positive for Mycobacterium bovis. The diagnosis of mycotic aneurysma following intravesical BCG therapy was then retained. Vascular complications after intravesical instillation of BCG, a live attenuated strain of Mycobacterium bovis, are extremely rare. Haematogenous or lymphatic spread is the most common hypothesis proposed to explain an arterial infection by M. bovis. Both medical and surgical approach are requested in the management of BCGinduced mycotic aneurysm. A combination with at least three antituberculous agents for 9–12 months is recommended. Pyrazinamide should not be used due to widespread resistance of M. bovis.

We report on a 75-year-old woman who presented with recurrent episodes of hypotension, anasarca, renal failure, hypoalbuminaemia without proteinuria, suggestive of systemic capillary leak syndrome (SCLS). Further investigations led to a diagnosis of diffuse large B-cell lymphoma. Secondary SCLS associated with non-Hodgkin lymphoma is reviewed.

Background: Septic arthritis (SA) is a rheumatological emergency that can lead to rapid joint destruction and irreversible loss of function. The most common pathogen causing SA is Staphylococcus aureus which is responsible for 37-65% of cases. Streptococcus pneumoniae is traditionally described as an uncommon cause of SA of a native joint. The objective of our study was to analyse clinical characteristics, treatment, and outcome of all cases of pneumococcal septic arthritis treated in our institution, and to compare them with other series published in the literature.Materials and methods: We conducted a retrospective study of pneumococcal SA identified among all cases of SA diagnosed in a teaching hospital of one thousand beds between 2004 and 2009. Diagnosis was based on culture of joint liquid or by the presence of pneumococcal bacteraemia and purulent (more than 50 000/mm(3) white blood cells with more than 90% neutrophils) joint fluid aspiration.Results: Among 266 cases of SA, nine patients (3.3%) were diagnosed as having pneumococcal SA. The median age was 75 years. The main affected joint was the knee (7/9). No patient had more than one joint involved. Four patients suffered from concomitant pneumonia. Joint culture and blood cultures were positive in 7/9 and 5/9, respectively. Median (range) length of stay was 18 days (3-47 days). One patient with associated pneumococcal bacteraemia died 19 days after admission. Seven patients recovered completely.Conclusions: Streptococcus pneumoniae is now being increasingly recognized as a common agent of SA. This organism is frequently associated with pneumococcal pneumonia or bacteraemia, particularly in patients with advanced age and comorbidities. Direct inoculation of joint fluid into blood culture medium BACTEC system increases the probability of microbiological diagnosis. The prognosis is usually favourable if the disease is promptly recognized and treated (antibiotic therapy combined with joint drainage).

We report a case of Charcot spinal arthropathy in a diabetic patient and emphasize the clinical reasoning leading to the diagnosis, discuss the differential diagnosis, and insist on the crucial role of the radiologist and pathologist which allows the distinction between Charcot spinal arthropathy and infectious or tumoural disorders of the spine.

We read with interest the review of Van Den Broecke et al. discussing methadone-related fatalities (1). We would like to report a case of acute methadone overdose complicated by unusual cardiac manifestations. A healthy, opiate-naive, 51-year-old woman was found unconscious in the morning by her partner. On arrival of the emergency mobile unit, she was found with a Glasgow Coma Scale score of 9/15 (E3V1M5), bilateral miotic pupils, bradypnea and hypoxia (oxygen peripheral saturation [SpO2] of 70%). On admission in the emergency room, central hypoventilation was confirmed by arterial blood gas analysis (under 10 l/ min supplemental oxygen): pH 7,08 pCO2 82 mmHg, pO2 82 mmHg. An orotracheal intubation was performed and mechanical ventilation was started. The relevant routine laboratory findings were: serum creatinine 2,67 mg/dl (normal values [NV] 0.6–1.4 mg/dl), serum creatinine kinase 3133 IU/l (NV < 200 IU/l) and troponin-I 0,77 ng/ml (NV < 0.08 ng/ml). The admission electrocardiogram (EKG) failed to reveal any ischemic change, with also normal QRS morphology and QT interval duration. The patient did not develop significant hypotension. We learned a few hours later from her partner, who was currently under methadone maintenance therapy, that she could have voluntarily ingested a maximal amount of 400 mg methadone during the night before admission. In addition to methadone in serum (203,2 ng/ml) and urine, the extensive toxicological screening revealed the presence of ethanol (serum: 0,5 g/l), but no vasoconstrictive substances were detected. Forty-eight hours after ICU admission, serum troponin-I levels rose up to 23.76 ng/ml together with a ST-segment elevation in the anterolateral leads on the EKG (Figure 1). After extubation, the patient was perfectly alert and did not complain from any chest pain. Methadone serum concentration was still 110,4 ng/ml. The EKG returned to normal morphology after 24 hours. Repeated echocardiography remained normal (no segmental contractility abnormalities). Further clinical course was uneventful. A coronary CT angiography and a stress test with MIBI myocardial scintigraphy performed soon after discharge were unremarkable. To our best knowledge, only one case of methadonerelated acute coronary syndrome with normal coronary arteries has been previously described (2). This 22-year-old man was chronically receiving methadone and presented an acute occlusion of the left anterior descending coronary artery; he had however additional cardiovascular risk factors. The most common cardiac complication of therapeutic use of methadone is prolonged QT interval with an increased risk of “torsades de pointe” (3). Acute overdose may result in circulatory collapse or even cardiac arrest, but without clear evidence of myocardial ischemia (4).

A 56-year-old man with a history of hypertension, alcoholism and active smoking, was admitted because of progressive dyspnoea and leg oedema. He also mentioned an increase of his abdominal perimeter and a weight loss of 20 kg during the last two months. On admission, blood pressure was 130/80 mmHg, body temperature was 35.6° C and pulse rate 75 per minute. Physical examination revealed bibasal thoracic dullness, bilateral massive kidney enlargement and ascites. Relevant laboratory data were: C-reactive protein 0.9 mg/dl, white blood cell count 6940/μl, serum urea 78 mg/ dl, serum creatinine 1.65 mg/dl, GammaGT 184 UI/l, total serum bilirubin 1.8 mg/dl and serum albumin 4.2 g/dl. Urinalysis was unremarkable. Abdominal ultrasonography showed non-cystic polylobulated kidney enlargement (20 cm of major axis), with irregular contours. Abdominal MRI demonstrated large and numerous bilateral renal masses, with enlarged left adrenal gland (Figure A and B). Bilateral pleural effusion and ascites were also noted. A differential diagnosis of bilateral oncocytomatosis – benign kidney involvement by oncocytoma – and malignancy was then made. Percutaneous biopsy of the left kidney revealed malignant infiltration in keeping with the diagnosis of clear cell carcinoma. Bilateral nephrectomy with left adrenalectomy was performed with subsequent hemodialysis treatment. Macroscopic peroperative inspection also demonstrated liver cirrhosis. Final anatomopathological findings confirmed bilateral multifocal clear cell carcinoma invading the left adrenal gland, without evidence of oncocytoma. Brain MRI, fundoscopy and genetics studies ruled out a Von Hippel Lindau syndrome (VHL). Renal cell carcinoma (RCC) is the most common kidney cancer and accounts for about 2% of adult malignancies. Bilateral synchronous multifocal renal cell carcinoma occurs in approximately 4% of all patients with RCC. Bilateral RCC of the same subtype can exist in a hereditary form (VHL, hereditary papillary RCC) or a sporadic form. Hereditary forms are more common than the sporadic forms, and occur at an earlier age. Sporadic bilateral synchronous RCC can be of either the clear cell as in our case, or of the papillary subtype. Tumour multifocality is demonstrated in preoperative imaging in only one-third of patients.

This paper presents work performed for a study investigating the ability of different flexible materials to induce fragmentation of a hypervelocity projectile. Samples were chosen to represent a wide range of industrially available types of flexible materials like ceramic, aramid and carbon fabrics as well as a thin metallic mesh. Impact conditions and areal density were kept constant for all targets. Betacloth and multi-layer insulation (B-MLI) are mounted onto the targets to account for thermal system engineering requirements. All tests were performed using the Space light-gas gun facility (SLGG) of the Fraunhofer Institute for High-Speed Dynamics, Ernst-Mach-Institut, EMI. Projectiles were aluminum spheres with 5 mm diameter impacting at approximately 6.3 km/s. Fragmentation was evaluated using a witness plate behind the target. An aramid and a ceramic fabric lead the ranking of fabrics with the best projectile fragmentation and debris cloud dispersion performance. A comparison with an equal-density rigid aluminum plate is presented. The work presented can be applied to optimize the micrometeoroid and space debris (MM/SD) shielding structure of inflatable modules.

Calciphylaxis is a rare disorder which mainly affects patients with end-stage renal disease and secondary hyperparathyroidism. We report here a case of calciphylaxis in a 56-year-old woman with primary hyperparathyroidism, a much more uncommon association. Skin biopsy revealed the characteristic pictures of the disease. Soon after parathyroidectomy, the parameters of the phosphorus-calcium metabolism normalised but the cutaneous lesions persisted for several months.

Object: Chronic fatigue syndrome (CFS) patients report usually cognitive complaints. They also have frequently comorbid depression that can be considered a possible explanation for their cognitive dysfunction. We evaluated the cognitive performance of patients with CFS in comparison with a control group of healthy volunteers and a group of patients with MOD.Patients and methods: Twenty-five patients with CFS, 25 patients with major depressive disorder (MDD), and 25 healthy control subjects were given standardized tests of attention, working memory, and verbal and visual episodic memory, and were also tested for effects related to lack of effort/simulation, suggestibility, and fatigue.Results: Patients with CFS had slower phasic alertness, and also had impaired working, visual and verbal episodic memory compared to controls. They were, however, no more sensitive than the other groups to suggestibility or to fatigue induced during the cognitive session. Cognitive impairments in MDD patients were strongly associated with depression and subjective fatigue; in patients with CFS, there was a weaker correlation between cognition and depression (and no correlation with fatigue).Conclusions: This study confirms the presence of an objective impairment in attention and memory in patients with CFS but with good mobilization of effort and without exaggerated suggestibility. (C) 2011 Elsevier B.V. All rights reserved.

Myopathy, including rhabdomyolysis, is a well-known, albeit rare complication of statin therapy. Predisposing factors include comorbidities and the concomitant use of cytochrome P-450 (CYP) 3A4 inhibitors. We report a case of severe simvastatin-induced rhabdomyolysis triggered by the addition of amiodarone to previously well-tolerated chronic statin therapy. Physicians should be aware of the risk of this potentially severe drug interaction. The dose of simvastatin should be reduced (to 20 mg daily) when concomitant treatment with amiodarone is required, or preference should be given to pravastatin, rosuvastatin or fluvastatin, which are not metabolised by the CYP 3A4.

La fibrose rétropéritonéale (FR) est une maladie inflammatoire et fibrosante du tissu rétropéritonéal périaortique, dont l’étiopathogénie reste mal comprise. Des données récentes suggèrent que la FR pourrait, dans certains cas, être l’expression particulière d’une dyscrasie lymphoplasmocytaire. Nous rapportons ici l’observation d’un homme de 59 ans présentant une FR associée à un myélome IgG lambda, et discutons les arguments physiopathologiques pouvant relier ces deux affections. Cette observation soulève l’hypothèse que l’association FR et dyscrasie plasmocytaire n’est peut-être pas fortuite.

We report the case of a 46-year-old woman who noticed a swelling of the left supraclavicular fossa of rapid onset soon after a Mycoplasma Pneumoniae upper respiratory infection. On the basis of clinical history, physical examination and imaging findings, a diagnosis of chyloma due to intense non-productive coughing bouts was made. The supraclavicular swelling progressively disappeared after a few days. This observation prompted us to briefly review the pathophysiology of chylomas.

We describe an HIV1-positive patient under long-term tenofovir treatment who developed a severe, biopsy-proven, acute tubular necrosis with proximal tubule (PT) dysfunction, precipitated by the very recent start of diclofenac, a nonsteroidal antiinflammatory drug (NSAID). Recent studies show that NSAIDs not only alter glomerular filtration but also multidrug resistance protein (MRP) 4-mediated PT secretion of several substrates. Since the patient tolerated tenofovir well for several years prior to diclofenac use, our observation suggests that diclofenac interfered with tenofovir clearance, thereby favoring its nephrotoxicity. NSAIDs should be avoided in patients under tenofovir.

We report the successful treatment of a patient with HIT-associated venous thrombosis by fondaparinux, a synthetic pentasaccharide. Although not yet approved for this indication, this new anticoagulant may be a useful alternative in the setting of HIT.

Reconsidering the place of reading and writing activities in the light of lexical closeness In France and in Quebec, when you teach English as a foreign language to beginners in the primary school, you are expected to start with oral communication activities. Yet, when you are French, it is easier to read English than to speak it because the two languages share many words in common called transparent words or cognates. This project explores the possibility of commencing the teaching of English with children by paying special attention to transparent words. It suggests that children's attention should be drawn to the large number of words the English and French language have in common. The aim is to challenge pupils to ask questions about language. It consists in making pupils explore their mother tongue and the target language in order to find regularities based on their own knowledge. After studying both their mother and foreign tongues, they are eventually able to make a contrastive analysis of the two language systems. An experimental application in the form of a series of lessons based on cognates was developed in accordance with modern theories of language acquisition so that the practical aspects could be knowingly discussed. En France comme au Québec, quand vous enseignez l'anglais à l'école primaire comme seconde langue à des débutants, il semble préférable de commencer par l'oral. Pourtant, quand vous êtes français, il est plus facile de lire l'anglais que de le parler parce que les deux langues ont beaucoup de mots en commun que l'on appelle mots transparents ou cognates. Cette étude propose de commencer le début de l'apprentissage de l'anglais à l'école primaire en accordant une attention spéciale aux mots transparents. Elle montre qu'il est profitable d'attirer l'attention des enfants sur les correspondances entre l'anglais et le français étant donné le grand nombre de mots que les deux langues ont en commun. Le but est de faire en sorte que les élèves se posent des questions à propos de la langue. Ils doivent explorer leur langue maternelle et la langue cible afin de dégager certaines régularités à partir de leurs observations. Après avoir étudié les deux langues, ils sont amenés à conduire une analyse contrastive. Un dispositif expérimental sous forme d'une « méthode à partir des mots transparents » a été mis en place en tenant compte des avancées des données théoriques actuelles sur l'apprentissage d'une langue étrangère afin que les fondements de toute pratique soient discutés avec une pleine mesure de ce qui les légitime. Mots-clés : mots transparents, école primaire, analyse contrastive, compréhension et expression écrites