Membrane oxygenators for acute respiratory insufficiency. Clinical use in 11 patients.

Extracorporeal circulation with a membrane oxygenator (ECMO) was used in 11 patients with acute respiratory insufficiency who did not respond to conventional treatment. By pass was veno-arterial in every case, seven times with femoral artery return, three times with axillary artery return, and once with both femoral and axillary return. Five patients died on ECMO. Six patients were taken off ECMO and two of them are long-term survivors. In nine cases ECMO allowed short-term control of respiratory failure. The respective roles of oxygen supply from ECMO and the haemodynamic changes incurred by its use are discussed. Although use of ECMO for long periods seems less hazardous now, present results are restricted by the lack of therapy for the underlying pulmonary lesions.

[Acute cerebral ischemia: an uncommon complication of ritodrine?]. / Ischémie cérébrale aiguë: complication exceptionnelle de la ritodrine?

Cerebral ischaemia is reported in a 33 year-old woman at 34 weeks gestation during an infusion of ritodrine to stop premature labour. CT Scan revealed multiple ischemic bilateral lesions. These lesions disappeared completely under artificial ventilation and thiopental infusion. The authors discuss the other possible causes of cerebral ischaemia in pregnant patients.

[Non-cardiogenic pulmonary edema associated with severe diabetic ketoacidosis]. / Oedema pulmonaire non cardiogénique associé à une acidocétose diabétique sévère.

Non cardiogenic pulmonary oedema occurs rarely in patients with diabetic ketoacidosis, except in conjunction with an infection. A case is reported of non cardiogenic pulmonary oedema in a patient with severe diabetic ketoacidosis, which resolved within 72 h with oxygen supply only. There were no objective facts which could explain its pathogenesis, despite the important pulmonary asymmetry due to a unilateral diaphragmatic paralysis.

[Neuromuscular complications of long-term treatment of inflammatory diseases. 3 cases]. / Complications neuromusculaires du traitement de fond de maladies inflammatoires. Trois observations.

Chloroquine and colchicine, widely used in internal medicine practice for a variety of inflammatory diseases including systemic lupus erythematosus, rheumatoid arthritis, familial Mediterranean fever, and Behçet's disease, may induce neuromuscular complications. Physicians must be familiar with this diagnosis as this iatrogenic neuromuscular pathology may simulate polymyositis, leading thus to inappropriate treatment with prednisone whereas the only effective treatment is to discontinue the drug involved whenever possible. We report three cases of toxic myopathy and/or neuropathy related to chronic chloroquine or colchicine therapy for systemic diseases, and outline the main points to be considered in this situation.

[Necrotizing sarcoid granulomatosis. Apropos of 4 cases]. / Granulomatose nécrosante sarcoid-like. A propos de 4 observations.

Necrotizing sarcoid granulomatosis (NSG) was first described by Liebow in 1973 among the heading "pulmonary angeitis and granulomatosis". We reported four cases of NSG. The diagnostic was made by open lung biopsy in all, and the distinctive features were those described by Liebow: presence of numerous sarcoid-like granulomas, foci of fibrinoid necrosis and granulomatous vasculitis. Clinical, radiological, and clinical course characteristics allow the reasonable conclusion that NSG is the histopathological substratum of a variety of sarcoidosis affections termed "nodular sarcoidosis".