Fat pulmonary embolism after liposuction

A 24-year-old woman undergoes buttock's liposuction as an outpatient procedure. As she went back home, progressive dyspnea, respiratory distress and collapse developed. At hospital admission, she was dyspneic with thoracic oppression, tachycardia and anguish. Chest X-ray and thoracic CT scan suggested a pulmonary localisation of fat emboli. Symptomatic treatment allowed complete recovery. This report discusses diagnosis of fat emboli after liposuction as well as epidemiology and physiopathology.     

Multiple aneurysms in a seven-year-old child

Arterial aneurysms, rarely encountered in childhood, pose difficult etiologic and therapeutic problems. We report the case of a seven-year-old Algerian girl with aortoiliac, visceral, and limb aneurysms revealed by a tumefaction in the left popliteal fossa. Aortic rupture subsequently occurred. The aneurysms were resected with subsequent prosthetic or vein graft replacement. Three years later, clinical and functional results of the grafts were satisfactory. Possible etiologies include inflammatory arteritis, dysplasia, or idiopathic primary aneurysms.Presented at the Annual Meeting of the Société de Chirurgie Vasculaire de Langue Française, La Grande Motte, France, May 20–21, 1988.     

Detection of autologous blood doping with adaptively evaluated biomarkers of doping: a longitudinal blinded study

BACKGROUND: Since no direct detection method for autologous blood transfusions exists, the most promising attempt is the Athlete Biological Passport (ABP) and its adaptive model that enables a longitudinal monitoring of hematologic measures to identify patterns of blood manipulations. The purpose therefore was to evaluate the performance of this adaptive model for the detection of autologous blood transfusions in a longitudinal blinded setting. STUDY DESIGN AND METHODS: Twenty‐one subjects were divided into a doped group (multiple transfusions of 1‐2 units of red blood cells, n = 11) and a control group (n = 10). The time course of a cycling season (42 weeks) was simulated including three major competitions (Classics, Grand Tour, World Championships). Up to 10 venous blood samples were ordered per subject by a blinded investigator mimicking the intelligent approach in obtaining hematologic data for the adaptive model (hemoglobin [Hb] concentration, reticulocyte percentage, OFF‐score). RESULTS: Retrospective analysis allowed identification of four (probability >99%) or three (probability >99.9%) abnormal samples for Hb and eight (probability >99%) or five (probability >99.9%) abnormal samples for OFF‐hr in doped subjects. Four doped subjects (36%) presented an abnormal OFF‐hr sequence and three doped subjects (27%) an abnormal Hb sequence; there were no false‐positive sequence results. The best possible sensitivity was 82% when a combination of all tests was used. CONCLUSIONS: This investigation provides evidence that the adaptive model allows detection of autologous blood transfusions with a good sensitivity. An intelligent testing approach and the adherence to World Anti‐Doping Agency's ABP operating guidelines are nevertheless determinant in the success.     

Vena cava filter migration: an unappreciated complication. About four cases and review of the literature

Inferior vena cava filter placement is performed to prevent pulmonary risk secondary to deep venous thrombosis. Indications for this treatment are limited to patients experiencing recurrences under well-managed anticoagulant treatment or presenting with contraindication to anticoagulant treatment. Nowadays, as these clinical situations are rare, this device is less and less used, all the more since, for several years now, thrombosis, fracture, or infectious complications as well as filter migration have been reported. Filter migrations are responsible for atypical and varied clinical presentations likely to defer diagnosis. To treat them, the filter is extracted, which is very risky in patients with a thromboembolic history. In our center, during a period of 14 years, we retrospectively collected and studied partial or complete vena cava filter migration cases that had been treated by extraction. We are reporting four very different clinical cases and, more specifically, the second published case of migration to a renal vein, which mimicked a systemic disease. Because of its very atypical clinical presentations, cava filter migration is an unappreciated and certainly underdiagnosed complication. However, this complication must not question cava filter placement when it is justified. In contrast, it prompts early filter extraction or long-term radiological surveillance.     

Endocarditis caused by Cardiobacterium valvarum

A fastidious, gram-negative bacterium was isolated from the blood of a 51-year-old man who had acute infectious endocarditis (IE). Characterization of the organism through phenotypic and genotypic analyses revealed the causative role of Cardiobacterium valvarum. This is the third reported case of IE caused by C. valvarum.     

Sub-acute neuropathy in patients with African tick bite fever

African tick bite fever (ATBF) caused by Rickettsia africae is an emerging health problem in travellers to sub-Saharan Africa. We here present 6 patients with evidence of long-lasting sub-acute neuropathy following ATBF contracted during safari trips to southern Africa. Three patients developed radiating pain, paresthaesia and/or motor weakness of extremities, 2 had hemi-facial pain and paresthaesia, and 1 developed unilateral sensorineural hearing loss. When evaluated 3-26 months after symptom onset, cerebrospinal fluid samples from 5 patients were negative for R. africae PCR and serology, but revealed elevated protein content in 3 and mild pleocytosis in 1 case. Despite extensive investigations, no plausible alternative causes of neuropathy could be identified. Treatment with doxycycline in 2 patients had no clinical effect. Given the current increase of international safari tourism to sub-Saharan Africa, more cases of sub-acute neuropathy following ATBF may well be encountered in Europe and elsewhere in the y to come.