[Paraspecificity of antivenins: example of severe envenomation by the Sahara horned viper (Cerastes cerastes) treated with non-specific antivenin]. / La paraspécificité des antivenins: exemple d'une envenimation grave par la vipère à cornes du Sahara (Cerastes cerastes) traitée par un antivenin polyvalent non spécifique.

Snake bites are a major public health problem in Morocco. Both morbidity and mortality of ophidian envenomation remain very high in this country. Antivenin immunotherapy, the only etiological treatment of this envenomation, is often unavailable in local hospitals. Moreover, when available, antivenins are not necessarily suitable for local ophidian species. This case report describes severe poisoning caused by a Sahara horned viper (Cerastes cerastes) in southern Morocco. In the absence of specific immunotherapy, FAV-Afrique®, a polyvalent antivenom serum, was administered. The favorable outcome suggests that this serum is paraspecific against the Sahara horned viper. The paraspecificity of antivenin immunotherapy could be a solution to ophidian envenomation in the absence of an antivenin adapted to local snake species.

[Acute negative pressure pulmonary edema: illustration from a unusual clinical case following a postoperative recurrent laryngeal nerve palsy]. / L'œdème aigu du poumon à pression négative : illustration à partir d'un cas clinique inhabituel compliquant une paralysie récurrentielle postopératoire.

Acute postoperative negative pressure pulmonary edema (NPPE) is a respiratory complication due to upper airway obstruction occurring most commonly in the postoperative period. Pathophysiologically, NPPE is explained by the abrupt generation of highly negative intrathoracic pressure that lead to fluid transudation from the pulmonary capillaries. This observation reports an unusual case of a young patient who has undergone total thyroidectomy for multinodular goiter. The postoperative period was marked by the occurrence of bilateral recurrent laryngeal nerve palsy that was complicated by a NPPE. The outcome was favorable after mechanical ventilation with reversal of NPPE and recovery of the recurrent laryngeal nerve function. This article stresses the importance of prevention of recurrent nerve palsy during thyroid surgery. It also highlights a little known respiratory complication: the NPPE. Understanding the pathophysiology of NPPE, rapid diagnosis and appropriate therapeutic measures could prevent its potential lethal consequences.