Characteristics of deep vein thrombosis in the critically ill COVID-19 patient - an observational cohort study with Doppler ultrasound measurements.

OBJECTIVE: COVID-19 is associated with an increased prevalence of deep venous thrombosis (DVT), mainly in the lower limbs. However, the characteristics and rheological conditions, which contribute to facilitating DVT occurrence have been poorly investigated. We aimed to report DVT characteristics, vein diameters and peak blood flow velocities (PBFV) in the common femoral veins (CFVs) of critically ill COVID-19 patients. PATIENTS AND METHODS: We conducted a prospective single-center cohort study in March-October 2020 including all consecutive mechanically ventilated COVID-19 adults. Doppler ultrasound of the lower limbs was performed systematically during the first week of hospitalization. In DVT-free patients, a second Doppler ultrasound was performed seven days later. Data are expressed as medians (interquartile ranges) or percentages. Comparisons were performed using Mann-Whiney and Wilcoxon signed-rank tests or Fischer's exact tests, as appropriate. RESULTS: Fifty-five patients [age, 63 years (56-74); female/male ratio, 0.62; body-mass index, 29 kg/m2 (26-33); hypertension, 47%; diabetes, 38%; ischemic heart disease, 11%] were included. DVT was diagnosed in 19 patients (35%) including in 5 femoral (9%), 2 popliteal (4%) and 12 below-the-knee sites (22%). CFV diameter was increased to 12.0 mm (11.0-15.0) (normal range, 9.1-12) and PBFV reduced to 11.9 cm/s (8.8-15.8) (normal range, 21.3-49.2) [right-side values]. In four patients who had ultrasound before intubation, CFV diameter increased from 12.5 mm (11.8-13.3) before to 14 mm (13.6-15.3) after intubation (p = 0.008). CONCLUSIONS: DVT in the CFV occurred in 9% of the critically ill COVID-19 patients with an overall 35%-DVT prevalence. Venous return difficulty evidenced by larger than normal CFV diameters and lower than normal PBFVs may have facilitated proximal DVT occurrence.

Polymicrobial meningitis revealing an anterior sacral meningocele in a 23-year-old woman.

Polymicrobial meningitis has become increasingly rare during recent decades. Historically, it has mainly been reported as being associated with disorders of the ENT-sphere. The treatment of these infections being optimized, polymicrobial meningitis nowadays is essentially a complication of gastrointestinal or gynaecological disorders and trauma. We present a case of polymicrobial meningitis following puncture of a unrecognized pre-sacral meningocele in a patient with Currarino syndrome and review of the relevant literature.

Streptococcus B meningitis in post-partum.

We report a case of post-partum meningitis due to group B-streptococcus developing 24 h after vaginal delivery. Diagnosis was established by latex agglutination of streptococcus B-antigenes and confirmed by cerebrospinal fluid-culture later on. Clinical and haematological signs of meningitis disappeared after treatment with ampicillin. In a review of the literature we found eight other cases of streptococcal post-partum meningitis. In all of these cases, delivery was vaginal and no antibioprophylaxis was given.

[Neurologic toxicity of methotrexate in a patient with cerebral arteritis. Report of a case]. / Toxicité neurologique du méthotrexate avec artérite cérébrale. Un cas.

We report the case of an 18 year-old woman treated for femoral osteogenic sarcoma who presented generalized seizures requiring sedation, tracheal intubation and artificial ventilation. CT brain scan showed diffuse hypodensities. Doppler studies showed an increased cerebral arterial resistance. Regional cerebral blood flow was decreased. A right carotid angiogram showed abnormalities consistent with diffuse cerebral arteritis. The patient slowly recovered and 6 weeks later, magnetic resonance imaging showed disseminated areas of hyposignal on T1 and hypersignal on T2 weighted images. We reviewed the different published cases of acute high dose methotrexate neurotoxicity and the different underlying mechanisms.

[Thrombosis of the basilar trunk in a young woman previously treated by radiotherapy for malignant lymphoma]. / Thrombose du tronc basilaire chez une jeune femme précédemment traitée par radiothérapie pour lymphome malin.

We report the case of a 23-year-old-woman, who had received mediastinal radiotherapy for non-Hodgkin lymphoma. Five years later, she presented a basal artery thrombosis. Arteriography showed an ectopic origin of the left vertebral artery on the aortic arch located within the irradiation field. This artery was irregular and narrowed up to 15 cm from its origin. All other cerebral arteries were normal. We reviewed the literature of other observations describing radiation-induced cervical arteritis.

[Motor block induced by spinal injection of pethidine. Quantification and comparison with lidocaine]. / Bloc moteur induit par la péthidine intrarachidienne. Quantification et comparaison avec la lidocaïne.

Intrathecal pethidine (or meperidine) at a dose of 1 mg.kg-1 has proved to be effective and useful for surgical procedures by producing a spinal nerve block due to its local anaesthetic properties. Motor blockade was assessed by dynamometric measurement of the dorsal flexion of foot in ten ASA I patients after subarachnoid pethidine, and in seven ASA I patients after subarachnoid 5% lidocaine at the same dosage. Measurements were made every 5 min during the first 30 min, then every 15 min until complete motor block recovery was obtained. Values were expressed as a percentage of the initial muscle strength registered before lumbar puncture. The two drugs gave a dramatic and similar decrease in muscle strength (92 vs 95%; NS). However, the delay of maximal effect was significantly longer with pethidine than with lidocaine (33.5 +/- 14 min vs 19 +/- 5.6 min; p less than 0.05). The duration of the motor blockade was similar for both drugs (116 vs 106 min) and the 25%-75% time intervals were identical (32 +/- 14 min vs 33 +/- 12.6 min). Two severe respiratory depressions were observed with pethidine, which were rapidly reversible by intravenous naloxone. Numerous other minor side-effects occurred more frequently with meperidine than with lidocaine. It was concluded that dynamometry gave an accurate description of motor blockade induced by spinal anaesthesia.

[Surgery to save body-packers]. / La chirurgie au secours des body-packers.

Cocaine body packing may expose to the risk of intestinal obstruction or acute cocaine poisoning. During the last five years (1998-2002), 17 symptomatic body-packers were admitted to our intensive care unit, for a closed monitoring. Clinical evolution of three patients required a surgical intervention. The first patient had a laparotomy, in the presence of an occlusive syndrome, to recover the packets of cocaine. The second patient presented peritonitis, in relation to an ileal perforation, treated with an intestinal segment resection followed by a double ileostomy. The third patient presented severe ventricular dysrhythmia, due to cocaine toxicity, after a bullet disruption in the stomach. Adrenaline and labetalol-combined therapy as well as gastric incision to recover the bullets were needed to allow cardiovascular stabilization. In these three cases, the surgical treatment allowed patient survival.

Group B streptococcus meningitis in an HIV-positive adult: case report and review.

We report a new case of meningitis due to group B streptococci (S. agalactiae) in an HIV-positive patient. Only three other cases have been reported so far, and common features are discussed.