Acute hypoxic pulmonary hypertension associated with right heart failure.

COPD is a cause of chronic pulmonary hypertension, with increased pressure during exacerbations. But acute right ventricular failure is very rare in this condition. We reported two cases in which exacerbation and hypoxaemia have induced an acute severe pulmonary hypertension complicated by right ventricular failure and cardiogenic shock. The supportive treatment and the correction of hypoxaemia have rapidly solved the clinical situation.

New-Onset Refractory Status Epilepticus: More Investigations, More Questions.

A 27-year-old previously healthy woman was admitted to the hospital with recurrent seizures. Status epilepticus developed that became refractory to third-line therapy with propofol and barbiturates. The patient had a very extensive diagnostic workup including autoimmune, viral and genetic investigations. A tentative immune therapy was proposed with high doses of steroids and plasma exchanges. Our patient had an inherited heterozygous single nucleotide variant in the sequence c.1280A>G [p.Lys427Arg] of the SMC3 gene that was insufficient to explain the seizures. Surprisingly, IgM antibodies against Japanese encephalitis virus were positive on the serum drawn 11 days after symptom onset, as detected by ELISA and the immunofluorescence antibody (IFA) technique. IgG antibodies were also positive using the IFA technique, but not with ELISA. The same investigations as well as the detection of the viral genome by the q-RT-PCR technique were negative on cerebrospinal fluid. Despite the suspicion of a viral infection, we concluded that our patient had a new-onset refractory status epilepticus of cryptogenic origin. Termination of the status epilepticus was obtained after 47 days, with a possible benefit from the introduction of ketamine.

Use of the neutrophil-to-lymphocyte ratio as a component of a score to predict postoperative mortality after surgery for hip fracture in elderly subjects.

BACKGROUND: Hip fracture precedes death in 12-37 % of elderly people. Identification of high risk patients may contribute to target those in whom optimal management, resource allocation and trials efficiency are needed. The aim of this study is to evaluate a predictive score of mortality after hip fracture in older persons on the basis of the objective prognostic factors easily available: age, sex and neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP). PATIENTS AND METHODS: After the ethical committee approval, we analyzed our prospective database including 286 consecutive older patients (>64 years) with hip fracture. A score [range 0-4] was constructed, based on a previous analysis, combining age (1 point per decade above 74 years), sex (1 point for male gender) and NLR at postoperative day +5 (1 point if > 5). A receiver-operating curve (ROC) analysis was performed. Similar analyses were performed with CRP (1 point if > 7.65 mg/dL). RESULTS: In the 286 patients (male 31 %), the median age was 84 (65-102) years, and the mean NLR values were 6.47 ± 6.07. At 1 year, 82/286 patients died (28.7 %). In the 235 patients with complete data, significant differences in term of mortality risk are observed (P < 0.001). Performance analysis shows an AUC of 0.72[95 % CI 0.65-0.79]. CRP performed less than NLR (AUC for CRP alone: 0.53[95 % CI 0.45-0.61], P = 0.42, with a sensitivity of 58.5 % and a specificity of 57.1 % for a cut-off value of 7.65 mg/dL; and for NLR alone: 0.59 [95 % CI 0.51-0.66]; P = 0.02, with a sensitivity of 55 % and a specificity of 65 % for a cut-off value of 4.9). CONCLUSION: A discrete 0-4 scoring systems based on age, sex and the NLR was shown to be predictive of mortality in elderly patients during the first postoperative year following surgery for hip fracture repair.