Transthoracic electrical bioimpedance versus thermodilution technique for cardiac output measurement during mechanical ventilation.

To study the possible influence of mechanical ventilation on the accuracy of thoracic electrical bioimpedance (TEI) in the measurement of cardiac output, we determined cardiac output concurrently by TEI using Kubicek's equation and by thermodilution in 8 acutely ill patients who were mechanically ventilated (assist/control mode) but who had no underlying respiratory failure. Cardiac outputs were lower with TEI than with thermodilution (3.97 +/- 0.80 vs 4.83 +/- 1.16 l/min p = 0.004) and there was poor correlation between the values (r = 0.41). Although there is a need to develop non-invasive techniques to measure cardiac output, the present study indicates that TEI is not reliable in mechanically ventilated patients.

[Radiography profile in forced plantar flexion for studying unsteady feet]. / La radiographie de profil en flexion plantaire forcée pour l'étude du pied instable.

We have studied the interest of an original radiological incidence ("Plantar hyperflexion") allowing to demonstrate a possible hyperlaxity of medio-tarsal joints. We discovered a significant difference of mobility between patients with unstable feet and the control group. The existence of a medio-tarsal hyperlaxity should be taken into account before starting any treatment.

[Jaundice secondary to a metastasis of a malignant melanoma at the level of the common bile duct]. / Ictère secondaire à une métastase de mélanome malin au niveau de la voie biliaire principale.

A patient presenting with a malignant melanoma of the skin developed obstructive jaundice. Ultrasound examination of the upper abdomen revealed dilated bile ducts and the presence of a solid mass at the hilum level. There was no evidence of biliary lithiasis. The intraluminal location of the mass was confirmed by endoscopic cholangiography. Laparoscopy disclosed a 2 cm mass within the wall of the common bile duct. Pathological diagnosis was common bile duct wall metastasis from malignant melanoma.

Terminal events in the intensive care unit: review of 258 fatal cases in one year.

The last events before death were analyzed in 258 patients who died in our ICU. Deepening coma (104 patients) and acute circulatory failure (90 patients) were the most common events preceding death. Catastrophic events accounted for only 12% of deaths. In 168 (65%) of 258 patients, death was considered inevitable and CPR was not performed. Furthermore, 22 (9%) patients were allowed to die after withdrawal of intensive care support. These observations indicate that most deaths are expected in the ICU and that "do-not-resuscitate" orders can be reasonably given in the majority of fatal cases. Moreover, complete withdrawal of intensive care support should be considered as a reasonable option in hopeless patients. Since circulatory shock was identified as the most common potentially reversible problem, better prevention and management of acute circulatory failure are needed to improve survival.