Severe heart failure secondary to 5-fluorouracil and low-doses of folinic acid: usefulness of an intra-aortic balloon pump.

Objectives: To report 5-fluorouracil in combination with folinic acid as a cause of severe nonischemic heart failure and to demonstrate the potential usefulness of an intra-aortic balloon pump.

Design: Case report.

Setting: An adult, 19-bed medical/surgical intensive care unit of a university hospital.

Prone position in mechanically ventilated patients with severe acute respiratory failure.

The purpose of this study was to characterize changes in oxygenation, expressed as PaO2/F(I)O2, when patients with severe acute respiratory failure (PaO2/F(I)O2 < 150), unrelated to left ventricular failure to atelectasis, were turned to and from a supine to prone position at 1- and 4-h intervals. Ventilator settings were unchanged. Thirty-two consecutive patients were studied 1 h before, 1 and 4 h during and 1 h after placing in a prone position with PaO2/F(I)O2 of 103 +/- 28, 158 +/- 62, 159 +/- 59, and 128 +/- 52, respectively (ANOVA, p < 0.

[-Emergency surgical treatment of acute carotid occlusion-].

Conservative medical treatment of acute occlusion of the extracranial internal carotid artery usually gives mediocre results. When a major neurological deficit is involved, mortality can reach 16 to 55%, morbidity due to definitive deficit 40 to 69% and cure only 2 to 12%. It is thus logical to attempt revascularization as an emergency procedure.

Hepatic cytolytic and cholestatic changes related to a change of lipid emulsions in four long-term parenteral nutrition patients with short bowel.

Long-term parenteral nutrition hepatic-related impairment is commonly reported and diversely explained. However, with a low cyclic caloric intake (100% to 130% of basal metabolism calculated with the Harris-Benedict formula) consisting of two-thirds glucose, one-third lipid, and 0.20 to 0.

Short- and long-term prognosis, functional outcome following ICU for elderly.

Among 1532 ICU patients we analysed 295 elderly patients (19%) aged more than 70-years-old. We determined prospectively the immediate and subsequent one-year outcome with a study of the predictive value of their ICU admission parameters. Then we followed the ICU survivors over the year after discharge (1, 6, 12 months) by quality of life questionnaires.

Severe falciparum malaria (21 cases).

The incidence of severe falciparum malaria is increasing in the developed countries and mortality remains high despite progress in intensive care management and schizonticide treatment. Many authors emphasize the importance of exchange transfusion (EXT) in the most severe cases. We studied 21 cases (34 +/- 12 years, 6 females; SAPS: 8.

Prognostic significance of early intracranial and cerebral perfusion pressures in post-cardiac arrest anoxic coma.

The prognosis of prolonged cardiac arrests is generally related to brain damage due to the cerebral anoxia. A neurological worsening leading to irreversibility is sometimes associated with an increase in intracranial pressure. We studied for 5 years the early intracranial and cerebral perfusion pressures in 84 patients with deep anoxic coma after cardiac arrest.

[Massive small bowel resection. Apropos of 27 cases].

27 patients were admitted in the Digestive intensive care unit of Croix-Rousse Hospital after a massive bowel resection (residual bowel 120 cm). The etiology was of vascular origin in 15 cases. The length of intestine was nil in 4 cases, between 20 and 50 cm in 12 cases, and between 50 and 120 cm in 11 cases.

Early effects of nimodipine on intracranial and cerebral perfusion pressures in cerebral anoxia after out-of-hospital cardiac arrest.

Some calcium entry blockers seem to improve the neurological survival of anoxic comas. The early monitoring of intracranial pressure shows the frequency of intracranial hypertension. A calcium channel blocker has been shown to increase the cerebral blood flow which can potentially lead to deleterious increases of the intracranial pressure.

[Current modalities of mechanical ventilation for acute respiratory failure in chronic respiratory insufficiency].

Acute respiratory failure in patients with chronic obstructive lung disease is a frequent and serious complication, with a mortality rate of 20 p. 100 and 57 p. 100 of the patients kept under mechanical ventilation for more than two weeks.

[Prognosis of acute pneumococcal respiratory insufficiency requiring mechanical ventilation].

A retrospective study was carried out between 1980 and 1988 in an attempt to determine the prognostic factors in pneumococcal pneumonia requiring mechanical ventilation. Thirty-six of the 57 patients studied died (63 per cent). The initial severity of the lung disease, was the same in the patients who died and in those who survived.

[Subpleural air cysts. A complication of barotrauma during mechanical ventilation].

The presence of air in the interstitial pulmonary tissues is shown as interstitial emphysema and is often the first sign of barotrauma. It results from hyper-pressure in the airways occurring for the greater part of the time on some underlying pulmonary pathology. This extra alveolar air may diffuse into the interstitium and collect under the visceral pleura, appearing on radiographs as air cysts from 3 to 10 centimeters in diameter.

Nosocomial maxillary sinusitis during mechanical ventilation: a prospective comparison of orotracheal versus the nasotracheal route for intubation.

Nosocomial maxillary sinusitis during mechanical ventilation may cause life-threatening complications in ICU patients. The aim of this prospective study was to compare the incidence of maxillary sinusitis according to the route of intubation. 111 consecutive adult patients (mean age: 53, mean SAPS: 12) were randomly assigned to receive either orotracheal (n = 53) or nasotracheal (n = 58) intubation.

Continuous arteriovenous haemodialysis during emergency hepatic retransplantation: two case reports.

Two patients with severe hepatic and renal failure underwent emergency hepatic retransplantation (2nd and 6th day after transplantation). Continuous arteriovenous haemodialysis was begun before surgery and successfully performed, without any incident, during the retransplantation with a biospal (SCU/CAVH AN 69 S) device, without pump. Vascular access was obtained with femoral catheters.

[Diagnosis of post-traumatic pleural effusion].

A rare case of post-traumatic pleural effusion is reported. A 19 year old male patient was admitted after a road traffic accident with a scalp wound, femoral shaft fracture and haematuria related to a ruptured bladder. Shortly after extubation following bladder surgical repair, the patient had to be reintubated because of acute respiratory failure.

Comparison of nonbronchoscopic bronchoalveolar lavage to open lung biopsy for the bacteriologic diagnosis of pulmonary infections in mechanically ventilated patients.

We compared nonbronchoscopic bronchoalveolar lavage (NB-BAL) with open lung biopsy to determine the etiological diagnosis of lung infiltrates in patients requiring mechanical ventilation. NB-BAL was performed via a cuffed reusable 7F catheter generally used for right heart catheterization (BAL-C). In 13 patients, BAL-C and open lung biopsy were performed in the same lobe immediately after death when the ventilator was still functioning.