[Duodenocaval fistula: an unusual form of peptic ulcer revelation]. / Fistule duodénocave: mode de révélation inhabituel d'un ulcère duodénal.

The duodenocaval fistula is exceptional. We report the case of a 44-year-old patient with duodenocaval fistula. The patient had no history of peptic ulcer disease. The clinical feature was firstly a septic shock and then an haemorrhagic shock. Only laparotomy confirmed the diagnosis. The treatment was a surgical one with a rapid improvement. The prognosis depends on surgical experience and remains serious.

Nadroparin in the prevention of deep vein thrombosis in acute decompensated COPD. The Association of Non-University Affiliated Intensive Care Specialist Physicians of France.

Low molecular weight heparins are as effective as unfractionated heparin in deep-vein thrombosis (DVT) prophylaxis for major surgery. However, there is no evidence nor consensus for prophylaxis in medical patients. We compared the efficacy and safety of nadroparin calcium (nadroparin) with placebo in medical patients at high risk of DVT. A total of 223 patients mechanically ventilated for acute, decompensated chronic obstructive pulmonary disease, were randomized to treatment with subcutaneous nadroparin adjusted for body weight (0.4 ml, i.e., 3,800 AXa IU, or 0.6 ml, i.e., 5,700 AXa IU) or placebo. The average duration of treatment was 11 d. The incidence of DVT in patients receiving nadroparin was significantly lower than that in patients receiving placebo (15.5 versus 28.2%; p = 0.045). Although the incidence of adverse events was high in both groups, there were no significant differences between nadroparin and placebo for total adverse events (46.3 versus 39.8%; p = 0.33), serious adverse events (25.0 versus 19.5%; p = 0.32), or those resulting in early permanent discontinuation of treatment (12.0 versus 8.8%; p = 0.44). The most common adverse event was hemorrhage. There was the same number of deaths in both treatment groups. Subcutaneous nadroparin resulted in 45% decrease in incidence of DVT compared with placebo.

[Colon hernia through a defect in the iliac crest after bone graft harvesting] . / Hernie colique à travers la fenêtre osseuse d'une prise de greffon iliaque.

A case of a patient with an hernia through a defect in the iliac crest after bone graft harvesting is described. The osseous defect provides a rigid ring against which repeated sudden elevations in abdominal pressure can result in disruption of soft tissue and herniation of abdominal contents. Standard plain radiographs and barium studies are of limited interest and may even be misleading in diagnosing the herniation. Findings on computed tomography led to detection of this abnormality, and should be the first line exam in these cases.

[Bronchial lobar obstruction from a sucralfate tablet: a rare cause of acute respiratory insufficiency]. / Obstruction d'une bronche lobaire par un comprimé de sucralfate: une cause rare d'insuffisance respiratoire aiguë.

We report two cases of patients with chronic respiratory disease who experienced an asphyxia after aspirating a sucralfate tablet that occluded a lobar bronchus. In adults, a foreign body is a rare cause of acute respiratory failure from tracheobronchial occlusion. The sucralfate tablet has the physical property of expanding rapidly when wet (contact with mucosa). After aspiration, the tablet expands to a larger size and can occlude a lobar bronchus, causing acute respiratory failure. In patients at risk of aspiration, we recommend the use of sucralfate in liquid or suspension form.

Prognostic value of the dobutamine test in patients with sepsis syndrome and normal lactate values: a prospective, multicenter study.

OBJECTIVES: To determine the oxygen supply (DO2) and uptake (VO2) responses to a 60-min dobutamine infusion in critically ill septic patients without circulatory shock and with normal blood lactate concentrations. Also, to determine whether these responses would predict outcome. DESIGN: Prospective, cohort study. SETTING: Five intensive care units in university-affiliated, city hospitals. PATIENTS: Fifty critically ill patients with sepsis syndrome were studied from April 1990 to August 1991. INTERVENTIONS: Pulmonary artery catheterization; fluid loading if pulmonary artery occlusion pressure was < 10 mm Hg; and 10 micrograms/min/kg dobutamine infusion for 60 mins. MEASUREMENTS AND MAIN RESULTS: Cardiac index, DO2, VO2, and oxygen extraction ratio were determined immediately before and 1 hr after the onset of the dobutamine test. Using receiver operating characteristic curves, responders to the dobutamine infusion were identified by a > 15% increase in VO2 from the time immediately before to 1 hr after the onset of the dobutamine test. We identified 23 responders and 27 nonresponders. Groups differed significantly in age (responders 46 yrs vs. nonresponders 55 yrs) and associated chronic disease (responders one cancer vs. nonresponders six cancers). Significant changes in responders were: a) cardiac index increased 42.9%; b) systemic vascular resistance decreased 20.7%; and c) DO2 increased 39.1% while VO2 increased 40.8%, with no changes in oxygen extraction or blood lactate concentration. Significant changes in nonresponders were: a) cardiac index increased 14.2%; b) DO2 increased 13.2% and c) oxygen extraction decreased from 0.26 to 0.22. Lactate concentration increased significantly by 25.1% in nonresponders. The mortality rate in responders (8.7%) was significantly less than that rate in nonresponders (44.4%). CONCLUSIONS: Most of these septic patients without shock or hyperlactatemia responded to dobutamine infusion in one of two ways: with little increase in DO2 and no increase in VO2, or with significant increases in both DO2 and VO2. The latter response is typical of healthy volunteers given dobutamine. Because of the calorigenic effect of dobutamine, our results imply nothing about the presence or absence of oxygen supply limitation. Still, patients who had increases in DO2 and VO2 had a much higher survival rate than patients who did not. We speculate that the inability of some patients to respond to dobutamine and the associated higher mortality rate may be related to beta-adrenoreceptor dysfunction.

[Opportunistic pneumopathy caused by Torulopsis glabrata]. / Pneumopathie opportuniste à Torulopsis glabrata.

Yeasts are taking a growing place in the development of opportunistic pneumonias in a hospital environment. We report a case of pneumonia due to Torulopsis glabrata in a patient of 58 years in complete remission from a malignant oesophageal tumour after surgery and radiotherapy, and not given immunosuppressive treatment.