Rapports de cas cliniques et médicaux

Neurology, as a rapidly evolving field, is witnessing numerous advancements and emerging trends that have the potential to reshape the landscape of diagnosis, treatment and patient care. This critical review article aims to provide an in-depth analysis of the current literature, focusing on the emerging trends in neurology. By critically examining the latest research and scientific developments, we explore key areas such as neuroimaging techniques, biomarkers, genetic discoveries, innovative therapies and technological advancements. This comprehensive review sheds light on the potential implications of these emerging trends for improving patient outcomes, advancing scientific knowledge and shaping the future of neurology.

Precision medicine, a paradigm shift in healthcare, has emerged as a promising approach in various medical specialties, including cardiology. By integrating individual patient characteristics, genetic information, biomarkers and advanced diagnostic technologies, precision medicine aims to optimize treatment strategies and improve patient outcomes. In the field of cardiology, the application of precision medicine has transformed the way cardiovascular diseases are diagnosed, risk-stratified and managed. This review paper provides an overview of precision medicine in cardiology, highlighting its principles, methodologies and impact on clinical practice. It explores the role of genetic profiling, biomarkers, imaging modalities and data-driven algorithms in tailoring treatment plans for cardiovascular patients. Furthermore, it discusses the challenges and future directions of precision medicine, emphasizing the potential of this approach to revolutionize cardiology and enhance patient care.

Borderline Ovarian Tumors (BOT) and Uterine STUMP (smooth tumors of uncertain malignant potential) are tumors with a low or an uncertain potential of malignancy and a high risk of recurrence or metastasis. They are challenging in terms of management and follow-up.

We present a rare association of BOT and uterine STUMP in a 50-year-old woman with abdominal distension. The patient had a history of left oophorectomy and myomectomy. Examination revealed a distended abdomen with a pelvic mass corresponding to uterine enlargement and a right latero uterine mass.

Pelvic ultrasound showed a unilocular anechoic cyst and an enlarged uterus with multiple myometrial masses. On Pelvic MRI the ovarian mass showed papillary projections with marked enhancement and a high-intensity signal on DWI. The uterus was enlarged with multiples masses. One of the masses showed an intermediate signal on DWI.

The patient underwent exploratory laparotomy, there was a bulky right adnexal mass with an enlarged and bosselated uterus. A radical hysterectomy and a right oophorectomy were performed.

The pathological examination of the ovarian mass showed cell proliferation, with slight nuclear atypia and micropapillary patterns, without stromal invasion corresponding to a serous borderline tumor.

The examination of the Uterus showed ten stromal tumors: One tumor presented diffuse moderate to severe cellular atypia without coagulative cell necrosis evoking STUMP.

The patient is on close follow-up for 2 years postoperatively with no signs of recurrence or metastasis.

Purpose: To present the clinical, functional outcomes of radiofrequency ablation in three cases of focal atrial tachycardia arising from the right atrial appendage (RAAT).

Method: A retrospective case series reporting the profile, pre-ablation presentation, catheter ablation process and post-ablation outcome of focal atrial tachycardia originating in the right atrial appendage of three patients who had been masquerading as inappropriate sinus tachycardia before ablation. After catheter ablation, three patients had a minimum of three months follow-up. A retrospective analysis was performed to identify two patients with LV dysfunction, defined as an ejection fraction <50% on echocardiography. Recovery of LV function was also assessed.

Results: The patients were one female and two males aged 29, 14 and 54, respectively. All RAAT was confirmed and eliminated successfully with mapping and ablation. Post-ablation electrocardiogram from two cases demonstrated a negative notched P-wave in leads V1 and V2 during RAAT compared with a beat of sinus rhythm and one case remained the same as pre-ablation ECG pattern in P-wave in leads V1 and V2. After successful ablation, LV function was restored in two patients at three months. The symptoms of palpitations and dyspnea were significantly improved in all patients.

Conclusion: RAAT is likely to be misdiagnosed as sinus tachycardia and induce cardiac insufficiency. Long-term restoration of LV function can be achieved after successful catheter ablation of the tachycardia focus.

Object: The thistle is an herbaceous plant known for its toxicity; it contains two diterpenic heterosides the Atractyloside and the carboxyatractyloside, which are mitochondrial poisons, disrupting cellular respiration. The clinical manifestations of thistle poisoning are digestive, neurological and hematological disorders. But there are also mild forms of poisoning. We report the case of a 9 month old female infant with no personal and family medical pathological history, admitted to the PII service in a table of jet vomiting associated with consciousness disorders and hypoglycaemia, the biochemical assessment found hepatic cytolysis. The history revealed the notion of local administration of thistle in powder form on diaper rash of the infant. The outcome was favorable with symptomatic treatment based on N-acetyl cysteine.

Conclusion: The use of phytotherapy can induce very significant toxic incidents. Prevention and public awareness remains one of the most effective ways to address this great problem.

Sarcomas in irradiated tissues are often considered second cancers and, among these, Angiosarcoma (AS) is an aggressive, malignant endothelialcell tumour of vascular or lymphatic origin. AS can arise in any site of the body, but it very rarely occurs in major blood vessels or in the heart.

We report the case of 51-year old woman who developed a cardiac AS 20 year after chemoradiation therapy for bulky non-Hodgkin’s disease.

She was healthy until December 2013 when, because of persistent dyspnea, the family physician prescribed an echocardiographic exam that evidenced an intracavitary left atrial mass that caused functional severe mitral stenosis. After complete surgical excision, the mass was confirmed to be high grade AS. No residual tumor was detected by a post-operative cardiac magnetic resonance (MRI) and a positron emission tomography (PET) scan didn’t show images of neoplastic masses in other sites.

The patient was treated with adjuvant chemotherapy. She died 27 months after diagnosis.