L’incidence de l’obésité et de la chirurgie bariatrique est croissante. La maladie de Cushing est rare et son dépistage systématique n’est pas recommandé. Nous rapportons 2 patients adressés pour ...chirurgie bariatrique, dont le bilan a permis le diagnostic de maladie de Cushing.
Mme G. 28 ans IMC 61kg/m2, G2P2, DT2, dyslipidémie, SAOS. Cliniquement : buffalo neck, vergeture foncées lombaires, acné, hirsutisme. Biologiquement hypercorticisme (CLU 2,5N, cycle rompu, DXM 1mg à 376nmol/L), ACTH-dépendant. Freinage fort incomplet, DXM-CRF positif. IRM hypophysaire doute sur image gauche. Cathétérisme sinus pétreux : origine hypophysaire. Adénomectomie : adénome corticotrope sans signe d’agressivité. Pas de déficit corticotrope postopératoire. DXM Minirin à 1 an absence de récidive. À 18 mois : sleeve gastrectomie, IMC :49,5kg/m2 à M3.
Mr L. 50 ans, IMC : 60kg/m2, SAOS, ostéopénie, HTA, DT2, Dyslipidémie. Cliniquement : Buffaloneck, obésité faciotronculaire, vergetures pourpres abdominales. Biologiquement : rupture cycle cortisol, DXM 1mg : 301nmol/L. CLU entre 2-3N. Freinage fort incomplet. ACTH-dépendant. Scanner hypophysaire : macroadénome hypophysaire 34mm invasif. Chirurgie hypophysaire : adénome corticotrope, Ki67 à 1 %. Bilan à M3 pas d’insuffisance corticotrope, absence de guérison. Reliquat au TDM. Décision de radiothérapie hypophysaire complémentaire permettant la rémission de la maladie de cushing. Sleeve gastrectomie 1 an après la radiothérapie. IMC : 56kg/m2 à M3 (IMC max : 65kg/m2).
Un bilan endocrinologique est indispensable dans le bilan préchirurgie bariatrique afin de ne pas méconnaître l’éventualité d’un hypercorticisme. La prise en charge diagnostique et thérapeutique est compliquée par cette obésité massive.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
We aimed to identify prognostic factors for AIDS-associated disseminated histoplasmosis. In a multivariate analysis, we found that dyspnea, a platelet count of <100,000 platelets/mm3, and lactate ...dehydrogenase levels of >2 times the upper limit of the normal range were significantly independently associated with the death of the patient during the first 30 days of antifungal treatment.
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BFBNIB, NUK, PNG, UL, UM, UPUK
We conducted a retrospective cohort study to determine the influence of crack cocaine use on the outcomes of HIV infection. The use of crack cocaine was associated with an increased incidence of ...AIDS: 27.8 per 100 person-years versus 6.6 per 100 person-years for nonusers, adjusted hazard ratio = 3.8 (1.9-7.5), P < 0.001. More specifically, crack users had a greater incidence of disseminated histoplasmosis, pneumocystosis, pulmonary tuberculosis, bacterial pneumonia, oesophageal candidiasis, cerebral toxoplasmosis, salmonellosis, and genital herpes. The care of HIV-infected crack users is particularly challenging and requires additional efforts to reduce the high morbidity of these patients.
A retrospective cohort study was conducted to determine whether the incidence of leprosy varied with the duration of antiretroviral therapy (ART). Between 1992 and 2006, seven cases of leprosy were ...observed. The incidence of leprosy in untreated patients was 0.7 per 1000 person-years, 13 per 1000 person-years in persons receiving HAART for more than 3 months and 0.9 per 1000 person-years for persons receiving HAART for more than 3 months. The adjusted hazard ratio was 18.5 (95% confidence interval, 1.6-217) with P = 0.02. In tropical areas where HAART is increasingly available, physicians should be aware of the possibility of incident leprosy shortly after HAART initiation.
Risk factors for delayed HIV diagnosis in French Guiana were studied in 1952 patients between 1992 and 2003. At the time of diagnosis, 30% of patients had less than 200 CD4 lymphocytes/mm3; age, male ...sex, and foreign nationality were independently associated with a low CD4 cell count. The availability of highly active antiretroviral therapy was not associated with an earlier HIV diagnosis. Promoting HIV information and testing should be done in several languages to reach minorities.
French Guiana is the region of France where the HIV epidemic is most prevalent. To determine the risk factors for being lost for follow-up, we followed a cohort of 1,213 patients between 1992 and ...2002 and determined which variables were related to two definitions of being lost to follow-up: permanently disappearing from HIV clinics and coming back after more than 1 year of missed appointments. The incidence rate for permanent follow-up interruption was 17.2 per 100 person-years. The median time to lost to follow-up was 4.3 years (interquartile range = 1.4-8.4 years). Cox modeling showed that the younger age groups, foreigners, patients with initial CD4 counts at the time of HIV diagnosis less than 500/mm3, and patients followed before the availability of highly active antiretroviral therapy (HAART) were significantly more likely to be permanently lost to follow-up, suggesting that some of the patients may have died. When looking at temporary loss to follow-up, younger age groups, untreated patients, patients consulting before the availability of HAART, and patients with CD4 counts more than 500/mm3 were more likely to not come back for a period of more than 1 year.
To determine whether the initiation of highly active antiretroviral therapy (HAART) had any influence on the incidence of disseminated histoplasmosis, a retrospective cohort study was performed on ...1551 patients followed for up to 12 years. After controlling for CD4 counts, age, and sex, patients taking HAART for 2 months or less were more likely to develop disseminated histoplasmosis than untreated patients (respectively, hazard ratio, 3.7 95% confidence interval, 1.57-8.7; P = 0.003). In contrast, after 6 months of HAART, treated patients were less likely to develop disseminated histoplasmosis than untreated patients (hazard ratio, 0.6 95% confidence interval, 0.37-0.98, P = 0.04). This increased incidence suggests that the initiation of HAART and the subsequent immune reconstitution may reveal undiagnosed latent disseminated histoplasmosis.
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