Biomedical subjects
Publications and source records attributed to B Becq-Giraudon.
The authors report the case of a 81 years-old-woman who had simultaneously atypical Cogan's syndrome, cutaneous vasculitis and diverticular sigmoiditis. The relations being between these three diseases are discussed.
A 72 years old, male complains difficulty in walking, a peripheral neuropathy of four limbs is found. Clinical examination shows a peripheral lymphadenopathy predominating in left inguinal nodes. A malignant IgA k plasmocytoma is seen on lymph node biopsy. There is no pathological plasmocytosis on bone trephine biopsy. Bone radiographies are normal. Immunoelectrophoreses finds a monoclonal IgA lambda protein of little abundance without lowering of other immunoglobulins. Insufficiency of adenohypophysis clinically suspected, is confirmed by static and dynamic tests as well as anomaly of glucose tolerance. Biopsies of skin, muscle and nerve show neither plasma cell infiltrate nor amyloid deposit. Evolution is stabilized during 12 months by an hematosarcoma type treatment which must be stopped because of bad hematologic tolerance. This interruption is followed by a fast severe evolution that leads to death in few weeks. This case as comparable with those reported by japanese authors in Far East and of which rare cases have been reported in non japanese people. It seems that the association of a non myelomatous plasma cell dyscrasia of uncertain malignancy with peripheral neuropathy, endocrinic, cutaneous and various visceral signs must be individualized. It could be considered as a particular paraneoplastic syndrome more especially as in many case the cure of the plasma cell proliferation has been followed by disparition of visceral signs.
Post-operatory partial tetanus is a more and more rare event. It can outcome after any type of surgery but especially after abdominal surgery. The contamination is usually endogenous through the digestive bacteria and it develops in anaerobic context. These different factors were united in this report. The diagnosis is difficult if not keep in mind. The treatment is usual, but prevention might be pointed out.
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In this cooperative trial, 181 patients with various urinary tract infections were treated by dibekacin, a new hemi-synthetic aminoglycoside. Clinical and bacteriological results confirm the efficacy of dibekacin in this indication. Local and systemic tolerance, and thus renal and cochleo-vestibular, were very satisfactory.
During an open multicentric trial (17 centers), we have treated 62 septicemia by dibekacin, alone or associated with other antibacterial drugs. Taking into account the degree of severity of these patients, the results are considered satisfactory in 47 patients. 15 failures were noted (including 9 deaths). General and local tolerance were good, in spite of the duration of treatment.
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Among 208 cases of aseptic lymphocytic meningitis seen over a nine-year period, 24 were diagnosed as viral infections. Diagnosis was established by both isolation of the virus from one or several specimens (feces, pharyngeal mucus, CSF) and significant rise in specific antibody titres. The usual clinical and epidemiological characteristics of these benign infections were demonstrated in our series: prevalence in males; recrudescence in summer; infectious syndrome associated with an unequivocal, though moderately severe, meningeal syndrome, and occasionally with various visceral manifestations (exanthema, pharyngitis, acute respiratory disease, myalgia); clear CSF usually with pleiocytosis (relative but not absolute predominance of lymphocytes) and normal chemical findings. All the cases in our series were due to enteroviruses, Echo or coxsackie. Isolation of a poliovirus (type III) in one case deserves mention. Cases where clinical examination led to unequivocal diagnosis of mumps or herpes zoster were not included in our study.
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Hypercalcaemia accompanied a bladder tumour in a 77-year-old woman. Immuno-reactive parathormone (IPTH) in the tumour being high, the hypercalcaemia could thus be attributed to secretion by the tumour of a substance with parathormone activity. The rarity of bladder tumours at the origin of paraneoplastic hypercalcaemia is recalled. The mechanism of the metabolic disturbance and the disagreement between serum and tumour levels of IPTH are discussed.
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Cardiac involvement in the course of familial Portuguese amyloidosis, as apart from the other primary amyloidosis, is characterised by the early and wide-spread intracardiac conduction disorders, and the contrasting late presentation of the clinical signs. A case is presented of Portuguese amyloidosis which was typical from the viewpoint of the neurological disorders, the familial characteristics, and the positive biopsy; the main conduction defects found in primitive amyloidoses are also recalled. The patient described had for many years suffered from first degree heart block, and then presented with lipid changes with syncopal attacks which led to electrophysiological investigation of the conduction defect, no similar example of which has been found in the literature. The severity and widespread nature of the disorders which were found, together with the localisation of a sub-His block led us to implant the pacemaker. We have only found two other patients who had implants for disorders of conduction secondary to cardiac amyloidosis. Emphasis has been laid on the importance of this investigation which, when it leads to the positioning of a pacemaker, should avoid the onset of syncopal attacks and sudden death which together constitute one of the primary causes of mortality in primary amyloidosis. The length of follow-up in our case has been 14 months (April 1977).