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INTRODUCTION: Cytomegalovirus-associated thrombosis has been extensively reported in the medical literature, mainly in immune-compromised patients. However, the association with splenic infarcts has rarely been reported. CASE REPORT: We report a 32-year-old Caucasian and immunocompetent woman who presented with a splenic infarction during a primary infection with CMV. The differential diagnostic ruled out embolic, hematologic, gastrointestinal and coagulation disorders. The outcome was favorable with symptomatic treatment. CONCLUSION: A primary infection with CMV must be added to the diagnostic work-up in the presence of a febrile splenic infarction, especially when it is associated with a biological mononucleosis reaction.

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We report a 70-year-old woman who presented with a chronic cough of 3-month duration, secondarily associated with fever and weight loss. She had no other symptoms. Physical examination was unremarkable and laboratory tests showed an increase level of acute phase reactants. Thoracic, abdominal and sinus computed tomographic scan was normal and bronchoscopy showed a non specific mucosa inflammation. Despite the absence of characteristic manifestations of temporal arteritis, a temporal artery biopsy was performed and disclosed evidence of typical temporal arteritis.

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We report the case of a 38-year-old woman, born and raised in Congo, in France for 7 years, who developed ascites 2 months after delivery by C-section. Thrombopenia at 95,000 elements per millimeter cube was diagnosed during her pregnancy and her obstetrician initiated a treatment with corticosteroids. Analysis of the ascitic fluid showed a high concentration of proteins (55.7 g/l), with 2000 elements, 80% of which were lymphocytes, and very high levels of adenosine deaminase. Thoracoabdominal tomodensitometry revealed ascites, a multinodular spleen, and hyperemia of the peritoneum; but the liver and the lungs were normal and no adenoma was identified. Laparoscopy was not performed and the suspected diagnosis of peritoneal tuberculosis was confirmed by only one culture of ascitic fluid.

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We report a 53-year-old woman with hyperkaliemia secondary to treatment with atenolol. The diagnosis of atenolol induced hyperkaliemia was obtained after excluding other causes of hyperkaliemia and normalization of potassium serum level following the discontinuation of this medication without any other modification (treatment or diet). Furthermore, when atenolol was again introduced, serum potassium level increased and normalized when atenol was definitively discontinued. The mechanism of hyperkaliemia we suspected is probably a reduction of potassium intracellular transfer.

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INTRODUCTION: Despite a wide national use, the usefulness of the protein profile has only been evaluated in a small number of studies, essentially in patients with unknown diagnoses. METHODS: We conducted a survey on 339 french internal medicine departments to evaluate how the protein profile was used in these services. Concomitantly we achieved a prospective study on 229 patients in our department, with a mean follow up of 9 months, to evaluate how did the protein profile influence the diagnosis process. RESULTS: We received 183 responses to our national survey: the protein profile was available in 110/183 (60%) departments with 94/110 (85%) using it during hospitalisation and 20/94 (21.3%) using it systematically. Among the 229 protein profile analysed in our department, 44 (19.2%) were considered useful with 20 (8.7%) of them allowing the diagnosis of a new pathology. If the profile had not been done systematically, the physicians of our department would have performed the profile in 102/229 (44.5%) cases, whereas seven (3%) useful profiles would not have been done. CONCLUSION: We think that the profile has a consistent interest in hospitalized patients with a known or unknown pathology but performing systematically such a test appears to be of limited benefit.

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Endobronchial neurogenic tumours are exceptional and little known. The authors report two cases of such tumours: a neurofibroma of the right main bronchus in a 32 year old man and a schwannoma of the left main bronchus in a 10 year old child. Pneumonectomy was necessary in both cases due to destruction of the pulmonary parenchyma distal to the obstruction. The incidence of this type of tumour is estimated to be between 0.2 and 4%. They may be either schwannomas or neurofibromas, the discovery of which always raises the problem of the possible association of von Recklinghausen's disease malignant forms, neurogenic sarcomas or malignant schwannomas may also be encountered. The diagnosis is based on endoscopy which reveals the tumour and allows biopsy. Treatment of these essentially benign tumours should be conservative, provided the diagnosis is made early, prior to parenchymal destruction. The prognosis is poor in the malignant forms and chemotherapy may be useful in malignant schwannomas.

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