An unusual manifestation of hyperkalemia

An 82 years old patient was admitted to the emergency department complaining since 15 days of fatigue, dizziness and lipothymia. He had a history of hypertension and diabetes; and had undergone a coronary bypass in 2005. His physical examination showed a blood pressure at 160/50mmHg, a heart rate at 26cycles/min, and he was afebrile. On admission the ECG showed a third degree atrioventricular bloc with a regular rhythm at 26 cycles/min, P wave was absent, QRS complex was not wide (<0.10ms) and the T wave was not “tente like”, tall, peaked and symmetric, it was negative in the inferior territory and the ST segment was underlined in the laterobasal derivations. The laboratory findings included a serum potassium level of 6.9mEq/l (normal 3.6-5.5), sodium 132mEq/l (normal 135-140), creatinine 30mg/l (6-14) and urea nitrogen 0.82g/l (0.17-0.43), MDRD clearance was at 20ml/min (normal>80). The arterial blood gas analysis revealed a pH of 7.32, pO2=115mmHg, and pCO2=34mmHg. The patient was treated immediately with furosemide, bicarbonate serum, calcium gluconate, glucose solution, and insulin, after three hours, the ECG showed normal sinus rhythm with visible P waves, a heart rate at 60cycles/min and a shortening of the QT interval in comparison with the first ECG. Blood potassium at this moment was at 5.60mEq/l. Hyperkalemia is known to cause a depression of the conduction velocity and excitability of the pacemaker cells and conduction tissues, resulting generaly in an advanced atrioventricular bloc with wide QRS complex. In this case the QRS remained normal

Kyste hydatique du foie révélé par sa fistulisation dans le thorax

Une patiente âgée de 28ans, sans antécédent pathologique particulier, avec notion de contact avec les chiens (hébergement d'un chien au domicile), accusait depuis 2 mois des douleurs basithoraciques droites avec gêne respiratoire. Dix jours avant son hospitalisation, le tableau s'est aggravé par l'apparition d'une toux sèche, une asthénie et une fièvre. L'examen clinique a révélé un syndrome d'épanchement basi thoracique droit. La patiente a bénéficié d'une radiographie thoracique de face (A), qui montrait un épanchement liquidien pleural droit de moyenne abondance sans foyer parenchymateux visible. Une tomodensitométrie thoracoabdominale a montré un épanchement liquidien pleural droit associé à une scissurite, l'épanchement communiquant par le biais d'une fistule avec une lésion arrondie, hypodense, bien limitée du dôme hépatique, renfermant une calcification périphérique et ne se rehausse pas après injection de produit de contraste (B). Le complément échographique réalisé a confirmé la présence de la lésion du dôme hépatique avec les caractères sémiologiques suscités (C). Biologiquement, on notait une discrète élévation de la VS à 15mm la première heure avec une sérologie hydatique positive. La patiente a bénéficié d'une chirurgie avec drainage de liquide pleural et fermeture de la fistule. L'évolution post opératoire était favorable. Le kyste hydatique est une parasitose due au développement de la forme larvaire d'échinococcus granulosus. L'hôte habituel est le chien, l'homme étant l'hôte intermédiaire. Toutes les localisations sont possibles. La fistulisation dans le thorax est beaucoup plus rare et varie de 2 à 5% selon les séries.Pan African Medical Journal 2015; 2

Complication rare et grave de la rachianesthésie: la méningite bactérienne (à propos d’un cas et revue de la littérature)

La rachianesthésie (RA) est la première anesthésie locorégionale. Elle comporte des effets secondaires et des risques qu'il faut pouvoir éviter, prévenir ou traiter précocement. C'est le cas d'une patiente opérée sous rachianesthésie qui a présenté quelques jours après l'interventionde céphalées intenses associées à des nausées et des vomissements évoluant dans un contexte de fièvre. La ponction lombaire mettait en évidence un liquide trouble avec la présence de cocci gram + à l'examen direct, ce qui a permis de poser le diagnostic d'une méningite bactérienne et dont l'évolution a été favorable après antibiothérapie.Mots clés: Méningite bactérienne, rachianesthésie, nosocomiale, complication grave, asepsieEnglish Title: Rare and severe complication of spinal anesthesia: bacterial meningitis (about a case and literature review)English AbstractSpinal anesthesia (SA) is the first locoregional anesthesia. It can cause side effects and carry risks that need to be avoided, prevented or treated early. We here report the case of a female patient operated under spinal anesthesia who had intense headache associated with nausea and vomiting evolving in the context of fever within a few days after surgeryLumbar puncture showed cloudy liquid revealing Gram + cocci on direct examination. This allowed the diagnosis of bacterial meningitis. Patient’s evolution was favorable after antibiotic therapy.Keywords: Bacterial meningitis, spinal anesthesia, nosocomial, serious complication, asepsi

Thrombolysis for acute ischemic stroke by tenecteplase in the emergency department of a Moroccan hospital

Introduction: Thrombolysis has radically changed the prognosis of acute ischemic stroke. Tenecteplase is a modified form of rt-PA with greater specificity for fibrin and a longer half-life. We report the experience of a Moroccan tertiary hospital in thrombolysis using Tenecteplase. Methods: We conducted an open prospective study of all patients who were treated with Tenecteplase for an acute ischemic stroke admitted to our emergency department. Tenecteplase was administered intravenously at a dose of 0.4 mg/kg single bolus. The primary outcome measure was the proportion of patients achieving significant early neurological recovery defined as an improvement of 4 or more points on the NIHSS score at 24h. Results: 13 patients had been treated by intravenous thrombolysis. 31% were women. Mean age was 63 years old. The mean NIHSS score at admission was 14.3 and 24h after was at 9.1. The right middle cerebral artery was involved in 69% of cases. The carotid atherosclerosis was predominant 63.3% and the cardio embolic etiology 27%. The mean time to the first medical contact after the onset of symptoms was 3h 30 min. One patient presented a capsulo-lenticular hematoma of 5 mm3 in the same side of the ischemic stroke. Conclusion: Tenecteplase is a more interesting thrombolytic than alteplase, it seems to be more suitable for thrombolysis in our center.Keywords: Acute ischemic stroke, thrombolysis, tenecteplas

Synthesis, crystal structure and mono-dimensional thallium ion conduction of TlFe(0.22)Al(0.78)As(2)O(7)

A new solid solution TlFe0.22Al0.78As2O7 has been synthesized by a solid-state reaction. The structure of the title compound has been determined from a single-crystal X-ray diffraction and refined to final values of the reliability factors: R(F2) ¼ 0.030 and wR(F2) ¼ 0.081 for 1343 independent reflections with I42s(I). It crystallizes in the triclinic space group P-1, with a ¼ 6.296(2)A ˚ , b ¼ 6.397(2)A ˚ , c ¼ 8.242(2)A ˚ , a ¼ 96.74(2)1, b ¼ 103.78(2)1, g ¼ 102.99(3)1, V ¼ 309.0(2)A ˚ 3 and Z ¼ 2. The structure can be described as a threedimensional framework containing (Fe/Al)O6 octahedra connected through As2O7 groups. The metallic units and diarsenate groups share oxygen corners to form a three-dimensional framework with interconnected tunnels parallel to the a, b and c directions, where Tl+ cations are located. The ionic conductivity measurements are performed on pellets of the polycrystalline powder. At 683 K, The conductivity value is 5.23106 S cm1 and the ionic jump activation energy is 0.656 eV. The bond valence analysis reveals that the ionic conductivity is ensured by Tl+ along the [001] directio

Une dysphagie révélant une artère sous-clavière droite aberrante: à propos d’un cas

Nous rapportons le cas d'une patiente ayant une dysphagialusoria, c'est-à-dire une dysphagie en rapport avec un trajet aberrant de l'artère sousclavière droite. Le diagnostic a été confirmé par un angioTDM thoracique et une artériographie des troncs supra-aortiques. Le traitement est toujours chirurgical.Pan African Medical Journal 2016; 2

Conservative treatment of a psoas hematoma revealed by a lower limb palsy

The psoas hematoma is a rare complication of the anticoagulation therapy. It cause abdominal or lumbar pain, muscle dysfunction and sometimes nerve palsy. The optimal treatment is not well established, surgery or conservative treatment? We report here a case of psoas hematoma revealed by a lower limb palsy

Management of Ischemic Stroke during cardiac catheterization: A case report and review of literature

Stroke following coronary interventions is a devastating and most dreaded complication with signiβicant morbidity and mortality. Various factors have been ascribed for this complication including the technical errors [1]. A small percentage of strokes are iatrogenic, including those associated with invasive cardiac procedures. According to the literature, it is a rare complication of left heart catheterization [2]. Percutaneous coronary intervention is increasingly used to treat patients with diffuse atherosclerosis, acute coronary syndromes and even high-risk patients such as low ejection fraction [1]. The authors describe a patient who underwent percutaneous coronary intervention in the context of inferior infarction, which was complicated by ischemic stroke during cardic catheterization