[Acute arsenic poisoning]. / Intoxication aiguë à l'arsenic.

Acute arsenic poisoning is a rare cause of suicide attempt. It causes a multiple organs failure caused by cardiogenic shock. We report the case of a patient admitted twelve hours after an ingestion of trioxide arsenic having survived thanks to a premature treatment.

[Prolonged curarisation following succinylcholine injection on butyrylcholinesterase deficiency and potentiated by a lithium treatment: a case report]. / Curarisation prolongée après injection de succinylcholine sur déficit congénital en butyrylcholinestérase et potentialisée par un traitement au lithium: à propos d'un cas.

Succinylcholine is a short-term curare which degradation depends on its quick hydrolysis by butyrylcholinesterase (or pseudocholinesterase). Thus, a butyrycholinesterase deficiency, congenital or acquired, is a cause of a prolonged neuromuscular block. From an autosomal recessive inheritance, genetic deficiency remains the first etiology. The most frequently discussed variant is the atypical variant which caused a 2 hours prolonged curarisation after administration of succinylcholine. We report a patient who had a prolonged curarisation after succinylcholine's injection, due to a congenital butyrylcholinestérase deficiency and contributed by a lithium treatment. Extubation was only possible 7 hours after administration of curare.

[Thrombotic microangiopathy mimicking a heparin-induced thrombocytopenia]. / Une microangiopathie thrombotique mimant une thrombopénie induite par l'héparine.

We report a case of a 47 years old woman. In her case of medical history, there were vein thrombosis and an allergic to tinzaparin. The patient entered in critical care unit under medical supervision for a multivisceral infarction due to an arterial mesenteric, renal and splenic thrombosis. An heparinotherapy was introduced. A laparotomy was realized because of an occlusion. Small intestine necrozed was removed. 8 days after the introduction of the heparin, there was a thrombocytopenia. Considering the background and the initiale situation, an heparin-induced thrombocytopenia of type II (HTI) was suspected. Whereas the heparinotherapy was stopped, the thrombocytopenia maked worse. Biological tests infirmed HIT's diagnosis. A recurrent anemia in spite transfusions associated to a renal failure suggest a thrombotic microangiopathy which was secondary confirmed. The intensivist is sensibilized to evoke an heparin induced thrombocytopenia when there is a thrombocytopenia under heparin. However, he must not forget diagnosis of thrombocytopenia which required specific investigations and emergency treatment such as thrombotic microangiopathy.

[Severe imported Falciparum malaria treated with artesunate]. / Paludisme grave d'importation à Plasmodium falciparum traité par artésunate.

Falciparum malaria is a potentially deadly infectious disease, imposing a sure and fast biologic diagnosis, an early and efficient treatment. We report a case of severe imported Falciparium malaria who received artesunate, and we rewiew the different diagnostic methods of malaria as well as the clinico-biological characteristics of severe malaria. Recent data concerning malaria treatment are presented, as a pharmacokinetic study leaded during this case.

Intestinal prolapse through a persistent omphalomesenteric duct causing small-bowel obstruction.

Persistent omphalomesenteric duct as a cause of small-bowel obstruction is an exceptional finding. A neonate presented with occlusion due to intestinal prolapse through a persistent omphalomesenteric duct. Remnants of the duct were successfully resected, and the postoperative course was uneventful. We discuss the presentation of omphalomesenteric duct and its management.

[Fulminant Neisseria meningitidis B revealing multiple myeloma]. / Purpura fulminans à Neisseiria meningitidis B révélateur d'un myélome multiple.

We report the case of a 64 years-old woman, presenting in our hospital with purpura fulminans due to invasive meningococcal B infection. Biological exams led to the diagnosis of multiple myeloma. This case illustrates the importance of immunosuppression in this hematologic disease and allows us to insist on the prophylactic measures to be implemented.

[Sickle cell disease: from molecular aspects to clinical practice. A case report and a literature analysis]. / Drépanocytose : des aspects moléculaires à la pratique clinique. À propos d'un cas et revue de la littérature.

Sickle cell disease is the genetic disease most frequently detected at birth in France. The comprehension and knowledge of its pathophysiology allow to establish the principles of management for the drepanocytic patient, especially in the perioperative phase. In the light of recent recommendations published for anesthesia of a drepanocytic adult, this clinical case revealed allows to reexamine that subject, with a focus on biological aspects, which are transfusional strategy and antibioprophylaxy. The presented observation is a concrete feature of daily collaboration between clinician and biologist, which is an essential point of the ISO standard EN 15189 concerning laboratories' accreditation.

[Septic shock Fusobacterium necrophorum from origin gynecological at complicated an acute respiratory distress syndrome: a variant of Lemierre's syndrome]. / Choc septique d'origine gynécologique à Fusobacterium necrophorum compliqué d'un syndrome de détresse respiratoire aigu : une variante du syndrome de Lemierre.

We report a case of a female patient of 47 years old who presents in a state of septic shock with acute insufficient respiratory complicated with syndrome of acute respiratory distress, together with a list of abdominal pain and polyarthralgia too. In her case of medical history, it is retained that she has had a intra-uterine device since 6 years without medical follow up. The initial thoraco-abdomino-pelvic scan shows a left ovarian vein thrombosis, as well as the opaqueness alveolus diffused interstitiel bilaterally and an aspect of ileitis. The IUD is taken off because of sudden occuring of purulent leucorrhoea. This results in a clinical and paraclinical improvement, whereas aminopenicillin was administered to the patient since 1 week. The microbiological blood test allows to put in evidence Fusobacterium necrophorum found in a blood culture and is sensitive to the amoxicilline-acide clavulanique and metronidazole. Isolation of this bacteria, classically found in Lemierre's syndrome, allowed to explain the multilfocalization of the symtoms and the list of pain. The whole concerns about a variant of Lemierre's syndrom: a state of septic shock secondary then caused by the anaerobic Gram negative bacilli, which is a commensal bacteria of the female genital tractus, complicated of septic emboli typical.

Splicing defects in the CFTR gene: minigene analysis of two mutations, 1811+1G>C and 1898+3A>G.

BACKGROUND: Cystic fibrosis is caused by mutations of the Cystic Fibrosis Transmembrane conductance Regulator gene (CFTR). Among the 1795 reported mutations, 221 (12.31%) are believed to affect pre-mRNA splicing. Nevertheless, not all splicing mutations have been demonstrated, by functional assays, to affect splicing in living cells. METHODS: We have used a minigene-based approach, coupled to site-specific mutagenesis, to analyze the effects of presumptive pre-mRNA splicing mutations. RESULTS: We show here that the intron 11 1811+1G>C and the intron 12 1898+3A>G mutations strongly affected CFTR pre-mRNA splicing. The encoded proteins are predicted to be defective, which would thus participate in the disease phenotype of carrier individuals. CONCLUSIONS: These results further validate the minigene strategy for the study of presumptive splice mutations, and report unanticipated defects in splicing. Such assays should improve the analysis of genotype-phenotype correlations.

[Pharmacokinetics of biological tags in a case of acute valpromide self poisoning]. / Pharmacocinétique des marqueurs biologiques d'une intoxication médicamenteuse volontaire grave au valpromide.

We report the case of a 35-year-old woman hospitalized in intensive care unit after valpromide self-poisoning (Dépamide). The dose supposed to be taken was 15 g. The patient eleven hours after ingestion, presented, a coma with bilateral non-reactive mydriasis, justifying intubation and mechanical ventilation. An acidosis (pH = 7.24), a hyperlactatemia (2.72 mmol/L), a hyperammonemia (328.9 micromol/L), and were diagnosed valproic acid plasmatic concentration was 1190 microg/mL at 22 hours. Symptomatic treatment and L-carnitine therapy (50 mg/kg/12h) normalized the action of biological abnormalities and allowed disappearance of symptoms; the patient was extubated after 46 hours, and outcome from intensive care unit at 65 hours.