A case of community-acquired spondylodiscitis caused by Achromobacter xylosoxidans.

Achromobacter xylosoxidans is a Gram-negative, aerobic, non-fermenting bacillus mainly responsible for nosocomial infections. We report the first case of community-acquired spondylodiscitis caused by Achromobacter xylosoxidans in a 61-year-old woman, immunocompromised with necrotizing dermohypodermitis of the right lower limb successfully treated with ertapenem and ciprofloxacin.

Impact of rifampicin dose in bone and joint prosthetic device infections due to Staphylococcus spp: a retrospective single-center study in France.

BACKGROUND: Prosthetic joint infections (PJI) are a major cause of morbidity and mortality burden worldwide. While surgical management is well defined, rifampicin (RIF) dose remains controversial. The aim of our study was to determine whether Rifampicin dose impact infection outcomes in PJI due to Staphylococcus spp. METHODS: single-center retrospective study including 411 patients with PJI due to Rifampicin-sensitive Staphylococcus spp. Rifampicine dose was categorized as follow: < 10 mg/kg/day, 10-20 mg/kg/day or > 20 mg/kg/day. The primary endpoint was patient recovery, defined as being free of infection during 12 months after the end of the initial antibiotic course. RESULTS: 321 (78%) received RIF for the full antibiotic course. RIF dose didn't affect patients recovery rate with 67, 76 and 69% in the < 10, 10-20 and > 20 mg/kg/day groups, respectively (p = 0.083). In univariate analysis, recovery rate was significantly associated with gender (p = 0.012) but not to RIF dose, or Staphylococcus phenotype (aureus or coagulase-negative). In multivariate analysis, age (p = 0.01) and treatment duration (p <  0.01) were significantly associated with recovery rate. CONCLUSION: These data suggest that lower doses of RIF are as efficient and safe as the recommended high-dose French regimen in the treatment of PJI.

Agenesis of the left internal carotid artery associated with coarctation of the aorta: report on an unusual case.

An unusual association of agenesis of the left internal carotid artery and coarctation of the aorta is reported. There was also an aneurysm of the thoracic aorta distal to the coarctation. The subclavian artery was obstructed and revascularization occurred through the vertebral artery via anastomoses with the occipital artery. An embryological hypothesis for this association is proposed.

[Right coronary artery issuing from the pulmonary artery: review of the literature apropos of a case]. / Coronaire droite née de l'artère pulmonaire: revue de la littérature à propos d'une nouvelle observation.

A new case of right coronary artery abnormally issued from the pulmonary trunk is reported. The patient was an asymptomatic young man in whom a continuous cardiac murmur was discovered by chance and an angiographic examination disclosed the coronary abnormality. A review of the literature yielded 37 cases of this anomalous origin which was either isolated, as in the case reported here, or associated with another congenital or acquired cardiopathy. The diagnosis may be suspected on the presence of a continuous murmur in an usually asymptomatic subject and is confirmed by angiography. The abnormality is generally well tolerated owing to an inter-coronary collateral circulation resulting in retrograde perfusion of the right coronary artery from the left coronary artery. This good tolerance explains why an isolated abnormality of that type is often discovered belatedly, in contrast with the anomalous origin of the left coronary artery from the pulmonary trunk, which is usually revealed at birth by clinical signs of acute coronary insufficiency. However, the likelihood of either cardiac failure due to the left-to-right shunt in elderly people or, chiefly, acute myocardial ischaemia by coronary steal with a risk of sudden death in young people makes it imperative in such cases to perform reimplantation surgery.

[Permeability of venous aortocoronary bypasses one year after their implantation]. / Perméabilité des pontages veineux aorto-coronaires un an après leur implantation.

For a short-term evaluation of the patency of aortocoronary bypass vein grafts, 54 consecutive patients who underwent this operation alone were examined, irrespective of their functional state, 12.4 +/- 2.1 months after surgery. Examinations included coronary arteriography, selective opacification of the graft and ventriculography. The patients were 47 men and 7 women who had coronary arteriography for stable angina pectoris (22.4%) or a recent episode of unstable angina (59.3%) or a recent myocardial infarction (18.5%). Coronary arteriography showed one-vessel (5.5%), two-vessel (27.8%) or three-vessel (42.6) disease or stenosis of the main left coronary artery (24.1%). The mean number of distal anastomoses in multiple-vessel patients was 2.6. Peri-operative mortality was 1.04%, and the proportion of peri-operative electrocardiographic signs of necrosis was 11%. At the time of control examination, 82% of the patients had few or no symptoms, and 88% were improved by at least one functional class. 79% (97/123) of distal venous anastomoses were patent. All anastomoses were patent in 59% (22/54) and all were occluded in 7% (4/54) of the patients. Localized stenosis of the graft was found in 11% and diffuse stenosis in 4% of the cases. The patency of vein grafts was higher when the distal bed was of normal size than when it was small or poorly visualized at the initial angiography (85% vs 62%, p less than 0.01), or when the diameter of the artery bypassed was greater than 1.3 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary spasm and thrombosis associated with myocardial infarction in a patient with nearly normal coronary arteries.

A 37-year-old man presented with an evolving inferior myocardial infarction. Coronary angiography performed within 3 hours after the onset of the pain showed spasm of the right coronary artery and the presence of intracoronary thrombi. After resolution of spasm and the disappearance of thrombi, angiography revealed nearly normal coronary arteries. An ergonovine test was positive when the patient was not taking medication and became negative when he was taking diltiazem. The course was uncomplicated, and after 9 months the patient is free of angina.

[Ionized plasma calcium variations and injection of radiologic contrast media]. / Variation du calcium ionisé plasmatique et injection de produit de contraste radiologique.

Ionized serum calcium was determined, using a selective electrode, after administration of 80 ml of radiological contrast medium. The ionized calcium concentration was significantly diminished during five minutes after injection (control: 0,98 +/- 0,02 mmol/l; 3 min: 0,94 +/- 0,02 mmol/l, p less than 0,01; 5 min: 0,94 +/- 0,01 mmol/l, p less than 0.05). Determinations were also performed in vitro on whole blood and separated plasma after addition of contrast medium. These determinations revealed a direct interaction between ionized calcium and contrast medium and the importance of the delay after mixing. Clinical consequences under the conditions of the study are probably null but this secondary effect of the contrast medium can explain incidents or accidents observed during the first local circulation of contrast medium especially during coronarography.

[Arterial blood gas analysis in acute pulmonary embolism]. / La gazométrie artérielle dans l'embolie pulmonaire aiguë.

Arterial blood gases (pH, pO2, p CO2) were studied in 100 patients with documented pulmonary embolism (Group A), confirmed by pulmonary angiography (n = 51) or scintigraphy ( n = 49). The pO2 ranged from 32 to 97 mm Hg (average 60,5 +/- 13 mm Hg). Hypoxaemia was found in 97 cases and would therefore seem to be a reliable sign of pulmonary embolism. In the three cases in which it was absent, the embolism was small. Hypoxaemia was associated with hypocapnia and alkalosis in 91 cases. However, hypoxaemia was not a specific finding; it was also present in 49 patients with suspected pulmonary embolism (Group B) in whom the diagnosis was excluded by pulmonary angiography or scintigraphy. A previous history of cardiovascular disease was found in 37 patients (76%) in this group: of the 12 remaining patients, 6 were heavy smokers and 4 were significantly obese. No correlation was found between the degree of hypoxaemia and the extent of amputation of the vascular bed on pulmonary angiography or scintigraphy. Nevertheless, a pO2 of under 50 mm Hg was always associated with a severe embolism with amputation of over 40% of the pulmonary vascular bed. A significant correlation was found between the severity of hypoxaemia and the degree of cyanosis (p less than 0,05) and ECG changes (p less than 0,01). The average pO2 was 59 +/- 12 mm Hg in patients with cardiovascular disease ( n = 21) and 55 +/- 11 mm Hg with known pulmonary disease ( n = 6). A higher average pO2 was found when these conditions were absent (61,5 +/- 13 mmHg). The difference was not statistically significant unless previous cardiac and pulmonary disease were associated (pO2 = 51 +/- 14 mm Hg, p less than 0,05).

[The diagnostic value of radiological examinations in Conn's syndrome: angiographic findings in 58 cases (author's transl)]. / Apport de la radiologie au diagnostic du syndrome de Conn; séméiologie angiographique à propos de 58 observations.

Selective adrenal phlebography with measurement of hormone levels was used to investigate the majority of 58 cases of primary hyperaldosteronism. The authors stress the importance of pre-operative diagnosis of the lesion as surgery is indicated for adenomas only, and because of their small size they are often missed in adrenal scintigrams and on manual exploration during operation. They are in agreement with most other authors that adrenal phlebography is the most valid investigation, as it gives a precise diagnosis of the lesion in 92% of cases. The angiographic findings in the most common lesions are described, the difficulty in diagnosing peripheral small adenomas stressed, and the problems associated with the diagnosis of nodular hyperplasias outlined. They also underline the fundamental importance of selective hormone levels measurement, as these results are of equal value to those of the images themselves.

[Angina and "normal coronarography" results: diagnostic approach and future perspectives (author's transl)]. / Angine de poitrine et "coronarographie normale". Approches diagnostiques et perspectives d'avenir.

Patients with angina but with "normal coronarography" results, are not a rare finding during angiographic investigations, more especially in the case of women. The authors review the clinical, electrical, hemodynamic and metabolic characteristics of these cases, and discuss the principal known etiologies, and limits of "normality" with respect to coronary artery angiography results.

[Radiologic exploration of pheochromocytoma]. / L'exploration radiologique des phéochromocytomes.

The authors present their experience of radiological investigation of pheochromocytoma based on a series of 80 patients. The aim of radiological investigation are defined and primarily involve a topographical diagnosis and a preoperative assessment of the tumour. Each technique is discussed critically and their indications defined. At present, nephrourotomography by rapid injection is the technique of choice for the diagnosis of an adrenal lesion. Echotomography and scanning do not give as much precision. The assessment of the tumour requires above all arteriography, but staggered measurements from the vena cava is a promising new technique.