[Small bowel obstruction secondary to massive hookworm infestation complicated by fatal plurimicrobial bacteriemia]. / Occlusion iléale par infestation massive par des ankylostomes responsable d'une septicémie plurimicrobienne d'évolution fatale.

INTRODUCTION: Intestinal symptoms (cramping, flatulence) and iron deficient anemia are classical presenting manifestations of duodenal hookworm infestation in patients living in endemic area. CASE REPORT: We report a 45-year-old immunocompetent metropolitan man who presented with intestinal obstruction secondary to massive hookworm infestation complicated by fatal plurimicrobial bacteriemia with refractory septic shock. CONCLUSION: We report a case of acute surgical abdominal presentation with septicemia and refractory shock syndrome due to ileal translocation secondary to massive hookworm infestation. To the best of our knowledge, such a case has not yet been reported.

Maternal sepsis during pregnancy or the postpartum period requiring intensive care admission.

BACKGROUND: Previous studies on severe maternal sepsis during pregnancy or the postpartum period are rare and have focused on septic abortion. Voluntary abortion was legalized in France in 1975. This study was conducted to reassess the characteristics of maternal sepsis that have been managed in a French intensive care unit. METHODS: A retrospective study of 66 women admitted to an intensive care unit for sepsis from 1977-2008 was performed. Data on sources of infection, microbial agents and maternal and fetal outcomes were collected. Data from 1977-1992 and 1993-2008 were compared. RESULTS: Over time, the rate of intensive care admission for maternal sepsis did not change (0.75 episodes per 1000 deliveries in 1977-1992 versus 0.72/1000 in 1993-2008, P=1.0). The percentage of septic abortions decreased from 14% to 0%, whereas that of antepartum infections increased from 50% to 79% (P<0.01). The percentage of non-bacterial infections increased from 0% to 19% (P=0.04), and the percentage of pelvic infections had a tendency to decrease from 54% to 27% (P=0.06). Pelvic infections were due to enterobacteriaceae (50%), gram-positive cocci (45%), and/or anaerobes (23%). Maternal and fetal mortality rates were 6% and 33%, respectively. CONCLUSIONS: Over time, our intensive care unit has seen fewer cases of septic abortion. However, maternal sepsis remained a cause of intensive care admission and both maternal and fetal death. The percentages of antepartum and non-bacterial infections have increased over time. A prospective multicentre study is required to confirm these results and to investigate questions such as the effect of maternal sepsis on long-term fetal outcome.

[Acute renal failure after amoxicillin crystallization]. / Insuffisance rénale aiguë par cristallisation d'amoxicilline.

BACKGROUND: Drug-induced nephrolithiasis is a rare finding, especially with beta-lactamins. We report a case of acute renal failure due to amoxicillin crystallization. CASE REPORT: A 48 year-old woman was admitted because of pneumococcal meningitis. After 4 days on high-dose amoxicillin (320 mg/kg/day), she developed acute oliguric renal failure and amoxicillin crystallization was documented by infrared spectrometry. The outcome was favorable after amoxicillin dosage tapering, together with one single hemodialysis session and further hydratation. DISCUSSION: Amoxicillin is mainly excreted in the urine in its unchanged form. The risk of crystalluria is increased by low urinary pH, low urine output and high-dose of the drug. Such a crystalluria should be accurately identified by infrared spectrometry.

[Epidemiology and prognosis of acute renal insufficiency in 1997. Recent data]. / Epidémiologie et pronostic de l'insuffisance rénale aiguë en 1997. Données récentes.

In an unselected population, the annual incidence of acute renal failure (ARF) seems close to 200 patients per million inhabitants. In elderly patients, this incidence is five times higher than that of younger patients. Mortality is particularly high in intensive care units and doubles if ARF develops after rather than before admission. Death is mainly due to hypovolemic and septic shock, and to cardiovascular diseases. An increasing number of deaths is related to therapeutic limitation. In many cases, ARF can be prevented, e.g. by correcting any sodium deficit and hypovolemia before a surgical procedure, and by considering the true GFR of a given patient before prescribing a potentially nephrotoxic drug, especially in older patients. A poor previous health status, hospitalization prior to admission, and ARF occurring after admission are important predictive factors of mortality, as well as any acute organ dysfunction. Second generation severity scores seem to have a better performance than older ones. The use of continuous hemodialysis and hemofiltration is increasing in ARF patients, but it is not proven that mortality is thereby reduced. A beneficial effect of biocompatible membranes is not clearly demonstrated in these patients. Later, most ARF patients recover a normal, or nearly normal, renal function. Recovery is delayed in older patients and in those whose oliguric period is prolonged. Lastly, the high cost of therapy in ARF justifies the use of all currently preventive measures in patients at risk.

[Epidemiology and prognosis of acute renal insufficiency]. / Epidémiologie et pronostic de l'insuffisance rénale aiguë.

The annual incidence of acute renal failure (ARF) in the general population seems close to 150 per million inhabitants. For the past 20 years, there has been an increase in ARF of medical origin and a simultaneous decrease in surgical, traumatic and obstetrical ARF. Drug-induced ARF accounts for 20% of total cases. Factors of poor prognosis include a poor previous health status, the presence of oliguria, cardiac or respiratory insufficiency, sepsis, coma, a need for mechanical ventilation and, most importantly, the number of failing organs. The three main severity scoring systems used are SAPS, APACHE II and OSF. The predictive value of these scoring systems seems acceptable provided the data are collected when ARF is diagnosed and not on the patients' admission. After years, the overall survival rate does not exceed 30% to 50%. Full renal recovery is observed in 1/3 to 2/3 of surviving patients and varies according to the type of nephropathy. The social and financial consequences of these results emphasize the importance of preventing ARF, especially in its iatrogenic form.

Acute renal failure after the use of angiotensin-converting-enzyme inhibitors in patients without renal artery stenosis.

During a 4-year period, acute renal failure was observed in 27 patients (mean age 65 years) treated by various angiotensin-converting-enzyme (ACE) inhibitors for hypertension, heart failure, or a combination of both. None had significant renal artery stenosis on angiography. Overt volume depletion was present in 21 and hypotension in 12 cases. All patients received diuretic therapy and/or a low-salt diet. Other facilitating factors included cardiac failure, pre-existing chronic renal insufficiency, combined therapy with non-steroidal anti-inflammatory drugs, and diabetes mellitus. Twenty-two patients had two or more of these factors at presentation. A renal biopsy performed in 10 cases showed severe arteriosclerosis of small renal arteries in eight and acute tubular necrosis in five instances. Therapy comprised volume expansion, and withdrawal of diuretics and, except in two patients, of ACE inhibitors. Twenty-one patients recovered normal renal function, two died, and permanent renal damage remained in four. These results suggest that sodium depletion has a critical role in inducing acute renal failure, whose outcome is not always benign. A combination of diuretics and ACE inhibitors should be prescribed with caution, especially in older patients with small as well as with large renal vessel disease.

[Diabetic hyperlipemia with or without acute pancreatitis in patients with chronic alcoholism. A study of 4 cases]. / Lipémie diabétique avec ou sans pancréatite aiguë chez l'alcoolique chronique. Etude de 4 observations.

Diabetic lipemia with and without acute pancreatitis in chronic alcoholism. A report of 4 cases. Diabetic lipemia was observed in 4 chronic alcoholic men after ingestion of high doses of alcohol and/or sugar-rich beverages, including one patient who was treated for insulin-dependent diabetes. None had a previous history of serum lipid disturbances. All had marked hyperglycemia, hyperosmolality and hypertriglyceridemia (mean: 60.8 mmol/l), 2 of undetermined type and 2 of type IV with eruptive xanthomas. Factitious hyponatremia was present in 3 cases, but true serum sodium was normal (138 mmol/l) or elevated (154, 156, 182 mmol/l) after correction. Three patients developed acute pancreatitis ascribed to high serum triglyceride levels and/or to alcohol ingestion. Serum and urine amylase activity was inhibited by hypertriglyceridemia. The diagnosis of pancreatitis was assessed twice by echography and computed tomographic scan, and once by tomographic scan and an elevation of the amylase on creatinine clearance ratio. It is likely that hypertriglyceridemia predisposed these patients to develop pancreatitis, alcoholism being a precipitating factor. We suggest that the diagnosis of acute pancreatitis should be systematically considered in any case of diabetic lipemia without true hyponatremia.