Iatrogenic events contributing to ICU admission: a prospective study.

Objective: To determine the incidence, risk factors, severity, and preventability of iatrogenic events (IEs) as a cause of intensive care unit (ICU) admission.

Design: Comparison of patients admitted or not for IE. IE was diagnosed after assessing independently predefined criteria.

Changes in BP induced by passive leg raising predict response to fluid loading in critically ill patients.

Objective: To test the hypothesis that passive leg raising (PLR) induces changes in arterial pulse pressure that can help to predict the response to rapid fluid loading (RFL) in patients with acute circulatory failure who are receiving mechanical ventilation.

Design: Prospective clinical study.

Setting: Two medical ICUs in university hospitals.

Outcome of older patients requiring ventilatory support in intensive care: impact of nutritional status.

Objectives: To determine predictors of mortality in the intensive care unit (ICU) and at 6 months after discharge; to assess the lifestyles of survivors 6 months after discharge.

Design: Prospective cohort study of patients screened upon admission and 6 months after discharge from the ICU.

Setting: The ICU of a university hospital.

[Septic shock caused by Pasteurella multocida in alcoholic patients. Probable contamination of leg ulcers by the saliva of the domestic cats].

Background: Pasteurella multocida septicemic septic shock without scratches in chronic alcohol abusers are rare and paucibacillar. Chronic legs ulcers could be predisposing factors. Three severe cases of such diseases with early multiple organ failure without endocarditis despite 3, 5 and 3 positive blood cultures respectively are reported.

[Weber-Rendu-Osler disease: pulmonary arterio-venous malformation with shunt disclosed after 5 occurrences of purulent meningococcal encephalitis].

Hereditary hemorrhagic telangectasis or Weber-Rendu-Osler disease is associated with the presence of capillary malformations with pulmonary visceral shunts. These shunts are the cause of recurrent infections of the nervous system by loss of the anti-infectious lung filter. Hereditary hemorrhagic telangiectasis was diagnosed in a 68-year-old woman with a history of epistaxis, cutaneous telangectasis, purulent and pyogenic brain abscesses and meningitis.

[Cerebrospinal fluid complement and antinuclear antibodies in lupus meningoencephalitis].

Central nervous system involvement in systemic lupus erythematosus (SLE) requires immediate treatment. We report a case in a 30-year-old woman. Clinical features associated asthenia, headache, right nystagmus and coma.

[Septic shock with coma revealing typhoid fever].

Background: Typhoid fever may be difficult to distinguish from malaria. Septic shock, encephalopathy and leukopenia are common features of both diseases.

Case Report: A 20-year-old South Korean woman was admitted to the intensive care unit with coma and shock.

[Legionnaires' disease with acute respiratory insufficiency. Clinical and biological characteristics, comparison with pneumococcal pneumonia].

Objectives: Legionnaires' disease is one of the main etiologies of bacterial pneumonias because of its frequency as well as its potential severity. The therapeutic choice implies the need to look for distinctive clinical, biological or radiological signs, due to the unreliability of rapid immunological criteria. Pneumococcus is the first cause of bacterial pneumopathy.

Outcome of elderly patients requiring ventilatory support in intensive care.

The objectives of the study were: 1) to evaluate mortality in elderly patients requiring ventilatory support in Intensive Care Unit (ICU) and at 6, 12 and 18 months after discharge from ICU; 2) (main objective) to determine predictors of mortality in ICU and after discharge; and 3) to assess the life-style of survivors. One hundred and ten consecutive hospitalized patients > or = 70 years were included in this retrospective study. Follow-up evaluation was conducted by telephone interview.

[Malaria, pregnancy and prophylaxis].

We present two case histories. The first is a case of congenital malaria in a newborn whose Laotian mother immigrated into France 2 years ago. The other is a case of very severe malaria with fetal death in a 28 year old woman who was 8 months pregnant and who had come back to France from Gabon where she had lived for 2 years.

[Onset of convulsive crises with theophylline therapy at therapeutic doses].

Six patients treated with theophylline, including five with advanced chronic obstructive pulmonary disease, developed generalized seizures with serum theophylline concentrations ranging from 7 to 21 mg/l. Cerebral computed tomographic scans showed a small sylvian infarction in one patient. In the other five patients nothing, except theophylline, could account for the seizures.

[Central pontine myelinolysis and hyponatremia].

Central pontine myelinolysis is a rare, but probably underreported, complication of the treatment of severe hyponatraemia. The typical presentation, with pseudobulbar palsy, quadriplegia and locked-in syndrome, made the diagnosis clinically possible in the two new cases reported. It was confirmed by computed tomography (CT).

[Hypercapnic status asthmaticus. Rapid reversibility of hypercapnia under medical treatment].

Fifty-four episodes of hypercapnic status asthmaticus (Pa CO2 50 mmHg or more) were treated with intravenous theophylline (6 mg/kg over 30 minutes, then 1 mg/kg/hour), intravenous hydrocortisone hemisuccinate (1 g then 500 mg 4-hourly) rehydration and oxygen therapy at a sufficient rate to obtain a Pa O2 of 80 mmHg or more. As a rule, improvement was rapid with a significant decrease of mean Pa CO2 values from 61 +/- 14 to 44.5 +/- 11.

[Tetanus. An appraisal of 503 cases (author's transl)].

Five hundred and three patients with tetanus were hospitalized in the intensive care unit of "Hôpital Bretonneau" between January 1st, 1960 and December 31, 1979. An analysis of all these 503 cases is undertaken herein. The results of a similar study by the authors concerning 254 cases of tetanus were published in this journal in 1971 [16].

[Tumor of the adrenal gland associating pheochromocytoma and ganglioneuroma (author's transl)].

An adrenal gland tumor associating of both a pheochromocytoma and a ganglioneuroma was discovered upon its fissuration in a 58-year-old male having a family history of neurofibromatosis. The patient's clinical course was fatal due to complications of necrotizing enteritis which was discovered at laparotomy. The association of pheochromocytoma, ganglioneuroma, and "café au lait" spots in the same patient illustrates the polymorphism of neural crest dysgenetic pathology.

[Laryngeal edema and alveolar hypoventilation as primary manifestations of hypothyroidism (author's transl)].

Laryngeal manifestations are well known and relatively frequent in hypothyroidism. For example horseness, which is due to edematous infiltration of the larynx and vocal cords is often the patient's chief complaint, prompting his initial consultation with a specialist. Of much rarer occurence, however is the concomitant development of laryngeal edema and acute respiratory failure.

[Transfusional malaria. Another case (author's transl)].

Transfusional malaria is an unusual disease. Any fever, happening immediately after blood transfusions must evoke this diagnosis, confirmed by parasites detection in the blood. The treatment is rapidly efficacious.

[Acute intoxications by tricyclic antidepressants (author's transl)].

The authors report 87 cases of acute voluntary intoxications with tricyclic antidepressants. They essentially studied the cardiac complications; and conclude that the prognosis is more severe than for other intoxications.

[Paroxysmal paralytic myoglobinuria. Restatement according to a personal observation (author's transl)].

The authors relate the case of a 24 year old man with deadly evolution in keeping with a paroxysmal paralytic myoglobinuria. Clinical, biological and histological studies of this disease are successively recorded. The pathogenesis is obscure.