[False positive on macrotroponin]. / Faux positif lié à une macrotroponinémie élevée.

The determination of I and T subunits of cardiac troponin isoforms are the biochemical gold standard for the detection of myocardial distress. The advent of so-called highly sensitive measurements has optimized the diagnosis of acute coronary syndromes at the cost of making the diagnostic approach more complex and increasing sensitivity to analytical interference. This article presents a case of macrotroponinemia, characterized by circulating IgG-troponin T immunocomplexes, in order to raise prescribers' awareness of the critical interpretation of high and persistent cardiac troponin values.

Le dosage des sous-unités I et T des isoformes cardiaques de troponines est le gold-standard biochimique de la détection de la souffrance myocardique. L'avènement des mesures dites hautement sensibles a optimisé le diagnostic des syndromes coronariens aigus au prix d'une complexification de la démarche diagnostique et d'une sensibilité accrue aux interférences analytiques. Cet article présente un cas de macrotroponinémie, caractérisé par des immunocomplexes IgG-troponine T circulants, afin de sensibiliser les prescripteurs à l'interprétation critique des valeurs élevées et persistantes de troponines cardiaques (cTn).

Atypical presentation of Lemierre's syndrome: case report and literature review.

BACKGROUND: The classic Lemierre's syndrome refers to a septic thrombosis of the internal jugular vein, usually caused by a Fusobacterium necrophorum infection starting in the oral cavity, and typically complicated by pulmonary emboli. However, unusual forms of the disorder have been rarely reported. CASE PRESENTATION: We describe an unusual case of a previously healthy 58-year-old male with Lemierre's syndrome, manifesting with lumbar pain and fever. A thrombosis of the iliac veins and abscesses in the right iliac and the left psoas muscles was diagnosed by a computed tomography scan, together with a right lung pneumonia complicated by pleural effusion and an L4-L5 spondylodiscitis. Blood culture and pus drainage were positive for Fusobacterium nucleatum and an atypical Lemierre's syndrome was suspected. The patient was treated with anticoagulant therapy for 12 weeks and intravenous antibiotic therapy for 6 weeks with a good evolution and resolution of the thrombosis. CONCLUSIONS: This case illustrates the thrombogenic and thromboembolic tendency of Fusobacterium nucleatum and its potential invasiveness, regardless of the site of primary infection. The concept of an atypical Lemierre's syndrome is redefined here to take into consideration non-cervical sites.

Early Discharge in Low-Risk Patients Hospitalized for Acute Coronary Syndromes: Feasibility, Safety and Reasons for Prolonged Length of Stay.

INTRODUCTION: Length of hospital stay (LHS) is an indicator of clinical effectiveness. Early hospital discharge (≤72 hours) is recommended in patients with acute coronary syndromes (ACS) at low risk of complications, but reasons for prolonged LHS poorly reported. METHODS: We collected data of ACS patients hospitalized at the Geneva University Hospitals from 1st July 2013 to 30th June 2015 and used the Zwolle index score to identify patients at low risk (≤ 3 points). We assessed the proportion of eligible patients who were successfully discharged within 72 hours and the reasons for prolonged LHS. Outcomes were defined as adherence to recommended therapies, major adverse events at 30 days and patients' satisfaction using a Likert-scale patient-reported questionnaire. RESULTS: Among 370 patients with ACS, 255 (68.9%) were at low-risk of complications but only 128 (50.2%)were eligible for early discharge, because of other clinical reasons for prolonged LHS (e.g. staged coronary revascularization, cardiac monitoring) in 127 patients (49.8%). Of the latter, only 45 (35.2%) benefitted from an early discharge. Reasons for delay in discharge in the remaining 83 patients (51.2%) were mainly due to delays in additional investigations, titration of medical therapy, admission or discharge during weekends. In the early discharge group, at 30 days, only one patient (2.2%) had an adverse event (minor bleeding), 97% of patients were satisfied by the medical care. CONCLUSION: Early discharge was successfully achieved in one third of eligible ACS patients at low risk of complications and appeared sufficiently safe while being overall appreciated by the patients.

[Diagnosis, management and treatment of chylothorax]. / Diagnostic, prise en charge et traitement du chylothorax.

Chylothorax is characterized by a milky pleural effusion that results from the injury to the thoracic duct, causing leakage of chyle into the pleural space. Its diagnosis relies primarily, on the determination of triglycerides and/or the identification of chylomicrons in the pleural fluid. The most common causes are traumatic, mainly after surgery. Among non-traumatic causes, tumors are the most frequent (like lymphomas). Conservative treatment is based on pleural drainage with a low fat diet and appropriate etiological approach. In case of failure, occlusion of the thoracic lymph duct should be considered, either by a surgical approach or interventional radiology.