[Thrombotic thrombocytopenic purpura: a case report]. / Le purpura thrombotique thrombocytopénique: à propos d'un cas.

We report a case of thrombotic thrombocytopenic purpura (TTP) in a 60 years-old woman with Sjogren's syndrome. Symptomatology on admission leads to evoke the diagnosis of TTP. Biological results allow to set the diagnosis. Actually, association of haemolytic anaemia, schizocytes and thrombocytopenia are in favour of TTP. Undetectable ADAMTS 13 activity (below 5%) confirms the diagnosis. In congenital TTP, plasma ADAMTS 13 is absent or severely reduced as a consequence of mutations in the two ADAMTS 13 gene. In acquired TTP, circulating antibodies inhibit plasma ADAMTS 13 activity. In those cases, further biological studies are needed to find a cause of TTP. Follow-up implies standard laboratory tests. Plasma exchanges are progressively tapered after normalization of platelets count.

[Carotido-cavernous fistula after traumatic brain injury: an unusual vascular complication]. / Fistule carotidocaverneuse post-traumatique : une complication vasculaire inhabituelle.

The authors reported the case of a young man who suffered a cranial traumatism and showed neurological, ophthalmic and orbital signs with orbital bruit, cranial nerve palsy and chemosis while he was in the intensive care unit. Further examinations of imagery made it possible to highlight a high-flow carotid-cavernous fistula which was the origin of these symptoms and which was successfully treated by endovascular way. The aim of this article is to remind the reader of the characteristics of this pathology, in terms of epidemiology, physiopathology, clinical and paraclinical presentation, and therapeutic care.

[Acute cardiovascular complications of cocaine. About two case reports]. / Les complications cardiovasculaires aiguës de la cocaïne. A propos de deux observations.

Concerning any socioprofessional category, some addictive drugs like cocaine are responsible for many complications. The authors relate two case reports of young patients who suffered from cardiovascular accidents due to this drug. The first one was diagnosed with an ischemic stroke caused by carotid artery dissection and a leg distal vascular obliteration, the second one with a myocardial infarction with transient left ventricular dysfunction. Through these two case reports, the authors take stock of the pathophysiological and therapeutic knowledge of cardiovascular accidents after cocaine intake.

[A serious complication of sternal puncture: penetrating injury of the ascending thoracic aorta]. / Une complication grave de la ponction sternale: la plaie de l'aorte thoracique ascendante.

INTRODUCTION: Penetrating thoracic aorta wounds are rare but responsible for a high mortality when medical and surgical management is delayed. OBSERVATION: We report the case of a 71 year-old patient with malignant lymphoma who sustained an accidental penetrating injury of the ascending thoracic aorta while undergoing trephine biopsy of the sternum. He was successfully treated with emergency sternotomy and aortic suture-repair. CONCLUSION: This case report highlights the limits of sternal trephine biopsy, notably in patients whose bones are weakened by a malignant haematological process, and proposes preventive measures in order to avoid accidents.

[An unusual cause of acute respiratory distress: obstructive bronchial aspergillosis]. / Une cause inhabituelle de détresse respiratoire aiguë: l'aspergillose bronchique obstructive.

We report the case of a 77-Year-old immunocompetent woman who required intensive care for acute dyspnea revealing complete atelectasia of the left lung related to an aspergillus mycelium plug blocking the principal bronchus. The clinical course was favorable after deobstruction by thermocoagulation and oral itraconazole given for six Months. The patient was free of parenchymatous or endobronchial sequelae. Adjuvant oral corticoid therapy was given temporarily during the second Month of treatment when signs of transition towards allergic aspergillosis developed. Four Months after discontinuing the antifungal treatment, the patient developed a new episode of acute dyspnea caused by atelectasia limited to the right lower lobe. Treatment by itraconazole was resumed and continued as long-term therapy. No recurrence has been observed for eighteen Months. The diagnostic and therapeutic problems raised by Aspergillus fumigatus are well known in the immunocompromised subject, but can also be encountered in the immunocompetent subject.

[Blast lung injuries]. / Lésions pulmonaires liées aux explosions.

In armed conflicts and during terrorist attacks, explosive devices are a major cause of mortality. The lung is one of the organs most sensitive to blasts. Thus, today it is important that every GP at least knows the basics and practices regarding treatment of blast victims. We suggest, following a review of the explosions and an assessment of the current threats, detailing the lung injuries brought about by the explosions and the main treatments currently recommended.

[Assessment of the usefulness to use a software supervising continuous infusion rates of drugs administered with pumps in ICU and estimation of the frequency of rate of administration errors]. / Description de la prévention et estimation de la fréquence des erreurs de programmation de vitesse d'administration en continu des médicaments en réanimation par une application informatique.

OBJECTIVES: To assess the usefulness and the feasibility to use a software supervising continuous infusion rates of drugs administered with pumps in ICU. STUDY DESIGN: Follow-up of practices and inquiry in three intensive care units. MATERIAL: Guardrails software(TM) of reassurance of the regulations of the rates of pumps (AsenaGH, Alaris). METHODS: First, evaluation and quantification of the number of infusion-rates adjustments reaching the maximal superior limit (considered as infusion-rate-errors stopped by the software). Secondly, appreciate the acceptance by staffs to such a system by a blinded questionnaire and a quantification of the number of dataset pumps programs performed with the software. RESULTS: The number of administrations started with the pumps of the study in the three services (11 beds) during the period of study was 63,069 and 42,694 of them (67.7 %) used the software. The number of potential errors of continuous infusion rates was 11, corresponding to a rate of infusion-rate errors of 26/100,000. KCl and insulin were concerned in two and five cases, respectively. Eighty percent of the nurses estimated that infusion-rate-errors were rare or exceptional but potentially harmful. Indeed, they considered that software supervising the continuous infusion rates of pumps could improve safety. CONCLUSION: The risk of infusion-rate-errors of drugs administered continuously with pump in ICU is rare but potentially harmful. A software that controlled the continuous infusion rates could be useful.

[Mamba envenomation in mainland France: management of exotic envenomations needs rethinking]. / Envenimation cobraïque en France métropolitaine : repenser la prise en charge des envenimations exotiques.

We report a case of accidental green mamba (Dendroaspis viridis) envenomation in the suburbs of Paris. Although moderate, neurotoxic symptoms were clearly present. Immunotherapy with polyvalent serum FAV-Afrique was decided, but logistical problems prevented reasonably quick serum delivery to the hospital. Despite a spontaneously favourable outcome probably due to minimal envenomation, this case exemplifies a near-miss of the care system. Given the increasing incidence of potentially life-threatening exotic envenomations, management of similar cases should be improved. Besides breeders and health care professionals' information, we suggest that victims of an exotic envenomation be referred to a facility with experienced staff and ready access to a limited bank of carefully chosen antivenins.

[Paraspecific antivenins and exotic bites of snakes: about two case reports]. / Antivenins paraspécifiques et morsures de serpents exotiques : à propos de deux cas cliniques.

Envenomation from bite of exotic snakes is rare in France and represent a serious therapeutic problem: only an adapted antivenom is effective and obtaining such a treatment is a real difficulty. The authors report two clinical cases of envenomation with defibrination after bite by pit vipers from South America. The two patients were treated with nonspecific antivenom therapy with divergent results. The use of the paraspecific effects of antivenom can allow an effective treatment in the absence of specific antivenom, but requires to be known better.

[How the drug allergy risk in the intensive care software is considered? About a comparative study]. / Comment est pris en compte le risque allergique dans les logiciels spécifiques à la réanimation ? A propos d'une étude comparative.

The aim of this study was to evaluate the way the drug allergy risk was considered in five intensive care software available for the French market. It is an observational study conducted by a survey with the five firms asked during the 26th International Symposium on Intensive Care and Emergency Medicine in Brussels (March 2006). The drug allergic risk is documented to various degrees among the software selections. However, no software proposes an alternative or blocking of the prescription in case of allergy to a drug.

[Treatment of a septic shock due to multiresistant Acinetobacter baumannii with tigecycline in combination]. / Traitement d'un choc septique à Acinetobacter baumannii multirésistant par tigécycline en association.

We report a case of pulmonary and bloodstream infection due to multiresistant Acinetobacter baumannii six days after a severe trauma. Clinical condition transiently improved following antimicrobial treatment with ticarcillin-clavulanate and rifampicin. However, a septic shock developed on the fourth day due to the emergence of a strain only sensible to cotrimoxazole, colistin and tigecycline. Cure was achieved after a two week treatment with piperacillin-tazobactam, cotrimoxazole and tigecycline. This case shows that combined antimicrobial therapy including tigecycline can be relevant in some severe pulmonary infections due to multiresistant A. baumannii.

[Use of rFVIIa (Novoseven) in the case of a patient with mitral valvular prothesis and anticoagulant accident]. / Utilisation du rFVIIA (Novoseven) lors d'un accident des anticoagulants chez une patiente porteuse d'une prothèse valvulaire mitrale.

We report the case of an haemorrhagic shock observed in a woman who received heparin for a cardiac valve in mitral position, efficiently treated with rFVIIa. The haemorrhagic complications under anticoagulation treatment remain rare, but can lead to real therapeutic dilemma. The use of rFVIIa has been evaluated in different clinical situations, including traumatic or post-operative haemorrhagic shock. The use of rFVIIa in the treatment of haemorrhagic complication under anticoagulation treatment is discussed.