[Septic iliac artery pseudo-aneurysm and spondylodiscitis L5-S1 induced by foreign body (wood shard) after intra-abdominal penetrating injury]. / Faux anévrisme iliaque et spondylodiscite L5-S1 septiques au décours d'une plaie pénétrante abdominale avec corps étranger (écharde de bois).

We report the case of a 46-year-old man, admitted in emergency department with a small penetrating abdominal wound. Haemodynamically stable, a first surgical exploration has been performed under local anaesthesia in the emergency department, showing no evidence of peritoneal penetration. Six weeks later, a foreign body adjacent to iliac artery septic pseudoaneurysm associated to a spondylodiscitis L5-S1 was showed on multislice CT and led to exploratory laparotomy which confirmed the radiologics pictures and found a jejunal perforation.

[Widerspread septic peripheral emboli from acute Enterococcus faecalis aortic valve endocarditis in a 39-year-old patient, drug addict]. / Endocardite aortique aiguë à Enterococcus faecalis avec multiples emboles septiques périphériques chez un toxicomane de 39 ans.

Enterococci have emerged in the last decades as a major cause of nosocomial or common infections and Enterococcus faecalis is responsable for 80% of all enterococcal infection. Actually, E. faecalis is the third-most-common cause of bacterial endocarditis overall and predisposing risk factors are the existence of a prosthetic valve, the age, or a previous endocarditis. Among the complications of infective endocarditis, systemic emboli are an ominous prognostic sign. Infective endocarditis still carries high morbidity and mortality rates for the patients requiring intensive care unit admission. The choice and optimal timing depend on many factors like the tolerance of the underlying cardiac disease. Indications for urgent surgical intervention are heart failure, systemic emboli, and uncontrolled sepsis despite a first adequate antibiotic therapy associating aminopenicilline and gentamicine. We report the case of a 39-year-old patient, drug-addict, admitted to the emergency department due a respiratory insuffiency, acute abdominal pain and left brachiofacial palsy and who presented a acute native aortic valve endocarditis with renal, splenic and cerebral emboli and required an urgent mechanical valvular prosthese implantation associating to a right colostomy.

[Spontaneous spinal epidural haematoma causing rapid flaccid paraplegia in a healthy 25-year-old patient]. / Hématorachis spontané avec paraplégie flasque d'installation rapide chez un patient de 25 ans sans antécédent.

Although clinical presentation of a spinal epidural compressive haematoma is well recognized, causing acute radicular pain shortly followed by cord compression syndrome, its aetiology may pose a quandary. Rare and most commonly seen after trauma, spinal surgery, epidural anaesthesia, anticoagulation therapy, vascular malformation or coagulopathy (haemophilia), spinal epidural haematoma (SHE) can be spontaneous. Surgical decompression remains the mainstay treatment especially when the prognosis depends on the interval to surgery and the severity of preoperative neurological deficit. We report the case of a healthy 25-year-old man who presented, three days after an acute back pain, a flaccid paraplegia with urinary retention. Magnetic resonance imaging of the spinal column identified a compressive SHE extending from T3 to T6, requiring an early laminectomy. After decompression, clinical outcome revealed a complete recovery excepted some mild sensibility trouble remains.

[Knee arthrodesis using a customized intramedullary nail: 14 cases]. / Arthrodèse du genou par implant intra-médullaire sur mesure. A propos de 14 cas.

We report our experience with knee arthrodesis using a customized intramedullary nail implanted in 14 patients. Indications for knee arthrodesis were: recurrent prosthesis infection (n=11), post-traumatic septic arthritis (n=1), aseptic loosening of a hinge prosthesis (n=1), and nonunion (n=1). A two-stage procedure was used for the 12 patients with infected joints. Mean follow-up was 19 months. Weight bearing began during the first week after arthrodesis in 13 patients. First intention bone healing was achieved in 13 patients. Mean time to healing was three months. All patients rapidly recovered full independence. Complications were: one misinsertion of the tibial stem, one nonunion which fused after repeated grafting, and two recurrent infections (controlled chronic fistulae) which required skin flaps for cover. We have found that this customized nail is a useful method for achieving bone fusion in patients with difficult indications for arthrodesis, particularly recurrent prosthesis infection.

[Acute myocardial infarction management in a hospital center with emergency ambulance service and intensive care unit, without cardiac catheterization laboratory]. / Prise en charge de l'infarctus aigu du myocarde dans un centre hospitalier équipé de services SMUR et réanimation médicale, sans salle de cathétérisme cardiaque.

OBJECTIVES: We report our experience about acute myocardial infarction management in a small hospital with no possibility of coronarography. MATERIALS AND METHODS: In 1998, 60 patients were hospitalized for acute myocardial infarction < 10 days. We studied characteristics of patients, the management of myocardial infarction, the mortality. RESULTS: Our population consisted of 83% of men and 17% of women with a mean age of 63.5 and 74 years respectively. An out-hospital doctor was first warned by 60% of patients. For hospitalization, the emergency ambulance service (SMUR) was used in 45% of cases, out-hospital doctors using these means of transport in 36% of cases. The global time of intervention was 18h30. The mean time for patients managed in the first sixth hours was 2h10. A thrombolysis was applied for 35% of patients (15% in prehospital that is to say 32% of "SMUR patients", and 20% in hospital). A transfer to the neighbouring university hospital for primary or rescue coronary angioplasty was decide for 41% of patients. A total of 77% of our patients underwent a coronarography. The global mortality at 10 days was 13.3% (< 75 years: 10.6%; > 75 years: 23%). CONCLUSIONS: A low volume centre and with no possibility of coronarography can manage the acute phase of myocardial infarction with results closed to those of the literature.

Acetabular fractures due to bone insufficiency. Two case-reports.

Acetabular fractures due to bone insufficiency are rare and difficult to diagnose based on clinical findings alone. Plain films are often normal for a long period of time. We report two cases of acetabular fractures in women aged 78 and 90 years, respectively. An acetabular fracture should be considered in elderly females with sudden onset of pain in the groin occurring immediately upon weight-bearing, a clinostatic syndrome, and increased radionuclide uptake by the acetabulum. Computed tomography and magnetic resonance imaging are useful when the diagnosis remains in doubt.

[HIV infection manifesting as a pneumococcal spondylodiscitis]. / Spondylodiscite à pneumocoques revélátrice d'une infection par le VIH.

In this report the authors describe a patient in whom pneumococcal spondylitis was the presenting manifestation of HIV infection and discuss bone and joint infections during HIV infection. The case report involves a 43-year-old man from Mali who was admitted for fever and back pain that occurred during upper airway infection. Pneumococcal spondylitis was diagnosed based on MRI images showing an epidural effusion and on positive hemocultures for Streptococcus pneumoniae. Initial standard x-ray findings were normal but repeat imaging revealed the disco-vertebral lesions. HIV serology was positive but there was no evidence of immunodepression or decreased CD4 lymphocyte levels. Since the introduction of antibiotics bone and joint involvement in pneumococcal disease has become uncommon in developed countries. In patients with HIV infection pyogenic arthritis is rare but the risk of pneumococcal disease is greatly enhanced and arthritic lesions can occur. Only eleven cases of pneumococcal arthritis associated with HIV infection have been reported in the literature. However the incidence of these infections seems higher in Black Africa where they account for 50% of pyogenic arthritis. The authors emphasize the lack of correlation between the stage of HIV infection and the onset of pneumococcal osteoarthritic infections which could account for occurrence of the latter as presenting manifestations of retroviral seropositivity.