[Short emergency hospitalization].

In France, the number of admissions to emergency departments increase by 5 to 10 per cent per year. Traditionally, patients who require services beyond the first hours in the emergency department have been admitted to the acute care hospital. Observation unit are becoming common in hospitals because they allow an additional option to admission or discharge.

Prevalence and consequences of nutritional depletion in lung transplant candidates.

Nutritional status was studied in lung transplant (LT) candidates. The hypotheses were that nutritional depletion was highly prevalent and lean body mass depletion was a risk factor for a higher mortality both before and after LT. Of 78 consecutive patients listed for LT, 16 (21%) died while on the waiting list, eight (10%) were alive awaiting LT, and 54 (69%) received a graft.

[Lung volume reduction in patients with emphysema after prolonged ventilatory assistance].

A 42-year-old patient with emphysema was hospitalized in the intensive care unit for an episode of acute respiratory failure. The patient became dependent on invasive mechanical ventilation and surgical lung volume reduction was performed. The indication of lung volume reduction in this pathological situation but was followed by rapid weaning 48 hours postoperatively.

Successful stenting of a pulmonary arterial stenosis after a single lung transplant.

A 44 year old patient with end stage idiopathic pulmonary fibrosis underwent single left lung transplantation. A perfusion lung scan performed 13 days after transplantation revealed deficient perfusion in the transplanted lung. Pulmonary angiography showed severe pulmonary artery anastomotic stenosis.

[Neuromeningeal listeriosis in adults. Clinical aspects and contribution of cotrimoxazole in monotherapy].

A series of 28 patients suffering from neuromeningeal listeriosis is reported. This disease is consecutive to infection by Listeria monocytogenes--an ubiquitous and opportunistic Gram-positive bacillus--and has become a public health problem: its incidence is increasing and its prognosis is very severe despite the development of new bacteriological identification methods. Human beings are contaminated by food, which explains the frequent outbreaks of epidemics which are widely publicized, the infection being one of the consequences of the unprecedented development of the food industry and the cold food chain.

Double lung transplantation for adult respiratory distress syndrome after recombinant interleukin 2.

Patients suffering from acute respiratory failure are considered poor candidates for lung transplantation (LT). We report a successful double lung transplantation performed in a patient with adult respiratory distress syndrome (ARDS). The 32-year-old woman received recombinant interleukin 2 (rIL-2) three months after an autologous bone marrow transplant for acute myelogenic leukemia as consolidation treatment.

Removal of circulating tumor necrosis factor. Its role in septic shock treatment.

The tumor necrosis factor (TNF) is a polypeptide secreted by macrophages in response to endotoxins, especially from Gram-negative bacteria. Previous investigations suggest that TNF plays a prominent role in septic shock and meningococcal disease toxicity. A positive correlation was found between the initial serum TNF level and the patient's outcome.

[Should metabolic acidosis be alkalinized?].

At present, the administration of bicarbonate for metabolic acidosis has become controversial with regard to the indications and the modalities of treatment. Scientific evidence of the therapeutic value of bicarbonate is still lacking. In the opposite, there is a strong evidence of its adverse effects, such a paradoxical acidosis, sodium load and over all a worsening of haemodynamic status.

[Heterotopic hepatic transplantation in fulminating hepatitis].

Based on a rare case of heterotopic hepatic transplantation (HHT) carried out in a 24 year old woman for fulminant hepatitis of viral origin, the authors present the technique used and the principal post-operative events (rejection, resistant large volume ascites and the clinical course for the liver itself). They discuss the rarity of success in this type of graft, where the causes of failure in man have not been entirely elucidated: the venous pre-existing portal hypertension is probably a very unfavorable factor. The place of this particular type of HHT in cases of acute severe hepatic failure is then proposed: this may produce a smaller operative insult than orthotopic transplantation and, in this respect, deserves consideration when advanced hepatic encephalopathy is present, notably due to delay in finding a suitable graft.

[Can zinc deficiency in the mother be responsible for the occurrence of spina bifida aperta in the fetus?].

The occurrence in the fetus of closure defects of the neural tube and especially spina bifida aperta (SBA) has been related, by some authors, to nutritional deficiencies of the mother, in addition to well-known genetic factors: a folic acid deficiency and more recently a zinc deficiency have been evoked. The retrospective study of 23 couples mother/newborn selected from the presence of a SBA in the child, and 14 reference couples, shows that the mothers of children with SBA have a zinc blood level lower than that of the reference group; this result is confirmed by the alkaline phosphatases and zinc enzymes which are markedly decreased. Measurement of the incorporation of radioactive zinc in the skin fibroblasts shows, in case of SBA, in the mother, an increased incorporation rate, and in the newborn a decrease of that rate in relation to the reference group.

[Use of helium and oxygen mixtures in status asthmaticus].

Four patients in status asthmaticus and with alveolar hypoventilation were given a helium-oxygen (He-O2) mixture to breathe during 4 hours. Clinical improvement and return to normal of arterial blood gas levels were rapid and dramatic in all patients. The He-O2 mixture, which is a low density gas, causes a reduction in pulmonary resistance and an improvement in overall alveolar ventilation.

[Severe neurologic complications secondary to poisoning by slow-release theophylline].

Three cases of severe slow-release theophylline toxicity (plasma theophylline levels above 30 mg/l) in patients with severe chronic pulmonary disease are reported. Seizures were noted in all patients, and one had tachyarrhythmia. Two of the patients died.

Peripheral venous complications of a hyperosmolar (960 mOsm) nutritive mixture: The effect of heparin and hydrocortisone. A multicenter double-blinded random study in 98 patients.

Peripheral intravenous nutrition with hyperosmolar solutions usually results in a high rate of venous complications. The aim of this multicenter double blind randomised study in 98 patients has been to measure: (a) tolerance by the peripheral veins being perfused with a protein-glucose-lipid nutritive mixture of 960 mOsm/l (group A, n = 33), (b) the protective effect of the additive to the nutritive mixture of either heparin: 1000 IU/1 (group B, n = 32) or heparin with hydrocortisone (5 mg/l) group C, n = 33). Tolerance by the veins was evaluated on a single vein site during a 48 h perfusion with 21 per day.

Effect of parenteral nutrition on muscle amino acid output and 3-methylhistidine excretion in septic patients.

The effects of adequate total parenteral nutrition (TPN) on nitrogen excretion, urea N percentage, 3-methylhistidine excretion, and leg amino acid output, were studied during the ten-day period following abdominal surgery for generalized peritonitis in nine patients. The first two postoperative days were without nutritional intake, TPN was started on the third postoperative day (57 cal/KgBW--40% as Intralipid--0.30 g of N/KgBW).

[Mesenteric clamp syndrome complicating pancreatic trauma (author's transl)].

Duodenal obstruction by the mesenteric artery has mostly been reported in profoundly denutrated patients. We here report one case after left spleno-pancreatectomy following pancreatic isthmus rhexis concerning a seventeen years old injured young boy, who was kept in supination position because of a backbone fracture. Vertebral osteo-synthesis allowed a quickly efficient postural treatment.

[Controlled therapeutic "evisceration" in so-called "terminal" peritonitis (author's transl)].

Absence of closure of the abdominal wound following reoperation for severe peritonitis is an additional therapeutic technique in dealing with peritoneal infection. However, this technique poses the problem of covering the loops of the small intestine in order to avoid fistulisation in the exposed viscera. The loops are initially protected by a "wound protector" or covered with a plate of polyurethane foam.

[Peritoneal irrigation and lavage using iodinated polyvinyl-pyrrolidone in acute generalized peritonitis (70 cases treated in an intensive care unit)].

The authors report 70 cases of severe acute generalise peritonitis treated during the immediate postoperative periode by peritoneal irrigation-lavage using iodinated polyvinyl-pyrrolidone for 16 days. All of the patients were hospitalised in an intensive care unit because of septicaemia, respiratory distress, acute renal failure, etc. After an aetiological study of these cases of peritonitis, the technique of installation and surveillance and the complications of peritoneal irrigation-lavage are analysed.