Tamponnade révélant un kyste hydatique intra-péricardique – un cas

Introduction

Hydatid disease is a parasitic infection caused by the development of the larval form of the Teania of Echinococcus granulosus. It is endemic in many regions of the world such as the Mediterranean basin. Location without pericardial cardiac involvement is extremely rare. In this case study, we will elaborate the case of an intra-pericardial hydatidosis disease without cardiac location revealed by a tamponade.

Observation

AA is a 60-year-old man with no pathological history and who was admitted for a tamponade assessment. Indeed, the cardiovascular examination showed a muffling of the heart sound and signs of a right heart failure. Besides, the ECG shows a microvoltage, and the chest radiography shows cardiomegaly. Moreover, the transthoracic echocardiogram confirmed the presence of an abundant pericardial effusion along with signs of a tamponade. It also reifies the presence of, at the intra-pericardial level, a multiple vesicular formation giving a cluster of grapes highly suggestive of an intra-pericardial hydatid disease. An emergency surgical drainage allowed removing about two liters of suspicious fluid along with cysts and white membranous. The pathological examination of the membranous confirmed the diagnosis of a pericardial hydatid cyst. The performance of a chest CT and an abdominal ultrasound's scan to identify other locations shows no further anomalies. The patient was put under medical treatment (Albendazole^®) and is showing a good clinical improvement.

Conclusion

The intra-pericardial hydatid disease is another cause of tamponade not to fail despite its rareness, as it is endemic to North African countries.     

Troponinémie faussement positive chez un patient présentant un pneumothorax : cas clinique

A 20-year-old patient is admitted to the emergency room for chest pain occurring in the context of recurrent left complete pneumothorax. Ultrasensitive troponinemia is elevated to 20 times normal. Myocardial distress is attributed to pneumothorax following the negativity of cardiological examinations (EKG, TTE, cardiac MRI). The pneumothorax is drained with a favorable evolution.This is the first reported case of pneumothorax associated with a significant elevation of troponin without ECG change, TakoTsubo syndrome, or myocardial inflammation. Several mechanisms are considered: rotation of the myocardium around its axis, increase in pulmonary vascular resistance with overload of right ventricular pressure, disturbance of coronary blood flow on significant mediastinal compression with decrease in systolo-diastolic myocardial perfusion.     

Responsabilité de la ciclosporine dans la survenue d’un neuro-Behçet ?

Central neurological involvement in Behcet's disease (neuro-Behcet) occurs in 10 to 20% out of the patient. We report a 47-year-old man treated with cyclosporine who presented with neurologic manifestations of Behçet's disease. Relationship between cyclosporine and neuro-Behcet's disease are discussed.     

Quel est l’intérêt de rechercher un hypogonadisme chez un patient présentant des ulcères de jambe récidivant depuis l’âge de 20 ans ?

Androgen replacement therapy has been reported to have a beneficial effect in patients with Klinefelter's syndrome or perforating plantar ulcers. We report the case of a 55-year-old man with a 35-year history of leg ulcers and venous insufficiency. His leg ulcers healed 4 months after a management scheme including vascular rehabilitation (intermittent pressure therapy, ankle mobilization, multiple layer compression bands on the lower limbs), skin grafts and foam sclerotherapy of the great saphenous vein. The ulcers recurred 1 month later. This recurrence and the unusually young age for development of venous leg ulcers led to a search for a rare cause. The diagnosis of anterior pituitary failure was established. Sclerotherapy and androgen replacement therapy led to complete healing without recurrence at the 1-year follow-up visit. A link between androgen deficiency and fibrinolysis, protein synthesis deficiency, inflammation and trophicity is well documented in the literature. A search for hypogonadism may be useful in young patients presenting a longstanding history of leg ulcers or in patients with suspected andropause irrespective of age.     

L’insuline par voie inhalée : un modèle pour l’absorption systémique pulmonaire ?

European Union has recently approved a form of insulin intended to be inhaled. This innovative presentation has the potential to partially or completely replace the injections and thus facilitate starting insulin therapy which is considered with apprehension and too often differed. On this occasion, we reviewed the issues raised by this pulmonary route for systemic absorption (anatomical and cytological limits, cellular mechanisms, relevant physical parameters, facilitating chemical cofactors, role of tobacco smoking and of common respiratory diseases). The pharmacokinetics of inhaled and injectable insulins are comparable, apart from an appreciably faster absorption of the former and both show the same intra-individual variability. The total biodisponibility is definitely lower with the inhaled way but it is notably increased in smokers. These characteristics can vary according to the inhalation system used. A frequent induced cough, the increase in circulating anti-insulin antibodies and a potentially higher cost are not really determining obstacles. The indications will have to be clearly specified and the long-term inocuity of long term inhalation of such a mitogene especially in children and former smokers remains to be formally proven.