Cisplatin-induced hyperglycemic hyperosmolar coma.

We present a case of severe hyperglycaemic hyperosmolar derangement after treatment with cisplatin in a patient without previous diabetes mellitus. Limited data are available on this adverse reaction, explaining why impaired glucose handling due to cisplatin is not generally recognised.

[An unusual cause of meningo-encephalitis: Japanese encephalitis]. / Een ongewone oorzaak van meningo-encefalitis: Japanse encefalitis.

Two women, 29 and 30 years of age, who had visited Indonesia and Thailand, respectively, during the summer, presented with diarrhoea, headache, fever and later neurological symptoms. The first patient had to be sedated because of restlessness and was admitted to the intensive-care unit for intravenous antimicrobial therapy; the second became comatose and received intravenous rehydration and antipyretics. No diagnosis was made during the acute phase ofthe illness, but later there was serological evidence of Japanese encephalitis. Both patients recovered, but memory and concentration difficulties persisted for a long time. Due to the increase in travelling, we see more and more cases of (rare) imported diseases. Japanese encephalitis is a viral infection that causes 50,000 cases each year in Asia with a mortality of 30%. The risk of transmission for tourists is very low. Most infections with Japanese encephalitis virus do not lead to symptomatic disease; only 0.1-5% of infections lead to clinical disease. The symptoms are initially non-specific, consisting of general discomfort and diarrhoea. After this, patients can develop headache, decreased consciousness and sometimes convulsions. Therapy consists of supportive care. For travellers at high risk of exposure, a formalin-inactivated vaccine is available. For the proper diagnosis of rare imported diseases, it is advisable to consult an infectious-disease specialist or microbiologist at an early stage when evaluating a patient who has recently returned from the tropics.

Lung mechanical profiles in acute respiratory failure: diagnostic and prognostic value of compliance at different tidal volumes.

The mean airway pressure difference within a respiratory cycle at end-inspiration was measured at different tidal volumes (VT) in 59 patients treated with mechanical ventilation, and plotted in a pressure-volume (P-V) diagram. Regression analysis revealed three types of regression lines which were clearly correlated with clinical pulmonary condition and outcome. The slope of such regression lines may be a more realistic representation of lung elasticity than conventional total static compliance, which is measured at only one VT, and the intercept of these lines may be a more appropriate reflection of operating lung volume than functional residual capacity. Ventilator settings should put the patient's lungs on the steepest part of the P-V curve with the smallest intercept, while maintaining acceptable arterial blood gas tensions.

Mechanical ventilation for acute postoperative respiratory failure after surgery for bronchial carcinoma.

From 1978 to 1982 365 patients were treated surgically for bronchial carcinoma. Lobectomy was performed in 250 and pneumonectomy in 115. Sixteen (4.4%) needed mechanical ventilation for acute respiratory failure. Six out of eight with a lobectomy, but only two out of eight with a pneumonectomy, survived initially. Of these eight survivors, five died from recurrent malignancy within a year but three were alive and well at two years. The complications leading to acute respiratory failure were unpredictable in most patients. Improving techniques of mechanical ventilation and intensive care may lead to better results in the future.

Central venous versus esophageal pressure changes for calculation of lung compliance during mechanical ventilation.

Esophageal and CVP changes were measured simultaneously during mechanical ventilation in 12 patients with acute respiratory failure (ARF). The results of these measurements were different and showed no correlation. Values of transpulmonary pressure changes and calculated lung compliances correlated well, because of the higher airway pressure changes. It is concluded, therefore, that measurements of esophageal and CVP changes are equally well suited for these calculations. For practical purposes, there is no need to measure a representant of intrapleural pressure changes, because during mechanical ventilation total static compliance calculations can be used to monitor changes in lung compliance, provided the thoracic cage compliance is not reduced substantially and does not change during the course of the studies. Clinical awareness of factors influencing thoracic cage compliance is important. The difference in transpulmonary and transthoracic pressure relationships during mechanical ventilation and during spontaneous breathing is emphasized. In spontaneous breathing, intrapleural pressure changes are determined primarily by the elastic properties of the lungs; in mechanical ventilation, on the other hand, by the elastic properties of the thoracic cage.