Fentanyl therapy controls autonomic hyperactivity in tetanus.

This report describes the use of fentanyl in severe tetanus after failure of established therapeutic modalities (heavy sedation, neuromuscular blockade and ventilation). Cardiovascular instability accompanying severe tetanus secondary to sympathetic overactivity and raised catecholamine levels is associated with a mortality of over 50%. In this clinical situation, a variety of drugs with a primary or secondary action on the cardiovascular system has been used with varying success. The following case of severe generalised tetanus in the adult associated with autonomic hyperactivity, was successfully managed with large doses of intravenous fentanyl.

Treatment of an ilio-caval thrombosis by mechanical thrombolysis.

In proximal deep vein thrombosis, thrombolytic treatment is more effective than heparin from a recanalization point of view but with a failure rate of 20%. We describe an interventional therapeutic procedure that may be effective in these cases. Mechanical thrombolysis with the thrombolizer (Angiocor, Lille Hellemmes, France) has been tried in 2 cases of deep vein thrombosis, when systemic thrombolysis alone had failed.

Gaucher's disease and pregnancy.

For a long time, pregnancy has been discouraged for patients with Gaucher's disease. Because of the scarcity of complications found in the literature, the obstetrical attitude is favorable towards an authorization of pregnancy for patients with Gaucher's disease. We describe the evolution of pregnancy of a woman suffering from Gaucher's disease type I and the anesthesiological support provided.

[Coxiella burnetti pleuropericarditis]. / Pleuropéricardite à Coxiella burnetti.

We report here a case of acute fever with pleuropericarditis and high levels of Coxiella burnetti antibodies (phase II), excluding other possible etiologies. Complete recovery occurred with the use of non-steroidal anti-inflammatory agents combined with tetracycline.

[Prospective, randomized, controlled study of imipenem-cilastatin versus cefotaxime-amikacin in the treatment of lower respiratory tract infection and septicemia at intensive care units]. / Etude prospective randomisée contrôlée imipénème-cilastatine versus céfotaxime-amikacine dans le traitement des infections respiratoires inférieures et des septicémies de réanimation.

In a multicentre, prospective, controlled trial 211 patients with suspected septicaemia or pneumonia were allocated at random to either imipenem-cilastatin 500 mg 8-hourly or cefotaxime 1 g 6-hourly combined with amikacin 5 mg/kg 8-hourly. The treatments were administered for at least 5 days. Seventy patients on imipenem and 70 patients on cefotaxime-amikacin were assessable for comparison. There were no statistically significant differences between the two groups in underlying pathology and in the clinical results obtained: septicaemia 20/26 patients of the imipenem group and 20/25 patients of the cefotaxime-amikacin group were cured; pneumonia 38/44 patients of the imipenem group and 34/45 patients of the cefotaxime-amikacin group were cured. There were also no differences in the initial organisms and in the bacteriological cure rate, except for Pseudomonas aeruginosa. At the moment, imipenem administered alone is as effective as the cefotaxime-amikacin combination in the treatment of septicaemia or pneumonia in intensive care patients, with the exception of P. aeruginosa pneumonia in patients under assisted ventilation.

[Posttraumatic infarction with a surgically treated floating thrombus of the left ventricle. Apropos of a case]. / Infarctus post-traumatique avec thrombus flottant du ventricule gauche traité chirurgicalement. A propos d'un cas.

Forty-two days after severe thoracic trauma which had led to thrombosis of the left renal artery and to nephrectomy, a 22 year old patient developed anterior wall infarction. Echocardiography and coronary and left ventricular angiography showed distal occlusion of the left anterior descending artery and the presence of a large, mobile thrombus at the left ventricular apex. The thrombus was removed surgically without any complications but a small thrombus adherent to the ventricular scar was observed postoperatively. After a discussion on the different possible physiopathological mechanisms, the authors conclude that the patient probably suffered primary myocardial contusion which led to secondary occlusion of the LAD artery, late myocardial infarction and extension of the initial intraventricular thrombus. This case illustrates the value of two-dimensional echocardiography in the detection and follow-up of ventricular thrombosis.