[Hyponatremia in a cirrhotic suffering from late cutaneous porphyria: a drug to avoid, demeclocycline].
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Biomedical subjects
Publications and source records attributed to C Laroche.
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The association of hyperthyroidism and thyroid cancer is rare. The commonest finding is multilobular goitres. When a toxic adenoma is associated with a thyroid cancer they are usually clearly separate lesions. A thyroid cancer lying within a toxic adenoma, as in this case, is a much rarer occurrence, and a review of the published literature suggests that the relatively frequent association of the two lesions is fortuitous. The possibility of a cancer occurring near, or within a toxic adenoma, is an argument in of surgical treatment of these formations.
A particularly high hypercalcemia (141 mg/ml) was observed in a man with Graves' disease. An intense muscle asthenia, with lack of dynamism and vomiting which may cause dehydration, are the most suggestive signs of hypercalcemia. Bone biopsy and above all parathormone estimations permit one to eliminate associated hyperparathyroidism. The efficacy of mithramycin used alone, without any other hypocalcemic drug, was remarkable. The direct responsibility of thyrotoxicosis as a cause of the calcium disorder seems undoubted but the precise mechanism of the hypercalcemia remains unexplained.
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The authors report the case of a 55 year old woman suffering from an astrocytoma of the corpus callosum, probably originating in the middle part of the commissure and subsequently involving the whole structure, beyond which it extended very little. They describe the symptoms and signs, consisting initially of a progressive isolated astasia-abasia, in the absence of any psychological disturbance, and subsequently consisting of an apraxic disorganisation involving particularly gestural activity of the left upper limb. They discuss the significance of the psychological disturbances and problems of stasis and walking classically described in relation to tumoural pathology of the corpus callosum, generally attributed to an associated pre-frontal involvement. They review the principal features the "callosal disconnection syndrome" of which their patient constituted an example.
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The authors report a new case of Behcet's disease in association with ankylosing spondylitis. A study of the HLA system in this patient, showed the presence of an HLA 5 (Behcet's disease) and the absence of HLA W 27 (ankylosing spondylitis). The authors recall the frequency of HLA W 27 during ankylosing spondylitis, whether primary or associated with psoriasis, or enteric disease. Desensitisation to autologous saliva proved a failure. A trial of D-Penicillamine produced no beneficial effect on the course of the mucosal ulcers and the inflammatory joints.
The authors report a case of Waldenstrom's disease, the first sign of which, remaining for a long time the only sign, was a pseudo-carcinomatous infiltration of the stomach. Later, the patient developed a pleural localisation. These two lesions, gastric and pleural, are known but rare. The authors recall the main signs. They emphasize the long duration of the disease when treated by chlorambucil. A pathological IgM was found, not only in the serum of this patient, but also in the jejunal fluid aspirated during small intestinal biopsy.
The authors report a personal case of mitral incompetence, due to rupture of the chordae tendineae and note the signs of this disease. The patient first developed pulmonary oedema with thoracic pain, a mitral systolic murmur and a presystolic gallop rhythm, which suggested the diagnosis in a patient in sinus rhythm with a normal size heart, the left atrium was expansive and there were obvious signs of pulmonary congestion. The rapidly fatal course may be explained by the large number of ruptured chordae tendineae. Autopsy showed that the mitral valve was normal in texture. Histological study of the ruptured cord, showed lesions of dense hyaline fibrosis and mucoid infiltration of the basic substance.
The authors report a new case of extra-dural hematoma of the spinal cord due to anticoagulants causing a clinical Brown-Sequard syndrome. Spontaneous recovery, which was almost complete, appears quite exceptional.
The authors present the case of an 84 year-old woman with chronic constipation who suddenly developed acute obstruction of the lower oesophagus on taking a tablespoonful of mucilage without water. The obstruction was relieved by fiber endoscopy. There was no other previous lesion which might explain this complication. The patient was seen again later in good general health. The authors recall the clinical and radiological signs of acute obstruction of the oesophagus and discuss the physiopathology. They propose treating them exclusively by oesophageal fiber endoscopy.
In a young girl, aged 17 years, there occurred, 9 months after starting treatment with isoniazid and rifampicin, clinical signs of rheumatoid arthritis with facial erythema of vespertilio type. The presence of L.E. cells and antinuclear antibodies with a high titer, the rapid disappearance of all the clinical signs on stopping isoniazid, and the transient exacerbation of the syndrome on giving a single dose of isoniazid, gave the diagnosis of systemic lupus erythematosus induced by isoniazid. 18 months after stopping the drug, the patient is apparently cured, but there persists in the serum antinuclear antibodies in low concentration (1/200). A study of acetylation of isoniazid in this patient and her 3 sisters, showed that they were all of the slow acetylating phenotype. The late prognosis of this disease and the physiopathological value of the slow acetyl phenotype are worth discussion.
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Fibrosis of the intestinal lymphatic vessels, produced in one case by tuberculosis and, in the other, by appendicitis and peritonitis, caused blockage of the main lymphatic vessels causing, clinically, a protein-losing enteropathy similar to that noted in congenital lymphatic diseases of childhood. In the laboratory, there was noted a fall in serum protein, lipid and cholesterol. A fat absorption test was very abnormal showing a flat curve. During laparotomy, there was discovered on the small intestine, the same layout of lymph vessels, resembling a lace network, as that observed in congenital malformations. Intestinal lymphography showed considerable stasis of the opaque substance and absence of injection of the lymph vessels in the mesentery.
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