Cerebral thromboembolism after direct current cardioversion for pure atrial flutter.

The need for prophylactic anticoagulation before electrical cardioversion for atrial arrhythmias is clearly established in the case of atrial fibrillation. By contrast, such prophylaxis is not a current standard of care before cardioversion for pure atrial flutter, since this arrhythmia seems not to increase the risk of postcardioversion embolism. We present a patient who developed two cerebral embolisms 24 h after electrical cardioversion for pure atrial flutter.

[Nontraumatic coma in extramural practice].

After a short review on pathophysiologic mechanisms of comatose states and their complications, a cohort of 392 comatose patients (Glasgow Coma Scale < or = 8) hospitalized in intensive care is analyzed in order to estimate the relative frequency of the different causes of nontraumatic coma. Depending on pathology, the following practical, sequential procedure is recommended: at first, identification and treatment of disorders of vital functions, objective estimate of the severity of the coma and rapid diagnostic orientation with a targeted neurologic investigation; then, simple therapeutic interventions in order to treat reversible causes of a metabolic encephalopathy as well as immediate measures for neuroprotection (anticonvulsive and antihypotensive therapy, oxygen, etc.).

[Anaphylactic shock].

Anaphylactic shock is an unexpected, sudden and sometimes deadly event that attacks the patient in 75% of the cases without pre-existent history of allergy. In general, drugs, hymenopteric poisons and nutrients (according to the recent concept) are responsible. Beside the classical IgE-mediated anaphylactic shock there exists another anaphylactic shock, identical in its clinical picture and treatment but not in the mechanism of development.

[Myocardial lesion secondary to defibrillation. Literature review and practical implications].

A 39 years old patient was defibrillated during the acute stage of an inferior myocardial infarction. He presented an elevation of the ST segment in the right precordial leads immediately after resuscitation. The evolution of the electrocardiographic changes were characterised by the development of a septo-apical subepicardial necrosis, whose sequelae remained nine months after the initial event.

[Late post-traumatic pericardial effusion. Identification of promoting conditions and literature review apropos of 2 cases].

The authors report two cases of post traumatic haemopericardium discovered 18 days after a iatrogenic penetrating trauma (sternal puncture) for the first one, and 102 days after a fall with blunt thoracic trauma and multiple associated injuries, for the second one. After admission, the first case rapidly developed a severe tamponade requiring a pericardial drainage, of 420 ml of non coagulated blood. The second case, in spite of a volume of liquid of more than 1000 ml, showed only a fatigue and a dyspnea, without any sign of haemodynamic failure.

[Prevention of recurrence of thromboembolic disease: maintenance of anticoagulant therapy].

Deep venous thrombosis and pulmonary embolism are frequently diagnosed in patients encountered in a primary-care practice. Poor prognosis is related to acute sudden death and to recurrent thromboembolic disease. Anticoagulant therapy with heparin followed by coumarin derivatives is highly effective in preventing such recurrences, but the intensity of anticoagulation must be strictly monitored.

[Arrhythmogenic ventricular dysplasia or Uhl's disease?].

Uhl's anomaly and arrhythmogenic right ventricular dysplasia are characterized by an analogous morphologic lesion which can be attributed to a major or minor expression of the same genetic disorder. The clinical diagnosis of arrhythmogenic dysplasia is not always easily established. A 23-year-old patient is discussed who showed extrasystolic arrhythmia, electrocardiographic signs of myocardial impairment and syncopes, the latter proving fatal.

[Activities of intensive care units in 1986].

Based on a yearly evaluation carried out by the Swiss Society for Intensive Care Medicine and the Swiss Nurses Association, statistical reports for 1986 from 72 recognized intensive care units are presented.

Pharmacokinetics of tenoxicam in healthy human volunteers.

Tenoxicam, a thieno-thiazine derivative, belongs to a new chemical class of non-steroidal anti-inflammatory drugs. Single dose kinetics was investigated after intravenous and oral administration to define the disposition and general absorption characteristics of the drug. After intravenous administration of 20 mg tenoxicam to 12 volunteers the time course of the plasma concentrations of unchanged drug followed two-compartment model characteristics.