Kounis syndrome associated with amoxicillin/clavulanic acid.

Kounis syndrome (KS) is a life-threatening medical condition that causes severes allergic reaction and acute coronary syndrome (ACS). We describe the case of 56-year-old woman who developed ACS following an anaphylactic reaction to amoxicillin/clavulanic acid. Immediately after the administration of amoxicillin/clavulanic acid, she presented a chest pain, cutaneous allergic, hypotension, and ST depression on the electrocardiogram. After the necessary diagnostic test, the final diagnosis was variant I of KS.

[Chronic epicarditis, a soft pericardial constriction: about one case]. / L'épicardite chronique, une constriction à péricarde souple : à propos d'un cas.

Chronic constrictive epicarditis is a special form of chronic pericarditis. It is characterized by a thickening of the visceral pericardium that becomes adherent to cardiovascular structures, thus impeding the diastolic filling of the ventricles. The parietal pericardium remains soft, without symphysis with the visceral pericardium. We illustrate the diagnostic and therapeutic approaches to this pathology by a clinical case.

[Anaphylaxis to protamine during cardiovascular surgery]. / L'allergie à la protamine en chirurgie cardiovasculaire.

Protamine is a polypeptide with low molecular weights that is used widely to reverse heparin anticoagulation during cardiac surgery. Protamine, efficient and relatively sure, can produce multiple adverse reactions after intravenous administration, including pulmonary hypertension, or systemic hypotension leading at times to cardiovascular collapse and death. Physiopathologic mechanisms, underlying these reactions, are not clear. Immunologic and non-immunologic pathways are suggested. Some risk factors expose to protamine's adverse reactions. Preoperative identification of these factors should prompt specific preventive measures. The anesthesiologist and the cardiac surgeon must be vigilant when administrating protamine. Reheparinization and reinstitution of cardiopulmonary bypass should be considered in patients with refractory shock.

[Vidéo-assisted mitral valve surgery: state of the art]. / La chirurgie mitrale vidéo-assistée : état de l'art.

Video-assisted mitral valve surgery by right mini-thoracotomy is adopted systematically in many centers in the world. It is a safe procedure that offers good results with low morbidity. His major interest can be appreciated in surgical management of mitral valve regurgitation after coronary artery bypass.

[Fahr syndrome discovered following a bacterial meningitis]. / Syndrome de Fahr découvert à la suite d'une méningite à pneumocoque.

Fahr's disease refers to a rare syndrome characterized by symmetrical and bilateral intracranial calcifications. The basal ganglia and dentate nucleus are the most common site of involvement and most cases present extrapyramidal symptoms. This disease is mostly associated with a phosphocalcic metabolism disorder, especially to hypoparathyroidism. The authors report a case of Fahr syndrome (FS) discovered when a young patient with hypocalcemia and bacterial meningitis had a cerebral CT scan disclosing intracerebral calcifications. She fully recovered after both meningitis and hypocalcemia were treated.

[Neuroimaging findings in eclamptic patients still symptomatic after 24 hours: a descriptive study about 19 cases]. / Apport de l'imagerie neurologique chez les éclamptiques encore symptomatiques après 24 heures: étude descriptive à propos de 19 cas.

OBJECTIVE: To describe the neuroimaging findings in eclamptic patients still symptomatic after 24 hours. PATIENTS AND METHODS: All parturients consecutively admitted over a 12-month period for eclampsia and presenting with neurological disorders (coma, focal neurological abnormalities, and eye sight disturbance) underwent cerebral CT-scan and/or MRI. RESULTS: Nineteen women were studied, and all had abnormal neuroradiological findings. The CT-scan was normal in three cases. Cerebral oedema was the predominant lesion (14 cases). It was localized in the parietal or occipital area (12 cases), paraventricular area (1 case), or was diffuse (1 case). Diffusion weighted MRI was performed in four cases and showed cytotoxic cerebral oedema in one case. There were three cases of cerebral venous thrombosis and two cases of intracerebral haemorrhage. CONCLUSION: Various neuroradiological lesions can be observed in eclamptic patients. A localized cerebral oedema is the most frequent. Diffusion weighted MRI should be systematically done when neurological disorders persist.

[Pulmonary legionellosis at the earliest stage of hairy cell leukemia]. / Pneumopathie à Legionella pneumophila, inaugurale d'une leucémie à tricholeucocytes.

Legionella pneumonia is frequently reported in immunocompromised patients. The most important predisposing factor is a quantitative and qualitative defect of the monocytic-macrophagic system. We report a case of Legionella pneumophila in a 43-year-old man revealing hairy cell leukemia. The patient presented with community-acquired pneumonia resistant to common antibiotics. Serology provided the diagnosis and the patient improved with adequate treatment. Early diagnosis and appropriate treatment may reduce the mortality of this serious complication.

[Cecal volvulus: a case report in a child]. / Le volvulus du caecum chez l'enfant: à propos d'un cas.

Volvulus of the caecum is a rare entity in childhood. We report on a case of caecal volvulus in a 6-year-old child, admitted with clinical symptoms of gut occlusion and shock. Outcome was favourable after surgical treatment. The epidemiological, clinical, radiological aspects and therapy are discussed in light of data of the literature.

[Emphysematous pyelonephritis with favourable outcome after conservative treatment]. / Une pyélonéphrite emphysémateuse d'évolution favorable après traitement conservateur.

Emphysematous pyelonephritis is a necrotizing renal infection characterized by bacterial gas production in the renal and perirenal area. It is a rare infection diagnosed in diabetic patients in most cases. Emphysematous pyelonephritis is responsible for a high mortality rate. We report the case of a woman, unknown diabetic, who presented with emphysematous pyelonephritis. Early diagnosis performed by CT-scan allowed effective and conservative surgical treatment and final positive outcome.

[Intraspinal air, a rare complication of blunt chest trauma]. / Le pneumorachis, complication rare du traumatisme thoracique fermé.

Pneumorachis, defined as the presence of air within the spinal canal, has rarely been described, and is exceptionally due to thoracic trauma. We report the case of a 37-year-old patient who sustained a motor vehicle accident. The chest CT-scan showed a bilateral-hemothorax, a small right pneumothorax, rib fractures, and a fracture of the fourth thoracic vertebra associated with air in the spinal canal extending from T6 to L2. The fracture of T4 associated with the pleural lesion is probably responsible for the pneumorachis. Possible pathogenic mechanisms of this rare blunt chest complication are discussed.

[Unilateral spinal anaesthesia in elderly patient for hip trauma: a pilot study]. / Rachianesthésie hypobare unilatérale chez le sujet âgé pour la chirurgie traumatique de la hanche: étude pilote.

INTRODUCTION: Fractured neck of femur is encountered more frequently as life expectancy increases. All anaesthetic techniques aim to avoid deleterious fall in arterial blood pressure. The haemodynamic effects of hypobaric unilateral spinal anaesthesia have been rarely assessed in patients over 80 year's old. This study aims to do that in a prospective manner. PATIENTS AND METHODS: Twenty-five patients were enrolled. Following a preload with HES 240/0.576 % (Hesteril) (5 ml/kg) and the administration of an iliofascial block, patients were placed in the lateral decubitus position, operative side uppermost. 3.5 ml of 0.12% hypobaric bupivacaine was administered intrathecally at a rate of 0.25 ml/second. Patients were kept in position for 15 minutes. Systolic, mean and diastolic arterial pressures, heart rate, SaO2 % and ephedrine consumption were recorded at five minutes intervals as was the rate of onset, height and duration of sensory and motor block and extent of bilateralization. Patient and surgeon satisfaction scores were also recorded. RESULTS: No significant changes in systolic, mean and diastolic pressures, or SaO2 % occurred. Median onset times of sensory and motor block were 8+/-5 and 16+/-7 minutes on the operative side and 30+/-15 and 36+/-15 minutes on the contralateral side in those with bilateralization, respectively. The maximum height of sensory block was T6 for sept patients, T8 for huit patients and T8-T10 for the remainder. Mean duration of sensory and motor block was 134+/-26 and 119+/-24 minutes on the operative side and 100+/-26 and 98+/-25 minutes on the contralateral side, respectively. In 12 patients (48%) bilateralization of their block occurred. Patients and surgeons rated the technique highly. CONCLUSION: Hypobaric unilateral spinal anaesthesia is a simple technique, produces satisfactory operative conditions and induces very little haemodynamic change in the elderly population.

[Acute rhabdomyolysis due to butane inhalation. Report of two cases]. / Rhabdomyolyse aiguë lors d'une intoxication au butane. A propos de deux cas.

Prolonged inhalation of gas butane induced mostly neurological and cardiovascular symptoms. We reported two very rare cases of acute rhabdomyolysis caused by accidental prolonged inhalation of butane. The early diagnosis and the symptomatic treatment were associated with favourable evolution in the two cases. The mechanism of this complication is discussed and compared with the literature.

[Pheochromocytoma. Severe and uncommon presentations]. / Phéochromocytomes. Formes graves et inhabituelles.

We report five cases of phaeochromocytoma in patients admitted for myocardial infarction, severe cardiac failure, with shock, stroke and ischaemic gangrene of a lower limb respectively. The pathophysiology of these events is discussed. Early surgery prevents visceral damage from massive release of catecholamines.