Syndrome d’irritation bronchique

Reactive airway dysfunction syndrome (RADS) was first described in 1985 by Brooks et al. as the occurrence of asthmatic symptoms within 24 hours after a single high-level exposure to an irritant gas, vapor or fume with persistence of airflow obstruction and/or airway responsiveness for several months. The original diagnosis criteria have been modified and extended to the occurrence of asthmatic symptoms following repetitive exposure to a lower level of irritant agent. This condition has been labelled “irritant induced asthma”. We here discuss different aspects of this syndrome including its prevalence, pathophysiology, diagnosis and management.     

À propos d’un cas d’invagination intestinale chez un patient porteur d’une maladie de Crohn méconnue

Gastrointestinal intussusception is an uncommon clinical entity in adults and is interestingly distinct from its paediatric form. Crohn disease is an exceptional cause of intussusception in adults. We report a case of coeco-ileal intussusception in an adult suspected in computed tomography and endoscopy. Diagnosis of Crohn disease was made by histological study after surgical treatment. The patient had immunosuppressive therapy (azathioprin) and had no relapse until now.     

Vascularite de l’artère hépatique : à propos d’un cas d’atteinte d’organe isolée

Introduction

Vasculitis usually have a systemic involvement. Rare cases of localized vasculitis have been described, but the exclusive involvement of the hepatic artery is exceptional. We report the case of a patient who developed a vasculitis of the right and left hepatic arteries.

Compression cardiaque d’origine hydatique

Introduction

Cardiac hydatid disease is uncommon and occurs in 0.5 to 2% of patients with hydatidosis. Isolated intrapericardial hydatid cystic disease is extremely rare.

Endocardite infectieuse aortopulmonaire d’évolution fatale : à propos d’un cas

We report the case of an aortic and pulmonary infective endocarditis in a 25-year-old patient originating from Guinea Conakry. The patient did not have any particular cardiovascular antecedent. He is allowed in a table of total heart failure and fever. The transthoracic echocardiography found vegetations on the level of sigmoid aortic and pulmonary ones. A probabilistic bi-antibiotherapy was instituted while waiting for the results of hemocultures. The patient was apyretic after one week, with regression of inflammatory biological syndrome. However, he was deceased after 20 days in a table of heart failure. The necropsy found vegetations on the level of sigmoid aortic and pulmonary ones, which were perforated, a right lung oedema and a cardiac liver.     

Proposition d’un score prédictif d’infection bactérienne selon le taux d’éosinophiles : étude observationnelle

Introduction

Several studies have shown that eosinopenia less than 0.04 g/L is a marker of bacterial infection in the presence of unexplained inflammatory syndrome. The aim of our study was to test this hypothesis and to propose a predictive score for bacterial infection (score CIBLE, C reactive protein, bacterial infections, levels of leucocytes and eosinophils).

Fermeture d’auricule et pathologie embolique

Atrial fibrillation (AF) is frequent and responsible for embolic events. Currently, the gold standard to prevent such embolic events is anticoagulant therapy with vitamin K antagonist (VKA) or direct oral anticoagulant in nonvalvular AF. Recently, left atrial appendage closure was proposed as an alternative to anticoagulant inpatient with high embolic risk and contraindication to anticoagulant therapy. Data from randomized trials were consistent with a non-inferiority of left atrial appendage closure in comparison to VKA in terms of stroke and cardiovascular death. However, despite improvements in procedure results and complications reduction, this invasive strategy has to be performed with optimal security as this strategy is a preventive treatment in high-risk patients. These improvements may allow an extension of indications of left atrial appendage closure to lower profile risk patients as an alternative to anticoagulant. Indeed, anticoagulant is a risky therapy with hemorrhagic events and observance is a real issue in an asymptomatic population. Finally, there is a lack of data in recent literature comparing left atrial appendage closure to direct oral anticoagulant, widely used in daily practice, as well as cost-effectiveness of this procedure in comparison to anticoagulant.     

La troponine I hypersensible comme marqueur diagnostique d’un(e) malaise/syncope d’origine cardiaque au service d’accueil des urgences adultes

AimsThe objective of this study is to evaluate the diagnostic accuracy of high-sensitivity (hs) troponin I to predict cardiac origin after syncope. The secondary objective is to determine the causes of elevated troponin.ProcedureWere included hospitalized patients with syncope/near syncope diagnosed in ED. The diagnostic accuracy to predict cardiac origin was evaluated and compared to the “high risk” group, defined by the 2018 European Society of Cardiology guidelines.ResultsA total of 163 patients were enrolled, 26% had a cardiac origin. Positive troponin I hs predict a cardiac origin with a sensitivity of 31%, a specificity of 80%, positive predictive value of 35% and negative value of 77%. These diagnostic performances are not discriminating and lower than the ESC classification. A positive troponine I hs level is associated with 5 times more cardiac failure during the hospitalization.ConclusionA positive troponin I hs level after syncope/near syncope is not predictive of cardiac origin. It appears to be an early marker of ventricular remodeling in heart failure.     

Prise en charge diagnostique des uvéites : recommandations d’un groupe d’experts

Introduction

Diagnostic work-up of uveitis involves many uncertainties. Search for an etiology should take into account the epidemiology of uveitis and focus on the most severe diseases or those, which can be treated. This work was undertaken to establish recommendations for the diagnosis work-up of uveitis.

Le cavernome portal : cause rare d’hémorragie digestive et d’ictère

Introduction

Rupture of esophageal varices due to schistosoma induced portal hypertension remains the major etiology of non ulcer gastrointestinal bleeding in Madagascar. The author reports two cases of portal cavernoma, a rare etiology of gastrointestinal bleeding.We want to increase the knowledge of this pathology and to discuss its management in our centre.

Observation

The first patient had esophageal varices diagnosed 6 years ago and the second one had a history of jaundice of unclear etiology 6 years ago. Both were admitted for upper gastrointestinal bleeding. Upper gastrointestinal endoscopy showed stage III esophageal varices. Abdominal ultrasonography led to the diagnosis of portal cavernoma. The exploration of an associated portal biliopathy was not feasible in our centre due to the lack of transhepatic or retrograde endoscopic cholangiography and Magnetic Resonance Imaging. We medically managed the gastrointestinal bleeding. Betablocker drugs were prescribed to prevent the recurrence of any gastrointestinal bleeding.

Conclusion

Portal cavernoma is a rare but possible etiology of gastrointestinal bleeding and jaundice. Management of these two complications is difficult in our country due to the lack of investigation and therapeutic tools.