Syndrome d’activation macrophagique et grossesse : à propos d’un cas

Haemophagocytic syndrome (HPS) results from an inappropriate stimulation of macrophages in bone marrow and lymphoid organs, leading to haemophagocytosis and hypercytokinemia. HPS may be primitive, essentially in pediatric population, or secondary to malignancy, infection or autoimmune disease. This disease is rare and prognosis is poor. A small number of cases during pregnancy have been described in literature. We report one HPS case in a pregnant patient at 21 week's gestation with systemic lupus erythematosus. We discuss diagnostic difficulties, obstetrical complications and therapeutic options.     

Embolie amniotique : à propos de l’issue favorable d’un cas avec arrêt cardiaque inaugural et CIVD précoce compliquée d’un hémopéritoine d’origine iatrogène et d’un saignement sur un adénome hépatique

Amniotic fluid embolism is a relatively rare clinical entity and with difficult medical recognition. However, it is the second leading cause of maternal mortality. We report here the case of a 32-year-old patient who underwent elective caesarean section complicated by an amniotic fluid embolism with cardiac arrest. The presence of a major disseminated intravascular coagulation favored the occurrence of a retroperitoneal hematoma of iatrogenic origin on attempt of femoral venous catheterization and that of hemoperitoneum on bleeding of an hepatic adenoma. The diagnostic of amniotic fluid embolism was confirmed by the presence of amniotic cells in the bronchoalveolar lavage. The patient survived without sequelae.     

Section intrapleurale d’un drain thoracique par un trocart de Monod

We report the case of a 56-year-old man who presented a section of a chest drain into the pleural cavity. Following an oesogastrectomy with coloplasty for oesophageal carcinoma, the patient developed a pleural effusion. During the implementation of pleural drainage, the intrathoracic drain tip was sectioned. The patient underwent a thoracotomy to remove the foreign body. The drain was probably cut during device removal through the particularly cutting trocar. This observation strengthens the need to refrain from withdrawing the movement tube through a Monod trocar.     

Neurocytome central : à propos d’un cas

In this study, we report one case of central neurocytoma treated in our department. It is a benign tumor of the lateral ventricles of the brain with neuronal differentiation. The clinical symptoms mainly consisted in intracranial hypertension syndrome. Immunohistochemical studies are necessary for the histopathological diagnosis. The treatment of choice is surgical. To guarantee good progression, complete ablation is necessary. The clinical progression, radiological aspects, treatment, histopathology, and postoperative progression will be discussed.     

Prise en charge anesthésique d’un accouchement chez une patiente atteinte d’une paramyotonie congénitale d’Eulenburg

A patient presenting with paramyotonia congenita (Eulenburg's paramyotonia) was seen at the preanaesthetic visit during pregnancy. The underlying disease was known for years. Analysis of the literature and advice taken from specialists emphasized the safe use of regional anaesthesia and analgesia which was indeed used for labour and delivery without any complication. By contrast, the limited information available on the use of general anaesthesia suggests the risks associated with the use of succinylcholine and possibly with halogenated agents. Additional and useful factors that may limit the occurrence of myotonic crises such as maintenance of normal temperature and plasma potassium concentration, should be undertaken simultaneously.     

Utilisation d’un ECMO (extracorporeal membrane oxygenation) dans un cas d’hypoxémie réfractaire associée à un traumatisme crânien grave

Traumatic brain injuries are fairly sensitive to hypoxia. For patient with associated lung and brain traumas, different means used to improve oxygen blood level are poorly described. We report the use of ECMO in a refractory hypoxemia occurred to a multitrauma young patient with neurological lesions.     

Embolie gazeuse iatrogène au cours d’une gastroscopie chez un patient porteur d’un drain biliaire multiperforé posé par voie radiologique

The authors report the first case of gas embolism arising during an upper gastrointestinal endoscopy to a patient carrier of a biliary drain placed by radiological way. The hypothesis of a biliary-vascular fistula with abnormal connection between the biliary tree and the hepatic vascular system and finally an arteriovenous intrapulmonary shunt was retained to explain the physiopathology. The immediate stop of the endoscopic procedure and the implementation of symptomatic treatment allowed a favorable neurological outcome without sequelas. The realization of an upper gastrointestinal endoscopy to a patient carrier of a biliary drain has to lead the anaesthesiologists and the gastroenterologists to take care given the incurred risk of gas embolism.     

Retrait impossible d’un cathéter de péridural

The knotting of an epidural catheter is a rare complication preventing catheter withdrawal. We report two cases of catheter knotting and subsequent impossible withdrawal with moderate repeated traction. Imaging by CT scan allowed visualisation in the epidural space of a loop and a real knot for the first and the second patient respectively. The common risk factor found was an excess in catheter length inserted. A surgical procedure was necessary for both patients.