[Reactive haemophagocytic syndrome and multiple organ failure in intensive care unit patients]. / Syndrome d'activation macrophagique réactionnel: une cause sous-estimée de défaillance multiviscérale en réanimation?

The incidence of the haemophagocytic syndrome in the ICU patients with multiple organ failure seems to be high. The haemophagocytic syndrome can be considered as the consequence of the initial aggression leading to multiple organ failure. On the contrary the haemophagocytic syndrome could be the cause of multiple organ failure. A case of haemophagocytic syndrome is presented which led to rapidly fatal multiple organ failure.

Is morphine-induced sedation synonymous with analgesia during intravenous morphine titration?

BACKGROUND: Postoperative morphine titration frequently induces sedation. The assumption is made that patients sleep when their pain is relieved. Some patients complain of persistent pain when they awake. We studied the time-course of sedation and analgesia to understand the determinants of patients' sleep during morphine titration. METHODS: Seventy-three patients requiring morphine titration in a post-anaesthetic care unit after major surgery, were studied. Fifty-two patients slept (Sleep group) and 21 did not (Awake group). When a patient slept during titration, morphine was discontinued. Visual analogue pain scale (VAS), Ramsay score (RS), and the bispectral index (BIS) were recorded at the beginning of titration (STonset), at sleep onset (STsleep), then 5, 10, 20, and 30 min afterwards (ST4). RESULTS: In the Sleep group, mean (SD) RS increased from 1.7 (0.4) to 2.4 (0.6) (P<0.05 vs STonset) and BIS decreased from 95 (5.0) to 89.8 (10.2) between STonset and STsleep (P<0.05), RS remained stable thereafter. Conversely, RS and BIS remained unaltered in the Awake group. The reduction in VAS was comparable between groups (from 78 (17) to 39 (21), and from 64 (16) to 30.4 (11), respectively). Even though mean (SD) VAS was 39 (21) at ST4 in the Sleep group, 13 patients (25%) maintained a VAS above 50 mm. CONCLUSION: We observed dissociated effects of morphine on the time-course of sedation and analgesia with sedation occurring first, followed by analgesia. Therefore, morphine-induced sedation should not be considered as an indicator of an appropriate correct level of analgesia during i.v. morphine titration.

Large enhancement of the sub-barrier fusion probability for a halo nucleus

The fusion-fission cross sections of the 4He+238U and 6He+238U systems have been measured, at Louvain-la-Neuve, for energies around and below the Coulomb barrier, using an array of Si detectors surrounding a UF4 target. The data taken with 4He are in good agreement with previous data and with the coupled channel fusion calculation performed with ECIS. The 6He data show a regular trend with a large enhancement below the barrier which is attributed to the halo structure of the 6He nucleus.