Tamponade a rare cause of shock in patients with pancreatitis: difficulty of diagnostic in patients with positive pressure ventilation.

The causes of hemodynamic instability in acute pancreatitis are numerous. Although pericardial effusion during pancreatitis is common, a cardiac tamponade is rarely reported. The diagnosis of compressive cardiac disorders (CDD) by echocardiography is easily reported when the patient is breathing spontaneously; it becomes difficult when the patient is assisted with positive pressure ventilation.

[A serious "acetaldehyde syndrome" compounded by dopamine]. / Effet antabuse sévère aggravé par la dopamine.

Disulfiram is commonly used in the treatment of alcohol dependence. It induces aversive symptoms after alcohol ingestion: the "acetaldehyde syndrome". Most often "acetaldehyde syndrome" is moderate but severe life-threatening symptoms may occur in specific circumstances. We report the case of a serious "acetaldehyde syndrome" with shock compounded by the initial administration of dopamine. Discussion clarifies the pathophysiology and develops the therapeutic management.

[Headaches in a 21-year-old man with Goodpasture disease]. / Céphalées chez un patient de 21 ans atteint d'une maladie de Goodpasture.

The case of a 21-year old man who died due to an intracranial thrombosis just after diagnosis of Goodpasture's disease, is reported. Discussion deals with the putative mechanisms, which could be responsible for the thrombosis.

[A very extensive necrotizing fasciitis]. / Une fasciite nécrosante très extensive.

Necrotizing fasciitis is a severe skin infection. Fluidized bed may be indicated to improve healing. We report a 36-year-old woman case, who developed an important skin emphysema on a fluidized bed that may have worsen the situation.

[Perioperative management of traumatic spinal cord injured patients after the acute phase]. / Prise en charge périopératoire des traumatisés médullaires à la phase chronique.

OBJECTIVE: To understand the physiopathology and the consequences of a traumatic spinal cord injury after the acute phase. The aim is to describe the preoperative management of these patients and the various anaesthetic techniques available. DATA SOURCE: The data were retrieved from the PubMed data base, papers from the major French anaesthesiology and intensive care conventions, publications from the French medico-surgical encyclopaedia, combined with reference analysis of major articles in this field. RESULTS: In France, there are 40,000 patients with traumatic spinal cord injury. These lesions lead to major handicap and frequent complications particularly urologic and orthopaedic ones. These patients often require surgical procedures under anaesthesia. Besides neurological deficits, the spinal cord injury leads to an imbalance between sympathetic and parasympathetic nervous systems with serious dysautonomic complications. During surgery, anaesthesia is necessary to prevent this autonomic dysreflexia. All anaesthetic techniques are usable and effective, subject to their careful implementation for those patients with cardiovascular and respiratory restricted adaptation. The use of suxamethonium can induce fatal hyperkaliemia for up to 10 years after the initial injury, with maximal frequency at six months post-trauma. CONCLUSION: Notwithstanding insensitivity resulting from a spinal cord lesion, it is necessary to anaesthetize these patients before all surgical procedures.

[Pharmacodynamic interest of ceftazidime continuous infusion vs intermittent bolus administration in patients with severe nosocomial pneumonia]. / Intérêt pharmacodynamique de la perfusion continue vs l'administration intermittente de ceftazidime dans les pneumonies nosocomiales sévères.

GOAL OF THE STUDY: It is well known today that the main determinant of beta-lactam antibiotics efficacy is the duration of the time that concentrations remain in excess of the minimum inhibitory concentration (MIC) of susceptible organism over the course of therapy. This prospective study aimed to evaluate the efficacy, in term of pharmacodynamic profile, of continuous infusion versus intermittent administration of ceftazidime in intensive care unit patients with severe nosocomial pneumonia. PATIENTS AND METHODS: 16 patients under mechanical ventilation with nosocomial pneumonia were randomised to receive either 60 mg/kg/day ceftazidime by constant rate infusion following a 20 mg/kg loading dose (Group A) or 20 mg/kg every 8 hour by intravenous bolus injection (Group B). In both groups, serial blood samples were collected during 48 hours (12 and 18 samples in Group A and B, respectively) after the start of drug administration. Plasma concentrations of ceftazidime were measured by high performance liquid chromatography. Based on our local bacteriological conditions, the pharmacodynamic profile of ceftazidime was assessed as the duration of time the plasma concentration remained above a desired target concentration of 20 mg/l for each regimen. RESULTS: The mean time (expressed as a percentage) for which plasma ceftazidime concentrations were above 20 mg/l was 100% for the continuous infusion group (Group A) and 56+/-33% for the intermittent administration group (Group B). CONCLUSION: These findings show that ceftazidime administered by continuous infusion in critically ill patients under mechanical ventilation with nosocomial pneumonia appears to substantially improve the pharmacodynamic profile of this beta-lactam compared to the intermittent regimen.