La Revue de médecine interne
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Medullary thyroid carcinoma is a rare disease which originates from the secretion of calcitonin by thyroid parafollicular cells. Sporadic (75%) and inherited (25%) forms of the disease are encountered. Familial forms (termed multiple endocrine neoplasia type IIa, IIb, or familial medullary thyroid carcinoma) may or may not be associated with other endocrinopathies such as pheochromocytoma and/or hyperparathyroidism. ⋯ Family screening is much easier, as germ line mutations of the proto-oncogene RET have recently been identified in inherited forms of the disease. Treatment includes extensive surgery. This, and prophylactic thyroidectomy in gene carriers, is discussed. Prognosis is much better nowadays, but precise follow-up has to be instituted.
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Cervicocranial arterial dissection is a major cause of cerebral infarction in young subjects. Traumatic and infectious factors are frequently suspected to be at the origin of cervicocranial artery dissection. However, they are usually too minor or too common to explain the vessel wall split-off. Underlying arteriopathy predisposing to dissections is therefore often suspected. ⋯ Classification of dissections according to the various vascular wall alterations would therefore permit to better define recurrence and familial risks and to improve overall management of the patients.
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Dissecting aneurysms of the internal carotid artery are due to arterial wall dissection caused by hematoma. We report a case of spontaneous dissection. ⋯ Distal and subadventicial dissection can induce compression of adjacent nerves without modifications of the arterial lumen. This type of wall hematoma may not be detected by ultrasonography and angiography. Magnetic resonance imaging proves to be the best method of investigation and should be primarily advocated. Anticoagulation treatment is necessary.
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Editorial Comment
[Cervical artery dissections: several questions remain unresolved].