S. Berthier

Démarche diagnostique devant une hyperferritinémie

The discovery of a hyperferritinemia is most of the time fortuitous. The diagnostic approach aims at looking for the responsible etiology and at verifying if an iron hepatic overload is present or not. Three diagnostic steps are proposed. The clinical elements and a few straightforward biological tests are sufficient at first to identify one of the four main causes: alcoholism, inflammatory syndrome, cytolysis, and metabolic syndrome. None of these causes is associated with a significant iron hepatic overload. If the transferring saturation coefficient is raised (>50%) a hereditary hemochromatosis should be discussed. Secondly, less common disorders will be discussed. Among these, only the chronic hematological disorders either acquired or congenital are at risk of iron hepatic overload. Thirdly, if a doubt persists in the etiologic research, and the serum ferritin level is very high or continues to rise, it is essential to verify that there is no iron hepatic overload. For that purpose, the MRI with study of the iron overload is the main test, which will guide the therapeutic attitude. Identification of more than a single etiology occurs in more than 40% of the cases.

Pancréatite aiguë non alcoolique non biliaire : Difficultés du diagnostic étiologique et toxicité possible de la nicotine

Resume Introduction Parmi les causes de pancreatite aigue œdemateuse, la possibilite d’un surdosage nicotinique, meme si elle est exceptionnelle, doit etre envisagee. Observation Une femme âgee de 30 ans a ete hospitalisee pour le bilan etiologique d’un premier episode de pancreatite aigue œdemateuse. La mise en evidence d’anticorps anti-ADN natifs et d’anticorps anticardiolipides a fait discuter puis eliminer une pancreatite lupique et/ou un syndrome des antiphospholipides. Le diagnostic finalement retenu a ete celui d’un surdosage en nicotine lie a l’association entre des patchs de nicotine et la persistance d’un tabagisme actif. Conclusion Cette observation, bien qu’il n’ait pas ete decrit jusqu’alors de poussee de pancreatite aigue sous patch de nicotine, pourrait inciter a penser qu’une telle poussee peut etre une complication exceptionnelle d’un surdosage nicotinique.INTRODUCTION The possibility of nicotine toxicity, although rare, should be considered in cases of acute edematous pancreatitis. CASE A 30-year-old woman was hospitalized to identify the cause of an initial episode of acute edematous pancreatitis. The observation of native anti-DNA and antiphospholipid antibodies suggested lupus pancreatitis and/or an antiphospholipid syndrome, both subsequently ruled out. The final diagnosis was nicotine poisoning induced by the combination of a nicotine patch and tobacco smoking. CONCLUSION Although a nicotine patch has never been reported in connection with an episode of acute pancreatitis before, this case suggests that such an event might be a rare complication of an overdose of nicotine.

Mise au pointDémarche diagnostique devant une hyperferritinémieDiagnosis of an increased serum level of ferritin

The discovery of a hyperferritinemia is most of the time fortuitous. The diagnostic approach aims at looking for the responsible etiology and at verifying if an iron hepatic overload is present or not. Three diagnostic steps are proposed. The clinical elements and a few straightforward biological tests are sufficient at first to identify one of the four main causes: alcoholism, inflammatory syndrome, cytolysis, and metabolic syndrome. None of these causes is associated with a significant iron hepatic overload. If the transferring saturation coefficient is raised (>50%) a hereditary hemochromatosis should be discussed. Secondly, less common disorders will be discussed. Among these, only the chronic hematological disorders either acquired or congenital are at risk of iron hepatic overload. Thirdly, if a doubt persists in the etiologic research, and the serum ferritin level is very high or continues to rise, it is essential to verify that there is no iron hepatic overload. For that purpose, the MRI with study of the iron overload is the main test, which will guide the therapeutic attitude. Identification of more than a single etiology occurs in more than 40% of the cases.

Étude cas témoin évaluant l'incidence de l'hyperhomocystéinémie chez des patients porteurs de néoplasie dans un service de médecine interne

Purpose Cancer is a cause of venous thromboembolism. However, the physiopathology remains unknown. Hyperhomocysteinemia could be a promoting factor.

Article originalÉtude cas témoin évaluant l'incidence de l'hyperhomocystéinémie chez des patients porteurs de néoplasie dans un service de médecine interneCase-control study of hyperhomocysteinemia in cancer-bearing patients in a internal medicine department

Purpose Cancer is a cause of venous thromboembolism. However, the physiopathology remains unknown. Hyperhomocysteinemia could be a promoting factor.

Sueurs profuses invalidantes sous hydromorphone

Diffuse and abundant sweating in a middle age patient evolving for several weeks should raise suspicion of malignant lymphoma and infectious or neuroendocrine disorders before considering a drug origin. We report a patient who presented with severe and invalidating excessive sweating related to hydromorphone therapy for vertebral pain. Amongst their many reported side-effects, excessive sweating disappearing with discontinuation of the drug have been reported with some opiates.

Multiples hyperfixations sur une scintigraphie osseuse

J. Vinit a,∗, S. Audia b, C. Boichot c, J.-F. Couaillier d, S. Berthier b, B. Bonnotte b, J.-F. Besancenot a, B. Lorcerie b a Service de médecine interne et maladies systémiques, hôpital Général, CHU de Dijon, 3, rue Faubourg-Raines, B.P. 1519, 21033 Dijon cedex, France b Service de médecine interne et immunologie clinique, complexe hospitalier du Bocage, 2, boulevard du Maréchal-de-Lattre-de-Tassigny, 21000 Dijon, France c Service de médecine nucléaire, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France d Département de radiologie et d’imagerie médicale diagnostique et thérapeutique, complexe hospitalier du Bocage, 2, boulevard du Maréchal-de-Lattre-de-Tassigny, 21000 Dijon, France