Hepatotoxicity of alpha-methyldopa in pregnancy.

Alpha-methyldopa is one of the most widely prescribed antihypertensive agents used during pregnancy. Despite its known potential hepatotoxicity, there have been only a few reports describing hepatotoxicity with the use of this drug during pregnancy. We report here a new case of acute hepatitis in a pregnant woman related to the use of alpha-methyldopa, and briefly review the literature on alpha-methyldopa-induced hepatotoxicity in pregnancy.

[Diagnostic strategy and management of anemia: a consensus from a detailed study of 100 patients followed in internal medicine]. / Strategie diagnostique et conduite pratique devant une anemie: d'apres une etude approfon- die de 100 patients suivis en medecine interne.

Anemia is a frequent reason for seeking medical care in Internal Medicine. It is not a diagnosis, but rather a symptom that needs to be investigated in order to find an etiology. In a retrospective review of 100 cases of anemia, the cause was found in 86 % of cases. The etiologic profile was varied. Iron deficiency remained by far the most frequent cause seen in 47% of case. Other etiologies have been found such as neoplasm in 13 % of cases, chronic renal failure in 8% of cases and endocrinal cause in 5 % of cases. We recommend a diagnostic decision tree that provides a tool for rational and cost effective approach for anemia.

Unusual presentation of gastric dilatation. Dramatic complete atrioventricular block.

We report a case of gastric dilatation in a ventilated 18-year-old woman, which was revealed by the acute onset of hypotension, sinus bradycardia, and complete atrioventricular block. Hypotension and cardiac rhythm disturbances resolved with intravenous injection of atropine, but recurred a few minutes later and required a second bolus of atropine, which had a transient beneficial effect. Only gastric decompression, as soon as gastric distention was recognized, was able to restore normal cardiac rhythm and adequate blood pressure. This case highlights the seriousness of gastric dilatation and argues for the vagal mechanism of cardiac rhythm and conduction troubles complicating gastric dilatation.

Bronchoalveolar lavage in immunocompromised patients. Clinical and functional consequences.

Fiberoptic bronchoscopy and bronchoalveolar lavage are major tools in the diagnosis of acute pneumonia in immunocompromised patients. We conducted a prospective study to assess the morbidity associated with this procedure in 14 patients with AIDS and 16 patients with drug-induced immunosuppression. No patient had a PaO2 lower than 70 mm Hg with additional oxygen. Clinical data, chest roentgenogram, pulmonary function test, forced vital capacity, forced expiratory volume in one second, and arterial blood gases were recorded before and after bronchoscopy. Arterial oxygen saturation was monitored during the procedure, and initial, lowest, and final saturation values were noted. The patients were separated into three groups on the basis of chest roentgenographic findings. No procedure-induced pneumonia or need for tracheal intubation occurred. Minor clinical symptoms induced by the lavage in seven patients resolved spontaneously. By contrast, mean SaO2 decreased markedly during the procedure from 94 +/- 3 to 87 +/- 5 percent (p less than 0.0001) and returned to only 89 +/- 5 percent at the end of the procedure. Lowest SaO2 during the procedure and final SaO2 correlated poorly with initial SaO2 but correlated well with initial FVC and FEV1 (p less than 0.01). The PFT values were lower following bronchoscopy. O2 desaturation was more pronounced in patients with severe roentgenographic abnormalities. No significant differences were found between the three groups of patients, or between the AIDS and DII patients in terms of changes in PFT values. We conclude that in immunocompromised patients, bronchoscopy with BAL induces severe arterial oxygen desaturation which is correlated with initial PFT and chest roentgenographic findings, and most of these abnormalities are transient and do not lead to major complications.

[Mediterranean lymphoma mimicking Crohn's disease]. / Lymphome méditerranéen simulant une maladie de Crohn.

We report an uncommon localization of mediterranean lymphoma of the terminal ileum in a 28 year-old male patient. Ultrasound and Computed Tomography showed moderate regular and symmetrical intestinal wall thickening simulating Crohn's disease. We highlight the role of computed tomography in the diagnosis, staging and detection of complications.

[Sleep apnea syndromes and Arnold-Chiari malformation]. / Syndrome d'apnées du sommeil et malformation d'Arnold-Chiari.

The Arnold-Chiari malformation (MAC), ectopic medulla of the cerebral hemispheres, may be the basis of respiratory problems provoked by compression of the respiratory centre. It is associated with numerous respiratory problems in children; there are however few publications related to the association of MAC and ventilatory problems in adults. It was recently suggested and subsequently shown that the syndrome of sleep apnoea (SAS) could occur in relation to MAC. We report a new observation documenting the association of MAC and SAS. The surgical cure of MAC enabling a remission of SAS suggests the existence in this case of a causal relation between the two pathologies. A search for such a malformation by imagery of the occipito-medullary crest should be a part of the work up in SAS when the cause remains undetermined.

[Evaluation of 2 dosages of fentanyl in caudal anesthesia. A prospective randomized double-blind study]. / Evaluation de deux posologies de fentanyl en anesthésie caudale. Etude prospective randomisée en double aveugle.

A caudal block is currently performed in children. A randomized and double blind study including two dosages of fentanyl: 0.5 microgram.kg-1 (group I) and 1 micrograms.kg-1 (group II) in association with bupivacaine 0.25% at a dosage of 1 mL.kg-1 was carried out. Two groups of 25 children undergoing urogenital or orthopaedic surgery participated in this study. Analgesia and side effects were evaluated 24 hours postoperatively. Quality and duration of analgesia were similar in the two groups. Furthermore, recovery of anaesthesia was rapid and calm. The frequency of nausea and vomiting was respectively 24% and 20% in groups I and II and did not require any specific therapy. Therefore it appears that caudal block with bupivacaine 0.25% and fentanyl 0.5 microgram.kg-1 is a very satisfactory technique in children when indicated.

Sternocleidomastoid pseudotumor of infancy: a report of thirteen cases.

UNLABELLED: Stemocleidomastoid tumor of infancy (SCMTI) is a rare cause of benign neck masses in neonates and infants. It has to be differentiated from other congenital space-occupying lesions in the cervical region. PATIENTS AND METHODS: The files of 13 infants with a mean age of 6 weeks, presenting with a lateral neck mass at Sahloul University Hospital in Sousse (Tunisia) between 2007 and 2009 were retrospectively studied. All of them underwent physical and ultrasonographic examination. MRI was performed in only one case. RESULTS: Ultrasonography (US) showed a soft tissue mass of sternocleidomastoid muscle (SCMM), or a homogenously enlarged muscle without any focal mass. MRI revealed a fusiform enlarged muscle. Diagnosis of SCMTI was established in all cases. Conservative treatment was recommended in all cases with physiotherapy in 2 cases. CONCLUSION: US is the best imaging modality for the diagnosis of SCMTI and the first one to be performed. Additional diagnostic imaging modalities are unnecessary in most of the cases.