Une jeune fille de 11 ans était adressée pour un syndrome appendiculaire. La laparotomie révélait un hémopéritoine brunâtre et une dilatation de la trompe de Fallope droite, alors que l’appendice ...paraissait sain. Une appendicectomie de principe était, malgré tout, réalisée. Le diagnostic d’hématocolpos compliqué d’hématométrie avec hématosalpinx et hémopéritoine était alors suspecté. L’inspection vulvaire confirmait l’imperforation hyménéale avec une collection sus-jacente tendue visualisée en échographie pelvienne sus-pubienne et endorectale. Une hyménotomie permettait l’évacuation de 400cc d’un liquide « chocolat ». L’interrogatoire rétrospectif révélait des douleurs abdominopelviennes récidivantes motivant de nombreuses consultations au service des urgences. Les suites s’avéraient simples permettant la sortie de la patiente au 2e j postopératoire.
A case of imperforate hymen discovered after a surgical complication is reported. We discuss the lessons to draw from this case in terms of diagnosis and therapeutic management.
An 11-year-old girl was referred with fever and acute lower abdominal pain. A diagnosis of appendicitis was hypothesized because of rigidity located to the right iliac fossa, a psoas sign, polynuclear leukocytosis, and increased serum C-reactive protein. A McBurney laparotomy showed a brownish hemoperitoneum and a dilated right fallopian tube. The appendix appeared normal and an appendicectomy was done. A diagnosis of hematocolpos aggravated by hematometra, hematosalpinx, and hemoperitoneum was suspected. Pelvic examination revealed an imperforate hymen with a taut pelvic mass confirmed by transabdominal and endorectal ultrasonography. Hymenotomy was performed, which allowed the discharge of 400cc of chocolate-colored fluid. The history-taking revealed recurrent intermittent lower abdominal pain with several referrals to emergency departments. The patient recovered uneventfully and was discharged 2 days later.
In case of acute abdominopelvic pain in pubertal girls with no previous menstruation, the possibility of an imperforate hymen must be suspected. Examination should include observation of secondary sexual characteristics and inspection of the external genitalia. Treatment is surgical and consists of a hymenotomy.
Full text
Available for:
IJS, IMTLJ, KILJ, KISLJ, NUK, SBCE, SBJE, UL, UM, UPCLJ, UPUK
L'intérêt de la mesure de la procalcitonine pour le diagnostic des infections néonatales est en cours d'évaluation.
Ce paramètre a été étudié au cours d'une enquête prospective réalisée dans les ...unités de réanimation néonatale et de néonatologie du centre hospitalier universitaire de Clermont-Ferrand, afin de comparer son intérêt à celui de la protéine C réactive. Les nouveau-nés admis avant 24 heures de vie ont été inclus dans l'étude s'ils n'avaient pas reçu préalablement des antibiotiques. Cent deux nouveau-nés ont été inclus et répartis en quatre groupes: groupe 1:41 nouveau-nés non infectés, groupe 2:33 nouveau-nés présentant une infection possible, groupe 3: dix nouveau-nés présentant une infection probable et groupe 4:18 nouveau-nés présentant une infection bactérienne ou fongique prouvée. La protéine C réactive et la procalcitonine ont été mesurées à j0, j1, j3 et j8.
Pour la procalcitonine, les valeurs seuils étaient de 1,5 ng/mL à j0, et 10 ng/mL à j1, en raison de l'existence d'un pic physiologique à j1. Une différence statistiquement significative a été observée entre les groupes 1 et 4 pour la procalcitonine et pour la protéine C réactive tant à j0 qu'à j1. La protéine C réactive présentait une meilleure spécificité. En revanche, la procalcitonine, outre sa meilleure sensibilité, présentait une valeur prédictive négative supérieure.
L'apport de ce nouveau paramètre s'avère donc intéressant, surtout à j0, même si les mécanismes et les facteurs qui influencent sa production sont encore mal connus.
The value of procalcitonin (PCT) measurement is not presently completely assessed for the diagnosis of neonatal infections.
This parameter was assessed in a prospective study in the neonatal intensive care unit of ClermontFerrand Hospital (France) in comparison to C-reactive protein. All newborn infants admitted before 24 k of life (day 0) in the neonatal intensive care unit were included in the study. Newborns (102) were assigned to one of four groups: group 1: noninfected ewborns (
n = 41); group 2: possibly infected newborns (
n = 33); group 3: probably infected newborns (
n = 10); group 4: confirmed infections (
n = 18 bacterial or fungal infections). C-reactive protein and PCT were determined in the sera at D0, D1, D3 and D8. We determined the optimal cutoff value of PCT using the Receiver Operating Characteristic curves (R.O.C.).
The cutoff value is 1.5 ng/mL at D0 and 10 ng/mL at D1. PCT cutoff value is significantly higher at D1 because of a significant PCT peak on the first day of life independent of any infectious stimulus. Our study shows that at D0 and D1 infected newborn infants had significantly higher mean PCT and C-reactive protein values than non infected newborn infants. C-reactive protein has a better specificity but PCT has better sensitivity and negative predictive value.
PCT seems to be an interesting marker of neonatal infections especially during the first 24 h of life even though the mechanism of PCT synthesis remains unclear.
Full text
Available for:
IJS, IMTLJ, KILJ, KISLJ, NUK, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
A case of imperforate hymen discovered after a surgical complication is reported. We discuss the lessons to draw from this case in terms of diagnosis and therapeutic management.
An 11-year-old girl ...was referred with fever and acute lower abdominal pain. A diagnosis of appendicitis was hypothesized because of rigidity located to the right iliac fossa, a psoas sign, polynuclear leukocytosis, and increased serum C-reactive protein. A McBurney laparotomy showed a brownish hemoperitoneum and a dilated right fallopian tube. The appendix appeared normal and an appendicectomy was done. A diagnosis of hematocolpos aggravated by hematometra, hematosalpinx, and hemoperitoneum was suspected. Pelvic examination revealed an imperforate hymen with a taut pelvic mass confirmed by transabdominal and endorectal ultrasonography. Hymenotomy was performed, which allowed the discharge of 400cc of chocolate-colored fluid. The history-taking revealed recurrent intermittent lower abdominal pain with several referrals to emergency departments. The patient recovered uneventfully and was discharged 2 days later.
In case of acute abdominopelvic pain in pubertal girls with no previous menstruation, the possibility of an imperforate hymen must be suspected. Examination should include observation of secondary sexual characteristics and inspection of the external genitalia. Treatment is surgical and consists of a hymenotomy.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The effect of a change in the first line antibiotic treatment in a neonatal unit was studied. A total of 238 neonates (G1), admitted between 1 January and 31 July 1989, and treated with gentamicin, ...were compared with 398 (G2) admitted between 1 August 1989 and 31 July 1990 who received amikacin, in the combination of ampicillin plus an aminoglycoside. This change was implemented in an attempt to prevent the spread of an epidemic strain of Enterobacter cloacae resistant to third generation cephalosporins and all aminoglycosides, except amikacin. The change in treatment had no effect on the incidence of nosocomial infections 19.7% (G1) vs. 16.3% (G2) RR = 1.21 (0.86-1.70), but the proportion of patients with nosocomial infections caused by the E. cloacae decreased (6.3% vs. 2.0% RR 3.14 CI 1.35-7.28). Certain trends in the bacterial ecology emerged: E. aerogenes and Enterococci increased in G2. The proportion of gentamicin-resistant strains such as E. cloacae or Staphylococci decreased and there was no increase in aminoglycoside-resistant strains, except in Escherichia coli, in which resistance to amikacin rose from 0 to 3%. This study illustrates the influence of antimicrobial therapy on the species and the resistance of strains isolated in nosocomial infections. It also highlights the need for epidemiologic surveillance, and poses the question of how best to modify antibiotic policy.
