18F-FDG PET/CT Detection of a Popliteal Mycotic Aneurysm Complicating Staphylococcus aureus Bacteremia.

ABSTRACT: A 75-year-old man presented with Staphylococcus aureus bacteremia, fever, and right posterior knee pain. Venous Doppler ultrasound of the lower extremity showed an isolated right calf muscle vein thrombosis, without any sign of deep vein thrombosis. 18F-FDG PET/CT revealed an intense focal uptake on the right popliteal artery, suggesting a mycotic aneurysm (MA). Lower limb CT angiography confirmed an MA of the right popliteal artery. The patient underwent surgical procedure with excision of the MA, whose cultures grew methicillin-sensitive S. aureus. Our case highlights the importance of including lower limbs in 18F-FDG PET/CT acquisition in case of suspicion of septic emboli.

[Management of resistant hypertension. Expert consensus statement from the French Society of Hypertension, an affiliate of the French Society of Cardiology]. / Prise en charge de l'hypertension artérielle résistante. Consensus d'experts de la Société française d'hypertension artérielle, filiale de la Société française de cardiologie.

To improve the management of resistant hypertension, the French Society of Hypertension, an affiliate of the French Society of Cardiology, has published a set of eleven recommendations. The primary objective is to provide the most up-to-date information, based on the strongest scientific rationale and which is easily applicable to daily clinical practice for health professionals working within the French health system. Resistant hypertension is defined as uncontrolled blood pressure (BP) both on office measurements and confirmed by out-of-office measurements despite a therapeutic strategy comprising appropriate lifestyle and dietary measures and the concurrent use of three antihypertensive agents including a thiazide diuretic, a renin-angiotensin system blocker (ARB or ACEI) and a calcium channel blocker, for at least four weeks, at optimal doses. Treatment compliance must be closely monitored, as most factors that are likely to affect treatment resistance (excessive dietary salt intake, alcohol, depression and drug interactions, or vasopressors). If the diagnosis of resistant hypertension is confirmed, the patient should be referred to a hypertension specialist to screen for potential target organ damage and secondary causes of hypertension. The recommended treatment regimen is a combination therapy comprising four treatment classes, including spironolactone (12.5 to 25mg/day). In the event of a contraindication or a non-response to spironolactone, or if adverse effects occur, a ß-blocker, an α-blocker, or a centrally acting antihypertensive drug should be prescribed. Because renal denervation is still undergoing assessment for the treatment of hypertension, this technique should only be prescribed by a specialist hypertension clinic.

[Patient education program in chronic heart failure: assessment at one year in 81 patients]. / Education thérapeutique dans l'insuffisance cardiaque en milieu libéral: évaluation à 1 an chez 81 patients.

Disease management programs are implemented to manage heart failure. By means of a phone survey, using a standardized questionnaire, we aimed to evaluate the benefit at one year of a private practice disease management program in patients with heart failure. Among the 87 patients who had taken part in the program, six had died, so 81 (aged 70.8 +/- 10 years) were evaluated. Among those, 51 had been hospitalized at least once because of heart failure prior to entering the program, and 7 patients were hospitalized afterwards. The surveyed patients appeared to check more efficiently their weight and lower limbs edema (78.4%) than their heart rate, blood pressure (48.7%) and respiratory rate (5.4%). Regarding compliance with guidelines provided during the program sessions, it appeared that the patients followed better dietary guidelines (91.9%) than guidelines involving physical activity (44.6%) and kinesiotherapy (12.2%). In the end 72.6% among the surveyed felt that the disease management program was effective in helping them manage their heart failure.