Coupled plasma filtration-adsorption in Weil's syndrome: case report.

Weil's syndrome is a form of leptospirosis characterized by jaundice, renal failure and hemorrhagic diathesis. Its pathogenesis is related with the invasiveness of leptospires and with the subsequent systemic inflammatory response. Coupled plasma filtration-adsorption (CPFA) is a modality of extracorporeal blood purification in which plasma is separated from the whole blood and directed into a sorbent cartridge. Due to the ability of the sorbent agent to remove cytokines, CPFA has been proposed as an adjuvant treatment in septic shock. We report the case of a 27-year-old man with Weil's syndrome who was admitted to ICU with hypotension and anuria refractory to fluid therapy, ARDS, and hepatic involvement. The man needed intubation, mechanical ventilation and vasopressor infusion. CPFA was started early after the onset of shock. Five courses of CPFA were performed. Each course lasted for 10 h with 14 h interval. Weaning from vasopressors was achieved during the second course of CPFA (day 2 after admission). Weaning from ventilation was achieved on day 6. Interestingly, diuresis started during the first course of CPFA, with a creatinine clearance of 63 ml/min on day 8 and a normalization of the ratio urinary to plasma osmolality on day 28. The patient was discharged on day 11 and 28 from the Intensive Care Unit and hospital respectively.

Ultrasonography of the optic nerve in neurocritically ill patients.

The rapid diagnosis of intracranial hypertension is urgently needed for therapeutic reasons in various clinical settings. This can rarely be achieved without invasive procedures such as intracranial pressure (ICP) monitoring or neuroimaging. The optic nerve is surrounded by cerebrospinal fluid (CSF) and dura mater, which forms the optic nerve sheath (ONS). Because of the connection with the intracranial subarachnoid space, ONS diameter (ONSD) is influenced by CSF pressure variations. Bedside ultrasonographic measurement of ONSD has been proposed as a non-invasive and reliable means to detect raised ICP in neurocritically ill patients. In several studies, it proves to have a good correlation with the direct measurement of ICP and a low interobserver variability. However, no general consensus exists over the upper normal ONSD limit. We performed a review of the literature on the use of the ultrasonography of the optic nerve in the evaluation of patients with suspected intracranial hypertension. The aim of this review is to describe the technique and to assess the validity of this diagnostic method.

Symptom management in a patient with end-stage ovarian cancer: case report.

Bowel obstruction is a common complication in patients with far advanced abdominal or pelvic cancer. In patients with recurrent or advanced disease, where options for curative treatment have been exhausted, palliation of symptoms with minimal additional morbidity is the aim of therapy. Owing to the difficulties inherent in conducting perspective randomized trials, clinicians face a significant challenge in managing terminally ill obstructed patients. We evaluated the case of a woman with ovarian cancer. Clinically, the objective of the study was to focus attention on the most up-to-date evidence concerning the treatment of malignant bowel obstruction.