[Acute interstitial nephritis. Role of ceftazidime]. / Néphrite interstitielle aiguë: rôle de la ceftazidime.

A 22-year-old man treated with ceftazidime-amikacine for a Pseudomonas aeruginosa pneumonia, experienced two days later allergic symptoms, acute renal failure and urinary sediment abnormalities. The renal biopsy showed an acute interstitial nephritis. Basophils stimulation test was positive for ceftazidime. Early diagnosis and discontinuation of the suspected agent is essential to allow rapid and complete recovery of renal function.

[Laryngeal masks in emergency medicine]. / Le masque laryngé en médecine d'urgence.

Airway control and maintenance of effective assisted ventilation are an absolute priority in emergency medicine. Developed by Brain in 1988, the laryngeal mask offers a new means of ventilation management and is a reliable compromise between the face mask and endotracheal tubing. The laryngeal mask ensures no protection against gastric contents inhalation and its use is limited in patients with decreased thoracopulmonary compliance. However, compared to the face mask, the laryngeal mask offers several benefits in the management of cardiorespiratory arrests by paramedical staff and rescue teams: the procedure is easy to learn, the device improves airway patency, leaves the operator's hands free, allows endotracheal aspiration to be performed and reduces the risk of hyperinsufflation. These advantages make the use of the laryngeal mask a technique which should be taught to any staff liable to face and manage cases of cardiorespiratory arrest. The laryngeal mask cannot and does not replace endotracheal tubing which remains the only technique that guarantees upper airway patency and protection as well as efficient ventilation control. However, in some situations tubing may prove difficult and even, at times, impossible to perform. This is when the laryngeal mask will come in handy, either as a temporary solution or as an alternative to difficult or impossible tubing techniques.

[Endotracheal intubation under propofol with or without vecuronium]. / Intubation endotrachéale sous propofol avec ou sans vécuronium.

OBJECTIVE: In order to test the hypothesis that under the association propofol-alfentanil-IV lidocaine the trachea could be intubated easily without an additional muscle relaxant, this study compared the intubation conditions when this association was combined or not with vecuronium. STUDY DESIGN: Randomized comparative trial. PATIENTS: The study included 152 young adults classified as ASA physical class I and Mallampati presentation grade 1, randomly allocated either into Vecu+ group or Vécu0 group, depending on whether vecuronium was co-administered or not. METHODS: All patients received midazolam 0.05 mg.kg-1 i.v., one minute before induction. Those of group Vecu0 were given successively within two minutes: alfentanil 0.03 mg.kg-1, lidocaine 1.5 mg.kg-1 i.v. and propofol 2.5 mg.kg-1. Patients of group Vecu+ received similar doses of alfentanil and propofol as well as vecuronium 0.08 mg.kg-1. The endotracheal tube was inserted one minute after induction in the patients of Vecu0 group, and after three minutes in those of the Vecu+ group. During intubation, scores of mouth opening, glottis opening and coughing were established, in order to assess intubation conditions. RESULTS: Similar convenient intubating conditions were obtained in both groups (in 97% of patients in Vecu+ group vs 95% of those in Vecu0 group). In the latter, the glottis opening was less pronounced. CONCLUSIONS: In young healthy adults, without anaesthetic risk (emergency, full stomach) and without foreseen difficult intubation, the endotracheal tube can be inserted in convenient conditions without a muscle relaxant, under the association propofol-alfentanil-lidocaine iv.

[Severe accidental hypothermia]. / Hypothermie majeure accidentelle.

Two cases of severe accidental hypothermia (core temperature below 25 degrees C) are reported. Both occurred in an urban area during the same winter period. Both patients had the same age and similar clinical symptoms. In the first patient, the EEG, the echocardiography and the blood gases were in favour of a good tolerance of hypothermia, which led to choice a non aggressive rewarming method. The latter included the rewarming of inhaled gas mixture as well as i.v. fluids and gastro-intestinal lavage fluid. The outcome was uneventful. In the second patient, the visceral and biological consequences were more important (pH: 6.80, blood glucose concentration: 1.48 mmol.L-1, major coagulation disorders). Therefore a rapid rewarming via a cardiopulmonary bypass was preferred. The patient died from a prolonged shock with disseminated intravascular coagulation. The use of cardiopulmonary bypass which is essential in case of cardiac arrest rhythm, is controversial in case of severe hypothermia with a still beating heart.

[Spinal cord injury and secondary autonomic function disorders]. / Traumatisme médullaire et troubles dysautonomiques secondaires.

Autonomic dysfunction is frequently reported after high level spinal cord injury. These disorders usually occur in the first days and resolve spontaneously within 3 to 6 weeks. Usual clinical aspects are hemodynamic abnormalities and often bradycardia which can lead to death. These dysfunctions rarely reappear during neurological status recovery. In this case report, usual autonomic disorders were noted after a T5 level spinal injury with partial motor lesions. However during motor recovery periods, arrhythmias occurred, including ventricular extrasystoles and bursts of ventricular tachycardia. Physiopathological mechanisms are discussed and regulation changes of sympathetic and parasympathetic autonomic nervous system are evoked.