La Revue de médecine interne
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Review Case Reports
[Primary granulocytic sarcoma of the pancreas: efficacy of early treatment with intensive chemotherapy].
In the absence of systemic chemotherapy after the diagnosis of primary granulocytic sarcoma (PGS), all patients will subsequently develop acute myelogenous leukemia (AML). The authors describe a case of PGS of the head of the pancreas found at laparotomy in a 32-year-old man. The patient received early after surgery, two courses of high-dose chemotherapy and, with a follow-up of 2 years, never developed AML. This rare observation illustrates the necessity of further early systemic chemotherapy after surgical excision of PGS.
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Fifty-eight consecutive elderly patients (seven men and 51 women, mean age 84 +/- 6) admitted for congestive heart failure were prospectively investigated by doppler echocardiography in order to 1) define the prevalence of cardiac failure with normal left ventricular systolic function, 2) estimate the role of abnormalities of left ventricular filling (diastolic dysfunction), 3) evaluate echodoppler parameters for assessment of diastolic function: ratio of early peak on atrial peak of filling velocities (E/A), mitral deceleration time (MDT) and isovolumic relaxation time (IRT). Of the 58 patients, 32 (55%) had normal left ventricular systolic function and 26 (45%) had systolic dysfunction. ⋯ Sensitivity of clinical data being too low, doppler echocardiography is the easiest noninvasive technique for defining abnormalities of both left ventricular systolic and diastolic function. In the elderly, MDT and IRT are more sensitive parameters than E/A for the diagnosis of diastolic dysfunction.
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Review Case Reports
[Sweet syndrome and Yersinia enterocolitica infection. 2 cases].
Sweet's syndrome is an acute febrile neutrophilic dermatosis. Although it frequently appears as an idiopathic disorder, it may occur in association, often as presenting sign, with malignancy or more rarely with infections. We report two cases of Sweet's syndrome preceded by digestive infection due to Yersinia enterocolitica, affirmed by significant rises in serum antibody titers. ⋯ Sweet's syndrome is a rare complication of these infections. Treatment with systemic steroids, usually effective, can be replaced by antibiotics with apparently favorable results. The search of an infectious origin should be systematic in cases of Sweet's syndrome that appear to be idiopathic.
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The collagen vascular diseases and vasculitis, in particular, are occasionally associated with chronic, relapsing lower extremity ulcerations. Different mechanisms can induce such ulcerations, and an understanding of the type of ulcerations is important in the differential diagnosis of patients with leg ulcerations in general, and management of these patients in particular. In this review, the authors analyze the various mechanisms of the leg ulcerations in these patients and their treatments: vasculitis, thrombosis, traumatisms, calcinosis, panniculitis, pyoderma gangrenosum, infections, and induced by treatments.
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A 17 year-old young man developed two episodes of acute pancreatitis, separated by a 2 year interval and associated with isotretinoin therapy. In 1989, vesicular sludge without lithiasis was evidenced and in 1991, gall bladder stones were found by cholecystectomy. ⋯ It is interesting to note that far away from the use of isotretinoin, the patient suffered from another episode of acute pancreatitis without any coagulation disorder. The involvement of Roaccutane in cellular differentiation is discussed as well as its causal association with acquired dysfibrinogenemia and transient thrombocytopenia.