Central skull base osteomyelitis: a rare but life-threatening disease.

We present the case of a 70-year-old non-diabetic patient who presented to the emergency department with unrelenting otalgia. A severe otitis externa (OE) and mastoiditis were treated with broad spectrum antibiotics and surgical drainage. No bacteria was isolated from surgical samples. Because the otalgia persisted, a magnetic resonance (MR) was performed and showed an infiltrating process at the skull base. Biopsies failed to prove malignancy or granulomatosis. The patient's neurological state deteriorated. The suspicion of a skull base osteomyelitis (SBO) was raised and proven by CT-guided biopsies that grew Pseudomonas aeruginosa. Meropenem and ciprofloxacin, given for 8 weeks, lead to a fast clinical improvement and a full recovery. SBO is uncommon, often complicating severe OE. Pseudomonas aeruginosa is the main pathogen. Prompt diagnosis and adequate antibiotherapy are required to lower mortality and morbidity. The diagnosis may be delayed because of unawareness and large differential diagnosis including solid neoplasic tumours, malignant hemopathies and granulomatosis.

[How are palliative care needs estimated in short-stay establishments? Apropos of an experience in Côte d'Or]. / Comment estimer les besoins en soins palliatifs dans les établissements de court séjour? A propos d'une expérience en Côte d'Or.

The evaluation of needs and means concerning the care of patients in palliative treatment is among the problems seen as priority by the High Committee for Public Health. We have thus tried to characterise, in a specific health sector, the patients receiving palliative care in short-stay establishments in order to evaluate their care needs. We carried out an exhaustive descriptive survey among all public and private short-stay establishments in the Côte d'Or region. Of the 2116 patients in the hospital on the day of the survey, roughly 30% were considered as eligible for palliative care (patients suffering from serious, chronic and progressive illnesses). The average age of these patients is 63.9 years (standard deviation 19.7). They mainly suffer from tumours (50%), circulatory pathologies (15%), mental illness (7%), or neurological illnesses (6%). Among the patients that may need palliative care, 38% say they feel pain despite treatment with pain-killers among 25.3% of them. The personnel providing care is insufficiently trained in palliative care or in pain, as only a maximum of 18% of nurses and 5% of doctors in short-stay establishments have been trained in these areas.

[What alternatives to rectal temperature recording with a mercury thermometer?]. / Quelles alternatives à la prise rectale de la température avec un thermomètre à mercure?

Fever is a major symptom to characterize individual health status. Measurement of temperature is systematically made in everyday medical practice. In France, this measurement is generally assumed with a rectal glass mercury thermometer. In order to protect people and the environment, the "Conseil Supérieur d'Hygiène Publique de France" has approved recommendations to withdrawn medical use of mercury, specifically for thermometer. Rectal measurement is also debated since infectious risks are described. Thus, substitution of rectal glass mercury thermometer is on the agenda. New sites and techniques for measurement of temperature have been studied through a literature review, interview of experts and companies, and clinical research protocols. Cutaneous and axillary measurements are inaccurate and unsatisfactory. Two methods seems to be worth: oral measurement and tympanic measurement. Oral measurement is widespread in the world. This technique has some limits. Tympanic measurement is a new method in progress without these limits. Whatever the choice of the technique is, the substitution of rectal glass mercury thermometer requires training and awareness of staff and patients.