Emergence of vancomycin-resistant Staphylococcus aureus identified in the Tlemcen university hospital (North-West Algeria).

INTRODUCTION: Nosocomial infections are a matter of concern in surgical wards. Their incidence is constantly increasing, especially among immunocompromised patients who are vulnerable to colonization by opportunistic pathogens such as Staphylococcus aureus. The bacterium accumulates resistance mechanisms against antibiotics such as vancomycin. The objective of our study was to explore this resistance, to screen for Staphylococcus aureus strains resistant to vancomycin, and to try various antibiotic combinations against these strains. PATIENTS AND METHODS: The antibiotic susceptibility of 220 S. aureus strains was determined by agar diffusion and evaluation of minimal inhibitory concentrations (MICs), by dilution technique on solid medium according to clinical and laboratory standard institute (CLSI) standards. The screening of strains resistant to vancomycin was performed on brain heart infusion agar medium, supplemented with 6µg/mL of vancomycin according to CLSI standards, and confirmed by determining MICs. The effectiveness of various antibiotic combinations was assessed by the checkerboard microplate method. RESULTS: The results show multidrug resistance to agents known for their antistaphylococcal activity with fluctuations in the level of resistance. CONCLUSION: Three strains proved resistant to vancomycin. The vancomycin/gentamycin combination was the most effective.

[Q fever: a rare cause of endocarditis]. / Fièvre Q: une cause rare d'endocardite A propos d'un cas.

Coxiella Burnetii endocarditis is very rare. It is the main complication of the chronic form of Q fever. Blood cultures are negative and clinical presentation very variable and diagnosis is essentially based on indirect immunofluorescence serum analysis. The authors report the case of a 19 year old patient with a history of rheumatic aortic regurgitation admitted for an episode of left ventricular failure in a context of long-term pyrexia without valvular vegetations or mutilation. The antiphase I Ig G antibody levels were significant. Treatment with doxycycline and fluoroquinolone was initiated. The clinical improvement was spectacular. Three months later, the patient underwent aortic valve replacement and histological examination of the valve showed subacute endocarditis on chronically fibrotic valvular disease. This is an interesting case by its rarity and its diagnostic and therapeutic problems.

[Arrhythmogenic right ventricular dysplasia. Report of 4 cases]. / La dysplasie ventriculaire droite arythmogene. A propos de 4 cas.

Arythmogenic right ventricular dysplasia (ARVD) was supposed to be a part of VHL diseases; ARVD is in fact a well defined anatomo-pathological entity, originally described by Fontaine and Frank in 1977. The authors report 4 new cases of ARVD were desmitted at the department of cardio A. The disease was announced by the usual rhythmic disorders. The diagnostics of ARVD was based upon a bundle of electrical, echocardiographic and histological arguments. The rhythmic stability was obtained in three cases with medical treatment, the endocavity ablation was necessary in one case. A study of the diagnostic and therapeutic forms is performed from a literature review.

[KID syndrome, pachydermatoglyphy and Dandy-Walker syndrome]. / KID-syndrome, pachydermatoglyphie et syndrome du Dandy Walker.

We report a case of KID syndrome in a young girl born to non-consanguinous parents without any similar family history. The typical features of this dysplasia, erythrokeratodermia with dry rugous teguments, pachydermia folds of the knees, facial erythema, peribuccal grooves, leucokeratosic perleche, hypotrichosis of the eye lashes and eyebrows, early onset deafness and ophtalmological lesions were observed. The characteristic pachydermatoglyphia of the hands was present. A malformation of the posterior cerebral fossa--a dandy walker syndrome--was revealed at computed tomography.

[Percutaneous dilatation with a balloon catheter in subaortic stenoses]. / La dilatation percutanée par cathéter à ballonnet des sténoses sous-aortiques.

Since 1987, percutaneous transluminal dilatation with a balloon catheter was performed in 4 patients with subaortic diaphragm. The patients' mean age was 13 years (range 6 to 22 years). Two of them were asymptomatic and all had mild to moderate aortic valve regurgitation. In all patients two-dimensional echocardiography showed the presence of sub-aortic stenosis. Following dilatation, 2D-echocardiography showed an image of membrane floating in the left ventricular outflow tract. The left ventricular systolic pressure fell from 194 +/- 24 to 147 +/- 16 mmHg and the intraventricular systolic gradient, from 92 +/- 21 to 31 +/- 3 mmHg. There were no changes in aortic regurgitation. No complication was observed.

[Hemangio-endotheliosarcoma of the right atrium]. / Hémangio-endothéliosarcome de l'oreillette droite.

In reporting a case of haemangiosarcoma of the right atrium the authors emphasize the problems encountered in the diagnosis of primary tumours of the heart. The patient was a 50-year old woman who complained of digestive disorders and palpitations. Physical examination showed signs of right heart failure associated with a systolic murmur on the right side of the sternum. ECG gave normal results. Echocardiography displayed a pouch with liquid ultrastructure communicating with the right atrium. Angiography confirmed the presence of a cavity with irregular borders communicating with the right atrium. Coronary arteriography showed an abnormal disorderly distribution of the right coronary artery branches with newly formed vessels extending toward the tumour. At exploratory thoracotomy a large liquid tumour was found which bled at the slightest touch and was attached to the mediastinum and the right pericardium. The pleura and the lung contained several nodules of the same venous colour as the mother tumour. Extemporaneous biopsy and pathological analysis were in favour of a haemangiosarcoma. The patient died a few days after the thoracotomy.

[Rhythm and conduction disorders immediately after ventricular fulguration]. / Les troubles du rythme et de la conduction au décours immédiat de la fluguration ventriculaire.

UNLABELLED: Forty-four patients with ventricular tachycardias (VT) refractory to medical treatment underwent 73 sessions of endocavitary electrode catheter ablation. The clinical series included 16 cases of post-infarction VT, 14 cases of arrhythmogenic right ventricular dysplasia, 6 cases of dilated cardiomyopathy, 6 cases of idiopathic VT, 1 case of sequela of myocarditis and 1 case of VT consecutive to surgical repair of a congenital cardiopathy. Cardiomegaly was present in 30 patients, and 16 patients had an ejection fraction of less than 30 p. 100. None of the patients were receiving digitalis or class I antiarrhythmic drugs when ablation was performed. A total of 235 shocks of 100 to 320 J (mean 221 +/- 42 J) were delivered. 115 shocks (49 p. 100) were complicated by dysrhythmia and/or disorders of conduction; 29 shocks (12 p. 100) induced 13 ventricular fibrillations and 16 ventricular tachycardias. No relation was found between energy delivered, shock synchronization, haemodynamic status, heart cavity treated, underlying heart disease, CK MB levels and these arrhythmias. On the other hand, ablations performed while the patients were experiencing VT increased the risk of arrhythmia (p less than 0.02). 36 AV blocks, 21 left bundle branch blocks, 12 right bundle branch blocks and 11 sinus bradycardia were observed. With the exception of one right bundle branch block and one left posterior hemi-block, all blocks were transient. IN PRACTICE: (1) electrode catheter ablation may be complicated by disorders of cardiac rhythm or conduction in 50 p. 100 of the cases; (2) these disorders can easily be corrected by stimulation or defibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Efficacy criteria in the fulguration of the bundle of His]. / Critères d'efficacité dans la fulguration du faisceau de His.

The authors have endeavoured to determine which of the parameters commonly used for His bundle ablation are likely to predict that ablation will be effective in altering the atrioventricular (AV) conduction system durability. His bundle ablation was performed in 18 patients (9 men, 9 women; mean age 47 years) presenting with supraventricular tachycardia refractory to all medical treatments. A total of 29 shocks were delivered with an Odam fulgurator, using a distal electrode connected to the positive pole of a selected catheter. Fifteen shocks were effective, resulting in a complete and permanent AV block (group I); the remaining 14 shocks failed to modify permanently the AV conduction system (group II). The parameters which differed between these two groups were the amplitude and the stability of the His bundle potential, the energy per kg bodyweight delivered with the shock and the possibility to shock the potential with the greatest amplitude in case of instability. A discriminant linear analysis showed that 3 interrelated criteria could be used to classify 83% of the shocks into one or the other group. In order of importance these criteria were: (1) amplitude of the His bundle potential; (2)energy delivered per kg bodyweight, and (3) stability of the potential. The corresponding discriminant values for successful results were more than 300 mV for parameter 1, more than 3 J/kg bodyweight for parameter 2 and very good stability of His bundle potential.

[Enzyme activity of creatine kinase and its MB isoenzyme in endocardial countershock]. / Activité enzymatique de la créatine kinase et de son isoenzyme MB dans la fulguration endocavitaire.

Enzymatic activity of total serum CPK and of MB iso-enzyme was studied to assess changes in the myocardium caused by cardioversion. Assay of enzymes was performed prior to cardioversion and every two hours during the first 24 hours after it was administered. 79 instances of cardioversion were reported in a series of 56 patients, including 14 females (mean age 45 years). Cardioversion was employed in the treatment of 23 patients with supra-ventricular tachycardia, and in 56 cases to treat chronic ventricular tachycardia including 23 of ventricular tachycardia arising as a complication of myocardial infarction, 17 cases of arrhythmia-inducing disorders of the right ventricle, 8 cases of primary cardiomyopathy, 7 of idiopathic ventricular tachycardia and 1 of a congenital disorder. The energy of the electric shock administered was 620 +/- 522 joules during the 3 shocks per session, on the average, delivered by an Odam capacitor discharge using a distal electrode connected to the positive pole of an endocardial electrode catheter. A maximum level of total serum CPK equal to 333 +/- 396 U/l was observed 6 +/- 3 hours after cardioversion. The highest level of isoenzymes MB recorded was 30 +/- 24 U/l 4 +/- 2 hours after cardioversion. Compared to electric shock administered to treat ventricular tachycardia, an electric current applied to the His bundle produced the least MB isoenzyme activity (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of resistant ventricular tachycardia with endocavitary ablation combined with anti-arrhythmia agents]. / Traitement des tachycardies ventriculaires rebelles par fulguration endocavitaire associée aux anti-arythmiques.

Catheter ablation was used in 26 consecutive cases of high risk ventricular tachycardia (VT) resistant to antiarrhythmic therapy. Seven patients were in permanent VT at the time of catheter ablation, three of them were moribund. There were 10 cases of arrhythmogenic right ventricular dysplasia, 9 cases of VT complicating chronic myocardial infarction, 4 cases of dilated cardiomyopathy, 2 cases of idiopathic VT and one congenital cardiac malformation. Ten patients required 2 or more sessions of catheter ablation to treat their arrhythmia. Three of the 4 early deaths (less than 1 month) were due to technical problems. Combined with antiarrhythmic drugs in 8 cases, catheter ablation brought the VT under control in the 22 remaining patients. The follow-up period ranges from 10 to 28 months (average follow-up longer than 17 months). Catheter ablation is a technique which is currently under evaluation. The very encouraging results obtained in this series suggest that it may replace surgery in the treatment of chronic refractory VT.

[A case of an adult triatrial heart, associated with partial abnormal venous return from the left lung]. / A propos d'un cas de coeur triatrial de l'adulte associé à un retour veineux anormal partiel du poumon gauche.

The authors underline the value of echocardiography in the diagnosis and postoperative management of a case of cor triatrium. The patient was a 22 year old male who presented with dyspnoea of effort (stage III of the NYHA classification) and clinical signs of an infundibulo-pulmonary syndrome with tricuspid regurgitation. Chest X-ray revealed cardiomegaly (CTI = 61%) and filling-in of the aorto-pulmonary window. The electrocardiogram showed left atrial and right ventricular hypertrophy. The echocardiogram, the key to diagnosis, showed an abnormal echogenic structure within the left atrium. Cardiac catheterisation demonstrated pulmonary hypertension and a difference of pressure between the two lungs. The membrane dividing the left atrium and partial anomalous pulmonary venous drainage from the left lung into the superior vena cava were visualised on late stage pulmonary angiography. Surgical excision of the membrane in the left atrium and ligation of the anomalous venous drainage provided a radical cure to all these malformations.