[Endocarditis complicated by an aneurysm of the superior mesenteric artery]. / Endocardite infectieuse compliquée d'un anévrysme de l'artère mésentérique supérieure.

Infective endocarditis (IE) is a rare, polymorphic disease in children. Mycotic aneurysm is a rare condition that complicates about 2.5 to 10% of cases of endocarditis. It is responsible for significant morbidity and mortality [1,2]. Mycotic aneurysms are often asymptomatic, physical examination is poor, but the diagnosis should be considered with the triad including fever, abdominal pain, and abdominal mass beating. Abdominal ultrasound and computed tomography are the most useful for the identification of the aneurysmal mass. However, angiography is an interesting addition to confirm the diagnosis and implement a treatment procedure [3]. The treatment of SMA aneurysms is largely surgical. IE treatment is based on antibiotic therapy combined with surgical repair. We report the case of a 15-year-old patient, first operated for an SMA aneurysm complicating the course of IE, who secondarily underwent mitral valve repair. We review the epidemiology, diagnosis, and care principles of mycotic aneurysms of the SMA.

[The acute respiratory distress syndrome in malaria: is it always the prerogative of Plasmodium falciparum?]. / Le syndrome de détresse respiratoire aiguë au cours du paludisme: est-il toujours l'apanage du Plasmodium falciparum?

Severe malaria causes nearly one million deaths annually in endemic areas and is a public health priority worldwide. Severity associated with the occurrence of acute respiratory distress syndrome (ARDS) is a well-known complication of infection with Plasmodium falciparum and can reach 25% of infected adults. However, ARDS is less often described with other Plasmodium species. We report the case of a young Moroccan soldier who died in an array of ARDS related to malaria of Plasmodium ovale 7 months after his return from an endemic country.

[Blood-patch: immediate effective remedy for headaches secondary to dura mater injury]. / Le blood-patch: un remède d'efficacité immédiate pour les céphalées secondaires aux brèches dure-mériennes.

OBJECTIVE: The aim of this study was to evaluate if bed rest during 2 h in a supine posture is required to improve the efficacy of the blood-patch procedure. PATIENTS AND METHODS: Patients whose postdural puncture headache remained distressing 48 to 72 h after dural tap despite the use of stage II WHO painkillers were included in this prospective single center study lasted for a 2-year period. The patient's own blood injection in the epidural space was performed until discomfort or pain in the lumbar area occurred or was limited to 20 ml if no such sensation was observed. After blood had been injected, the patient was allowed to stand up as soon as desired, under close observation. The patient was then discharged to the ward for a 48 h follow-up. RESULTS: Nine female and 12 male patients (age: 16-35 years) were included. Headache occurred after spinal anaesthesia in 16 cases, epidural analgesia for delivery in two cases and lumbar puncture by during neurological workup in three cases. Autologous blood volume injected was 20 ml in 19 patients and was reduced to 18 and 16 ml, respectively, in two patients due to lumbar pain. All blood-patches were technically uneventful and led to immediate headache relief, associated with a feeling of wellbeing and desire to stand up. The 48 following hours were without any incident and painkillers were no more needed. CONCLUSION: In this prospective study, blood-patch was mainly performed after spinal anaesthesia and was associated with a high rate success. This encouraging result suggests that recumbent position maintained for 2h after the blood-patch is performed might not be necessary to obtain full efficacy.