[Pansclerotic morphea with a rapidly fatal outcome in an 11-year-old girl]. / Morphée pansclérotique d'évolution rapidement létale chez une jeune fille de 11ans.

BACKGROUND: Pansclerotic morphea is a poorly described but extremely debilitating variant of localized scleroderma. We report a case with a rapidly fatal outcome in an 11-year-old girl. PATIENTS AND METHODS: An 11-year-old girl with a 2-year history of morphea presented at our institution in April 2012. The sclerosis had started on her trunk and progressed rapidly to involve her entire skin. Initial treatment with corticosteroids was ineffective and she presented extremely painful ulcerations of the lower limbs. The outcome was rapidly fatal, in early 2014, due to cachexia and sepsis after two amputations and several failed treatments including methotrexate. DISCUSSION: Pansclerotic morphea is characterized by rapidly progressing sclerosis involving the entire skin, trophic cutaneous ulcers, painful contraction and limited joint mobility. The prognosis is poor since the disease has an incapacitating and potentially fatal outcome. No reliably effective treatment has yet been established. CONCLUSION: Our case highlights the clinical characteristics of this uncommon form of localized scleroderma, the extremely severe prognosis, and the therapeutic challenge involved.

[Propofol and etomidate: a comparative study in emergency anesthesia in ASA I and II patients]. / Propofol et étomidate: étude comparative en anesthésie d'urgence chez des patients ASA I et II.

The use of propofol and etomidate in emergency anaesthesia is studied in 39 patients ASA I and 11 patients ASA II. After premedication, the narcosis is induced and maintained either by iterative injections or by continued infusion. Concerning haemodynamic changes, the diastolic blood pressure decreases in propofol group without any deleterious effect for these patients. Recovering time is the same in the two groups. The time for recovering memorization is significantly shorter in the propofol group. The use of these two drugs is fully justified in an emergency situation with preference for propofol in case of preoperative haemodynamic stability.

[Evaluation of 2 bacterial filters connected to the respirator for the prevention of nosocomial pulmonary infection]. / Evaluation de deux filtres de rétention bactérienne branchés sur respirateur dans la prévention de l'infection pulmonaire nosocomiale.

Among 37 patients that are admitted for a more than 3 days breathing reanimation, 19 are ventilated with bacterial filter Pall BB 22 15 and 18 with Darex Hygrobac, exchanged every days and connected to the Y piece. In this study, 6 patients are ventilated with a humidifier (pilot population). For these 43 patients, 130 protected swabs were made with the RCS Biotest placed on the expired gaz. The day of the taking off the expiratory tube was rinsed with 100 ml of aseptic water which are strained on the membrane. The two filters give very good and comparable bacteriological results. The filters prevents nosocomial pulmonary infections making a bacterial frontier between the patient and the respirator and reducing aerial contamination from one patient to another.

Osteoid osteoma: percutaneous resection with CT guidance.

In 24 patients with presumed osteoid osteoma in the appendicular skeleton (n = 23) and lumbar spine (n = 1), percutaneous resection with a drill system and computed tomographic (CT) guidance was performed. In the procedure, a 7-mm-diameter toothed drill inserted over a guide wire is used to remove the nidus. Twenty-three patients were successfully treated. Histologic confirmation of osteoid osteoma was obtained in 19 cases. In one patient, open surgery with bone grafting and osteosynthesis was necessary because of inadvertent extensive bone resection resulting from damage to the drill. All patients have remained free of pain and recurrence for 3-24 months. Although the procedure was effective in all patients, the 7-mm diameter of the toothed drill may cause difficulty in small bones or even danger in areas such as the posterior vertebral arch. In locations such as the tubular bones of the lower extremity and the femoral neck, however, this technique is feasible and may become the treatment of choice for osteoid osteoma.