[Laparoscopy with liver biopsy in the diagnosis of prolonged unexplained fever].
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Biomedical subjects
Publications and source records attributed to C Massot.
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The authors report the case of 13 year old girl presenting with chronic hypernatremia. This case should be considered as either neurogenic or essential hypernatremia. Partial diabetes insipidus and hypodipsia hypernatremia. Partial diabetes insipidus and hypodipsia are the cause of chronic hypovolemia and a new homeostasis with an exceptionally high level of sodium (isoosmotic point 154 mEq/l). No cause was found and in particular, the search for a cerebral disease was until now proved negative.
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Temporal arteritis (Horton's disease) is a multifocal granulomatous arteritis which affects elderly people. Its prognosis depends upon the risk of blindness. In a retrospective study of 130 patients we paid special attention to the delay in diagnosis and its relation to the occurrence of ophthalmic complications. In 73 patients (56.2%), this delay exceeded 3 months and reached more than one year in 22 of them. It was not influenced by age or sex. In requests for admission, the diagnosis of temporal arteritis was suggested in only 28 of the 130 cases; 17.7% of the patients were blind. There was a significant increase in the occurrence of ophthalmic lesions when the diagnosis was delayed by 2 to 6 months. In 6 cases, blindness had been preceded by transient amaurosis. These findings confirm that temporal arteritis is belatedly diagnosed by practitioners and that blindness could be avoided by an earlier diagnosis.
We arbitrarily define "isolated weight loss" as the loss of at least 10 p. 100 of body weight over less than one year, without any single cause being disclosed by questioning, physical examination and such paraclinical examinations as blood electrolytes, blood count and differential, routine dipstick urinalysis and X-ray of the chest. Among the 105 patients we studied, the causes of isolated weight loss were: (1) psychic disorders (chiefly depression) in 60 p. 100 of the cases; (2) a variety of organic diseases in 29 p. 100, including gastrointestinal diseases (8 p. 100), cardiovascular and respiratory diseases (6 p. 100), Horton's disease (4 p. 100), Portuguese amyloidosis (1 p. 100), unexplained inflammatory syndrome (1 p. 100), endocrine disease (hyperthyroidism, 4 p. 100) and intoxication with medicines, alcohol or heroin (5 p. 100); (3) no definite cause could be found in 11 p. 100 of the cases. We suggest a diagnostic approach involving a limited number of examinations, viz.: erythrocyte sedimentation rate, measurement of transaminases, gamma GT and alkaline phosphatase enzymes, abdominal ultrasonography and ultra-sensitive TSH assay. We consider it important to switch from useless paraclinical tests to the detection and management of psychic disorders. Weight loss is a frequent motive of consultation, but its diagnostic value is often misunderstood. The purpose of this study was to provide data for the artiological diagnosis of isolated weight loss--a relatively frequent problem in internal medicine.
Anaemia during pregnancy is a common problem worldwide. In industrialised countries, it is still frequent in some groups of population. This study is based on the retrospective analysis of results of routine blood analysis performed on 15-44 years old women attending prenatal clinics (study group) or other outpatient clinics (non pregnant group) in a public hospital in Mons, Belgium from 1997 to 1999. In the non-pregnant group (2503 women), anaemia (haemoglobin < 12 g/dL) was present in 7.7% of the women. During pregnancy, anaemia was defined as haemoglobin level < 11 g/dL. In our sample, during the 1st trimester of pregnancy, anaemia was present in 4.3% of 887 pregnancies, among which 35% meeting CDC criteria (ferritin < 12 micrograms/L) for iron deficiency anaemia (IDA). Frequency of anaemia increases through pregnancy. Among 1313 pregnancies, 31% suffer from anaemia during the 3rd trimester, among which 75% meet criteria for IDA. Both low haemoglobin and low ferritin levels during the 1st trimester are good predictors of 3rd trimester anaemia. Systematic administration of iron supplement during pregnancy is matter of debate. In order to limit supplementation to pregnant women at risk of 3rd trimester anaemia, we suggest to treat anaemia (haemoglobin level < 11 g/d) detected at the first prenatal visit and to give small doses of iron (30 mg per day) when haemoglobin level is between 11 g/dL and 13 g/dL or ferritin level is less than 20 micrograms/dL. Low doses are generally well tolerated and compliance is better.