Intoxication à l'hydrate de chloral

The intentional ingestion of 5 g of chloral hydrate by a 67-yr-old man resulted in cardiac arrhythmia including tachyarrhythmia and polymorphic ventricular extrasystoles. As the ingested agent was unknown at admission, the patient was treated among others with sodium lactate, a non validated therapy of arrhythmia caused by chloral hydrate overdose. The discontinuation of arrhythmia was in favour of a beneficial effect of this treatment which remains to be confirmed. This unusual therapy is the original point of this case report which allows to question the so-called innocuousness of chloral hydrate, to remind the conventional treatment of the arrhythmias caused by this agent, the place of beta-adrenergic blockers, as well as the therapeutic difficulties when the causative agent remains unknown     

Formes graves de colite pseudomembraneuse à Clostridium difficile

Clostridium difficile causes a broad spectrum of enteric diseases in humans, ranging from mild antibiotic-associated diarrhoea to more severe pseudomembranous colitis. The authors report four cases of life-threatening pseudomembranous colitis with haemodynamic changes. Infection due to Clostridium difficile should be kept in mind whenever a patient undergoing antibiotic therapy develops a symptomatology of an acute abdomen.     

Arthrite septique à pyogène de l'adulte

Septic arthritis has shown no change in incidence, and despite advances in antimicrobial therapy is often responsible for residual functional impairment and for a high mortality rate among debilitated patients. Risk factors include older age, diabetes mellitus, rheumatoid arthritis, immunodeficiency, and a preexisting joint disease (e.g., rheumatoid arthritis) to which the symptoms of septic arthritis are sometimes ascribed. Staphylococcus aureus contributes over two-thirds of identified organisms; a range of streptococci and gram-negative bacilli are next in frequency. The most common site is the knee, followed by the hip and shoulder. Over 10 % of patients have polyarticular involvement reflecting bacteremia and diminished resistance to infection; (over 50% of polyarticular forms occur in rheumatoid arthritis patients). Prosthetic joint infection is becoming increasingly common; chronic forms due to intraoperative contamination and resulting in septic loosening should be distinguished from acute hematogenous infection in which emergency treatment can allow to salvage the prosthesis. Demonstration of the organism in the joint is the key to the diagnosis. Joint aspiration should be performed on an emergency basis, if needed after identification of radiographic landmarks or under ultrasonographic guidance. Seeding the fluid on blood culture flasks immediately after aspiration increases the yield. Antibiotics should be started as soon as the microbiological specimens have been collected. When aspiration is difficult (hip) or inadequate, arthroscopic drainage usually makes arthrotomy unnecessary. Early antiinflammatory therapy (nonsteroidal antiinflammatory drugs, systemic or local glucocorticoids, anticytokines, and antiinflammatory cytokines) are being considered as tools for limiting joint damage; their efficacy and safety will first have to be established in animal studies.     

Paragangliomes de la queue de cheval : à propos de six cas et revue de la littérature

Background and purposeParagangliomas of the cauda equina are rare tumors. The standard treatment is surgical resection. Our study aims to compare our clinical, radiological, prognostic data to the literature and to offer management and follow-up recommendations.MethodsIn this retrospective study, six patients with paraganglioma of the cauda equina region were treated. Symptoms included radicular nerve pain and low back pain with occasional sphincter dysfunction and motor deficit. MRI showed well-circumscribed lesions with homogeneous enhancement following gadolinium injection. Treatment involved complete surgical resection of the tumor under electrophysiological control. In addition to the characteristics of the tumor, we assessed operating results as well as postoperative morbidity and follow-up.ResultsAll patients had complete removal of the tumor, which required in most cases the resection of the carrying root. The intervention allowed a regression of the initial symptoms, with possible postoperative regressive sphincter disorders. Clinical and radiological follow-up (19 months on average), showed no tumor recurrence.ConclusionsThe reference treatment of these tumors is complete surgical resection, usually requiring the sacrifice of the carrying nerve root. Intra-operative nerve roots stimulation is recommended to reduce the risk of motor deficit linked to this radical treatment. A long-term clinical and radiological follow-up is recommended.     

Infection à cytomégalovirus chez un patient atteint de polyarthrite rhumatoïde

Background. – Pulmonary dysfunction in rheumatoid arthritis patients treated with low-dose methotrexate is usually caused by bacterial infection and less frequently by an immunoallergic reaction to the drug (acute hypersensitivity pneumonitis). Opportunistic infections are a rare cause. We report a case of cytomegalovirus pneumonia during bone marrow aplasia in a patient with rheumatoid arthritis taking methotrexate and cyclosporine.Conclusions. – Cytomegalovirus infection is a rarely reported cause of pulmonary dysfunction. This diagnosis should be considered in immunocompromised rheumatoid arthritis patients with no other satisfactory explanation to pulmonary dysfunction.     

Doença de Still do Adulto associada à neoplasia de ovário – relato de caso

We report a case of adult-onset Still's disease in a female patient with fever, myalgia, van- ishing rash and bilateral inguinal lymphadenopathy, diagnosed after extensive workup to exclude other rheumatic, infectious and neoplastic diseases. The patient initially respond- ed to corticosteroid therapy, but progressed to increased lymph nodes size that when biop- sied, revealed serous ovarian adenocarcinoma. To our knowledge, this is the first report of ovarian neoplasm associated with adult-onset Still's disease.     

Monoarthrite secondaire à une métastase articulaire : à propos de deux cas et revue de la littérature

Synovial metastasis of neoplasms are uncommon. We report two cases of monoarthritis of the knee due to articular metastasis. The diagnosis was performed by cytologic evaluation of the synovial fluid. The first case was an epidermoid carcinoma of the ureter with a metastasis to the left knee joint. The second was a chronic monoarthritis of the left knee unresponsive to classical treatment and found to have bony metastases of the distal femur from lung adenocarcinoma. Only 28 cases of synovial metastasis of solid tumor have been reported in the literature. The knee joint is the most commonly affected. Lung is the main localization of the primary neoplasm (12 cases) and histologic type is preferentially adenocarcinoma (12 cases). Articular metastasis has usually a poor prognosis with an average survival lower than 5 months.     

Circulation intraosseuse : de la physiologie à la pathologie

Blood flow within bones is unique in two ways: the blood circulates within a closed cavity in which pressure must remain constant, a feat achieved in part thanks to the considerable distensibility of the intraosseous vessels and, above all, veins; the intraosseous circulation allows traffic of minerals between the blood and bone tissue and sends the blood cells produced within the bone marrow into the systemic circulation. In contrast, the arterioles and capillaries within bones have the same anatomic structure as those located elsewhere in the body and are susceptible to arteriosclerosis, arteritis, or thrombosis. The mechanisms that regulate blood flow within bone are incompletely understood, probably because they are difficult to study in vivo. The cytokines and growth factors that regulate intraosseous angiogenesis also regulate bone remodeling, and close links exist between the blood supply to bone and bone formation and resorption : most diseases characterized by increased bone resorption are associated with increased bone vascularization. The vascular bud located at the center of bone multicellular units (BMUs) may determine the timing of bone resorption and bone formation. Avascular bone necrosis and bone infarction may result from acute blood vessel occlusion (thrombosis, lipid emboli, fat cell hypertrophy with compression of intraosseous capillaries), whereas arteriosclerosis may contribute to the development of osteoporosis.     

Résultats à long terme de la chirurgie endovasculaire à l'étage infra-inguinal dans le cadre de l'ischémie critique

Study aimEndovascular surgery can be proposed as an alternative to infrainguinal conventional surgery in critical ischemia. The aim of this study was to report the latest results of our series of 186 patients.Materials and methodsOne hundred and eighty-six patients (100 women and 86 men; mean age 74.5 ± 13 years) were treated for pain during rest (31.5%), gangrene (58%), or ischemic ulcer (10.5%). The lesions were unilateral (n = 172) or bilateral (n = 14). Two hundred eighty-seven target lesions were treated: for stenosis (n = 168) or occlusion (n = 119): of superficial femoral artery (31.7%), popliteal artery (40%) ortibial arteries (28.3%).ResultsTechnical success was achieved in 81% (15% amputations). The in-hospital mortality rate was 6.5%. The cumulative patency rate was 61 ± 3% at 12 months, and 52 ± 6% at 48 months. The limb salvage rate was 87 ± 3% at 12 months and 82 ± 4% at 48 months. Thirteen potential factors of patency were analyzed: the only predictive factors affecting patency were occlusion versus stenosis, and the use of atherectomy (Log rank test: P < 0.001 and P < 0.0001).ConclusionDespite a risk of technical failure and of midterm restenosis, endovascular surgery for critical ischemia provides a fair long-term limb salvage rate.     

Carcinome rénal à cellules chromophobes : à propos de 16 cas et une revue de la littérature

Objective

To determine the histo-clinical, pathological, therapeutic and prognostic characteristics of renal chromophobe carcinomas.