[Pneumococcal pneumonia in a patient with HIV infection. Development to excavation. Apropos of a case]. / Pneumopathie à pneumocoque chez une patiente infectée par le VIH. Evolution vers l'excavation. A propos d'un cas.

An HIV-infected patient presented with pneumococcal pneumonia with abscess formation. The causal effect of the pneumococcal infection on abscess formation was discussed. Since the advent of antibiotics, necrotizing pneumococcal pneumonia is rarely observed but clinicians should nevertheless be aware of this possibility, particularly because of the HIV epidemic.

[Myocardial infarction by spontaneous dissection of coronary arteries in a subject with type IV Ehlers-Danlos syndrome]. / Infarctus du myocarde par dissection spontanée des artères coronaires chez un sujet atteint d'un syndrome d'Ehlers-Danlos de type IV.

Acute myocardial infarction with spontaneous coronary dissection was fatal in a 33-years-old man. Autopsy and family history revealed type IV Ehlers-Danlos syndrome. In this disease, conjunctive tissue is fragilized due to a deficit in type III collagen which leads to spontaneous ruptures in large and medium sized arteries. The present case is the first with a proven rupture of the coronary arteries. This disease should be entertained in young people with no atherogenous risk factor and an acute coronary disorder since peripheral skin and joint syndromes may be discreet or missing. Treatment is difficult in case of spontaneous coronary dissection. Thrombolysis is not possible and diagnosis may require angiography which is in itself dangerous due to the fragility of the coronary vessels.

[Torsades de pointes during sultopride poisoning]. / Torsades de pointes lors d'une intoxication par sultopride.

A case of sultopride poisoning (ingested dose 16 g) in a 35-year-old, 65 Kg man is described. On admission myoclonus, mydriasis, vomiting and cardio-respiratory arrest were observed. Torsades de pointes were treated with potassium chloride infusion and pace maker stimulation. Plasma sultopride concentration was 25 mg/l and urinary concentration 12 g/l. A prolongation of Q-T interval may announce severe arrhythmias in sultopride poisoning.

Venous admixture in human septic shock: comparative effects of blood volume expansion, dopamine infusion and isoproterenol infusion on mismatching of ventilation and pulmonary blood flow in peritonitis.

A hemodynamic study with blood gas analysis was performed so we could observe changes induced by blood volume expansion, dopamine infusion and isoproterenol infusion in 20 adult patients suffering from peritonitis complicated with septic shock and acute respiratory failure. Blood volume expansion increased cardiac index (from 2.6 +/- 1.21/min/m2 to 3.4 +/- 1.31/min/m2; p less than 0.001), but also enhanced venous admixture (QS/QT) from 27 +/- 14% to 36 +/- 13%; p less than 0.01). Dopamine infusion increased cardiac index (from 2.6 +/- 0.9 1/min/m2 to 3.4 +/- 1 l/min/m2; p less than 0.001), but also enhanced venous admixture (from 25 +/- 11% to 31 +/- 12%, p less than 0.001). Isoproterenol infusion increased cardiac index (from 2.6 +/- 0.9 l/min/m2 to 3.6 +/- 1.1 l/min/m2; p less than 0.001), but also enhanced venous admixture (from 27 +/- 12% to 33 +/- 11%; p less than 0.001). This worsening in mismatching of ventilation and blood flow is correlated with the enhancement in pulmonary blood flow obtained by these three therapeutic procedures.

[Hemodynamic profile in acute respiratory distress syndromes in the adult (author's transl)]. / Profil hémodynamique du syndrome de détresse respiratoire aiguë de l'adulte.

Hemodynamic, investigations carried out on 25 patients suffering from acute respiratory distress in the adult established a specific hemodynamic profile for that syndrome, including precapillary pulmonary artery hypertension and systemic arterial hypotension. The level of pulmonary vascular resistance (abnormally high) and systemic arterial resistance (abnormally low) were referred to the cardiac index (which may be increased in some patients due to infusions of Dopamine, or reduced in others due to an veno-arterial bypass). The observed hemodynamic disorders are not related to hypoxemia since this is corrected by permanent positive pressure breathing, or by extracorporeal oxygenation.