Diagnostic value of procalcitonin in acutely hospitalized elderly patients.

The aim of this study was to evaluate procalcitonin as an adjunct to diagnose bacterial infections in older patients. One hundred seventy-two patients admitted to an acute-care geriatric unit during a 6-month period were prospectively included, 39 of them with an invasive bacterial infection. The best cut-off value to rule in a bacterial infection was 0.51 microg/l with sensitivity 64% and specificity 94%. The best cut-off value to rule out a bacterial infection was 0.08 microg/l with sensitivity 97% and specificity 20%. Procalcitonin was inconclusive (between 0.08 and 0.51 microg/l) for 112 admissions. Procalcitonin over 0.51 microg/l was useless 22 times out of 33 (infection already ruled in on clinical grounds) and misleading in eight of the 11 remaining cases (no infection). Procalcitonin below 0.08 microg/l was useless 23 times out of 27 (infection already ruled out on clinical grounds) and misleading in one of the four remaining cases (infection). Despite a good overall diagnostic accuracy, the clinical usefulness of PCT to diagnose invasive bacterial infections in elderly patients hospitalized in an acute geriatric ward appears to be very limited.

[Massive rhabdomyolysis revealing a McArdle disease]. / Rhabdomyolyse massive révélant une maladie de McArdle.

INTRODUCTION: McArdle's disease is an autosomal recessive glycogenosis caused by deficiency of muscle glycogen phosphorylase resulting in glycogen accumulation in the skeletal muscle. Typically, McArdle's disease is characterized by exercise intolerance with muscle cramps and myoglobinuria. CASE REPORT: We report a 20-year-old woman with massive rhabdomyolysis and acute renal failure revealing a McArdle's disease. DISCUSSION: Although muscle impairment is constant in McArdle's disease, massive rhabdomyolysis with severe acute renal failure has been rarely reported as a presenting feature. The mechanisms and therapeutic implications of renal injury are discussed.

[False hyperchloremia in a bromide intoxication]. / Fausse hyperchlorémie révélant une intoxication aux bromures.

A false hyperchloremia in a patient with a history of depression suspected bromide intoxication. The diagnosis was confirmed by an increased bromide concentration > 20 mmoL.L-1. Rehydration was effective and allowed to decrease bromide concentration. In conclusion, hyperchloremia associated with a negative anion gap is a clue to the diagnosis.

[Spontaneous idiopathic chylothorax. Case report and review of the literature]. / Chylothorax spontané idiopathique. Revue de la littèrature á propos d'un cas.

We present a new case of bilateral spontaneous idiopathic pneumothorax, occurring in a 52-year-old woman. A literature review of similar cases shows a quite reproducible picture, consisting in the occurrence of supraclavicular swelling and left or bilateral chylothorax after a mild effort in a woman in her fifties.

[Severe acute asthma in the emergency room: amelioration of decreased peak flow rate is interpreted with difficulty]. / Asthme aigu grave aux urgences: l'amélioration du débit de pointe doit être interprété avec discernement.

We report a severe acute asthma case whose course was marked by persistent hypoxemia whereas proximal flows were normalized. This discordance reveals a ventilation/perfusion mismatch. This data suggests that care must be taken in interpreting the peak flow improvement during acute severe asthma management.

[Bacteremia and Pasteurella multocida pneumonia revealing HIV infection]. / Bactériémie et pneumopathie à Pasteurella multocida révélant une infection à VIH.

Pasteurella multocida is a major pathogen in local wound infections due to animal bites. Pneumonia and bacteremia are less frequent and usually associated with local or general impairment of host defenses. Scarce reports exist about Pasteurella multocida infections in HIV infected patients. We report here a case of hypoxemic pneumonia and bacteremia due to Pasteurella multocida revealing an HIV infection in a young man.