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Resume Introduction Les infiltrations de corticosteroides dans le traitement des kystes synoviaux est de pratique courante dans le domaine therapeutique. Cet acte, repute anodin, n’est pas a l’abri de survenue d’incidents pouvant induire des sequelles fonctionnelles. Dans ce contexte, nous rapportons un cas de rupture d’un tendon extenseur de la main faisant suite a une injection locale de corticosteroides et nous discutons les implications medicolegales ainsi que la responsabilite du medecin traitant. Cas clinique Il s’agissait d’une jeune femme, presentant un kyste synovial de la main, pour lequel elle a eu une ponction evacuation du contenu du kyste suivie d’une injection locale de corticosteroides. L’evolution a ete emaillee par une rupture du tendon extenseur du pouce, decouverte apres six mois. Une plainte contre le medecin traitant a ete diligentee en justice. Les experts ont conclu que la rupture tendineuse entrait dans le cadre de l’alea therapeutique. Conclusion Bien que les injections de corticosteroides pour le traitement des kystes juxta-articulaires sont indiquees et constituent un acte relativement benin, des consequences graves, telles qu’une rupture tendineuse, peuvent survenir, parfois meme en dehors d’une administration inappropriee du medicament, d’ou la necessite d’une information adequate du patient, portant sur les differentes complications du geste.

Summary Electrical injuries consist mainly in external burn marks. Internal injuries are rarely observed especially in low-voltage electrocution. In this context, we report two fatal cases due to electrocution by low voltage current (220 volts), with a special emphasis on pathological internal changes. Case no. 1 A 30-year-old male construction worker died after a low-voltage electrocution in the workplace. A medico-legal autopsy was required by judicial authorities. An external examination of the body showed marked facial cyanosis and electrical burn marks on the chest. The autopsy findings showed necrotic lesions of the heart, the thoracic aorta and pulmonary artery. The ischemic lesions were confirmed by histological tests. Case 2 A 20-year-old male was admitted to the Intensive Care Unit for pneumothorax after an accidental low-voltage electrocution. Despite cardiopulmonary reanimation, he died two hours later. An external examination of the corpse showed an electrical burn mark on the right hand. The autopsy findings revealed mainly a right pneumothorax as well as some necrotic lesions in the inferior lobe of the right lung and the anterior face of the liver, which were confirmed microscopically. Discussion-conclusion Death during electrocution by a low-voltage current is uncommon. Visceral necrosis is rarely described in this situation.

Introduction Atrial fibrillation (AF) is the most documented arrhythmia in COVID-19 pneumonia. Left atrial (LA) strain analysis, assessing LA contractility have been associated with the development of new-onset atrial fibrillation (NOAF) in several clinical situations. We aimed to assess the diagnostic ability of LA strain parameters to predict NOAF in patients with severe hypoxemic COVID-19 pneumonia. Method We conducted a prospective single center study at Amiens Hospital University (NCT04354558). The population study was composed of adult patients with a severe or critical Covid-19 pneumonia in sinus rhythm at inclusion. Transthoracic echocardiography was performed within 48 hours of admission. LA strain analysis was performed by an automated software. The following LA strain parameters were recorded: LA strain during reservoir phase (LASr), LA strain during conduit phase (LAScd) and LA strain during contraction phase (LASct). The primary endpoint was the occurrence of NOAF during the intensive care unit (ICU) stay. Results From March 2020 to February 2021, 79 patients were included. Sixteen patients (18%) developed NOAF in ICU. LAScd and LASr were significantly reduced in the NOAF group compared to the other group (8.1[6.3-10.9] vs. 17.2[5.0-10.2]%; P 11% (log rank test P value

Lo sviluppo di un’infezione in un paziente di rianimazione e un elemento di gravita associato a un aumento della mortalita. Il ritardo nella somministrazione di un trattamento antibiotico efficace e un elemento di prognosi negativa. Un quadro di infezione con un rapido deterioramento clinico, una minaccia a breve termine della prognosi vitale, i terreni a rischio particolare, alcuni siti di infezione o l’insorgenza di un’insufficienza multiorgano sono indicazioni per un trattamento antibiotico probabilistico in urgenza. La terapia antibiotica probabilistica deve tenere conto dei batteri abituali e dell’ecologia delle resistenze locali. Il trattamento deve essere rapidamente attivo, in quanto una terapia antibiotica probabilistica inadeguata o ritardata e associata a un eccesso di mortalita. La scelta terapeutica e orientata dall’esame diretto dei campioni batteriologici. Gli elementi relativi al paziente e al suo ambiente permettono di indirizzare la terapia antibiotica probabilistica verso una flora batterica di tipo comunitario o nosocomiale. Il rischio di batteri multiresistenti e notevolmente aumentato in caso di infezione nosocomiale. Il vantaggio di un’associazione di antibiotici e essenzialmente l’allargamento dello spettro antibatterico. La farmacocinetica degli antibiotici nei pazienti di rianimazione e molto alterata, giustificando l’uso di dosi elevate per ottenere concentrazioni efficaci nel sito di infezione e un monitoraggio delle concentrazioni plasmatiche degli antibiotici. Dopo aver ricevuto i risultati batteriologici, e indispensabile un ritorno alla terapia antibiotica efficace piu semplice possibile. Sono rappresentate qui le raccomandazioni recenti per le infezioni piu frequenti in rianimazione.

A 65-year-old woman presented with a neuroendocrine pancreatic head tumor and known liver and bone metastasis. We performed Tc-99m-tektrotyd scintigraphy on this patient, which showed more developed diffuse bone metastases, in addition to the known lesions.

Usually differentiated thyroid cancer is a slow growing tumor with low metastatic potential. We present the case of female patient of 26-years-old who underwent thyroidectomy, followed by 3.7 GBq of 131 I. The post-therapeutic whole-body scan showed intense uptake in the left part of posterior thorax and a faint radioactivity in the upper right tibia. A Chest CT-scan and a localized knee MRI confirm that they are bone metastasis in the middle portion of the 8th right rib and in the upper tibial metaphysic.

Resume Introduction L’embolie pulmonaire pendant la grossesse represente une des premieres causes de mortalite maternelle. Le but de notre travail est d’evaluer chez les femmes enceintes (FE) avec suspicion d’embolie pulmonaire la prevalence des lesions revelees par la scintigraphie pulmonaire de perfusion ainsi que les relations pouvant exister entre ces lesions parenchymateuses et les differents facteurs de risque cliniques et biologiques. Methodes Il s’agit d’une etude retrospective colligeant 116 patientes enceintes adressees pour suspicion d’embolie pulmonaire. L’âge median etait de 30 ans avec des extremes allant de 15 a 47 ans et le terme gestationnel median etait de 31 semaines avec des extremes de 12 a 40 semaines. La suspicion d’embolie pulmonaire a ete etablie devant la presence de signes cliniques (dyspnee, douleur thoracique et de palpitations). Aucune patiente n’avait beneficie d’une radiographie pulmonaire. Les patientes ont beneficie d’une scintigraphie pulmonaire de perfusion planaire avec une activite injectee de 40 a 50 MBq de macroagregats d’albumine humaine (MAA) marques au 99m Tc. Les resultats scintigraphiques ont ete classes selon les criteres de PIOPED, en fonction de la probabilite d’EP. Les scintigraphies avec une probabilite faible ou intermediaire ont ete incluses dans un meme groupe, celui de resultats indetermines. Resultats La scintigraphie etait positive (avec une forte probabilite) chez 16 patientes (13,8 %), normale chez 78 patientes (67,2 %) et classee comme non concluante chez 22 patientes (18,9 %). Chez les 16 patientes avec une scintigraphie positive, les lesions ont interesse le poumon gauche dans 10 cas (62,5 %), le poumon droit dans 1 cas (6,25 %) et ont ete bilaterales dans 5 cas (31,25 %). Conclusions En cas de suspicion d’embolie pulmonaire chez une femme enceinte, le choix de la technique d’imagerie depend, d’une part, de son apport diagnostique et, d’autre part, de ses effets indesirables. La scintigraphie pulmonaire reste l’examen a realiser en premier chez les FE avec une radiographie pulmonaire. Chez les autres, c’est l’angioscanner qui doit etre realise en premiere intention.

Resume Introduction La pyelonephrite aigue est responsable d’une morbidite pendant la phase aigue et de lesions renales irreversibles a distance. Or, son diagnostic est souvent difficile chez l’enfant. Le but de notre travail est d’evaluer chez les enfants hospitalises pour suspicion de pyelonephrite aigue la prevalence des lesions aigues revelees par la scintigraphie a l’acide dimercaptosuccinique marque au 99mTc (DMSA) ainsi que les relations existant entre les lesions parenchymateuses renales et differents facteurs de risque cliniques et biologiques. Methodes Il s’agit d’une etude prospective colligeant 40 enfants hospitalises pour suspicion d’infection urinaire haute. Tous ont beneficie d’une scintigraphie renale au DMSA. Resultats L’âge moyen de nos patients etait de 3,25 ans. La scintigraphie au DMSA a montre des signes de pyelonephrite aigue dans 32,5 % des cas. En prenant cet examen comme reference, la fievre a ete le signe clinique le plus sensible (76,9 %), mais sa specificite n’a ete que de 48,1 %. La CRP (≥ 20 mg/mL) a ete le signe biologique le plus sensible (92,3 %), mais avec une specificite de 40,7 %. Une CRP elevee etait liee a une pyelonephrite aigue d’une facon significative (p = 0,0033). Soixante-trois pour cent des reins refluants ont ete associes a une pyelonephrite aigue versus 20,8 % des reins non refluants, avec une difference significative (p = 0,007). Conclusion En cas d’infection urinaire chez l’enfant, un tableau clinique et biologique complet peut suffire pour retenir le diagnostic de pyelonephrite aigue. Toutefois, cette eventualite est rare. Dans le cas contraire, une scintigraphie au DMSA doit etre realisee pour confirmer le diagnostic.

Background: The early and accurate diagnosis of acute myocardial infarction may be a challenging task for doctors in the emergency room. The patient’s history, electrocardiographic and cardiac markers data are sometimes non diagnostic and misleading which may lead to death. In this case, physician’s responsibility may be engaged. Case report: A 48-year-old man was admitted in the Emergency Department because of chest pain. Exploration (Percritical ECG, enzymatic levels and transthoracic echocardiogram) did not show any abnormality. He received a symptomatic treatment and was allowed to return home. The patient was confined to bed during his stay at home because of persisting chest pain. Two days later, he presented syncope and arrived dead to hospital. At autopsy, an abundant hemopericardium made by coagulated blood was noted, associated with an obstruction of the circumflex of about 90% of its light. A rupture of the myocardium was repaired in the lateral wall of left ventricle, surrounded by a semi recent infarction. Discussion: The peculiarity of this case is the difficulty of the diagnosis of the myocardial infarction because of the normality of the enzymatic assessment and the absence of electric modifications during the crisis and two hours later. Misdiagnosed cases can lead health professionals to legal suits. The claims about diagnostic error can be usually subject to trials in both of penal judgment and compensation trial.

Resume Introduction Les peritonites postoperatoires sus-mesocoliques sont associees a une mortalite pouvant atteindre 50 %. Le module d’intubation par drain de Levy (DDL) est une des modalites de drainage de ces patients, mais son utilisation reste limitee. L’objectif du travail etait de presenter notre experience dans la gestion de ce drain et d’analyser ses resultats. Patients et methodes Entre 2005 et 2010, 190 patients ont ete pris en charge au CHU d’Amiens pour peritonite sus-mesocolique. Parmi eux, 22 patients ayant une fistule gastrique ou duodenale ont ete traites par intubation trans-orificielle par un DDL. La technique operatoire comportait : un vissage du drain dans l’orifice fistuleux, deux modules de lames au contact et une jejunostomie d’alimentation. Les debits etaient quantifies quotidiennement. Il y avait 12 hommes et dix femmes avec un âge moyen de 66 ans. Le delai moyen entre l’intervention initiale et la mise en place du drain etait de 16,1 ± 14 jours. Resultats Le score Apache II moyen etait de 20 (10–28). Le score de Mannheim moyen etait de 28 (19–34). L’ablation du DDL etait realisee en moyenne apres 35,5 ± 11 jours. Six patients (27 %) sont decedes en postoperatoire. Les complications postoperatoires etaient un abces profond (n = 3), une pneumopathie (n = 1), et une evisceration (n = 2). Deux patients ont necessite une reintervention. La duree moyenne d’hospitalisation etait de 70,7 jours. Quatre patients ont presente une fistule chronique. Conclusion Le DDL est un des moyens de traitement des peritonites sus-mesocoliques. Sa gestion necessite une surveillance rapprochee.

Paragangliomas are rare tumors arising from extraadrenal chromaffin cells. We report a 43-year-old man who presented with abdominal pain. An abdominal computed tomography scan revealed a large retroperitoneal mass. During an endoscopic biopsy of this tumor, the patient experienced marked hemodynamic fluctuations with tachycardia and high blood pressure, and an extraadrenal pheochromocytoma was suspected. Measurements of plasma and urinary catecholamines and urinary total metanephrines ruled in the diagnosis. Echocardiography disclosed acute myocardial dysfunction that returned to normal after surgical resection of the paraganglioma. This report also underlines the importance of the anesthetic preparation and monitoring around the surgical procedure and the need of a long-term follow-up to detect malignant paraganglioma in the absence of histological criteria of benign tumor.

Background: The 2005, 2010, and 2017 McDonald diagnostic criteria for multiple sclerosis (MS) were compared at baseline in participants of a Canadian multicentre clinical trial of minocycline in clinically isolated syndrome (CIS). Methods: The cohort included 142 participants. Baseline clinical and imaging data were used to determine if participants met criteria for dissemination in space (DIS) and time (DIT) as required for each version of the criteria. We also explored the impact of permitting a clinical diagnosis of transverse myelitis to represent a spinal cord lesion, and for multifocal clinical onset to represent DIS. Results: The clinical trial excluded patients meeting the 2005 McDonald criteria at baseline. The 2010 criteria were met by 28.9% (41/142) of participants. If a multifocal clinical presentation was considered evidence of DIS 29.6% (42/142) met the 2010 criteria. The 2017 criteria were met by 36.7% (52/142). Allowing a clinical diagnosis of transverse myelitis to confirm a spinal lesion, or multifocal onset to confirm evidence of DIS, led to a diagnosis in 38% (54/142) and 38.7% (55/142), respectively. Conclusions: This study confirms that each revision of the McDonald diagnostic criteria allowed an MS diagnosis in more CIS patients at onset. Exploration of other modifications suggests further improvement may be possible.

Resume L’augmentation rapide et incontrolee du volume des visceres intra-abdominaux peut creer une hyperpression intra-abdominale capable d’engendrer des defaillances renales, gastro-intestinales, hemodynamiques, respiratoires et neurologiques. L’association de defaillances et d’une valeur de pression abdominale au-dela de 15–20 mmHg definit le syndrome compartimental abdominal. Bien connue chez les patients chirurgicaux et traumatises, ce syndrome concerne aussi certains patients medicaux en reanimation. Les symptomes systemiques evocateurs sont principalement un bas debit cardiaque avec acidose metabolique, une oligurie, une hypoxemie et une augmentation des pressions des voies aeriennes. Au maximum, il existe un syndrome de defaillance multiviscerale. La confirmation du syndrome compartimental abdominal est obtenue simplement par la mesure de la pression intravesicale. Ce syndrome pourrait participer a une surmortalite des patients de reanimation. Le traitement specifique reste mal codifie : une decompression chirurgicale rapide pourrait ameliorer le pronostic mais certains traitements medicaux (curarisation, aspiration digestive ou hemofiltration) restent a evaluer. Mieux connaitre le syndrome compartimental abdominal pourrait permettre de mieux traiter certains syndromes de defaillance multiviscerale y compris en reanimation medicale.

Assessing the theoretical knowledge, practical experience of French intensivists, and their compliance with French Anesthesiology and Critical Care Society's difficult airway algorithms of the expert's SFAR conference of 2006.Prospective and descriptive national survey.An anonymous questionnaire with 40 questions was emailed to physicians working in intensive care units in France.Five hundred and eight intensivists answered the survey. Ninety-seven percent of physicians reported having a portable storage unit for difficult intubation. As for practical experience, 421 physicians (83 %) have set up less than 10 laryngeal mask airway, 257 (51 %) have performed less than 10 intubations under fibroscopy and 269 (53 %) have never performed a cricothyroidotomy on mannequin, and 331 (65 %) on a patient. In case of emergency intubation, 29 % of them do not use a rapid sequence induction. Three hundred physicians (59 %) use capnography as monitoring of the endotracheal position. Two hundred and nine (42 %) consider they have not been trained to difficult intubation and 443 (87 %) would like to participate in high fidelity simulations mannequin.National airway management algorithm was insufficiently followed. Alternative techniques do not seem to be mastered by all physicians. French intensivists expect more training on difficult intubation, including high fidelity simulation.

Splenic rupture associated with anticoagulant therapy is a rare entity. We report a case of spontaneous splenic rupture in a 62-year-old man who was treated by acenocoumarol orally after an aortic-valve replacement. Unrecognised, minor trauma may lead to splenic haemorrhage in patients receiving anticoagulant therapy. The symptoms and signs may mimic those of acute myocardial infarction and cardiogenic shock. Early diagnosis is essential. Reversal of the anticoagulant and emergent splenectomy are the treatments of choice.

Storage of cisatracurium at room temperature seems to have no effect on its degradation in vitro contrary to the recommendations of storage at +4°C. The purpose of this study was to evaluate the influence of cisatracurium' s storage temperature on its onset time.Prospective, randomized, double-blind trial study.Thirty patients were enrolled. The control group consisted of 15 patients receiving cisatracurium (0.15mg/kg) stored at room temperature and the intervention consisted of 15 patients receiving cisatracurium (0.15mg/kg) stored at +4°C. The primary endpoint was to compare cisatracurium onset time depending on the storage temperature.Cisatracurium onset time was 235 (180-292) seconds in the "room temperature" group vs. 240 (210-292) seconds in the "refrigerated" group. There was no difference between the onset of cisatracurium depending on the temperature of storage (p=0.51). Subgroups analysis in the "room temperature" group did not show any difference in cisatracurium onset depending on whether it was stored at room temperature for one, two or three weeks. Excellent intubation score was obtained for 100% of the patients.This study demonstrated that cisatracurium's storage at room temperature had no influence on its onset time. It provides an argument for the preservation of cisatracurium at room temperature for a period not exceeding 21 days. Monitoring the onset of curarization may increase the quality score of intubation.

Summary Introduction Postoperative peritonitis arising in the upper abdomen requiring reoperative surgery has a mortality rate of up to 50%. One therapeutic modality for these patients is the use of the Helisonde ® drain, designed by Levy, the Levy Helical Drain (LHD), but it has not seen widespread use. In this paper, we describe our experience in managing supramesocolic peritonitis with this drain at the University Surgical Center at Amiens and we analyze our results. Patients and methods Between 2005 and 2010, we cared for 190 patients with supramesocolic peritonitis in our unit. Of these, 22 patients with gastric or duodenal fistula underwent transorificial intubation with the LHD. There were 12 men and 10 women with a mean age of 66 years. At surgery, the helical drain was screwed into the fistular orifice, two more flat drains were left adjacent to the fistula, and a jejunal feeding tube was placed. The mean interval between the initial surgery and the drainage procedure was 16.1 ± 14 days. Results The mean APACHE II score was 20 (10–28). The Mannheim score averaged 28 (19–34). The LHD was completely removed at a mean interval of 35.5 ± 11 days. Six patients (27%) died postoperatively. Postoperative complications included intraperitoneal abscess ( n = 3), pneumonia ( n = 1), and evisceration ( n = 2). Two patients required reoperation. The average hospital stay was 70.7 days. Four patients had a persistent chronic fistula. Conclusion The LHD is a useful technical device in the treatment of supramesocolic peritonitis. Its management requires close oversight.

Pulse pressure variations are used to assess fluid responsiveness in mechanically ventilated patients. The accuracy of this index in open chest conditions remained unclear. The aim of the study was to evaluate the effect of open chest conditions on pulse pressure variations.Non-interventional prospective study.Twenty-eight mechanically ventilated patients scheduled for open-heart surgery were included. Pulse pressure variations, peak aortic velocity, and stroke volume were measured before and after thoracotomy with pericardotomy. Measurements were made at each step and compared.Neither pulse pressure variation nor peak aortic velocity and nor stroke volume variation were modified by open chest conditions (median=5% [interquartile range=6] vs 4% [6], p=NS), (20% [11] vs 17% [12], p=NS and 11% [7] vs 10% [3], p=NS) respectively. Pulse pressure variations were correlated to stroke volume before thoracotomy (r'=-0.432; p=0.02) and after thorocatomy (r'=-0.433, p=0.02).In these studied patients, preload dependancy indices were not modified by open chest conditions. Pulse pressure variations remained correlated to stroke volume even after thoracotomy.

cataracts preferentially affect the elderly. More than 560,000 procedures are performed annually in France on vulnerable patients that are exposed to cardio-circulatory conditions requiring antiplatelet and/or anticoagulants. Haemorrhagic complications resulting from cataract surgery and/or eye regional anaesthesia are rare but can lead to serious damage to eye function.in this study, we compared the management care of two types of antiplatelet and/or anticoagulants successively utilizing the following procedure: first, the cessation of antiplatelet agents and anticoagulants were relayed with rapid elimination agents (constituting our reference "before" cohort [November 2004-May 2005]), then the antiplatelet or anticoagulant management was continued without stint according to recent data from literature (constituting our "after" cohort (April 2007-March 2008)).a reference population, consisting of 229 patients, was operated on exclusively with "surgical" sub-Tenon's anaesthesia. A second group, consisting of 178 patients, was operated on using "needle" regional anaesthesia. In both populations, nearly 33% of patients received antiplatelet or anticoagulant treatment. The incidence of subconjonctival haemorrhage occurred more frequently when anticoagulants agents were relayed (33% vs 0%; P0,05), but there was no significant difference with antiplatelet agents (23% vs 8%; NS). The most common non-bleeding event was Chemosis and related to the type of anaesthetic technique utilized, although not serious it tended to jeopardize surgical comfort (anticoagulants: 35% vs 36% (NS), antiplatelet agents: 38% vs 40%; NS).the technical changes do not explain fully that occurrence of the HSC, in patients under anticoagulant treatment, decreased in the second period. The achievement of "needle" regional anaesthesia in the anterior segment eye surgery is a safe technique that does not require stopping antiplatelet treatment or anticoagulation.

Paragangliomas are rare tumors arising from extraadrenal chromaffin cells. We report a 43-year-old man who presented with abdominal pain. An abdominal computed tomography scan revealed a large retroperitoneal mass. During an endoscopic biopsy of this tumor, the patient experienced marked hemodynamic fluctuations with tachycardia and high blood pressure, and an extraadrenal pheochromocytoma was suspected. Measurements of plasma and urinary catecholamines and urinary total metanephrines ruled in the diagnosis. Echocardiography disclosed acute myocardial dysfunction that returned to normal after surgical resection of the paraganglioma. This report also underlines the importance of the anesthetic preparation and monitoring around the surgical procedure and the need of a long-term follow-up to detect malignant paraganglioma in the absence of histological criteria of benign tumor.

Splenic rupture associated with anticoagulant therapy is a rare entity. We report a case of spontaneous splenic rupture in a 62-year-old man who was treated by acenocoumarol orally after an aortic-valve replacement. Unrecognised, minor trauma may lead to splenic haemorrhage in patients receiving anticoagulant therapy. The symptoms and signs may mimic those of acute myocardial infarction and cardiogenic shock. Early diagnosis is essential. Reversal of the anticoagulant and emergent splenectomy are the treatments of choice.

Pulmonary calcification is a subdiagnosed metabolic lung disease that is commonly asymptomatic and frequently associated with end-stage renal disease. We report a case of a 21-year-old man with a 4-year history of end-stage renal disease without respiratory symptoms. We discover incidentally on a bone scan a pulmonary calcification. Parathyroidectomy was refused by the patient. After 3 months of medical treatment, a second bone scan was done, and we found a partial response.

Objectif Etudier la place de la scintigraphie thyroidienne dans l’orientation diagnostique et therapeutique des dysthyroidies induites par Interferon. Materiels et methodes Une scintigraphie thyroidienne au pertechnetate (99mTc) a ete realisee chez 9 patients traites par interferon alpha pour hepatite C chronique active et chez qui on a objective une dysthyroidie biologique. Cinq patients avaient un bilan immunologique (anticorps anti-thyroperoxidase et anticorps anti-recepteurs TSH). Resultats L’âge moyen des patients etait de 53 ans (sex-ratio de 0,33). La duree moyenne de traitement par interferon etait de 34,85 semaines. Sept patients avaient une hyperthyroidie avec des Ac anti-TPO positifs dans 3 cas et negatifs dans 1 cas. Les Ac anti-RTSH etaient detectables chez 1 patient. Dans un autre cas les Ac anti-TPO etaient initialement faiblement positif avec apparition d’Ac anti-RTSH 6 mois apres. La scintigraphie thyroidienne avait objective un aspect de thyroidite chez 5 patients, avec transformation en maladie de Basedow (traite par de l’iode radioactif). Les deux derniers patients avaient un aspect de maladie de Basedow. Concernant les 2 patients en hypothyroidie, la scintigraphie thyroidienne presentait un aspect sequellaire de thyroidite, dans un cas et une fixation elevee et diffuse (possible recuperation de la fonction thyroidienne) dans l’autre cas. Conclusion La scintigraphie thyroidienne au Tc99m devrait etre indiquee systematiquement en cas de dysthyroidie induite par Interferon. En effet, elle permet de poser le diagnostic etiologique d’une thyrotoxicose et d’orienter ainsi le choix therapeutique. En cas d’hypothyroidie, l’aspect scintigraphique pourrait predire une possible recuperation de la fonction thyroidienne.

Introduction L’hyperparathyroidie recidivante se definit par la reapparition d’une hypercalcemie 6 mois apres la guerison. Nous essayons de montrer la place de la scintigraphie parathyroidienne TEMP-TDM dans l’hyperparathyroidie recidivante apres chirurgie. Patients et methodes Au total, 25 patients dont 13 femmes et 12 hommes, âges de 28 a 74 ans, atteints d’hyperparathyroidie recidivante, ont beneficie d’une scintigraphie parathyroidienne au 99mTc-Sestamibi double phase, completee par une TEMP-TDM dans le cadre du bilan etiologique. Resultats La scintigraphie etait negative aussi bien en mode planaire qu’en mode TEMP-TDM dans 9 cas. Elle etait negative en mode planaire et positive en mode TEMP-TDM dans 6 cas. Elle etait positive aux deux modes dans 10 cas : 7 cas avaient une localisation ectopique. La TEMP-TDM les avait localises avec precision (2 adenomes cervicaux et 5 mediastinaux). La TEMP-TDM a depasse le mode planaire dans 13 cas (52 %) : 6 cas (46 %) en montrant un adenome parathyroidien non vu au mode planaire et 7 cas (54 %) en localisant avec precision un adenome parathyroidien ectopique. Discussion Dans la scintigraphie parathyroidienne, l’apport de l’acquisition TEMP-TDM depasse celle en mode planaire et notamment dans les hyperparathyroidies recidivantes. Elle permet non seulement de detecter l’adenome parathyroidien mais aussi de le localiser avec precision.

L’utilisation des arteres thoraciques internes du bœuf introduite en France en 1987 par A. Piwmica et al. a repondu aux necessites d’un nombre croissant de reinterventions coronaires ainsi qu’a l’absence de greffons autologues disponibles. Ces greffons d’arteres thoraciques internes bovines ont permis de faire franchir a ces malades un episode aigu de leur maladie coronarienne mais n’ont pas permis de realiser une revascularisation complete et surtout durable. Les thromboses de ces pontages ont ete attribuees a l’absence de formation neo-intima avec constitution d’une couche de materiel proteique ne permettant pas a l’interaction plaquettes endothelium vasculaire de se faire et predisposant ainsi a la thrombose. Ils n’offrent donc pas une alternative satisfaisante aux vaisseaux autologues. Pour notre etude, nous avons explore les arteres thoraciques internes droite et gauche chez trois porcs que nous avons disseques (deux de race mixte et un de race Landrace), pesant en moyenne 82 kg et tous âges de 6 mois. Nous avons a la fois mesure la longueur et le calibre interne de ces arteres thoraciques internes et nous les avons envoyes en histologie afin d’analyser leur structure. L’artere thoracique interne du porc a une structure elastique. Sa paroi est riche en fibres elastiques, et pauvre en fibres musculaires. L’artere thoracique interne du porc a une longueur moyenne de 30 cm et un calibre interne moyen voisin de 3 mm (2,8 mm) de diametre. L’artere thoracique interne du bœuf, bien que de structure mixte, a un calibre interne moyen de 4 mm de diametre.

Pour tenter de comprendre les causes d’occlusion des arteres radiales, epigastriques, utilisees comme greffons dans les pontages aorto-coronariens et ameliorer les resultats, nous avons etudie la biometrie et l’histologie des arteres coronaires, radiales, ulnaires, epigastriques et thoraciques internes. Nous avons preleve ces differents types d’arteres chez 40 sujets anatomiques (27 hommes et 13 femmes). Le calibre interne des arteres radiales, ulnaires, epigastriques, thoraciques internes et coronaires a ete mesure avec des calibreurs de marque Garet Vascular Dilator Scanlay. Nous avons trouve des correlations entre les calibres internes de ces differentes arteres chez l’homme. Le remaniement de l’intima ainsi que la presence de plaques d’atheromes ont ete observes dans les arteres coronaires, radiales et ulnaires mais jamais dans l’artere thoracique interne humaine. Comme les arteres coronaires et leurs branches, les arteres radiales ulnaires et epigastriques sont de type musculaire. Leur vieillissement se traduit par un epaississement de l’intima qui se fibrose, par une migration myocytaire de la media et par un dedoublement de la limitante elastique interne. La media devient fibreuse, hypertrophique et atrophique. A l’oppose, l’artere thoracique interne est comme l’aorte une artere elastique. Le vieillissement se caracterise par la disparition, sur une etendue variable, d’une ou de plusieurs lames elastiques de la media et un epaississement intimal plus marque. Si, anatomiquement, nous n’avons pas trouve de difference entre les arteres coronaires, radiales, ulnaires et epigastriques, la permeabilite des pontages a long terme est en relation avec leur nature histologique, alors que l’artere thoracique interne a une structure differente et une situation protegee, fixee derriere les cartilages costaux.