Large outbreak in a surgical intensive care unit of colonization or infection with Pseudomonas aeruginosa that overexpressed an active efflux pump.

During a 30-month survey, 55 patients were colonized or infected by a single clone of Pseudomonas aeruginosa in a surgical intensive care unit (ICU). This clone overexpressed an efflux pump system, and its antibiotic resistance pattern was extremely stable as it spread from patient to patient. Pulsed-field gel electrophoresis showed that isolates from different patients were genetically identical or very similar.

Unilateral pure thalamic asterixis: clinical, electromyographic, and topographic patterns.

Eleven patients (nine with infarctions and two with primary hematomas) with isolated thalamic lesions and contralateral asterixis were examined using a standard electromyographic and neuroimaging protocol. Asterixis was a short-duration phenomenon associated with a hemiataxia hypesthesia syndrome in all patients. Electromechanical synchronization was constant for the two silent period types.

Arterial territories of the human brain: cerebral hemispheres.

The development of neuroimaging has allowed clinicians to improve clinicoanatomic correlations in patients with stroke. Anatomic structures are well delineated on MRI, but there is a lack of standardization in their arterial supply. As in our previous study depicting the arterial supply of the brainstem and cerebellum, we present a system of 12 axial sections of the hemispheres depicting the dominant arterial territories, the most important anatomic structures, and Brodmann's areas.

[Localizations and consequences].

The symptoms of amyloidosis depend on the type of precursor, the amount of deposits and their location. In systemic amyloidosis almost every organ may be involved. Cardiac involvement is severe, especially in AL amyloidosis, responsible for restrictive cardiomyopathy with right ventricular failure, leading rapidly to death.

Removal of piperacillin in critically ill patients undergoing continuous venovenous hemofiltration.

Objective: Continuous hemofiltration is now widely used in the intensive care unit. Our study aimed to assess the removal of piperacillin under continuous hemofiltration and to define a suitable dosage regimen of administration.

Design: Prospective study of blood and ultrafiltrate concentrations of piperacillin to assess the pharmacokinetics of the antibiotic.

Inhaled nitric oxide in patients with pulmonary embolism.

Objective: To describe the use of inhaled nitric oxide (NO) in four patients with severe pulmonary embolism.

Setting: The intensive care unit (ICU) of a university teaching hospital.

Patients: Four patients with severe pulmonary embolism on the basis of clinical, haemodynamic or blood-gas parameters received NO by inhalation either during spontaneous respiration (two cases) or while mechanically ventilated (two cases).

Influence of hypertonic monosaccharide infusions on the release of plasma arginine vasopressin in normal humans.

Six healthy men were investigated to determine the osmotic efficiency of hypertonic monosaccharide solutes on the release of plasma arginine vasopressin (AVP). Twenty percent hypertonic glucose infused at 0.187 mmol/kg body weight/min.

Arginine vasopressin response to insulin-induced hypoglycemia in insulin-dependent diabetics with asymptomatic hypoglycemia.

Insulin-induced hypoglycemia causes an increase in plasma vasopressin (AVP) in healthy subjects but the response in diabetics is not established. We investigated the effect of insulin-induced hypoglycemia on ten insulin-dependent diabetics with asymptomatic hypoglycemia, and compared the results with those for seven healthy subjects. The lack of adrenergic symptoms of hypoglycemia in insulin dependent diabetics being attributed to a diminished beta-adrenergic sensitivity, the effect of isoprenaline infusion was investigated as control.

Polyneuropathy: an unusual extraintestinal manifestation of Crohn's disease.

Among the extraintestinal complications of Crohn's disease, neuropathy seems to be rare, and is only exceptionally reported in the literature. The authors present the report of a patient followed over a 12-year period who developed polyneuropathy with a parallel course to Crohn's disease. There was no evidence of any other underlying condition.

[Hand-Schüller-Christian disease with tumor localization in the posterior fossa].

A 19-year-old girl had been suffering since the age of 4 from Hand-Schüller-Christian disease. The condition was diagnosed by biopsy of a cranial bone lacuna. Later on, she developed diabetes insipidus and bilateral exophthalmos, both being typical signs of Hand-Schüller-Christian disease.

[Multiple autoimmune syndromes].

The possibility of three or more autoimmune diseases occurring in the same patient cannot be fortuitous and suggests a pathogenic relationship between each of them. In the light of 4 personal cases, the authors have recorded 87 reports of such associations in the literature, an analysis of which leads them to propose a classification of three types of multiple autoimmune syndrome. The grouping of these syndromes under a single heading should make the research and analysis of these morbid associations easier.