[Spontaneous dissecting aneurysm of the internal carotid artery]

INTRODUCTION

Dissecting aneurysms of the internal carotid artery are due to arterial wall dissection caused by hematoma. We report a case of spontaneous dissection.

EXEGESIS

A 65-year-old man presented with painful Horner's syndrome and hypoglossal palsy, without a history of arterial traumatism. Magnetic resonance imaging showed carotid artery dissection.

CONCLUSION

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.

[Panhypopituitarism disclosing empty sella turcica syndrome]

INTRODUCTION

Empty sella syndrome is sometimes associated with anterior pituitary insufficiency, the latter being mostly partial or dissociated.

EXEGESIS

We report a case of a profound panhypopituitarism revealing an empty sella syndrome. This case shows that empty sella syndrome, although a generally benign and asymptomatic condition, can be associated with hypopituitarism.

CONCLUSION

In case of empty sella syndrome, especially if an endocrine dysfunction is clinically suspected, minimal hormonal analysis must be requested.

[Autoimmune cholangitis successfully treated with corticotherapy. One case]

Autoimmune cholangitis is a rare cause of chronic liver disease which has recently been described and associates the clinical, biological, and histological patterns of primary biliary cirrhosis without serum anti-mitochondrial antibodies. We report a case of this disease in a 67-year-old female. The patient presented with jaundice and marked biological cholestasis associated with pulmonary fibrosis and salivary and lacrymal sicca syndrome. Serum anti-smooth muscle antibodies were found without anti-mitochondrial antibodies. Corticotherapy resulted in rapid improvement of clinical and hepatic abnormalities, as well as of pulmonary lesions. The patient was still healthy 18 months later, with low dose corticotherapy. This report emphasizes the possible effectiveness of corticotherapy in autoimmune cholangitis.

[Microbial overgrowth syndrome after gastrectomy. Recent diagnostic aspects]

Blind loop syndrome is the most common syndrome of bacterial overgrowth following gastrectomy. We report two cases with diarrhea, steatorrhea, exudative enteropathy and major nutritional deficiency. Diagnosis was based on the breath test and aspirate analysis. Surgery with restoration of the duodenal continuity was the treatment. Patients with contraindications for surgery should be given prolonged antibiotic therapy which should be repeated if symptoms reoccur.

[Common variable immunodeficiency and total villous atrophy regressive after gluten-free diet]

A patient with a commun variable immunodeficiency (CVID) is hospitalized for chronic symptoms of malabsorption (weigh loss and diarrhea). The duodenal histology show a total villous atrophy. Investigations are negative and a gluten free diet is given. Symptoms of malabsorption disappear and improvement is histologically confirmed. Our observation suggest that the coincidence of gluten sensitive enteropathy and CVID is possible and clinicians should be aware of this association and should consider giving a gluten free diet. The sensitivity of serologic testing in this conditions is unknown.

[Laparoscopic resection of ileo-cecal tuberculosis]

Rarely seen in industrialised countries, ileo-caecal tuberculosis does not require surgery unless complications or diagnosis uncertainly occur. When laparotomy is contre indicated in presence of chronical respiratory disease, laparo-assisted ileo-caecal resection is an interesting alternative to classical surgery as it has less effect on ventilation. This laparo-assisted ileo-caecal resection appears to the first reported in presence of intestinal tuberculosis.