Prévalence et facteurs prédictifs de l'hypertension « de la blouse blanche » dans une importante base de données de mesure ambulatoire de la pression artérielle RÉSUMÉ Cette étude avait pour objectif de déterminer la prévalence de l'effet blouse blanche et de l'hypertension de la blouse blanche, et de recenser les variables cliniques qui sont des facteurs prédictifs de ce type d'hypertension. Au total, 2 462 sujets ont fait l'objet d'une mesure ambulatoire de la pression artérielle, en raison d'une hypertension légère (groupe 1), aux fins de l'évaluation d'un traitement antihypertenseur (groupe 2), ou en raison d'une hypotension (groupe 3). Dans la population générale, 33,0 % des sujets présentaient une hypertension de la blouse blanche, 32,8 % dans le groupe 1 et 37,0 % dans le groupe 2. Dans l'analyse multivariée, le sexe et le niveau d'hypertension étaient des facteurs prédictifs indépendants d'hypertension de la blouse blanche. ABSTRACT The objective of this study was to determine both the prevalence of white-coat effect and white-coat hypertension (WCH) and which selected clinical variables were predictors of WCH. A total of 2462 patients underwent ambulatory blood pressure monitoring either in borderline hypertension (group 1) or for assessment of antihypertensive treatment (group 2) or for hypotension (group 3). In the overall population 33.0% of patients showed WCH, 32.8% in group 1 and 37.0% in group 2. In multivariate analysis, sex and grade of hypertension were independent predictors of WCH in groups 1 and 2.

Luxatio erecta is an unusual humeral dislocation. It is frequently associated with neurovascular injuries and concomitant fracture. As such, they require a thorough clinical and imaging evaluation. The vast majority of cases may be treated with closed reduction alone, but infrequently, some may require an open procedure. The authors report a case of luxatio erecta with fracture of greater tuberosity to underline the rarity of this entity, and to describe the mechanism of this injury and the therapeutic modalities.

Functioning thyroid metastases are a rare cause of hyperthyroidism. Most are follicular carcinoma. Here, we report a case in which a 62-y-old man with a history of right subtotal thyroidectomy for a benign adenoma complained of symptoms of hyperthyroidism associated with left arm pain. Biopsy of a humeral lesion was consistent with papillary carcinoma metastatic from the thyroid. Postoperatively, the patient received a cumulative dose of 14.8 GBq of 131 I with good control of the hyperthyroidism but without eradication of the bone metastasis. Funct ioning thyroid metastases are a rare cause of hyperthyroidism. Fewer than 100 cases can be found in the worldwide literature. Most of them were follicular carcinoma with lung or bone involvement. Only 20 cases of functioning metastases from papillary carcinoma have been reported (1,2). CASE REPORTA 62-y-old man who had undergone right subtotal thyroidectomy 11 y previously for a benign adenoma had recently presented with symptoms of hyperthyroidism associated with left arm pain. His level of free thyroxine was elevated (68 pmol/L; reference level, 11-25 pmol/L), his level of thyroid-stimulating hormone (TSH) was suppressed (,0.01 mIU/mL; reference level, 0.2-3.2 mIU/mL), and he was negative for TSH-receptor antibody. 99m Tc-sodium pertechnetate planar scintigraphy of the neck and upper chest showed mild uptake in the left thyroid lobe, in contrast to heightened uptake in the left arm (Fig. 1). The planar posterior view and SPECT/CT fusion images showed focal, intense uptake in the fifth thoracic vertebra (Fig. 2), an area of involvement that had been asymptomatic at the first presentation but had become symptomatic within about 50 d. 99m Tc-methylendiphosphonate bone scanning showed a focus of increased uptake in the left humerus and a photopenic area in the right pelvic bone (Fig. 3). No other sites of bone involvement were detected. Biopsy of the left humeral lesion was consistent with papillary carcinoma metastatic from the thyroid. Left subtotal thyroidectomy was therefore performed, but no malignancy was found in the remaining lobe. The clinical course was marked by a rapid onset of medullar compression symptoms. Decompressive laminectomy was recommended, but the patient refused to undergo more surgery. Despite a persistently low TSH level, postablation 131 I whole-body scans showed bone metastases (Fig. 4). Six months after the patient had completed radioiodine therapy (3.7 GBq), the myelopathic symptoms improved but free thyroxine and triiodothyronine remained elevated. In the 48th mo after the diagnosis, he finally received a cumulative dose of 14.8 GBq of 131 I, which controlled the hyperthyroidism well but did not eradicate the bone metastases. Antithyroid drugs were replaced with lifelong TSH suppression. DISCUSSIONThree criteria on which to base the diagnosis of functioning metastases were present in our patient: failure of thyrotoxicosis to resolve after thyroidectomy, mild iodine uptake in the remnant thyroid lobe, and iodine uptake in metastases (2). Fu...

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Muscle metastases of bronchopulmonary cancer are rare, notably when they are revealing. They can affect all muscles of the body with a predominance of psoas, diaphragmatic and para-vertebral muscles. We report a case of psoas muscle metastasis revealing bronchopulmonary cancer in a 40-year-old patient with a long history of smoking (30 packs of cigarettes/year) presenting a chronic left low back pain with asthenia and weight loss (15 kg/year). The clinical examination was unremarkable. An abdominal computed tomography scan showing a retroperitoneal mass at the expense of the left psoas muscle, lysing the L2 vertebral and left pedicle with intraspinal extension. A complement by cervico-thoracic computed tomography scan showed a lung mass with hilar and mediastinal lymphadenopathy. A scan-guided biopsy puncture of the psoas muscle mass identified its metastatic origin. The clinical picture is often deceptive leading to diagnostic and therapeutic delay, hence the interest of the imagery as well as histological confirmation is recommended.