ABSTRACT
An 18-year old girl developed acute fulminating meningococcaemia with meningitis, coma, shock, coagulation disorders and extensive purpura. Measurement of intracranial pressure showed severe intracranial hypertension. After medical treatment of shock and intracranial hypertension had failed, external drainage of the cerebrospinal fluid was performed in the lumbar region, using a 16 G silicone catheter. This controlled the intracranial hypertension; also the state of shock regressed and the patient became fully conscious. The lumbar drainage was maintained for 12 days during which 3180 ml of blood-stained cerebrospinal fluid were evacuated. The fluid was sterilized by antibiotics as early as the 1st day of the disease, but it remained positive for bacterial antigen up to the 9th day. Cure was obtained without neurological sequelae, thanks to the lumber drainage which controlled intracranial hypertension and removed large amounts of microbial toxins.
Subject(s)
Meningitis, Meningococcal/complications , Pseudotumor Cerebri/etiology , Acute Disease , Adolescent , Anti-Bacterial Agents/therapeutic use , Drainage , Drug Therapy, Combination , Female , Humans , Meningitis, Meningococcal/cerebrospinal fluid , Pseudotumor Cerebri/therapy , Time FactorsABSTRACT
Of 3 alcoholic patients with severe lactic acidosis, one had shoshin beriberi; the second--a beer drinker--presented with convulsions associated with hyponatraemia and complicated by rhabdomyolysis and was not thiamine-deficient; the third patient had convulsions associated with Korsakoff's syndrome and was thiamine-deficient. In all three patients treatment with thiamine administered alone corrected the lactic acidosis within less than 4 hours. In patient 1, this result was obtained after symptomatic treatment of shock and lactic acidosis had failed and more than 24 hours before the haemodynamic disorders were corrected. In patient 2, who had no haemodynamic nor haematosis disorders, the lactic acidosis was corrected within 2 hours, i.e. more than 24 hours before neurological improvement developed. In patient 3, the lactic acidosis was also corrected within 2 hours. These results suggest that thiamine should figure among the treatments of lactic acidosis in alcoholic patients. Since thiamine alone is capable of correcting severe lactic acidosis, at least in some of these patients, it deserves to be tried in other types of lactic acidosis.
Subject(s)
Acidosis/drug therapy , Alcoholism/complications , Lactates/blood , Thiamine/therapeutic use , Acidosis/blood , Adult , Beriberi/diagnosis , Erythrocytes/enzymology , Humans , Male , Middle Aged , Thiamine Deficiency/diagnosis , Transketolase/metabolismABSTRACT
An epidemiological study was made on 3,249 patients admitted in the "Centre des Brûlés du C.H.U. de Lille" from January 1965 to December 1977. This study showed that 7.1 per cent of these patients has one or more positive blood cultures. The main bacteria are staphylococcus aureus, streptococcus, pseudomonias aeruginosa in spite of antibiotic therapy. Infection is the dangerous development in these patients of which generally a burned surface is more than 25 p.cent surface body.