Symptomatic Postoperative Compressive Pneumocephalus After Cholecystectomy.

A 75-year-old woman with a history of chronic hydrocephalus due to stenosis of the aqueduct of Sylvius was examined at the emergency department for altered mental status. There was placement of a ventriculoperitoneal shunt in 1970 complicated by meningitis, leading to removal of the material and ventriculociternostomy as definitive treatment in 2004. About one month previously, she had undergone a laparoscopic cholecystectomy complicated by an intra-abdominal collection. Clinical examination at the emergency department revealed a Glasgow score of 8 (E3 V1 M4). In the emergency department the patient presented a tonic-clonic seizure before a cerebral CT scan was performed showing a massive compressive pneumocephalus, then a second seizure. The patient was finally admitted to the neurosurgery department and underwent surgery. LEARNING POINTS: Changes in mental status in a patient with a history of chronic hydrocephalus should alert clinicians to a possible complication.This case reflects the delayed diagnosis of a critically ill patient in the emergency department.

Malignant hypercalcemia revealing a diffuse large B-cell lymphoma in a patient with a previous diagnosis of chronic myelomonocytic leukemia: An uncommon hematological coexistence.

A 76-year-old patient previously admitted to the cardiology department for replacement of a right ventricular lead on a double-chamber pacemaker was admitted to the internal medicine department 15 days after for bronchopneumopathy. His past medical history was relevant for Type 2 diabetes mellitus, heart failure due to dilated hypokinetic heart disease, transcatheter aortic valve implantation (TAVI), and chronic myelomonocytic leukemia (CMML-0) diagnosed in 2021. Twenty-four hours after admission, the patient's general condition deteriorated abruptly, with the onset of drowsiness and psychomotor retardation. Laboratory exams revealed hypercalcemia at 4.18 mmol/L. Intensive hydration, calcitonin, and zoledronic acid were initiated and the patient was transferred to the nephrology intensive care unit where he underwent two sessions of hemodialysis to normalize serum calcium levels before readmission to internal medicine. Laboratory exams revealed low parathyroid hormone, normal 1-25-OH vitamin D, and increased parathyroid hormone-related peptide. Thoracoabdominal and positron emission tomography (PET) scan showed diffuse abdominopelvic peritoneal carcinosis associated with low-grade pleural effusion and multiple supra- and sub-diaphragmatic adenopathies, leading to a search for a solid tumor. The patient's clinical condition worsened leading to a transfer to the intensive care unit. The biopsy of a peritoneal carcinosis nodule confirmed the diagnosis of diffuse large B-cell lymphoma. Specific treatments were unsuccessful and the patient expired.

[Long COVID, diagnosis and management : a survey among general practitioners in the Bas Rhin in France]. / Face à la COVID-19. COVID long, diagnostic et prise en charge : enquête auprès de médecins généralistes du Bas Rhin en France.

The long COVID includes non-specific symptoms affecting patients of all ages. METHODS: Monocentric, prospective, quantitative and descriptive study interested in comparing the knowledge of general practitioners in Alsace (France) with the positioning and recommendations of the World Health Organisation (WHO) on long COVID in the period November 2022-February 2023. A multiple-choice questionnaire was elaborated based on the WHO positioning and recommendations on the long COVID. RESULTS: 126 questionnaires were received, 65 (51.6 %) women, 42 % aged between 25-35 years. 84.9 % had knowledge about long COVID. The need for an impact on daily life, unexplained symptomatology and symptoms persisting at two months were criteria retained (84.9 %, 91.3 % and 82.5 %, respectively). A history of anxiety disorders (86.5 %) and severe acute forms of COVID-19 (57.9 %) were considered as risk factors. Fatigue, dyspnea, joint pain, headache and cough were associated with long COVID in 65.9 % of responders. About 74,6 % performed a complete blood test, 96.03 % recommended rehabilitation, 76.2 % referred to the pulmonologist and 71.4 % were in favour of a consensus document. CONCLUSIONS: General practitioners are aware of the existence of long COVID as a pathology and agree with the recommendations of scientific societies, among which those of WHO. However, this study has some limitations so that this topic deserves further dedicated investigations.

Le COVID long regroupe des symptômes non spécifiques affectant des patients de tous âges. Méthodes : Étude mono-centrique, prospective, quantitative et descriptive ayant pour but de confronter les connaissances des médecins généralistes d'Alsace (France) au positionnement et aux recommandations de l'Organisation Mondiale de la Santé (OMS) sur le COVID long. La période d'étude s'étend du 15 novembre 2022 au 15 février 2023. Un questionnaire à choix multiples est élaboré à partir des recommandations de l'OMS sur le COVID long. Résultats : 126 questionnaires analysés, 65 (51,6 %) femmes, 42 % des répondants âgés entre 25-35 ans. Globalement, 84,9 % des répondants disent connaître le COVID long. La nécessité d'un impact sur la vie quotidienne, la symptomatologie non expliquée et symptômes persistants à 2 mois étaient des critères retenus (84,9 %, 91,3 % et 82,5 %, respectivement). Les antécédents de troubles anxio-dépressifs (86,5 %) et les formes aiguës sévères (57,9 %) étaient considérés comme des facteurs de risque. La fatigue, la dyspnée, les douleurs articulaires, les céphalées et la toux sont associées au COVID long dans 65,9 % des cas. Dans l'ensemble, 74,6 % réalisent un bilan biologique complet, 96,03 % préconisent la rééducation, 76,2 % orientent vers le pneumologue et 71,4 % étaient favorables à l'élaboration d'un document de consensus. Conclusions : Les médecins généralistes interrogés connaissent l'existence de cette pathologie et les démarches des répondants sont en accord avec les recommandations des sociétés savantes, dont celles de l'OMS. Cette étude comporte cependant diverses limitations et ce sujet mérite certainement des enquêtes supplémentaires.

Focal Myositis of the Sternocleidomastoid Muscle: A Rare and Uncommon Cause of Cervical Mass.

We report on a 70-year-old male patient admitted to the internal medicine department for evaluation of a right cervical mass. He had been treated with antibiotics as an outpatient by his primary care doctor. Upon admission the patient was asymptomatic, but within a few hours his cervical mass enlarged; this enlargement was confined to the right sternocleidomastoid muscle. Complete blood investigations including serology and autoimmunity were negative. The neck scan and MRI were in favour of myositis. No other lesions were found either in the nasal fibre-optic exam or in the thoracic-abdominal-pelvic scan. The biopsy of the muscle showed a lymphoplasmacytic inflammatory infiltrate of the perimysium. The diagnosis of focal myositis was made. The patient clinically improved during hospitalisation with complete resolution of symptoms without any specific intervention. LEARNING POINTS: A thorough clinical examination is essential in the evaluation and characterisation of cervical masses.The diagnostic approach must be rigorous in order not to ignore potentially serious diseases.A high level of clinical suspicion is needed in the diagnosis of focal myositis.