[Acidosis in severe acute asthma].

On admission to intensive care units, the acid-base profile in acute severe asthma appears to be more diverse than previously. Especially a mixed or less frequently metabolic acidosis is eventually observed, which is not always caused by elevated lactate. On the other hand, hyperlactatemia is actually rather common, not necessarily accompanied by acidosis.

[Recent data on the physiopathology of septic shock].

This review is going on to emphasize recent advances of the pathophysiology of septic shock (SS) which goes-between the systemic inflammatory response syndrome (SIRS) and the multisystem organ failure (MOF). By several recent studies, our knowledge of the cellular and molecular pathophysiology of the SS has dramatically increased. Bacterial products, immunocompetent cells, soluble mediators, and cell-cell interactions between blood cells and endothelium have been reviewed.

[Spontaneous and iatrogenic pneumothorax in the adult. 217 personal cases].

This study is dedicated to the epidemiology of pneumothoraces (217 cases) during the last 8 years in an Intensive Care Department where most patients were admitted for respiratory diseases. Cases resulting from road-injury or surgery were excluded. Spontaneous pneumothoraces accounted for 61.

[Metabolic alkalosis].

Metabolic alkalosis (MA) only occurs after bicarbonate administration if given quickly and massively, or in the presence of renal failure. Most cases of MA are caused by a loss of hydrogen ions. This paper reviews the common causes (gastric aspiration, chronic diuretic therapy) and updates the list of drugs which may lead to this complication.

[Hemodynamic effects of enoximone and comparison with dobutamine in patients with chronic respiratory insufficiency and pulmonary arterial hypertension].

The aim of this study was to assess the effects of enoximone on the right ventricle and pulmonary hypertension in 10 patients (53 to 84 years) with chronic obstructive airway disease resulting in acute or chronic respiratory failure requiring mechanical ventilation in 9 cases. These effects were compared with those of dobutamine. All patients were in sinus rhythm and 6 had signs of right ventricular failure.

[Current humoral profile in acute severe asthma].

This study examined the relationships between acid-base disorders, hypoxemia, electrolyte imbalances, plasma adrenaline (Ad) and noradrenaline (NAd) in 94 patients with acute severe asthma. Criteria of inclusion were [PaO2 + PaCO2/.8] less than 140 mmHg when breathing air (FiO2 = 21%) and/or PaCO2 greater than or equal to 45 mmHg.

[Treatment of severe acute asthma in adults].

Although abnormal blood gases are unusual in status asthmaticus, hypercapnia indicates a considerable increase in bronchial resistance. The authors report their experience of 106 personal cases of acute severe asthma. Emergency management of acute respiratory failure consisted in symptomatic therapy (low rate oxygen or mechanical ventilation after nasal intubation).

[Therapeutic importance and tolerance of coated 50 mg Vectarion tablets (almitrine bismesylate) at a dosage of 100 mg/day. Study of blood gas, clinical and biological results after a year of long-term treatment].

The objectives of this study, in which Almitrine bismesylate was administered for one year in chronic bronchitics with obstructive hypoxia, were to assess its clinical and gasometric efficacy and its clinical, laboratory, spirometric and electrocardiac acceptability. The blood gas results show a significant rise in PaO2 (p less than 0.001) rising by 5.

Diffuse interstitial pneumonitis due to aspiration of gastric contents.

Two cases of interstitial pneumonitis are described which developed after the acute phase of aspiration pneumonitis. Open lung biopsy revealed an interstitial, granulomatous foreign body response induced by foodstuff aspiration. Steroid treatment was administered and both cases then showed a favourable course, with the pulmonary lesion healing within 12 days.

[Changes in the electrocardiogram in status asthmaticus].

The aim of this study, based on the electrocardiographic analysis of 42 patients in status asthmaticus, is to define the basic criteria which may be used as a basis for electrocardiographic differential diagnosis. The following ECG changes were observed: the pulmonary "p" wave is common, sometimes with exaggerated amplitude in peripheral leads, however, in the precordial leads, the voltage of the "p" wave is reduced; most cases have a vertical heart with clockwise rotation and mild right axis deviation, S1 Q2 Q3 and the transitional zone displaced to the left. Ten cases also had a S1 S2 S3 appearance and three cases showed Q1 Q2 Q3, simulating myocardial infarction; there is poor progression of the R wave in the precordial leads and marked persistence of the S wave in the left precordial leads.

[Fatal pneumopathy linked to subcutaneous injections of liquid silicone into soft tissue].

The case of a 23-year old transsexual male who developed a lethal lung disease 48 hr after a 1 l subcutaneous silicone fluid injection is reported. Histologic examination showed optically empty oil red O negative vacuoles in several specimens, and particularly in the lungs; refractile particles of silicium were also found. We identified the material as silicium, and evaluated its quantity in tissues by atomic absorption and spectrometric and toxicological analysis.

Adult respiratory distress syndrome and silicone injection.

This report describes a case of adult respiratory distress syndrome (ARDS) after massive subcutaneous injections of silicone. The patient, a 23 year-old transsexual man, treated with mechanical ventilation, died on the 12th day of hospital, in septic shock and refractory hypoxemia. Autopsy findings revealed empty vacuoles surrounded by macrophages in various organs, especially in lung tissue.

[Acute respiratory and circulatory failure. Prognostic value of plasma fibronectin levels].

Plasma fibronectin (FNp) concentrations were measured in 63 patients with acute respiratory failure and 28 patients with circulatory failure, using Laurell's electroimmunoassay method. Measurements were made in the acute phase and repeated in the course of the disease. The mean FNp concentration in 20 controls was 262 +/- 59 mg/l.

[Acute gangrenous acalculous cholecystitis disclosed by postoperative septic shock].

Three cases of acute gangrenous acalculous cholecystitis, revealed by a postoperative septic shock, are reported. Clinical examination was negative and the surgery gave the diagnosis. Infection with biliary stasis and ischaemia accounts for this pathological entity.