Heterotopic pregnancy: 3 case reports

Heterotopic pregnancy is a rare event combining intra and extra uterine pregnancies. We report 3 cases observed in patients aged 32, 32 and 31 years consulting for pelvic pain and metrorragia with amenorrhea of 6 to 7 weeks. Treatment was conservative in 2 cases and radical for the third patient. The frequency of this association has been increased since the development of medical procreation technique and the increased of ectopic pregnancy. The foetomaternal prognosis will be improved by an early diagnosis.     

Coronary disease in hypothyroidism. 10 case reports

The hypothyroidism and coronary disease are tightly related. Our retrospective study, based upon the data from ten patients with hypothyroidism and coronary disease, aimed to assess the diagnosis, the prognosis and the therapeutic measures in these patients. Our population aged in average 60 years and was almost composed with women. Acute Coronary syndrome was a circumstance to discover hypothyroidism three patients. Bi and tritruncular stenosis were found in seven of the patients. The mean number of coronary lesion by patient is 2, 1. Myocardial reperfusion was proposed in seven of the patients. The three remainders were treated medically. Among the six operated patients, three were insufficiently prepared by the opotherapy. One of these patients died in preoperative period. The only patient who underwent angioplasty presented an uneventful period. At short and long term follow-up the evolution of all survivors patients was satisfactory on the both coronary and thyroidal sides. During the course of hypothyroidism coronary lesions are more extended, complex and severe. The management of such patients is difficult because of destabilisation of affection by the treatment of the other one. Preventive measures seams to warrant the best result.     

Negative pressure pulmonary edema: 3 case reports

Negative pressure pulmonary edema is a complication, described since 1977, caused by upper airway obstruction in both children and adults. Although its aetiopathogeny is multifactorial, especially outstanding is excessive negative intrathoracic pressure caused by the forced spontaneous inspiration of a patient against a closed glottis, that causes high arteriole and capillary fluid pressures that favor transudation into the alveolar space The resulting pulmonary edema can appear a few minutes after the obstruction of the airway or in a deferred way after several hours. The clinical manifestations are potentially serious, but normally respond well to treatment with supplemental oxygen, positive pressure mechanical ventilation and diuretics. Diagnostic suspicion is important for acting promptly. We report three clinical cases with acute negative pressure pulmonary edema.     

Etonorgestrel concentrations in morbidly obese women following Roux-en-Y gastric bypass surgery: three case reports

Background

Pregnancy should be avoided for 12 to 18 months after Roux-en-Y gastric bypass (RYGB) surgery. The etonorgestrel (ENG)-releasing implant (Implanon®) may represent a safe and effective contraceptive method in morbidly obese women who are candidates for bariatric surgery. In addition, the subcutaneous delivery of steroid is unaffected by malabsorptive surgery.

Methods

Three cases of young women with ENG-releasing implant are reported. The device was inserted 1–2 months prior to RYGB.

Results

Their initial weights were 130 to 176 kg, and the mean weight loss was 33.6 kg at 6 months. The concomitant serum ENG concentrations decreased currently with weight loss but remained above the minimum concentration required for effective contraceptive effect of the implant for at least 6 months following RYGB (average, 170 pg/mL). The concentrations observed before weight loss were lower than in normal-weight women, but decreases in ENG concentrations following implant insertion were similar.

Conclusion

These unique data in morbidly obese women highlight the need for further pharmacokinetic studies of contraceptive agents in obese women during weight loss.     

Mucormycosis: four case reports

INTRODUCTION: Mucormycosis is a rare and invasive fungal infection, but frequently fatal when it occurs. It commonly affects patients with diabetes mellitus. The aim of this study is to assess the clinical presentation, radiological findings, management and prognosis of mucormycosis. METHODS: This retrospective study was conducted in the department of infectious diseases of Rabta hospital between January 1988 and December 2004 and included patients hospitalized for mucormycosis confirmed by mycological and/or histological findings. RESULTS: the study is about four diabetic patients with mucormycosis (3 men and a woman). Three of them had diabetic ketoacidosis at the time of diagnosis. The infection was sinusal in 2 cases and rhinocerebral in the the other two cases. Treatment consisted in systemic amphotericin B combined with surgical debridement in 3 cases. A fatal outcome was noted in 2 cases. CONCLUSION: Mucormycosis remains a severe infectious disease in diabetic patients. Early diagnosis and treatment is mandatory for a successful management of this infection.     

Suprasellar germinoma: two case reports

Suprasellar germinomas are frequent in childhood and adolescence, particularly in male sex. The clinical and neuroendocrine abnormalities depend of tumor localization: Increased intracranial pressure, visual disturbances, hypopituitarism, Parinaud syndrome. We report two cases of suprasellar germinoma in young male patients (16 and 18 years old). The first patient hrad corticotorpin insufficiency and clinical signs of hypothyro?dism and hypogonadism. The second had central hypocorticism, hypothyro?dism and hypogonadism associated with central diabetes insipidus and hyperprolactinemia. The diagnosis of germinoma was confirmed after surgery by anatomopathologic examination in the first case and by stereotaxic biopsy in the second case. Treatment by radiotherapy improves prognosis of this disease.     

Sarcoidosis: current concepts and case reports

Sarcoidosis is a systemic granulomatous disease of unknown etiology associated with various immune alterations and biochemical changes. This article reports recent advances in the conceptualization of the immune dysfunction with emphasis on helper T-cell overactivity in the lungs. Because 90 percent of patients with sarcoidosis have intrathoracic disease, the mode of presentation, radiographic findings, clinical course, and treatment of pulmonary involvement are discussed. Case reports are used to demonstrate the typical course of the disease and generally favorable outcome of the vast majority of patients seen in the non-referral setting. A rare case of neurosarcoidosis with neuroendocrine features is presented.     

Migration of implanon: two case reports

These two case reports describe migration of Implanon (the single-rod contraceptive implant). A review of the literature revealed true migration of Implanon to be rare. A change of practice locally is described.     

误诊为类风湿关节炎的麻风3例并文献复习

目的提高对有关节症状或类风湿因子（RF）阳性的麻风病的认识。方法回顾性分析3例误诊为类风湿关节炎的麻风患者的临床表现、实验室检查与影像学资料，并复习相关文献。结果3例患者中，2例男性，1例女性；2例有关节症状，2例RF阳性，3例血沉、C反应蛋白等炎性指标增高；误诊为类风湿关节炎的时间长达3~5年。结论对于合并皮肤、周围神经等系统损害的关节病变或RF阳性患者，应提高对麻风的警惕性，避免误诊、误治。     

Contamination of blood during cardiopulmonary bypass: the effect of antibiotic prophylaxis

Despite antibiotic prophylaxis in cardiac surgery, gram-positive bacteria can be isolated in up to 10% of intraoperative blood cultures. During a prospective randomized trial, blood was collected from the oxygenator at the end of bypass in 58 patients given teicoplanin and in 60 others given flucloxacillin and tobramycin. Coagulase-negative staphylococci were cultured from 16 patients given teicoplanin but in only four cases after flucloxacillin and tobramycin (Fisher's exact test, P = 0.005). In contrast, Propionibacterium spp. or coryneforms were isolated from 22 patients given flucloxacillin and tobramycin and from only one patient in the teicoplanin group. There were no cases of prosthetic valve endocarditis. After 3 h exposure to 4 x MIC of teicoplanin there was only a 10-60 fold reduction in cfus of Staphylococcus epidermidis, which may partly explain the excess of these organisms.     

Eating disorders in immigrants: Two case reports

The incidence of eating disorders has been highest among Caucasian American women of middle to upper middle social classes. Observations of anorexia nervosa and bulimia in two Eastern European immigrants to the United States are described. These cases illustrate the influence of immigration and acculturation on the adolescent and highlight their particular vulnerability to acculturation pressures of the new society. The case studies illustrate the complex interaction of individual, familial, and sociocultural factors associated with the development of anorexia nervosa and bulimia in a population not previously considered to be at risk. Consideration is given to the potential susceptibility of female immigrants in the United States to the pervasive messages emphasizing slimness and attractiveness as vehicles to acceptance and success in American culture.     

Epilepsy with affective symptomatology: three case reports

Disagreeable affect of fear or anxiety can form the essential of the epileptic critical semiology. The centrum seat is most often found to be temporal and in some rare cases frontal. This form of epilepsy makes it sometimes difficult to establish a differential diagnosis specially when confronted with panic attack. A careful semiologic analysis is needful. Some clinical criteria are in favor of an epileptic etiology like the shortness of the crises, the stereotyped characteristic of the semiology or the association with some other epileptic symptoms. The assumption of neurophysiologic substratum common to both entities is put forward by the authors. Indeed, the current researches are moving towards the likelihood that the limbic structures are stimulated by the epileptic discharge. These structures are taking a part in the pathogeny of the anxiety troubles. Three clinical vignettes are illustrating the difficulties in diagnosing this form of epilepsy.