[The intermediate syndrome during organophosphorus pesticide poisoning]. / Le syndrome intermédiaire des intoxications aiguës par les insecticides organophosphorés.

Acute intoxication by organophosphate pesticides is frequent in Morocco. We report two cases of malathion poisoning complicated by intermediate syndrome. The purpose of this work is to describe distinctive features of this syndrome, it arises 48-96 h after the cholinergic crisis and it is characterized by respiratory paresis with difficulties of weaning from the assisted respiratory, deficit of proximal limbs, neck flexors, and cranial nerves. This syndrome coincides with the prolonged inhibition of the acetylcholinesterase, and is not due to the necrosis of muscular fiber's necrosis. Both clinical and electromyographic features are explained by a combined pre- and postsynaptic dysfunction of the neuromuscular transmission. The difficulty of this syndrome lies in its rarity and also its severity, because of the respiratory failure, which justifies medical supervision in intensive care unit, for at least 96 h, in expectation for the respiratory distress, all the more cholinergic syndrome is intense.

[Phantom thoracic opacity]. / Opacité thoracique fantôme.

The etiology of the respiratory distress syndrome is dominated by pulmonary edema and the septic shock. We report a rare etiology of a respiratory distress secondary to a rupture of a well treated tuberculous latero-tracheal adenopathy. A 24-year-old woman was treated a year ago for a peripheral and mediastinal lymph node tuberculosis confirmed by the biopsy of a left supra clavicular adenopathy, by two months of isoniazid-rifampicin-pyrazinamide-ethambutol and seven months of isoniazid-rifampicin. The patient completed 9 month treatment with a good clinical and radiology course. Two months after stopping the antibacillary treatment, the patient was admitted to an intensive care unit with a respiratory distress syndrome requiring both intubation and artificial ventilation. The bronchial aspiration brought back plain pus. The telethorax from admission was normal and the retrospective history suggested the diagnostic of a ganglio-bronchial fistula which was confirmed by bronchial fibroscopy demonstrating right latero-tracheal fistula. The course was good with recovery of consciousness on the seventh day. Direct bacilloscopies and culture were negative. The digestive fibroscopy was normal. Finally, fistulization of a tuberculous adenopathy must be considered among the etiologies of respiratory distress even in a patient appropriately treated for mediastinal lymph node tuberculosis.

[Intermediary syndrome in acute malathion poisoning]. / Syndrome intermédiaire lors d'une intoxication aiguë par le malathion.

BACKGROUND: Acute poisoning by an organophosphorus insecticide is frequently observed in Morocco. We report a case of malathion poisoning complicated by an intermediate syndrome. CASE REPORT: A 42-year-old woman was hospitalized 3 hours after ingestion of 50 g of malathion. Intubation and ventilatory assistance was required due to failing consciousness and bronchial plugging. On day 4, a neurological syndrome suggestive of the intermediary syndrome with diaphragmatic palsy made it necessary to continue ventilatory assistance to day 20. DISCUSSION: The intermediary syndrome occurs 24 to 96 hours after the acute cholinergic phase of organophosphorus poisoning. It consists of an exclusive neuromuscular involvement. The intermediate syndrome is confined to an abnormality of neuromuscular function in specific muscle groups: proximal limb muscles, neck flexors, motor cranial nerves and respiratory muscles, with difficult weaning from respiratory assistance. The intermediary syndrome is quite uncommon. The risk of respiratory failure emphasizes the need for close monitoring in an intensive care setting for at least 96 hours, depending on the intensity of the cholinergic syndrome.

[Anaphylactic shock caused by application of fluorescein on the ocular conjunctiva]. / Choc anaphylactique par application de fluorescéine sur la conjonctive oculaire.

OBJECTIVE: Fluorescein is widely used in ophthalmology. Side effects related to fluorescein occur frequently but are usually benign (nausea, vomiting, lipothymia). Severe side effects are rare. We report a case of anaphylactic shock due to local application of fluorescein. CASE REPORT: A 70-year-old woman was treated for ocular conjunctivitis with local application of fluorescein. Cardiac arrest occurred due to anaphylactic shock. Resuscitation was successful. DISCUSSION: The gravity of certain complications related to the use of fluorescein underline the importance of adequate resuscitation material and adapted treatment.

[Acute hepatic steatosis in pregnancy can be cured without interrupting the pregnancy]. / La stéatose hépatique aiguë gravidique peut guérir malgré la poursuite de la grossesse.

Fatty liver during pregnancy is an acute hepatic disease of unknown origin. We report the case of a 24-year-old woman in whom the diagnosis was made on the basis of the histological examination. The disease did not disturb the normal course of the pregnancy and delivery. In the literature, it is generally suggested that pregnancy must be terminated in cases of acute fatty liver since no favourable outcome has been reported with continued pregnancy. We suggest that, in minor forms, close clinical observation and laboratory monitoring can provide the means of continuing the pregnancy to term.