[Propionibacterium acnes infective endocarditis. Study of 11 cases and review of literature]. / Endocardites infectieuses a Propionibacterium acnes. Etude de 11 cas et revue de la littérature.

BACKGROUND: Propionibacterium acnes, a gram positive, anaerobic, skin commensal bacillus, is too often considered a biologic fluid contaminant, of blood cultures in particular. Its implication has been shown in various infections, including brain abscess, ocular infections, osteitis, and acne. It is also the cause of infective endocarditis (IE). METHODS: Retrospective, observational study of 11 patients with P. acnes IE, hospitalised between 1993 and 2001 at the Louis Pradel Hospital, Lyon-Bron, and review of 20 published cases. RESULTS: P. acnes IE is rare, though its prevalence is probably underestimated. It is most likely to affect men (71%), and affects all ages (children 4/31 cases). An entry point, probably cutaneous, is rarely confirmed. P. acnes IE often develops on valve prosthesis (42%), and embolisms are common (61%). The infective site is usually aortic (55%). The often-subtle symptoms and slow growth of the organism in vitro complicate the diagnosis, which is often made at a late stage, when valvular and peri-valvular destruction has become major. Despite the high sensitivity of P. acnes to most antimicrobials, a surgical intervention is very often needed (81%). The mortality is relatively high (15% to 27%). Examination of pathologic specimens by polymerase chain reaction increases the sensitivity and speed of its detection. The identification of P. acnes in a biologic specimen, valvular tissue in particular, requires a thorough knowledge of the clinical context before concluding to contamination, and mandates close surveillance of the patient. P. acnes can be the cause of IE long before it has been detected.

[Pathophysiology and therapeutic implications of left heart failure]. / Données physiopathologiques et implications thérapeutiques au cours de l'insuffisance cardiaque gauche.

PURPOSE: Heart failure is the ultimate step of most cardiovascular diseases. Its frequency increases regularly because of the progressive increase of life expectancy and better management of cardiovascular diseases. The prognosis is very poor (5-year mortality: 50%) as is quality of life; heart failure is a very costly disease. CURRENT KNOWLEDGE AND KEYS POINTS: Aims of treatment are improvement of symptoms and thus improvement of quality of life and increase of survival. The treatment systematically combines: general advice, dietary measures; medical treatment (with betablockers, ACE inhibitors and/or angiotensin II receptor antagonists, diuretics, in some cases aspirin or oral anticoagulants, digitalis and amiodarone) according to severity of heart failure, presence of congestion, aetiology, age; etiologic treatment if possible; treatment and prevention of precipitating and exacerbating factors. According to clinical and paraclinical features, one may propose cardiac multisite stimulation, cardiac surgery, physical stress training and cardiac transplantation. In order to decrease frequency of heart failure, prevention of cardiovascular diseases which lead to heart failure must be done as often is possible (hypertension, valvular heart disease, ischemic heart disease). FUTURE PROSPECTS AND PROJECTS: The future of the treatment of heart failure is the multidisciplinary management of heart failure (networks) led by hospital units specialized in heart failure.

[Prone position and severe pneumopathy in a patient with head injuries and intracranial hypertension]. / Décubitus ventral et pneumopathie sévère chez un patient traumatisé crânien avec hypertension intracrânienne.

The treatment of hypoxaemia is one of the main goals of intensive care to patients with severe head injury. In the case reported here, the appearance of early pneumonia was accompanied by a severe deterioration of blood gases with worsening of intracranial hypertension. Prone position allowed rapid improvement of blood gases which contributed to the control of intracranial hypertension.