Pulmonary embolism-related sudden cardiac arrest successfully treated with systemic thrombolysis: management and outcome

Carmen Bartha*, Ruxandra-Iulia Milos **, Michele Yerna *, Alina Petrica *** Published in the journal : July 2019 Category : Observations cliniques

Sudden cardiac arrest caused by pulmonary embolism (PE) is highly refractory to conventional cardiopulmonary resuscitation (CPR). Systemic thrombolytic therapy has been shown useful for return of spontaneous circulation on patient resuscitation. Nevertheless, thrombolysis during CPR is still controversial due to the risks of severe bleeding complications. While the work-up for securing PE diagnosis can delay therapy initiation, thrombolysis should be administered as early as possible when it is considered during CPR. Thus, in selected cases presenting features highly indicative of PE, the pragmatic initiation of thrombolysis under ongoing CPR could significantly improve the patient outcome.

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Sternal osteomyelitis in a 15-month-old child: clinical case and review of clinical, radiological, and therapeutic features

Letizia Vega (1), Jean-Philippe Stalens (2), Jean-Luc Dutrieux (3), Chloé Brunelle (2) Published in the journal : May 2019 Category : Observations cliniques

Osteomyelitis is an infection that affects the bone tissue via hematogenous dissemination, direct post-traumatic or post-surgical inoculation, or a contiguous local infection, such as cellulitis or sinusitis. It is preferentially localized in the metaphyseal region of long bones. Short bones are more rarely affected. Sternal involvement is observed in about 1% of all pediatric osteomyelitis cases. Initial symptoms are often nonspecific, thus resulting in delayed diagnosis. Once the infection is established, symptoms of local inflammation appear. The treatment consists of a targeted antibiotic therapy depending on the child’s age and germs responsible for the infection.

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Hypercalcemia secondary to vitamin D intoxication: clinical vignette and literature review

Adrien De Voeght (1), Eric Godon (1), Alfred Chachati (1), Etienne Cavalier (2), Benoit Buysschaert (1) Published in the journal : May 2019 Category : Observations cliniques

We have reported a case of hypercalcemia with acute renal failure secondary to vitamin D intoxication induced by chronic use of calcitriol. In this article, diagnosis and treatment approaches have been discussed.

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Cardiac toxicity of 5-fluorouracil

Anne-Catherine Claikens, François D’Heygere (1) Published in the journal : May 2019 Category : Observations cliniques

A 53-year-old patient attended the emergency department, on two occasions, because of angina symptoms following the administration of 5-fluorouracil. This treatment was employed in a preoperative neoadjuvant approach in the setting of a recent diagnosis of colorectal cancer (T3N1M0).

Overall, 5-fluorouracil can be associated with cardiac toxicity that manifests itself as pectoral angina, infrequently resulting in irreversible, potentially lethal, cardiac pathologies. While multiple risk factors and action mechanisms have been proposed in the literature, they are still largely unknown among practitioners.

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Giant basal cell carcinoma successfully treated by photodynamic therapy

Muriel Creusot (1), Anne Le Pillouer-Pros (t)2 Published in the journal : May 2019 Category : Observations cliniques

Giant basal cell carcinomas, defined as lesions with a diameter reaching 5cm or more, are rare. They are usually treated by surgery, which can prove mutilating, depending on the size of basal cell carcinoma, or even impossible, depending on the patient’s age or presence of co-morbidities. Since 2003, dynamic phototherapy has become a non-invasive therapeutic alternative for basal cell carcinomas, proven effective. As early as 2010, research revealed the value of intensifying conventional phototherapy sessions with multiple methods, including fractionated CO2 laser, in order to enable trans-epidermal delivery of methyl aminolevulinate (MAL), thereby amplifying the therapeutic response.

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Diagnostic and therapeutic approaches in case of neurocysticercosis in Belgium

Mike Salavracos Published in the journal : April 2019 Category : Observations cliniques

Brain cysticercosis, or neuro-cysticercosis, is an infection involving the central nervous system caused by larvae of a flat worm called Taenia solium. This infection may give rise to numerous different medical presentations, complicating its diagnosis.

The interest of this clinical case assessment describe in this article lies in the rarity of its diagnosis, its non-specific infectious manifestation, as well as the fact that the patient had not recently travelled to a cysticercosis-endemic area.

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Legionella Pneumophila Pneumonia

Quentin Simon Published in the journal : April 2019 Category : Observations cliniques

Flu-like symptoms with cough may be the manifestation of many differential diagnoses. This article sought to demonstrate the relevance of a complete clinical examination, along with the need to look for underlying etiologies when faced to an unusual evolution of a flu-like syndrome

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Adult-onset Still’s disease: rare cause for prolonged fever syndrome

Omar El-Mourad1, Fabien Roodhans1,2, Valérie Huyge3 Published in the journal : April 2019 Category : Observations cliniques

The adult-onset Still’s disease is a rare cause of fever of unknown origin. The clinical presentation and biological signs are rather polymorphous and non-specific. We herein emphasize the usefulness of measuring serum ferritin and glycosylated ferritin (GF) levels. The diagnosis of adult-onset Still’s disease is based on the Yamaguchi criteria, with three major criteria (high fever for more than 1 week, neutrophilic leucocytosis, and diffuse arthralgia) and three minor criteria (liver enzyme elevation of neither toxic nor drug-related origin, lymphadenopathy identified on PET imaging, and negativity of rheumatoid factors and antinuclear antibodies) to be present. The disease’s pathophysiology is still uncertain, and treatment essentially relies on systemic glucocorticoids. In this paper, we have discussed the usefulness of biotherapies, comprising primarily the monoclonal antibodies directed against the IL-6 receptor.

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Gigant-cell arteritis: discussion on clinical and paraclinical presentations and therapeutic options

Omar El-Mourad (1), Fabien Roodhans (1,2), Valérie Huyge (3), Bruno Guetcho( 4) Published in the journal : April 2019 Category : Observations cliniques

Horton's disease, also termed giant cell arteritis, mainly affects large-caliber vessels within the territories of the external carotid branches. Of note is that this condition can also involve the eye, central nervous system, digestive tract, respiratory system, as well as the arterial system of the lower limbs, and the heart. The diagnosis is confirmed based on the biopsy of the temporal artery, which is not positive in all cases. PET imaging takes an increasingly relevant place in the diagnostic tree, revealing metabolic hyperfixation of large and medium vessels. Treatment is mainly based on systemic glucocorticoids. Of note is the progressively increasing place of biotherapies in the condition’s management, primarily comprising specific antagonists of the IL-6 receptor.

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Perforated neonatal appendicitis: conservative management

Geoffrey Jacqmin (1), Jean-Philippe Stalens (2), Jean-Luc Dutrieux (3), Philippe Malvaux (4) Published in the journal : April 2019 Category : Observations cliniques

Acute appendicitis is very rare in the neonatal period. The diagnosis may be delayed due to the lack of specific clinical symptoms, and because of its rarity in the patient population considered, leading to increased peritonitis and mortality rates. Despite neonatal appendicitis possibly manifesting as an isolated event, in many cases, it proves to be a complication of an underlying disease. While surgical treatment remains the gold standard in this pathological setting, conservative management may be considered in selected patients.

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