Subject(s)
Sister Mary Joseph's Nodule/diagnosis , Umbilicus/pathology , Abdominal Neoplasms/diagnosis , Abdominal Neoplasms/secondary , Adenocarcinoma/diagnosis , Adenocarcinoma/secondary , Adult , Aged, 80 and over , Colonic Neoplasms/diagnosis , Colonic Neoplasms/pathology , Diagnosis, Differential , Humans , Male , Neoplasms, Unknown Primary/diagnosis , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/pathology , Sister Mary Joseph's Nodule/pathologyABSTRACT
INTRODUCTION: Chondrocalcinosis results from calcium pyrophosphate crystals deposition in the joints. We report an exceptional case of aseptic psoas abscess with a deposition of calcium pyrophosphate crystals. CASE REPORT: A 92-year-old man presented to our department for an acute onset of inflammatory pain in the left hip. Computed tomography detected a coxofemoral arthritis and multiple intramuscular collections located in the iliopsoas muscle and the gluteus minimus. A sample of the fluid was obtained with a guided aspiration, and its analysis revealed an inflammatory liquid with no bacteria but numerous calcium pyrophosphate crystals. The final diagnosis was thus a muscular calcium pyrophosphate deposition pseudo-abscess, associated with a hip arthritis. CONCLUSION: Hip chondrocalcinosis is unusual, and the association with intramuscular deposition of calcium pyrophosphate crystals seems extremely rare as we found only four other published cases. A microcrystalline arthritis could have spread from the coxofemoral joint through the iliopsoas bursa and into the muscle. However, the imaging aspect with an abscess and a predominant muscular injury might suggest a mechanism of crystal formation originating directly within the muscle. The outcome was always favourable even if some patients required surgery.
Subject(s)
Abscess/diagnosis , Calcium Pyrophosphate/metabolism , Chondrocalcinosis/diagnosis , Myositis/diagnosis , Abscess/metabolism , Abscess/pathology , Aged, 80 and over , Chondrocalcinosis/metabolism , Chondrocalcinosis/pathology , Diagnosis, Differential , Hip , Humans , Male , Myositis/metabolism , Myositis/pathologyABSTRACT
INTRODUCTION: Vitamin K antagonists (VKA) are drugs with a major risk of side effect. Guidelines have been published in 2008 by the Haute Autorité de santé (HAS) concerning the management of an excessively elevated INR ratio. Our research aimed to assess physicians' adherence to those guidelines. METHODS: We realized a retrospective, multicentric study. One hundred and ten cases of excessively elevated INR ratio were identified and analyzed. RESULTS: Overall physicians adherence was 58%. However, patients with the most elevated INR, i.e., INR>6, were treated according to guidelines in only 33% of the cases. The use of vitamin K was the major source of mistakes. The rate of mortality was 20%. CONCLUSION: Adherence to HAS guidelines seems finally limited. It is necessary to put in place procedures to secure the behavior of physicians.
Subject(s)
4-Hydroxycoumarins/adverse effects , Anticoagulants/adverse effects , Guideline Adherence/statistics & numerical data , Indenes/adverse effects , International Normalized Ratio/methods , Vitamin K/antagonists & inhibitors , 4-Hydroxycoumarins/therapeutic use , Aged , Anticoagulants/therapeutic use , Drug Overdose , Female , France , Humans , Indenes/therapeutic use , Male , Middle Aged , Physicians , Practice Guidelines as Topic , Retrospective Studies , Vitamin K/adverse effects , Vitamin K/therapeutic useABSTRACT
The management of hypertensive patients is greatly influenced by blood pressure levels and accurate measurement of blood pressure is crucial in this context. Mercury sphygmomanometer has been progressively replaced by more precise oscillometric devices that can be widely used in the clinic and ambulatory setting. The purpose of this review was to detail the different methods for evaluating blood pressure, and to refine their indications and clinical benefit. Office blood pressure measurement has a great variability and should follow a strict protocol to give consistent results. National and international guidelines focus on blood pressure measurement in the ambulatory setting. When used by trained patients, home blood pressure monitoring is reproducible and can provide substantial prognostic information, even if ambulatory blood pressure monitoring remains the gold standard. The role of central blood pressure and pulse wave velocity monitoring in the therapeutic strategy of hypertension needs further assessment.
