Difficult intubation in a parturient with syringomyelia and Arnold-Chiari malformation: use of airtraq[TM] laryngoscope

Anesthetic technique in parturient with syringomyelia and Arnold-Chiari malformation is variable depending on the teams. Difficult intubation is one of the risks when general anesthesia is opted. Different devices have been used to manage the difficult intubation in pregnant women. We report the use of Airtraq[TM] laryngoscope after failed standard laryngoscopy in a parturient with syringomyelia and Arnold-Chiari type I malformation

[Community pneumonia Klebsiella pneumoniae producing beta-lactamase with extended spectre]

Klebsiella pneumoniae is the prerogative of nosocomial infections. Rarely Community lung infection by a strain of Klebsiella pneumoniae producing extended-spectrum beta-lactamase have been reported. We report a case of a case of pyopneumothorax due to infection by Community Klbsiella pneumoniae producing extended spectrum beta lactamase in a young patient of 29 years bacteriological examinations of pleural fluid drainage made the admission of the patient during his stay in intensive care have resulted in a K pneumoniae isolate producing extended spectrum beta lactamases. Despite treatment with imipenem and colistin prescribe 48 hours after admission of our patient, the evolution was fatal with death of the patient in an array of multi-visceral failure at 21 days of hospitalization. The isolation of an extended-spectrum beta-lactamase strain is often responsible for a fatal outcome, think about when you're facing a particular field, in the presence of risk factors such as outpatient antibiotic where the need 'control' strategy

Infection in diabetic patient in emergency

This retrospective study was conducted to evaluate the place of infection in diabetic ketoacidosis in an emergency unit. It included 214 patients who were admitted for ketoacidosis and in whom an infection was identified. The infection was present in almost all patients and it seemed to be the direct cause of decompensation in 41%. The diagnosis was made on the clinical signs and the biological evaluation. On the 112 urinalysis performed, 45 were positive and on the 43 hemocultures, 9 were positive. An empirical antibiotherapy was started on admission in 88 cases. Thirty four patients had a severe sepsis of whom 21 developed a septic shock and 13 [6%] were transferred to the Intensive Care Unit; 4 patients died [1.9%]. We found a strong correlation between the initial presence of infection and the occurrence of at least one organ dysfunction [p=0.0001]

[Incidence and risk factors of nosocomial infections in gravelly traumatised patients]

To evaluate the incidence and the risk factors of the nosocomial infections [NT] in gravelly traumatized patients. It is a retrospective study of 6 months concerning a cohort of patients admitted in resuscitation department for a grave traumatism [ISS >/= 15]. The risk factors of NI were studied in univariate and multivariate analyses. The study included 55 patients [54 men and 1 woman], the average age was 36 +/- 13 years, the ISS of 19.3 +/- 3. The incidence of NI was 49%, the pulmonary localization was most frequent [81%]. The variables related to occurrence of NI in the gravelly traumatized patients were a low GCS [p<0.001], an associated cranial traumatism [p = 0.004], high scores of gravity: IGS II [p = 0.04], APACHE 11[0.01] and ISS [p = 0.006], the recourse [p = 0.001] and the duration of artificial ventilation [p<0.0001]. The logistic regression retained two independent variables: the low GCS [OR: 3.9; IC95% = 1.6 - 88; p = 0.011. In this work the incidence of NI in of a gravelly traumatized patients was high [49%], it was dominated by the pulmonary localization. The low GCS and the duration of artificial ventilation were independent risk factors

[Cerebral toxoplasmosis revealing a neuro-Aids]

Cerebral infection to toxoplasmosis is an opportunist infection. Its radiological aspect is not specific. It concernes male patient of 38 years old, treated from Crohn disease since three months, who was presented by infectious intracranial hypertension syndrome, symptomatic treatment was prescribed. In front his clinical aggravation, a multiple intracranial MRI was done, which showed a miliary encephalitis. Tubercolous origin was thought of and the patient received an anti-tubercolous treatment. Secondary, stereotaxic biopsy and biological study showed an advanced stage of toxoplasmosis infection reveals to a neuro-Aids. Through this observation, the authors paid an attention to think always in the eventuality of neuro-Aids in front of cases of miliary encephalitis

Cerebral infection by candida albicans

We present a case of cerebral infection by candida albicans in a previously healthy 64-year-old man who had symptoms indicative of raised intracranial pressure without fever. Computed tomography scan and magnetic resonance imaging revealed multiple cerebral granulomas. Diagnosis was made after stereotactic biopsy. The patient's symptoms improved progressively with decrease in the size of lesions after antifungal therapy. No lesions were detected outside the central nervous system. However, he died 3 weeks later from pulmonary embolism. Candida albicans of the central nervous system is uncommon and occurs rarely in immunocompetent patients. As the neurologic sings and symptoms are vague, most cases of cerebral candidiasis are diagnosed just before death or during postmortem study. We have reviewed the main clinico-pathologic features of neurocandidiasis