Intrathecal use of amikacin: a case report

Meningitis caused by Acinetobacter baumannii is rare and are mostly hospital acquired after neurosurgical procedure. We report a case of a 40-year old man was admitted to the intensive care unit due to subarachnoid haemorrhage. Our patient developed a ventriculitis due to A.baumannii treated successfully with sulbactam IV and intrathecal amikacin.

Intrathecal use of amikacin: a case report.

Meningitis caused by Acinetobacter baumannii is rare and are mostly hospital acquired after neurosurgical procedure. We report a case of a 40-year old man was admitted to the intensive care unit due to subarachnoid haemorrhage. Our patient developed a ventriculitis due to A.baumannii treated successfully with sulbactam IV and intrathecal amikacin.

Obstetric patients in a surgical intensive care unit: prognostic factors and outcome.

The objective of this study was to assess the incidence, prognostic factors and the outcome of obstetric patients admitted in a surgical intensive care unit (SICU) during the ante-partum or postpartum period (within 6 weeks of delivery). Between 1995 and 2002, the patients transferred from the department of obstetrics were retrospectively included into the study. Demographics included: obstetric data, medical and surgical histories, diagnosis, simplified acute physiology score (SAPS II), acute physiology and chronic health evaluation system APACHE II score; and the occurrence of organ failure, therapeutic interventions, length of stay in the SICU and outcome were recorded. During the study period, 364 obstetric patients were admitted to the SICU. Obstetric admissions to the SICU represented 0.6% of all deliveries and the SICU utilisation rate was 14.96%. The main indications for admission were eclampsia (70.6%) and postpartum haemorrhage (16.2%). The overall mortality rate was 16.7% (n = 61). In a logistic regression model, risk factors for death included organ system failure (odds ratio (OR) = 3.95 confidence interval (CI) [1.84 - 8.48], bilirubin >12 mg/l (OR = 1.017 CI [1.00 - 1.03]), and prolonged prothrombin time (OR = 0.97 CI [0.95 - 0.99]). Median length of stay was longer in non- survivors (6.5 +/- 7.3 vs 5.5 +/- 4.6 days). Maternal condition on admission and associated complications are the major determinant of maternal outcome.

[Postoperative infection following craniotomy in adults]. / L'infection postopératoire après craniotomie chez l'adulte.

OBJECTIVE: The aim of this study was to determine the risk factors for postoperative infection after craniotomy, a threat for the vital prognosis, in order to define specific prevention measures. METHOD AND PATIENTS: An open prospective study was made on all adult patients undergoing craniotomy and followed 30 days postoperatively. The infections were defined according to CDCA criteria. The parameters studied were: age, sex, ASA and Glasgow scores, neurosurgical history, the type, the moment and the surface of shaving, antibioprophylaxis, and the type and duration of surgery as well as its emergency level. RESULTS: One hundred and seventy patients were included. Thirty presented with an infection (17.6%), nine with a skull infection, 13 with meningitis, three with empyema, and two with osteitis. The risk factors identified thanks to a univariate analysis were the emergency level of surgery (P < 0.01), duration of surgery >200 min, and duration of stay in ICU >72 h (P < 0.02).

[Emphysematous pyelonephritis: a case report]. / La pyélonéphrite emphysémateuse: à propos d'un cas guéri.

Diabetic patients with urinary tract infections had a certain risk of developping emphysematous pyelonephritis with gas producting bacteria. This disease was accompagned with high mortalité. We will report one case who was treated successfully by high dose antibiotic regim and emergency nephrectomy.

[Renal angiomyolipoma complicated by retroperitoneal hematoma]. / Angiolipome rénal compliqué d'un hématome rétropéritonéal.

Renal angiomyolipoma (AML) is a benign tumor, they are generally asymptomatic or can manifested by abdominal pain, palpable mass or hematuria. We report an uncommoun case of 65 years old women who consulted for retroperitoneal hemorrhage by spontaneous rupture of renal AML with palpable mass. The ultrasound and CT abdominopelvic scan were performed in the preoperative diagnosis and showed a typical right renal AML with retroperitoneal hematoma. The right nephrectomy by transperitoneal approach was performed with a good follow-up. The histological examination confirmed the diagnosis for renal AML. About this case, the authors discuses the diagnosis and the management for AML with retroperitoneal hemorrhage.

[Surgical complications of nephrectomy in living donors]. / Les complications chirurgicales de la néphrectomie chez le donneur vivant.

Renal transplantation from a living donor is now considered the best treatment for chronic renal failure. We reviewed the operative complications in 38 living related donor nephrectomies performed at our institution over the past 14 years. The mean age of our donors was 30 years old with age range between 18 and 58 years old and female predominance (55.2%). These swabs were realized by a posterolateral lumbar lombotomy with resection of the 11 third. The left kidney was removed in 34 donors (90%), surgical complications were noted in 39.4% of the cases: one case of wound of inferior vena cava (2.6%), one case of release of the renal artery clamp (2.6%), four cases of pleural grap (10.5%), one case of pneumothorax (2.6%), one case of pleurisy (2.6%), three cases of urinary infection (7.8%), three cases of parietal infection (7.8%) and one case of patient pain at the level of the wound (2.6%). There were no mortalities. We conclude that the morbidity of living donor nephrectomy is negligible compared with the advantages for the recipient.

[Anesthesia for electroconvulsive therapy: propofol versus thiopental]. / Anesthésie pour sismothérapie: propofol versus thiopental.

The anesthesia for sismotherapy is characterized by its briefness and repetitiveness, resulting in several imperatives: anesthesia of short duration, deep narcosis with muscular relaxation and ambulatory character. Thus anesthesic drugs should have a fast onset of action, in order to obtain a rapid and as alert as possible post anesthesia awakening. The objective of this study is to compare two anesthesic drugs: propofol versus thiopentone. We included in this study patients referred to our unit by the psychiatric service for sismotherapy, which was carried on under general anesthesia in the awakening room of the anesthesia department of Ibn Rochd University hospital. 7 of our patients received sismotherapy for schizophrenia, 2 for acute mania and 1 for suicidal depression. A total of 40 sessions of sismotherapy were analyzed, distributed in two groups: group I (n = 20): benefitted of a general anesthesia by thiopentone, the dose was 2 to 3 mg/kg; group II (n = 20): benefitted of general anesthesia by propofol, the dose was 1 to 1.5 mg/kg. Sismotherapy was carried out only once narcosis was considered as deep. To monitor our patients we used electrocardioscope and pulpe oxymeter. We evaluated the quality and especially the time of onset of anesthesia, its duration, the quality of narcosis, the degree of muscular relaxation, respiratory and cardiovascular parameters as well as side effect linked to anesthesia drugs and sismotherapy. Analysis of the results showed that the quality of anesthesia was excellent for both groups. The necessary dose for narcosis was 202 mg for thiopentone and 167 mg for propofol, time of onset of narcosis was 30 seconds for propofol and 45 seconds for thiopentone, anesthesia and the quality of muscular relaxation were considered deep for the two groups. Many authors showed that propofol is the most efficient agent in anesthesia for sismotherapy due to its brief delay of action and faster reversibility. As for thiopentone despite its convulsive properties and poor hemodynamic tolerance, it still is a good hypnotic in anesthesia for sismotherapy when administered at appropriate dose by slow injection. This is due on the one hand to easy administration, lesser incidence of side effects and on the other hand to brief duration of action and low cost. We conclude that thiopentone can be recommended in anesthesia for sismotherapy owing to good properties: deepness of anesthesia, good awakening, tolerance and lower cost.

[Enterocystoplasty complications at the intensive care setting]. / Complications de l'entérocystoplastie en milieu de réanimation.

The cystectomy with substitute enterocystoplasty because of the bladder cancer is a surgical technique which is the origin of several problems that the medicosurgical team faces. The aim of this study is to evaluate the postoperative complications of this surgical technique. We have realized a retrospective study of 56 patients hospitalized in intensive care service between 1994 and 1997. The complications observed were dominated by postoperative peritonitis (5.2%), urinary fistula (3.5%), digestive fistula (1.7%). Other general complications were recorded as pneumopathy (3.5%), digestive hemorrhage (1.7%) and dehydratation (3.5%). One death case in multivisceral failure system was noticed. A precocious diagnosis, a good preoperative value, and a preoperative adapted supervision should improve surely the prognosis.

[Extra-adrenal pheochromocytoma discovered peroperatively]. / Phéochromocytome extrasurrénalien découvert en peropératoire.

In this study, an uncommon case has been reported of an ectopic pheochromocytoma without the presence of any clinical symptoms. The radiological investigations showed a right retroperitoneal tumor without any kidney involvement. The diagnosis was established by biopsy and subsequent histological findings. In the course of surgery as the large tumor mass was being removed, tachycardia was observed which caused the resection to be performed as rapidly as possible. Once the tumor had been removed, bradycardia occurred, followed by cardiac arrest: although the latter was stabilized after cardiac massage, the patient died one hour after the operative field had been closed. In addition to this case report, the diagnosis, therapeutic strategy and prognosis regarding an ectopically located pheochromocytoma have been discussed.

[Pheochromocytoma discovered in the preoperative period: analysis of 3 cases]. / Le phéochromocytome de découverte peropératoire: analyse de 3 cas.

Phaeochromocytoma is a rare tumour that may be discovered incidentally during a surgical operation that can sometimes cause fatal arrhythmias. The authors report 3 cases of phaeochromocytoma presenting in the form of hypertensive crisis and serious arrhythmias following manipulation of the tumour with a fatal outcome in 2 cases. These cases illustrate the severity and complexity of the problems encountered and the importance of preoperative detection of phaeochromocytomas, particularly at the pre-anaesthetic visit.

[Peritonitis caused by spontaneous rupture of pyonephrosis in pregnancy. Report of a case]. / Péritonite par rupture spontanée d'une pyonéphrose au cours d'une grossesse. A propos d'un cas.

Peritonitis after spontaneous rupture of pyonephrosis into the peritoneal cavity is a rare complication, usually diagnosed intraoperatively. We report a case of a woman presenting with left lumbar pain and fever during pregnancy. On admission, ultrasonography showed a pregnancy with fetal activity for 16 weeks, and pyonephrosis in the left kidney, but on a normal right kidney. After antibiotic therapy and upper urinary, tract stenting renal drainage revealed purulent urine, fever persisted with acute abdomen. Clinical and radiological assessment showed features of acute peritonitis with pyonephrosis. Treatment consisted of laparotomy with nephrectomy and abdominal lavage and drainage. The postoperative complication was septic shock requiring resuscitation and artificial ventilation and prolonged convalescence.

[Critical analysis of hemostasis disorders in the course of eclampsia. Report of 106 cases]. / Analyse critique des troubles de l'hémostase au cours de l'éclampsie. A propos de 106 cas.

OBJECTIVE: Study of hemostatic disorders during eclampsia, their risk factors, maternal complications and associated mortality. METHODS: Retrospective study concerning 106 cases of severe eclampsia treated in intensive care between September 1992 and December 96. Patients with or without hemostatic disorders were compared for laboratory findings, maternal complications and mortality. RESULTS: Forty patients had hemostasis disorders as follows: isolated thrombopenia in 19 cases, disseminated intravascular coagulation (DIC) in 5 cases, Hellp syndrome associated to DIC in 7 cases and Hellp syndrome in 9 cases. Hemostasis disorders were associated to maternal advanced age, but not with gestational age or blood pressure in admission or time of convulsions. Complications and mortality associated with hemostasis disorders were more frequent compared to patients without hemostasis disorders. Among the 17 deaths of our series, 10 had hemostasis disorders. CONCLUSION: Hemostasis disorders were prognosis factors in eclampsia requiring systematic laboratory tests at admission and immediate delivery.

[Postpartum cerebral thrombophlebitis. A case secondary to acquired antithrombin III deficiency]. / Thrombophlébite cérébrale du post-partum. Un cas secondaire à un déficit acquis en antithrombine III.

The cerebral thrombophlebitis is a rare complication of the pregnancy and the postpartum. We report a case of a 21 year-woman presenting a post-partum cerebral thrombophlebitis, secondary to an acquired deficiency of antithrombin III. The clinical symptoms of cerebral thrombophlebitis can be misleading. The angiography and the magnetic resonance imaging permit the diagnosis. The treatment is relied on anticoagulating heparin therapy. This treatment will be adapted in case of coagulation's factors deficiency that must be searched in any thromboembolic accident having an unusual localization.