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Background: In comatose patients receiving oro-tracheal intubation for mechanical ventilation (MV), the risk of aspiration is increased. Aspiration can lead to chemical pneumonitis (inflammatory reaction to the gastric contents), or aspiration pneumonia (infection caused by inhalation of microorganisms). Distinguishing between the two types is challenging. We tested the interest of using a decisional algorithm based on procalcitonin (PCT) values to guide initiation and discontinuation of antibiotic therapies in intubated patients., Methods: The PROPASPI (PROcalcitonin Pneumonia/pneumonitis Associated with ASPIration) trial is a multicenter, prospective, randomized, controlled, single-blind, superiority study comparing two strategies: (1) an intervention group where threshold PCT values were used to guide initiation and discontinuation of antibiotics (PCT group); and (2) a control group, where antibiotic therapy was managed at the physician's discretion. Patients aged 18 years or over, intubated for coma (Glasgow score ≤ 8), with MV initiated within 48 h after admission, were eligible. The primary endpoint was the duration of antibiotic treatment during the first 15 days after admission to the ICU., Results: From 24/2/2015 to 28/8/2019, 1712 patients were intubated for coma in the 5 participating centers, of whom 166 were included in the study. Data from 159 were available for intention-to-treat analysis: 81 in the PCT group, and 78 in the control group. Overall, 67 patients (43%) received antibiotics in the intensive care unit (ICU); there was no significant difference between groups (37 (46%) vs 30 (40%) for PCT vs control, p = 0.432). The mean duration of antibiotic treatment during the first 15 days in the ICU was 2.7 ± 3.8 days; there was no significant difference between groups (3.0 ± 4.1 days vs 2.3 ± 3.4 days for PCT vs control, p = 0.311). The mean number of days under MV was significantly higher in the PCT group (3.7 ± 3.6 days) than in controls (2.7 ± 2.5 days, p = 0.033). The duration of ICU stay was also significantly longer in the PCT group: 6.4 ± 6.5 days vs 4.6 ± 3.5 days in the control group (p = 0.043). After adjustment for SAPS II score, the difference in length of stay and duration of mechanical ventilation between groups was no longer significant., Conclusion: The use of PCT values to guide therapy, in comparison to the use of clinical, biological (apart from PCT) and radiological criteria, does not modify exposure to antibiotics in patients intubated for coma. Trial registration Clinicaltrials.gov Identifier NCT02862314., (© 2021. The Author(s).)

The risk of Toxoplasma gondii infection in solid organ transplant recipients is well known but mainly after heart transplantation. We discuss a case of acute respiratory distress caused by Toxoplasma gondii on Day 32 after liver transplantation. The reported case, which is extremely rare, emphasizes how direct examination and Quantitative Polymerase Chain Reaction (QPCR) in broncholaveolar lavage help to diagnose the infection. Given Trimethoprim/Sulfamethoxazole toxicity, systematic prescription of Toxoplasma gondii chemoprophylaxis is not commonly approved in liver transplantation.

Objectives: To report a patient with systemic ANCA-associated vasculitis, under maintenance treatment, who had persistent microscopic hematuria and developed recurrent pelvic pain due to Corynebacterium urealyticum encrusting cystitis. The relevant literature on this infection is reviewed., Methods: Descriptive case report and a review of the literature (PubMed search)., Results: A 39-year-old woman on maintenance therapy for systemic ANCA-associated vasculitis, diagnosed 10 months earlier and with persistent microscopic hematuria, developed recurrent pelvic pain. She had received several immunosuppressants (including cyclophosphamide and rituximab) since the onset of her vasculitis, as well as cycles of broad-spectrum antibiotics during the acute initial phase of her disease. Computerized tomography of the pelvis and cystoscopy showed several encrusted calcifications in the bladder mucosa, and, finally, urine culture (selective media) led to the diagnosis of C. urealyticum infection. Most of the bladder-encrusted stones were removed during cystoscopy and daily intramuscular teicoplanin injections were given for 14 days. Her symptoms disappeared rapidly and completely. On reviewing the literature, immunosuppression, previous broad-spectrum antibiotics, urogenital alkaline pH, and prolonged bladder catheterization are predisposing factors for this rare infection. C. urealyticum encrusting cystitis has been reported in patients with systemic diseases but not yet in ANCA-associated vasculitis. Outcome is almost always good under adequate antibiotic therapy, mainly glycopeptides., Conclusion: Physicians should be aware of this unusual but potentially emerging infectious complication that can be challenging in ANCA-associated vasculitis, because the urinary tract can be affected by the vasculitis or as a complication of previous cyclophosphamide therapy., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The authors report a case of benign pseudosarcoma of the bladder and emphasize the endoscopic features of the tumour, which were highly suggestive of malignancy, leading to the decision to perform cystectomy. The diagnosis was corrected by endoscopic resection and histology. Treatment usually consists of partial cystectomy, but can sometimes be limited to one or several endoscopic resections.

The technique and results of endoscopic resection of submucosal uterine myoma performed in a series of 42 cases are presented. Following hysterography and hysteroscopy, endoscopic resection is carried out through a dilated cervix and under glycol infusion. The technique is very simple and the duration of the operation never exceeds 30 minutes. The postoperative period is short, and the average length of stay in hospital varies from 24 to 48 hours. Resection of submucosal myoma usually enables treatment with progestins to be discontinued. Moreover, when the submucosal myoma is not very large and solitary this technique offers an alternative to hysterectomy.

Eighteen patients with severe, acute ischemia of the lower limbs were treated with an arterial perfusion of the ischemic leg with Urokinase. This was associated, in thirteen patients, with a limited attempt of revascularization. The result of this treatment was an immediate improvement in twelve cases, which lasted, more than six months, in six patients. The authors insist on the interest of the arteriography performed after the fibrinolytic treatment in order to complete the revascularization.

The authors report 3 cases of acute complicated duodenal ulcers occurring during the course of Listeria meningitis. These three adults (2 females and 1 male) suffered from localised neurological involvement and, in 2 cases neurovegatative disorders an altered level of consciousness. The ulcers were situated in the duodenal cap, and in each case there were at least 2 large excavated ulcers. These ulcers were the site of late complications on the 13th and 15th days after the onset of neurological disease. In two cases the major symptom was haemorrhage, whilst in the third it subsided leaving a syndrome of peritonitis due to perforation. Treatment in all three cases consisted of vagotomy with pyloroplasty (the ulcers being excised or sutured). All the patients recovered from their digestive complications without relapse despite the persistence 6 and 10 months later of the same neurological problems in two of them. All these facts would be in favour of a neurogenic aetiopathogenesis, via the vagal nerve. Thus acute late duodenal ulcers in patients with neurological disease from a separate enity within the context of stress lesions.

This involves a supple metal prosthesis placed in the posterior urethra to relieve cervico-prostatic obstruction whilst allowing for normal function of the striate sphincter as well as satisfactory bladder drainage with normal continence. Easily inserted under local anesthesia and without morbidity, with a perfect functional result in the great majority of cases provided indications are complied with, i.e. essentially prostatic hypertrophy with retention. This prosthesis is designed for use in patients with temporary or permanent contraindications to surgery. Compliance with the very precise technique for insertion, under optical and televisual control, as well as with surgical contraindications (neurological bladder, cerebral arterial sclerosis, concomitant bladder lesion), ensures a good result. This prosthesis thus avoids the need for an indwelling catheter.