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We report a case of central nervous system toxicity induced by ropivacaine following a brachial block at the humeral canal. Forty millilitres 0.75% ropivacaine (4.28 mg·kg–1) were used uneventfully, with slow injections and negative intermittent aspirations. Fifteen minutes later, the patient presented two episodes of generalised convulsions treated by diazepam, 20 mg. The total venous ropivacaine concentration measured two hours after the block was 2.3 mg·l–1. [Copyright &y& Elsevier]

This is a case report about a 54-year-old man with hypovolemic shock, due to diarrhea and major vomiting after his return from India. The isolation of Vibrio cholerae serogroup O1 (Ogawa serotype) explains this typical clinical presentation of cholera, seen in 10% of cholera cases only. The patient had co-infection with Vibrio cholerae and Campylobacter coli. Co-infections appear to be frequent in endemic areas. The purpose of this case report is to recall the relevance of Vibrio isolation when the clinical context is evocative (diarrhea on travel return, raw sea food consumption).

A 21-year old woman from New-Caledonia had 40 ̊C fever with vomiting, arthralgia, myalgia, and measles-like rash. Etiological analyses showed primary infection with Zika virus. Because of severe clinical presentation, she was hospitalized in the intensive care unit of the Brest military Hospital. Zika virus is mainly transmitted by Aedes mosquitoes. If they settle in Metropolitan France, Zika virus might also spread there.

Baclofen is an agonist of peripheral and central B gamma-aminobutyric acid receptors, whose activation causes a myorelaxation and a powerfull depression of the central nervous system. Moreover, it has an action against addiction, in reducing craving. Commercialized since 1975 in France, to control muscle spasticity due to medullar affection or multiple sclerosis, it receives a temporary recommendation of use in march 2014, as a last-line adjuvant treatment in alcohol withdrawal. Beyond its therapeutic use, baclofen is involved in many self-induced intoxications. We report the case of a patient who develops, after a massive ingestion of baclofen (supposed dose ingested: 1 200 mg), a hypotonic and calm coma, requiring her admission in our intensive care unit, and then a status epilepticus.

Acute arsenic poisoning is a rare cause of suicide attempt. It causes a multiple organs failure caused by cardiogenic shock. We report the case of a patient admitted twelve hours after an ingestion of trioxide arsenic having survived thanks to a premature treatment.

A 24-years old Gabonese women with sickle cell disease had a severe vaso-occlusive crisis, which was treated by exchange transfusion. Then, she developed an extended bone marrow necrosis and needed repeated blood transfusion. The aim of this article is to relate an rare sickle cell disease complication.

Succinylcholine is a short-term curare which degradation depends on its quick hydrolysis by butyrylcholinesterase (or pseudocholinesterase). Thus, a butyrycholinesterase deficiency, congenital or acquired, is a cause of a prolonged neuromuscular block. From an autosomal recessive inheritance, genetic deficiency remains the first etiology. The most frequently discussed variant is the atypical variant which caused a 2 hours prolonged curarisation after administration of succinylcholine. We report a patient who had a prolonged curarisation after succinylcholine's injection, due to a congenital butyrylcholinestérase deficiency and contributed by a lithium treatment. Extubation was only possible 7 hours after administration of curare.

We report a case of a 47 years old woman. In her case of medical history, there were vein thrombosis and an allergic to tinzaparin. The patient entered in critical care unit under medical supervision for a multivisceral infarction due to an arterial mesenteric, renal and splenic thrombosis. An heparinotherapy was introduced. A laparotomy was realized because of an occlusion. Small intestine necrozed was removed. 8 days after the introduction of the heparin, there was a thrombocytopenia. Considering the background and the initiale situation, an heparin-induced thrombocytopenia of type II (HTI) was suspected. Whereas the heparinotherapy was stopped, the thrombocytopenia maked worse. Biological tests infirmed HIT's diagnosis. A recurrent anemia in spite transfusions associated to a renal failure suggest a thrombotic microangiopathy which was secondary confirmed. The intensivist is sensibilized to evoke an heparin induced thrombocytopenia when there is a thrombocytopenia under heparin. However, he must not forget diagnosis of thrombocytopenia which required specific investigations and emergency treatment such as thrombotic microangiopathy.

Falciparum malaria is a potentially deadly infectious disease, imposing a sure and fast biologic diagnosis, an early and efficient treatment. We report a case of severe imported Falciparium malaria who received artesunate, and we rewiew the different diagnostic methods of malaria as well as the clinico-biological characteristics of severe malaria. Recent data concerning malaria treatment are presented, as a pharmacokinetic study leaded during this case.

Sickle cell disease is the genetic disease most frequently detected at birth in France. The comprehension and knowledge of its pathophysiology allow to establish the principles of management for the drepanocytic patient, especially in the perioperative phase. In the light of recent recommendations published for anesthesia of a drepanocytic adult, this clinical case revealed allows to reexamine that subject, with a focus on biological aspects, which are transfusional strategy and antibioprophylaxy. The presented observation is a concrete feature of daily collaboration between clinician and biologist, which is an essential point of the ISO standard EN 15189 concerning laboratories' accreditation.

We report a case of a female patient of 47 years old who presents in a state of septic shock with acute insufficient respiratory complicated with syndrome of acute respiratory distress, together with a list of abdominal pain and polyarthralgia too. In her case of medical history, it is retained that she has had a intra-uterine device since 6 years without medical follow up. The initial thoraco-abdomino-pelvic scan shows a left ovarian vein thrombosis, as well as the opaqueness alveolus diffused interstitiel bilaterally and an aspect of ileitis. The IUD is taken off because of sudden occuring of purulent leucorrhoea. This results in a clinical and paraclinical improvement, whereas aminopenicillin was administered to the patient since 1 week. The microbiological blood test allows to put in evidence Fusobacterium necrophorum found in a blood culture and is sensitive to the amoxicilline-acide clavulanique and metronidazole. Isolation of this bacteria, classically found in Lemierre's syndrome, allowed to explain the multilfocalization of the symtoms and the list of pain. The whole concerns about a variant of Lemierre's syndrom: a state of septic shock secondary then caused by the anaerobic Gram negative bacilli, which is a commensal bacteria of the female genital tractus, complicated of septic emboli typical.

We report the case of a 35-year-old woman hospitalized in intensive care unit after valpromide self-poisoning (Dépamide). The dose supposed to be taken was 15 g. The patient eleven hours after ingestion, presented, a coma with bilateral non-reactive mydriasis, justifying intubation and mechanical ventilation. An acidosis (pH = 7.24), a hyperlactatemia (2.72 mmol/L), a hyperammonemia (328.9 micromol/L), and were diagnosed valproic acid plasmatic concentration was 1190 microg/mL at 22 hours. Symptomatic treatment and L-carnitine therapy (50 mg/kg/12h) normalized the action of biological abnormalities and allowed disappearance of symptoms; the patient was extubated after 46 hours, and outcome from intensive care unit at 65 hours.

We have detected 410 microcytosis among biological tests of military people. These microcytosis are principally coumpounded by haemoglobin's abnormalities (minor thalassemia, sickle cell diseases, E haemoglobin cases and cases of C haemoglobin) and cases of iron deficiency, usually among women.

Population migration is increasing the number of systemic mycosis cases, a condition little or not present in Metropolitan France, thus often weakly documented for medical teams. Paracoccidioidomycosis is a systemic mycosis geographically confined to Latin America. The causative agent is Paracoccidioides brasiliensis, a dimorphic fungus present at ground level. Discovering that the armadillo was a new host allowed documenting the ideal conditions for this fungus development. The mortality rate is currently 1.45 for one million people and the disease affects mainly farmers. The mode of infection is respiratory and all organs and mucous membranes can be affected by lymphatic dissemination. The chronic form with pulmonary, cutaneous and oral lesions is the most important. The diagnosis can be carried out by direct examination of samples revealing the presence of budding yeasts, as well as culture at 25 and 37 degrees C. Antifungals like the sulfamethoxazole-trimethoprime combination, amphotericin B, but especially azole derivatives are use in the therapeutic management of patients. Detection and gp 43 antigen assay is useful for the patient's follow-up.

We report the case of a 77-year-old man, with nefopam postoperative analgesia, who developed subacute neurological symptoms, whereas he had profound hypoprotidemia and acute renal failure. Chronological, semiological and bibliographical criteria are in favour of causality assessment. The plasma nefopam concentration (135 ng/ml) during the neurological symptoms is another argument.

Objectives: The N-terminal pro brain natriuretic peptide (N-BNP) is a promising cardiac natriuretic peptide used as a clinical hormonal marker in cardiac dysfunction. The main stimulus for N-BNP synthesis and secretion is cardiac wall stress, which is recognized as a common denominator of many cardiac diseases. Diving is associated with environmental factors leading to variations in thoracic blood volume and hemodynamic changes. The purpose of the present study was to examine the changes in the concentration of N-BNP in healthy men during and after scuba diving., Method: There were 10 healthy military divers (mean age 33 yr) who performed a dive in the sea for 1 h at 10 m depth. Venous blood samples were taken at timed intervals to allow evaluation of plasma levels of N-BNP at different steps, namely at To (before immersion), at T30 min (during the dive, after a short surfacing), at T60 min (right after surfacing), at T300 min (post-dive), and finally at T24 h. Peptide blood concentrations were determined by electrochemoluminiscence immunoassay. Data were analyzed using parametric statistics., Results: When compared with To, the results show a significant increase of N-BNP levels (in % of baseline levels) at T60(128 +/- 5%, p < 0.043) and at T300 (149 +/- 8%, p < 0.001)., Conclusion: This preliminary study reveals that N-BNP rises with scuba diving. Our findings suggest that diving involves a mechanical strain on the heart with a persistent endocrine myocardial activity post-dive.

We report a case of wood alcohol (methylated spirits) poisoning in a 40-year-old chronic alcoholic. The initial diagnosis of state of drunkenness was supported by the increased plasma level of ethanol (4.66 g.L-1) obtained with enzymatic method. The confirmation, using gas chromatography (GC), showed an unexpected peak with a retention time at 1.19 min, characteristic of methanol (0.41 g.L-1). The GC analysis of the absorbed beverage revealed a 5% methanol content. The osmolal gap was 115 mOsm.kg-1, with 13 mOsm.kg-1 due to methanol and 90 mOsm.kg-1 to ethanol. Seven hours after the ingestion, the anion gap was at 13 mmol-1. This result reflected the inhibition of methanol oxidation by alcohol-dehydrogenase, when the plasma ethanol concentration was above 1 g.L-1. This concentration was maintained by continuous intravenous administration of (Curéthyl-A) a 95% ethanol containing solution, until methanol concentration decreased below 0.2 g.L-1. The outcome was favourable without neurological and ophthalmological sequelae.

Cardio-vascular diseases are the most common cause of death in industrialized countries. A new marker has emerged among offending risk factors in the past few years: homocysteine. This sulphured amino-acid is an important intermediate in transsulphuration and remethylation reactions of methionine's metabolism. We proposed to evaluate a home made method of determination for this parameter by high performance liquid chromatography (HPLC) and to compare it to fluorescence polarization immunoassay technique (FPIA) and to gaz phase chromatography (CG-SM). This method associated with good sensibility and precision remain much less expensive than FPIA technique.