[Occurrence of sulfhemoglobinemia 10 years after the diagnosis of multiple myeloma].
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Biomedical subjects
Publications and source records attributed to Y Mafart.
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Four cases of hepatic granulomatosis with positive Yersinia serologic tests are reported. In one case, the Wright serodiagnostic tests were also positive. In the three other cases, no other likely etiology was demonstrated. The authors recall the main causes of hepatic granulomatosis, diagnostic criteria of Yersiniosis infections, and the possible occurrence of simultaneous positive serodiagnostic tests for Yersinia enterocolitica type 9 and Brucella abortus.
A case of Reiter disease in a HLA B27 positive man with urethritis followed by polyarthritis is reported. During the disease, serologic conversion for Yersinia enterocolitica type 9 was detected as well as positive serologic tests for Shigella flexneri and Chlamydia. The features of reactive arthritis related to Yersinia and the etiologies of Reiter disease are recalled.
We studied 18 cases of dracunculosis treated in our department of Internal Medicine in Paris. The mean duration of the hospital stay is 38 days (15 to 90). The cost of this stay, calculated on the basis of the daily charge, accounts for 93.3 % of the total cost. The longest stays are due to serious subcutaneous infections at the site of the worm and to multiple or complex associated diseases. Average charge for laboratory test, roentgenograms or other investigations amounts to 4.4 % of the cost of the hospital stay. A significant part of these investigations is warranted by cellulitis and the diagnosis of associated conditions. Antibodies prescribed for subcutaneous infections account for almost all of the drug expense (2.3 % of the total cost). Thus, investigations and treatment together amount to only 6.7 % of the daily charge. Traditional treatment of dracunculosis is based on manual extraction of the worm. Thiabendazole was added in 12 of the 18 patients. The average duration of hospitalization (34 days) and average charge for investigations and drug treatment (FF 611) were less in these 12 patients than in the 6 others (47 days, FF 1286). However, this result is to be considered with caution as the number of patients in each group is small, treatments were assigned without any statistical rule, subcutaneous infections were more or less serious and associated diseases may have had a bearing on results.
Among 31 patients with positive blood cultures for gram-negative bacilli seen in a department of internal medicine, 13 had at least 3 positive blood cultures from samples taken over more than 12 hours and were diagnosed as having septicemia (group I) ; 18 patients had less than three positive blood cultures over the same period or had several positive blood cultures over a shorter period and were diagnosed as having bacteremia (group II). There were no significant differences between these two groups concerning age, sex, fever, other clinical features, or biological findings. E. coli was recovered in 70 % of cases and was almost always related to urinary infection. 8 patients died (3 in group I, 5 in group II), 6 of whom had cirrhosis. The sensitivity of the pathogens to the main antibiotics is described. The most often used antibiotic combination was ampicillin-gentamycin. It is suggested that in departments receiving patients from outside the hospital rather than from intensive care units the ampicillin-gentamycin combination can be advocated as the first treatment. As there were no significant differences between patients with septicemia or bacteremia, in severe infections a single positive blood culture should be taken into account and discrimination between septicemia and bacteremia is useless.
Over 7 years, 592 patients infected by Schistosoma haematobium were detected. Among these, 102 had a cystoscopy which found carcinoma in 3 patients, polypi in 1 and vesical "bilharzioma" (so-called pseudo-polyps) in 14. From the results of the biopsies and data from the medical literature the relationship between schistosomiasis and carcinoma in the schistosomial bladder is discussed, as well as the meaning of various lesions, such as malpighian metaplasia, papillomatous hyperplasia and glandular cystitis, seen in biopsy specimens from "bilharziomas". The cystoscopic diagnosis of one (or several) tumours resembling "bilharzioma" requires biopsy, resection and close monitoring.
A case of undifferenciated carcinoma of the left lung with stenosis of the right pulmonary artery is reported. The characteristic clinical features of the systolic ejection murmur in pulmonary artery stenosis are recalled as well as the data from phonocardiographic, angiographic, and hemodynamic investigations. After radiation therapy, the grade of the systolic murmur decreased frankly although transiently. Noticeable decrease of the stenosis was substantiated by a second angiography. This improvement was still apparent 16 months later during chemotherapy.
A case of osteo-onychodysplasia (nail-patella syndrome) is reported. Features of this inherited condition include hypoplastic nails, hypoplastic to absent patellae, subluxation of the patellae, elbow dysplasia, and spurs in the posterior ileum (this last feature was absent in our patient). The nail hypoplasia is the most suggestive abnormality. Patients should be investigated for renal involvement which is a poor prognosis factor. In patients without renal involvement, prognosis is good.
Two cases of toxopachyosteosis involving the tibial and fibular diaphyses are reported. This rare condition, which is usually well tolerated, was first described by Weismann-Netter and Stuhl in 1954. This dysplasia affects both tibias and fibulas and usually results in symmetrical deformations. Characteristic features are anterior bowing of affected bones, with posterior thickening of the cortices. There are few clinical manifestations; small stature, often with delayed onset of walking. Biological investigations are negative. Roentgenograms often show embedding of the last lumbar vertebra with horizontalization of the sacrum. Scoliosis is a common finding.
The observations of two black African patients seen among 940 hospitalized patients are reported. Intraabdominal calcified larvas, probably of Porocephalus (Armillifer) armillatus were found in both patients. The cycle of this Pentostomida is recalled. Attention is drawn to the role of snake slime in accidental contamination of human beings. In man, this parasitic infection is almost always asymptomatic and detected fortuitously on roentgenograms, or during surgery or necropsy.
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Though no bacteria were isolated, a diagnosis of Yersinia enterocolitica infection was confirmed in two patients by strongly positive serology tests, with levels much above the normal. Both patients had fever, hepatic granulomatosis, and electrocardiogram anomalies, and there was associated dysuria and prostatitis in one case. The authors review the hepatic, urinary, and electrocardiogram manifestations reported in the published literature, and describe the antigenic and serologic relationships existing between Y. enterocolitica type 9 and Brucella abortus.
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