[Glue embolization of an unruptured ovarian aneurysm]. / Embolisation à la glu d'un anévrisme non rompu de l'artère ovarienne.

Ovarian artery aneurysms are extremely rare, only 17 cases having been published till now. They usually present with rupture during delivery or in the immediate post-partum. We report a case of asymptomatic, unruptured ovarian artery aneurysm in a 40-year-old woman. Diagnosis was achieved by computed tomography performed for an unrelated reason and confirmed by angiography. Transcatheter arterial embolization using coils and glue excluded the lesion. To the best of our knowledge, this is the first report of an asymptomatic ovarian artery aneurysm, diagnosed outside a context of rupture.

[The revival of colistin: an old antibiotic for the 21st century]. / The revival of colistin: an old antibiotic for the 21st century.

BACKGROUND: Multidrug resistant Gram-negative rods are emerging as major pathogens and are the cause of difficulty to treat infections. In certain situations colistin is the only active drug. METHODS: A retrospective review of the patient's charts admitted at Hôtel-Dieu de France hospital, Beirut, between October 2002 and February 2004 and treated with intravenous colistin. RESULTS: Fifteen patients were identified; they were suffering from urinary tract infections, cellulitis, osteomyelitis, mediastinitis and intra-abdominal abscess. The microorganisms were resistant to all available antibiotics except colistin. Three strains were also susceptible to aminoglycosides. Pseudomonas aeruginosa was the most frequently isolated pathogen. Colistin was used in monotherapy in 12 patients and combined with amikacin in three patients. At the end of therapy, a 93% rate of favorable clinical outcome was observed. Renal toxicity was encountered among 12 patients. It was severe in only two cases in which creatinine clearance decline surpassed 50% of the baseline value. No neurological toxicity was observed. CONCLUSION: Colistin has an important role to play when used for the treatment of infections with multiresistant Gram-negative bacteria. Nephrotoxicity seems much lower than expected and neurotoxicity is minimal.

[Acute respiratory distress syndrome complicating Ebstein-Barr virus pneumonia]. / SDRA par pneumonie à EBV.

INTRODUCTION: In the immuno-competent adult Ebstein-Barr virus (EBV) infection is a self-limiting disease that resolves spontaneously. CASE REPORT: We report a case of acute respiratory distress syndrome (ARDS) complicating severe EBV pneumonia and requiring prolonged artificial ventilation. The diagnosis was confirmed by specific serology and estimation of the viral load by PCR. Apart from supportive treatment with artificial ventilation the medical treatment included the use of Acyclovir and polyclonal immunoglobulins in the early phase and corticosteroids in the late phase. Recovery was progressive and complete. CONCLUSION: ARDS can complicate EBV pneumonia in an immuno-competent subject. Its management represents a diagnostic and therapeutic challenge.

[Neurobrucellosis: clinical features and therapeutic responses in 15 patients]. / Neurobrucellose: études clinique et thérapeutique de 15 patients.

We report a retrospective analysis of 15 cases of neurobrucellosis. Initial clinical manifestations consisted of meningoencephalitis in 5 patients, acute and subacute meningitis in 4, intracranial hypertension in 2, polyradiculoneuritis with albumin-cell dissociation in 2 (one with cerebral and subarachnoid hemorrhage), and transverse myelitis and lumbar epidural abcess with root involvement in 1 each. Cranial nerve involvement was noted in 5 patients. Fever was absent in 3. Transient clinical manifestations mimicking transient ischemic attacks were noted in 3 patients. Unusual central nervous system demyelinating lesions were observed on the MRI in 1 of the patients with meningoencephalitis. Cerebrospinal fluid Wright titers and culture were rarely helpful. Most patients responded favorably with minor neurological sequelae. The most commonly used antibiotics were rifampin, doxycycline, and trimethoprim-sulphamethoxazole, in various combinations for at least 3 months. The differential diagnosis of neurobrucellosis is wide. However, in endemic areas, the disease should be ruled out in all patients who develop unexplained neurological symptoms.

[Vacuolar leucoencephalopathy induced by heroin: 4 cases]. / La leucoencéphalopathie vacuolaire induite par l'héroïne: 4 cas.

We report 4 cases of toxic leucoencephalopathy after heroin inhalation. The clinical features, which usually occur some days or even longer after the last heroin consumption, are dominated by a cerebellar syndrome. The cerebellar hemispheres are almost always affected; the cerebral hemispheres, the cerebellar peduncles and the pyramidal tract may be affected. Vacuolar demyelination is the morphological substract of the lesions, which are symmmetrical, not contrast enhancing, hypodense on CT scan and hyperintense on T2-weighted MRI. The pathophysiology is unknown and seems different from post-anoxic leucoencephalopathy. The disease is usually progressive leading sometimes to death, but some cases show slow recovery.

Leucoencephalopathy after heroin inhalation. A case with partial regression of MRI lesions.

We report the case of a 41 year old patient who developed a severe cerebellar ataxia. MRI findings were suggestive of myelin damage with symmetrical involvement of the cerebellar hemispheres and, to a lesser extent, the decussation of the superior cerebellar peduncles, the corticospinal tracts and the centrum semiovale. He had been inhaling heroin for the last 5 years. Two years after stopping heroin, he showed clinical improvement with partial regression of the MRI lesions. MRI findings of leucoencephalopathy after heroin inhalation are well described in the literature, however longitudinal studies are rare. It is the purpose of this report to show that clinical and MRI features can be characteristic of this leucoencephalopathy and that regression of white matter lesions can be seen after heroin withdrawal.

Isolated septic arthritis of a lumbar facet joint.

This is a report of an isolated septic arthritis of a lumbar facet joint where the infectious agent was Bacteroides sp. and where an early diagnosis was made using MRI.

[Endoscopic evaluation of chronic human immunodeficiency virus-related diarrhea]. / La place de l'endoscopie dans le diagnostic etiologique des diarrhées chroniques des sidéens.

Chronic diarrhea is an important clinical problem in patients infected with HIV. Data assessing the diagnostic yield of upper and lower endoscopy are limited. We reported 10 cases of HIV-infected patient referred to our hospital for chronic diarrhea from March 1995 to June 1999. 60% of the pathogens were identified obviously by stool studies. Cryptosporidium and Mycobacterium avium intracellulare (MAI) were the most common organisms. In this study, endoscopy identified 2 additional cases of MAI and one of 5 cryptosporidia detected in stool. Immunologic test identified a CMV infection in one case. Stool tests and endoscopy identified obviously 80% of the pathogens. Most investigators and us agree that stool studies should be the first diagnostic test. In patients with negative stool studies, lower endoscopy is more cost-effective than upper endoscopy and indicated as an initial exam.

Efficacy of twice-daily amoxycillin/clavulanate in lower respiratory tract infections.

In this double-blind, double-dummy study, 324 patients with clinical evidence of community-acquired pneumonia (CAP) or an acute exacerbation of chronic bronchitis were randomly assigned to receive 10 days' treatment with either amoxycillin/clavulanate 875/125 mg twice daily or amoxycillin/clavulanate 500/125 mg three times daily. At the end of therapy, clinical success rates were 92.4% for the twice daily regimen and 94.2% for the three times daily regimen. There was no statistically significant difference between treatments (p = 0.647) and the 95% confidence interval around the treatment difference indicated that the two treatments were equivalent. Treatment equivalence was also confirmed at follow-up, four weeks after the end of treatment. Both regimens were well tolerated. In conclusion, amoxycillin/clavulanate 875/125 mg twice daily is as effective as amoxycillin/clavulanate 500/125 mg three times daily for the treatment of community-acquired lower respiratory tract infections and could improve patient compliance.

Acute rupture of a left ventricular false aneurysm.

Left ventricular aneurysm develop when rupture of the free ventricular wall is contained by the inflammatory surrounding tissues. These false aneurysms rupture secondarily and should be treated soon after diagnosis. The diagnosis is suggested by echocardiography and confirmed by cardiac catheterization. Immediate surgery is recommended, with good survival in most reports. The patient presented in this report had ruptured his left ventricular false aneurysm before diagnosis. He was operated and had a good initial postoperative course. He died later from a severe pulmonary infection.

Mycotic aneurysm of the popliteal artery secondary to tuberculosis. A case report and review of the literature.

Mycotic aneurysms of the popliteal artery are rare; 33 cases have been reported in the literature. The treatment of choice is a large excision with extra-anatomic revascularization. In situ revascularization is sometimes possible. To the best of our knowledge, tuberculosis has never been reported as a causal factor of mycotic aneurysms of the popliteal artery. We report a case of a recurrent tuberculous false aneurysm of the popliteal artery. After 2 attempts at in situ revascularization, the femoral artery was ligated with no distal ischemia.

[Imaging aspect of a case of fibrodysplasia ossificans progressiva]. / Aspect en imagerie d'un cas de fibrodysplasie ossifiante progressive.

Fibrodysplasia ossificans progressiva is a rare congenital disease that affects children under the age of five years. Soft tissue swelling of the cervical and dorsal regions with local pain, warmth and low grade fever are the early clinical manifestations, usually associated with hallux valgus and microdactily of the fingers and toes. Calcifications of the fascias and muscles cause muscular contractures leading to progressive disability and restrictive lung disease. In the early stage, CT shows edema of the soft tissues and later on, calcifications of muscular fascia. The association of these radiographic and CT findings is specific and should avoid muscular biopsies which are known to be an aggravating factor in this disease.

[Digestive manifestations of hereditary angioneurotic edema. Apropos of a case]. / Manifestations digestives d'un oedème angioneurotique héréditaire. A propos d'un cas.

We present a case of hereditary angioedema with cutaneous and intestinal manifestations mimicking a small bowel tumor on computed tomography, and in which unnecessary surgery was avoided by follow-up computed tomography. We discuss the pathophysiology, clinical and radiological manifestations of the disease, as well as its computed tomographic appearance.

Concomitant cerebral, brachiocephalic trunk, and cardiac revascularization. An unusual case.

Extensive transthoracic brachiocephalic revascularization is rarely performed. Instances of this operation performed concomitantly with cardiac revascularization and carotid endarterectomy have been reported in fewer than 10 cases in the literature. We report the case of a patient requiring complex brachiocephalic revascularization associated with coronary bypass grafting and a left carotid endarterectomy.

[Infections in cancer patients with granulocytopenia. Retrospective studies of 59 febrile episodes with hospitalization]. / Infections chez les cancéreux granulocytopéniques. Etudes rétrospectives de 59 épisodes fébriles hospitalisés.

A total of 59 febrile neutropenic episodes were retrospectively recorded at Hôtel-Dieu de France Hospital between August 1st 1991 and December 31st 1992. These episodes were recorded in 51 cancer patients. Median neutropenia was less than one week in 50% of the cases. The etiology of these fever was documented in 27 episodes (46%) and in 70% of the cases gram (-) rods were documented. B-Lactam and Aminoglycoside antibiotics were used in 34 episodes at the initial treatment of these patients. Success rate at this initial treatment or with a modification of the antibiotic therapy was recorded in 85% of the patients. Only 15% of the patients failed to this antibiotherapy, 2/3 of them had their disease in progression. The systemic use of Amphotericine E in those patients with prolonged febrile neutropenia and the concommitent use of growth factors in a sub-group of patients at high risk could lead to a higher success rate in these patients.

[Right-sided endocarditis caused by Staphylococcus aureus during the neonatal period. (A case report)]. / L'endocardite du coeur droit à staphylocoque aureus en période néonatale. (A propos d'un cas).

Right-sided infectious endocarditis in the neonate, due to staphylococcus aureus, is a rare entity. A high index of suspicion should be used when dealing with a very sick neonate, especially with aggressive reanimation. Although the diagnosis is clinical, echocardiography is essential to confirm the diagnosis and also is an excellent mean to follow the evolution of the disease. The pathogenesis of the infection is due to bacteremia with implantation of the staphylococcus on a normal endothelium. The prognosis is poor with a high mortality rate and possibility of sequelae (essentially cardiac and neurologic). The prognosis depends essentially on early diagnosis and treatment which should last for at least 4-6 weeks. The authors present the case of a 2-week-old girl who developed a right-sided staphylococcal endocarditis following treatment of neonatal jaundice with i.v. perfusion of albumin. The patient survived with cardiac and central nervous system sequelae.

[Hodgkin's disease and pregnancy. 3 case reports and a review of the literature]. / Maladie de Hodgkin et grossesse. A propos de trois cas et revue de la littérature.

The association between Hodgkin's disease and pregnancy is rare. Hodgkin's disease does not affect the normal progress of the pregnancy nor of the fetus. Pre-therapy investigations of Hodgkin's disease have to be modified by pregnancy and in particular radiological examinations. Three are certain recommendations to be considered: termination of pregnancy is sometimes indicated in the first trimester but it does not have to be carried out routinely. Chemotherapy can be used in pregnancy as can radiotherapy if the disease is localised to the sub-diaphragmatic area.

[Detection of Helicobacter pylori by the urease test in 244 patients]. / Recherche d'Hélicobacter pylori chez 244 patients par le test à l'uréase.

The authors report the results of the detection of Helicobacter Pylori (HP) in gastric mucosa by the urease test, in 244 patients between January 1989 and August 1991. The overall prevalence of HP was 38.1%. It was 19.5% in patients with normal upper gastrointestinal endoscopy (UE), 61% in duodenal ulcer (p < 0.001) and 68.7% in congestive antritis (p < 0.001), significantly higher than in controls. There was no significant difference between controls and patients with erosive antritis or healed duodenal ulcers. The prevalence of HP rises with age in all patients and in those with lesions at UE but not in those with normal UE. A rise of this prevalence seems to exist in the months of June and December. The authors conclude by pointing out the rise of the overall prevalence of HP in congestive antritis compared with erosive antritis, the similarity of prevalence in normal subjects and those with healed ulcer and the lack of influence of age on this prevalence in subjects with normal UE. These conclusions are in need of confirmation by further studies on much more longer series.