Histiocitosis de células de Langerhans: reporte de caso y revisión de la literatura

Histiocytosis comprises a heterogeneous group of inflammatory diseases whose main cellular components are dendritic cells and macrophages. The inflammatory infiltrate can affect the skin and other organs and the clinical outcome varies from mild to fatal depending on the involved cell subset and multisystemic compromise. Delay in diagnosis may occur due to its non-specific presentation and to a low suspicion on the part of the clinician. We report the case of an infant who despite multiple consultations with nonspecific but characteristic symptoms of the disease was only finally diagnosed thanks to histopathological findings.     

Histiocytose langerhansienne : place actuelle de l’imagerie

Langerhans cell histiocytosis (LCH) is a rare disease of the reticuloendothelial system which consists in various clinical manifestations from a single lytic bone lesion to multisystemic lesions with organ dysfunction. One single bone lesion, the most frequent presentation, has a good prognosis. We relate here the case of a 4-year-old child who had a pain of his right hip with lameness and fever. The bone scintigraphy (BS) highlighted an increased uptake of the right iliac wing. Biopsy of the lesion led to the diagnosis of LCH. The progression was spontaneously favourable with relief of pain after the biopsy. This case report allows us to highlight the most recent guidelines regarding the classification of the disease and the indication of imaging. Staging is currently based on chest radiograph, abdominal ultrasound and skeletal radiograph survey. The role of BS, MRI and FDG PET/CT for staging remains to be clarified.     

Radioactivité résiduelle avant vidange des cuves de décroissance de déchets liquides : bilan annuel d’un service de médecine nucléaire hospitalier au Luxembourg

Residual radioactivity within decay tanks in an in-hospital clinical nuclear medicine unit reflects the specific typology of the concerned unit. To learn how to improve management of emptying the tanks, measures of residual radioactivity over the year 2009 have been compared to prevailing legal norms in Luxembourg. Legal norms have in no case been outpassed. A minimal residual radioactivity, below legal thresholds, has been often found (84%). It concerned ¹³¹I, ^99mTc and ¹¹¹In. This is why management of radioactive decay tanks may be continued unchanged.     

Place de la scintigraphie dans le diagnostic de l’embolie pulmonaire chez la femme enceinte – À propos de 17 cas

IntroductionPulmonary embolism in pregnant women is a deadly disease; its diagnosis is based on specific algorithms. The lung scan is one of the recommended diagnostic suspicion in further investigations.Material and methodsRetrospective study of a series of cases of pulmonary embolism in the period pre-partum and post-partum pregnant women collected during 3 years, from January 2010 to January 2013, at the reanimation department maternity Souissi in Rabat.ResultsSeventeen cases of pulmonary embolism pre- and post-partum. The age ranged between 21 and 37 years (mean age 30 years). Four EP post-partum were recorded with 13 cases of EP pre-partum whose mean gestational age was 30SA. Several risk factors were found: 7 cases obesity, 4 cases cesarean section, 3 cases of varicose veins, 2 cases of endometritis, 1 case of twin pregnancy, 1 case of gestational hypertension and 1 case of alitement. The first reason for consultation was respiratory distress (12 cases), followed by chest pain (9 cas) and palpitations (6 cas). Lung scintigraphy performed in 14 patients’ objective 9 cases of perfusion defect, 4 cases of normal scan and 1 case of massive PE. No deaths or recurrences have been reported.ConclusionPregnancy and the post-partum period are at high risk of thromboembolic events due to physiological changes. The diagnostic approach is now well codified with scores of clinical and paraclinical probability. The lung scintigraphy can be a method of choice. Hybrid imaging is a good alternative for diagnostic performance.     

Un examen au 18F-FDG d’interprétation délicate : une histoire de diaphragme

We present a clinical case illustrating the difficulty of interpretation of hypermetabolic foci localisation in 18F-FDG-PET/CT exam performed without injection of iodinated contrast. In a patient with cystic fibrosis during infection, the focus appears to be pathologic in subdiaphragmatic and retroperitoneal region. After a careful reading, the focus represents in reality the pillars diaphragmatic muscle attachments. The presence of other uptake in intercostal muscles in this patient presenting with respiratory failure and especially the comparison with an enhanced CT scan demonstrated our assumption.     

Métastase rénale d’un carcinome vésiculaire de la thyroïde révélée par le balayage du corps entier à l’iode 131

Distant metastasis of differentiated thyroid carcinoma generally affect lung and/or bone tissue. Renal metastasis from thyroid carcinoma is extremely rare. We report a case of renal metastasis from a follicular thyroid carcinoma in a 55-year-old man, occuring 11 years after total thyroidectomy, fortuitously discovered on a whole body scan carried out after 131-iodine therapy for neck recurrence of disease. Salient features of our clinical case are the fortuitous mode of discovery the unilateral localization of metastases and especially the long time interval which separates its detection from that of the primitive tumour. This case report exemplifies the useful role of the whole body scan carried out after 131-iodine therapy better adapted to reveal often undetectable occult metastases with low dose, but also to ensure a regular and protracted follow-up of patients treated for differentiated thyroid carcinoma.     

Intérêt du dosage de la thyroglobulinémie chez les sujets porteurs du goitre en zones de déficience iodée au Bénin

In the present study, we analyze the results of thyroid hormones and thyroglobulinemia of 162 patients with goiter living in the departments of Collines and Donga, known to be areas of iodine deficiency in Benin. These results are compared with those of 85 healthy subjects living in the same departments. This study is a cross-sectional analytical study carried out from 1st July 2009 to 30th June 2010. The population of patients consisted of seven males and 155 females. The average age was of 45.7 years. Most of the patients were suffering of simple goiter. Only six of them had thyroid nodules. The diagnosis of biological hyperthyroidism was positive for 20 patients; 16 of them had subclinical hypothyroidism and four clinical hyperthyroidism. One case of clinical hypothyroidism was found. All other 141 patients were biologically normal (euthyroidism). Seventeen of the patients (including six patients presenting a thyroid nodule) had a normal thyroglobulin rate. Hyperthyroglobulinemia was observed in all other 145 patients. These results suggest that patients with goiter in zone of iodine deficiency are biologically euthyroid with hyper-thyroglobulinemia. Thyroglobulin dosage is then recommended, especially when nodules are perceptible.     

Eficiencia de las unidades geriátricas de agudos: metaanálisis de estudios controlados

Objective

After analysing the effectiveness in the reduction in the incidence of functional impairment and a higher probability of returning home between elderly patients hospitalised due to an acute medical illness cared for in acute geriatric units (AGU) compared to conventional care units, we propose to assess the efficiency of this care.

Material and methods

A systematic review and meta-analysis was made of controlled studies (randomised, no randomised and case-control) that compared care in UGA with care in conventional hospital units of patients of 65 years and over with an acute medical illness. Studies on administrative data bases, those that evaluated care of a single disease, and those that assessed units with care in the acute and sub-acute phase were excluded. A literature review was performed on articles published up to 31st of August 2008 in Medline, Embase, Cochrane Library, and references of systematic reviews and reviewed articles. The selection of the studies and the extraction of data on the hospital stay and care costs was made independently by two different researchers.

Results

A total of 11 studies were included, of which 5 were randomised, 4 were non-randomised, and 2 case control, all of them providing data on hospital stay, with 7 of them providing data on hospital costs (4 clinical trials, 2 non-randomised and 1 case-control). The overall analysis of all the studies showed that those admitted to UGA had a statistically significant reduction in hospital length of stay compared to the elderly hospitalised in conventional units (mean difference -1.01 days; 95% CI, -1.66 to -0.36) and hospital care costs (mean difference of -330 US dollars; 95% CI, -540 to -120).

Conclusions

Care in AGU is more efficient than that provided in conventional units, since, as well as achieving a reduction in the incidence of functional impairment at discharge and increasing the probability of returning home, they reduce mean hospital stay and the hospital care costs.     

Reactivación de la enfermedad de Chagas después de trasplante autólogo de progenitores hematopoyéticos. Reporte de caso y revisión de la literatura

Introduction:

Chagas disease is an endemic parasitic infection in Latin America transmitted by triatomines. It is associated with risk factors such as poverty and rurality. After acute infection, a third of patients will present target organ involvement (heart, digestive tract, central nervous system). The remaining two thirds remain asymptomatic throughout their life. Pharmacological immunosuppression breaks the balance between the immune system and the parasite, favoring its reactivation.

Clinical case:

We present the case of a 58-year-old man from a Colombian rural area with a diagnosis of multiple myeloma refractory to the first line of treatment who required a new chemotherapy scheme and consolidation with autologous stem cell transplant. During the post-transplant period, he suffered from febrile neutropenia. Initial microbiological studies were negative but the peripheral blood smear evidenced trypomastigotes in blood. With a diagnosis of acute Chagas disease in a post-transplant patient, benznidazole was started. The evolution of the patient was satisfactory.

Conclusions:

Positive serology prior to transplantation makes it necessary to rule out reactivation of the pathology in the setting of febrile neutropenia. More studies are required to determine tools for estimating the probability of reactivation of the disease and defining the best cost-risk-benefit relation for the prophylactic therapy.     

La unidad de ortogeriatría de agudos. Evaluación de su efecto en el curso clínico de los pacientes con fractura de cadera y estimación de su impacto económico

Objective

To study the effects of the management of hip fracture patients in an acute orthogeriatric unit shared between the departments of Orthopedic Surgery and Geriatrics compared with the usual hospital care, and to analyse financial differences in both systems of care.

Method

Prospective quasy-experimental randomized intervention study in 506 patients admited to a terciary hospital with an osteoporotic hip fracture. The usual model of care was the admission to the orthopedic ward with a request to Geriatrics (RC) and the study model consisted of the admission to an orthogeriatric unit (OGU) for the shared co-management between orthopaedic surgeons and geriatricians. This model included the appointment of one spokesperson from each department, the specialist geriatric nurse management, early geriatric assessment, shared daily clinical care, weekly joint ward round and coordinated planning of the surgery schedule, the start of the ambulation and the time and setting of patient discharge.

Results

Two hundred fifty five consecutive patients admitted to the OGU and 251 patients managed simultaneusly by the RC model were included. Except for a mean age slightly lower in the OGU group, there were no differences neither in the baseline patients characteristics nor in the surgical rates between the two groups. Among the OGU patients group it was more frequent to receive rehabilitation in the acute setting, to be able to walk at discharge and to be referred to a geriatric rehabilitation unit (all with P<.05). The OGU patients received geriatric assessment and were operated on earlier than the RC patients (P<.001). The length of stay in the acute ward was 34% shorter in the OGU patients (mean 12.48±5 vs 18.9±8.6 days, P<.001) (median 12 [9-14] vs 17 [13-23] days, P<.001). The whole hospital length of stay, including the days spent in the geriatric rehabilitation units, was 11% shorter in the OGU patients (mean 21.16 ±14.7 vs 23.9 ±13.8 days, P<0.05) (median 14 [10-31] vs 20 [14-30] days, P<.001). The OGU saved 1,207 € to 1,633 € per patient when estimated by the costs for process model, and 3,741 € when estimated by the costs for stay model.

Conclusions

The OGU is a hospital setting that provides an improvement in the patients functional outcome and a reduction in the hospital length of stay. Therefore it saves health care resources. These findings show the OGU as an advisable setting for the acute care of hip fracture patients.     

Etude de quelques propriétés de la phosphofructokinase érythrocytaire de l'homme normal

Human erythrocyte phosphofructokinase was purified 150 fold by DEAE cellulose adsorption and ammonium sulfate precipitation.At pH 7,5 the enzyme exhibits allosteric kinetics with respect to ATP, fructose 6 phosphate, and Mg²⁺.ATP at high concentration acted as an inhibitor and ADP, 5′AMP, 3′,5′, AMP, acted as activators. Both effectors seemed to decrease the homotropic interactions beetween the fructose 6 phosphate molecules.The activators increased the affinity of phosphofructokinase for the substrate (F6P), the inhibitor decreased it.These ligands had no effect on the maximum velocity of the reaction except in the case of ADP.Interactions between the substrates and the effector ligands on the enzyme were considered in terms of the Monod - Changeux - Wyman model for allosteric proteins.With GTP and ITP, no inhibition was observed. At saturing concentration of GTP, ATP still inhibited phosphofructokinase.Both 3′5′ AMP and fructose 6 phosphate increased the concentration of ATP required to produce an inhibition of 50 %.Citrate, like ATP, inhibited phosphofructokinase by binding most likely at the same allosteric site. Erythrocyte phosphofructokinase is inhibited by 2–3 DPG.The study of the relation log V max = f (pH) suggested, that the active center contains at least one imidazole and one sulfhydryl group.     

Synostose talo-calcanéenne et scintigraphie osseuse à l’HMDP-Tc : intérêt des images TEMP-TDM et problèmes de diagnostic différentiel

The purpose of this case report is to illustrate the scintigraphic aspect of a common foot disease, the tarsal synostosis. We report the clinical case of a 36 years old patient with a history of repeated injuries of left ankle, and experiencing residual pain. Foot radiographs and CT scan were not contributory and a MRI exam of the foot disclosed fibrous talocalcaneal bridge in favor of a syndesmosis. Bone scintigraphy with SPECT-CT images had a double interest, showing the active inflammatory process of the synostosis and delimiting the anatomical structures related to this uptake. Medical treatment with anti-inflammatory drugs has been introduced, associated to immobilization, and followed by sessions of physiotherapy.     

Prevención de las úlceras de talón en un hospital de media estancia. Estudio comparativo de vendaje clásico almohadillado respecto a las taloneras hidrocelulares de poliuretano

Introduction

The aim of the study is to determine the incidence of heel pressure ulcers (UPPT) and to compare the two systems for UPPT prevention: classic padded bandage and polyurethane heel.

Material and methods

Prospective intervention study in a medium-long hospital stay of all people admitted that had no UPPT but had a risk of UPPT according to the Braden Scale or clinical judgment. The patients were randomized to prevention with classic padded bandage or polyurethane heel. The outcome variable was the incidence of UPPT for each study group, which was recorded every 15 days or when there were clinical changes.

Results

Of the 940 patients evaluated, 409 with a mean age of 80.5 years and 59.1% women,were included in the study. Of these, 78% had Barthel score ≤30; 28.6% dementia; delirium 37.6%; 27.6% diabetes; and 19.6% other UPP. The overall incidence was 2.9% UPPT; 2.49% in the classic padded bandage and 3.37% in the polyurethane heel group (p=0.82).

Conclusions

No statistically significant differences were observed between the group with the classical dressing and the group with the polyurethane heel dressing. The use of multiple measures to prevent UPPT achieved a low incidence of these.     

Tumeur du scalp : mode révélateur rare de carcinome vésiculaire thyroïdien

Cutaneous metastases of thyroid follicular carcinoma are rare. A scalp metastasis revealing a thyroid cancer is exceptional. We report the case of a 70 year-old women who presented with a scalp tumor progressively increased. Morphological imaging disclosed an important cutaneous tumor in occipital region with osteolysis. Surgical resection of this tumor was performed and pathology identified a cutaneous metastasis of a thyroid follicular cancer. This case report illustrates a rare presenting sign of thyroid follicular cancer. Cutaneous metastases coexists with other metastases (bone or lung) and means and ominous prognostic factor for the evolution of thyroid follicular cancer.     

Detección de disfagia en mayores institucionalizados

Objective

To determine the prevalence of dysphagia in a population of institutionalised elderly people, and the effectiveness of a clinical method for its detection.

Methodology

A prospective study was conducted on a random sample of elderly residents. A clinical evaluation along with an assessment with different volumes and viscosities (MECVV) were used. Specific care and follow up was arranged following this assessment.

Results

Forty residents were studied. The prevalence of unrecognised dysphagia was 42.5%. Following assessment by the MECVV, the prevalence rose from 22.5% to 65% (P=.012). Dysphagia detected by MECVV was related to nutritional risk, as measured by the Mini-Nutritional Assessment (MNA) (P=.007), and to the diagnosis of dementia (P=.028).

Conclusions

The diagnosis of dysphagia in this sample of institutionalised elderly people increases when applying a clinical method for detection, reaching a prevalence similar to other studies.     

Array-CGH characterization of a de novo t(X;Y)(p22;q11) in a female with short stature and mental retardation

We report the clinical and molecular investigations in a girl with 46,X,-X,+der(X)t(X;Y)(p22;q11) de novo karyotype who presented an intricate phenotype characterized by mental retardation and facial dysmorphisms in combination with short stature. The structure of the derivative X chromosome was studied using BAC array-CGH which disclosed the Xp22 breakpoint between the STS and the VCX3A gene and the presence of the Yq11.1qter chromosome. It is common that females with Xp;Yq translocations present only short stature and are normal in every other aspect. Thus, this would be the first case in which a girl with Xp;Yq translocation presents an unusual phenotype with intermediate male clinical features with Xp;Yq translocations. The risk of developing gonadoblastoma in females with Y chromosome material is also discussed and, to this effect, different explanations related to this apparent variation are also presented.     

La eclosión de la sarcopenia: Informe preliminar del Observatorio de la Sarcopenia de la Sociedad Española de Geriatría y Gerontología

Sarcopenia is a common and prominent geriatric syndrome, of major interest for daily clinical practice of professionals working with older people. The number of affected individuals and its relation with disability, frailty, many chronic diseases, lifestyle and adverse outcomes are extremely relevant for geriatric care. Moreover, biological changes that lead to the loss of muscle mass and strength are intrinsically related to the mechanisms of aging. It is not therefore surprising that research in this field is growing exponentially in recent years, and sarcopenia has been placed in recent years in the forefront of research in geriatric medicine and gerontology.The Spanish Society of Geriatrics and Gerontology has recently created an Observatory of Sarcopenia, which aims to promote educational and research activities in this field. The first activity of the Observatory has been to offer the Spanish speaking scientific community a review of the current status of sarcopenia, that may allow unifying concepts and fostering interest in this promising field of geriatrics.     

Métastase méningée révélatrice de cancer thyroïdien multimétastatique

We report the case of a 74-year-old patient who presented with cognitive disorders. Morphological imaging showed a tumor which was considered as a meningioma. Surgical resection of this tumor was performed and pathology indicated a meningeal metastasis of a thyroid cancer. The patient had previously a thyroidectomy with an initial benign pathology report. Meningeal metastases of thyroid cancer are rare, and a meningeal metastasis revealing a thyroid cancer is very rare.