Subject(s)
Ofloxacin/adverse effects , Seizures/chemically induced , Female , Humans , Middle Aged , Time FactorsABSTRACT
Polyurethane (PU) and polyethylene (PE) central venous catheters were compared for their respective responsabilities in catheter related sepsis (CRS). From may 1988 to may 1989, 300 central venous catheters were inserted. Insertion sites were freely chosen by physicians. The polymer type was randomized. Catheters were removed after 10 days in place. Microbial loads were assessed on insertion sites, catheter hubs and tips, and blood drawn through the catheters lumen. One hundred eighty three catheters were available for complete evaluation (101 PE, 82 PE). Eleven were responsible for CRS, 4 were colonized (BB3 according to Brun-Buisson's classification), 19 were contaminated (BB2), and 149 were sterile (BB1). When comparing the "infected" group (CRS+BB3) and the "noninfected" (BB2 + BB1), no difference appeared between the tested polymers. CRS were significantly associated with insertion into the internal jugular vein. It seems useless to exclude from clinical practice any of the biomaterials tested.
Subject(s)
Catheterization, Central Venous/instrumentation , Polymers , Polyurethanes , Biocompatible Materials , Catheterization, Central Venous/adverse effects , Critical Care , Humans , Infections/etiologyABSTRACT
Nosocomial infections by Pseudomonas aeruginosa seen in a general intensive care unit from January 1987 through December 1989 were studied. Use of piperacillin, ticarcillin, cefsulodine, ceftazidime, and imipenem over the same period were recorded. Rate of infection by P. aeruginosa among the 1,844 patients admitted during the study period was 3.2%; 32% of all nosocomial infections during this period were due to P. aeruginosa. The proportion of P. aeruginosa strains exhibiting in vitro susceptibility to ticarcillin rose from 45.5% in 1987 to 59% in 1988 and 86% in 1989. Concomitantly, the proportion of P. aeruginosa strains simultaneously resistant to ticarcillin, piperacillin, cefsulodine and ceftazidime fell from 32% to 18.5% then 0%. A statistically significant correlation was found between the decrease in piperacillin use and the fall in penicillinase-producing ticarcillin-resistant strains of P. aeruginosa. Because piperacillin has undesirable effects on the intestinal flora and promotes the emergence of resistant strains of P. aeruginosa, the authors now use narrow spectrum antimicrobial agents as first line treatment of nocosomial infections.
Subject(s)
Cross Infection/drug therapy , Piperacillin/therapeutic use , Pseudomonas Infections/drug therapy , Pseudomonas aeruginosa/isolation & purification , Cefsulodin/therapeutic use , Ceftazidime/therapeutic use , Drug Resistance, Microbial , Female , Humans , Imipenem/therapeutic use , Intensive Care Units , Male , Middle Aged , Ticarcillin/therapeutic useABSTRACT
A 44-year old woman presented with haemolytic-uraemic syndrome due to predominantly arteriolar microangiopathy, with anuria lasting 48 days. The semeiology in this case was unusual: there was no anaemia and only rare schizocytes on admission, blood pressure was normal and anuria was prolonged. The severity of arteriolar thrombosis observed at renal biopsy stood in sharp contrast with the lack of arterial hypertension and the almost total recovery of renal function within three months.
Subject(s)
Anuria/etiology , Hemolytic-Uremic Syndrome/complications , Adult , Biopsy , Female , Hemolytic-Uremic Syndrome/diagnosis , Hemolytic-Uremic Syndrome/pathology , HumansABSTRACT
Anuria complicating urethrocystopexy is generally an obstructive uropathy. No urinary tract dilatation had been observed in these two following cases. The rupture of the collecting system, with urinary extravasation, is due to acute ureteral obstruction and furosemide associated. The first exam to be done is the ultrasonography. However, this exploration can fail to demonstrate obstruction. Urgent percutaneous nephrostomy appears to be the best curative method. Surgical liberation of the trapped ureters is almost necessary.
Subject(s)
Anuria/etiology , Furosemide/therapeutic use , Postoperative Complications , Urinary Incontinence, Stress/complications , Aged , Anuria/drug therapy , Female , Humans , Tomography, X-Ray Computed , Ultrasonography , Urinary Diversion , Urinary Incontinence, Stress/diagnostic imaging , Urinary Incontinence, Stress/surgeryABSTRACT
To evaluate the resistant strains selection during treatment with cefmenoxime, a 3rd generation cephalosporin, 10 adult inpatients of an intensive-care unit had quantitative stool cultures, before the treatment, on the 7-10th day of therapy, and 7-10 days after the end of the antibiotic course. The results show that the selecting effect of cefmenoxime is not different from the effect previously observed for cefotaxime.
Subject(s)
Cefmenoxime/therapeutic use , Feces/microbiology , Gram-Negative Aerobic Bacteria/drug effects , Candida albicans/drug effects , Cefmenoxime/pharmacology , Critical Care , Drug Resistance, Microbial , Gram-Negative Aerobic Bacteria/classification , HumansABSTRACT
Heat shock is the consequence of malignant hyperthermia triggered by general anaesthesia, the use of neuroleptic drugs, or strenuous muscular exercise. Chronic alcoholism could be a contributing factor by facilitating the triggering of malignant hyperthermia. We describe two cases of malignant hyperthermia which occurred during the summer in undernourished chronic alcoholics showing withdrawal syndrome during their stay in hospital. General anaesthesia and neuroleptics were excluded as the origin of their malignant hyperthermia, and we looked for new mechanisms to explain the heat shock, other than shivering associated with the withdrawal syndrome or the high temperature of the season. These two patients were considered deficient in thiamine on admission, their plasma pyruvic acid level being sharply increased (185 mumol/l and 304 mumol/l respectively; normal range: 45.6-91.2 mumol/l). This deficiency can lead to disregulation of thermal centres. Other metabolic disorders, frequently observed in alcoholics, could facilitate heat release during withdrawal syndrome shivering. The risk of heat shock during abrupt alcohol withdrawal should not be underestimated.
Subject(s)
Ethanol/adverse effects , Malignant Hyperthermia/etiology , Substance Withdrawal Syndrome , Adult , Alcoholism/metabolism , Female , Humans , Male , Middle Aged , Thiamine Deficiency/etiologyABSTRACT
Thirty-two of 320 patients with severe thoracic trauma were treated with costal stapling. The technique, described by R. Judet in 1973, is basically simple but sometimes difficult to perform. In the most favourable cases (here 23/32 patients), it avoids tracheostomy and its complications and reduces the restrictive sequelae associated with pleural adhesion or thoracic wall deformities. In addition, active respiratory physiotherapy can be undertaken at an earlier stage. The authors describe the indications and limitations of this treatment on the basis of the results obtained in this series.
Subject(s)
Fracture Fixation, Internal/instrumentation , Rib Fractures/surgery , Thoracic Injuries/surgery , Adolescent , Adult , Aged , Child , Female , Flail Chest/surgery , Fracture Fixation, Internal/adverse effects , Humans , Male , Middle Aged , Postoperative Complications/prevention & control , Tracheotomy/adverse effectsABSTRACT
An attempt was made to define the value of the bacteriological examination of tracheal aspirations in patients on artificial ventilation. Quantitative cultures of lung biopsies, taken immediately after death, were made on 21 patients in an intensive care unit. The results were compared with the clinical signs, antibiotic therapy and quantitative cultures of tracheal secretions taken before and very soon after death. A comparison of the results shows that microbial species present in tracheal secretions at a level equal to or greater than 10(7)/ml were found in 53 percent of lung biopsies. However, the predominant bacteria found in the lung biopsies were not necessarily similar to those in the tracheal secretions. Also, bacteria minimally present or completely absent in tracheal secretions could be found in lung biopsies. Therapeutic decisions can only be made on clinical and radiological signs; bacteriological examination may be a help in the choice of drugs once such treatment has been decided upon.
Subject(s)
Bacterial Infections/diagnosis , Lung/pathology , Trachea/metabolism , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/microbiology , Biopsy, Needle , Female , Humans , Lung/microbiology , Male , Middle Aged , Respiration, Artificial , Trachea/microbiologyABSTRACT
The appearance of a diastolic murmur in a pyrexial patient 15 days after trauma was suggestive of infectious endocarditis. This diagnosis was excluded, especially by echocardiography, and the aortic incompetence was attributed to the trauma. The value of echocardiography and the features of other reported cases are discussed with referrence to this case.
