Annales de médecine interne
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Ann Med Interne (Paris) · Sep 1999
Comparative Study[Current aspects of spinal tuberculosis: apropos of 16 case reports].
We retrospectively studied the epidemiological, clinical, histological and evolutive aspects of vertebral tuberculosis diagnosed in all consecutive patients recruited in 2 Parisian hospitals between January 1990 and July 1997. The diagnosis relied on a vertebral involvement associated with evidence of tuberculosis (culture of local puncture yielded Mycobacterium tuberculosis) or presumption of tuberculosis (evidence of other tuberculous focus, histological data, good outcome under specific treatment). Sixteen patients (mean age: 41 years; sex ratio: 1.29) have been included; thirteen were migrants. ⋯ The diagnosis of vertebral tuberculosis was confirmed in 12 cases according to the results of culture and/or histological grounds of local puncture. The diagnosis of vertebral tuberculosis was presumed in the 4 other cases according to the isolation of M. tuberculosis from an other site (2 cases), the characteristic histological pattern of a lymphadenopathy (1 case), and a favorable outcome upon specific treatment (1 case). All the patients were cured without complications with the exception of one patient who developed a spinal cord compression.
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Thyroid disease is very frequent in women, particularly during pregnancy and the post partum period. Several mechanisms are involved. The most frequent is related to immunological modifications during pregnancy and increased risk of producing anti-thyroid autoantibodies. ⋯ Exploration of a thyroid nodule in a pregnant women is a particular situation as scintigraphy is not advisable prior to the fourth month for the technetium method and for the entire pregnancy for 123-iodine. Needle aspiration can be used systematically and the histology results help guide management. Inquiry into past thyroid history and physical examination are thus required for all pregnant women or women desiring pregnancy in order to choose the best management scheme.
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Reflex sympathetic dystrophy (RSD) is currently defined as CRPS type I (complex regional pain syndrome). Due to the lack of comprehensive understanding of underlying pathophysiological mechanisms, a wide variety of therapeutic approaches are proposed, all of them being of unpredictable and variable efficacy. ⋯ Sympathetic blocks and active physiotherapy are, for many authors, the cornerstones of the efficient management. The role of prevention must be strongly emphasized, focusing, if RSD occurs following surgery, on the importance of pre- and postoperative efficient analgesia.
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Ann Med Interne (Paris) · Apr 1998
Case Reports[Palinopsia associated with partial seizures secondary to right parietal hemorrhage].
Palinopsia and motor partial seizures were associated in a 51-year-old man. The manifestation appeared six months after a right parietal hemorrhage. The relationship between the hallucinatory phenomena and epilepsy is discussed.