Increasing incidence of severe Epstein-Barr virus-related infectious mononucleosis: surveillance study.

Older patients are more susceptible to severe Epstein-Barr virus (EBV)-related infectious mononucleosis (IM). This condition may increase in industrialized countries where primary EBV infection occurs later in life. Between 1990 and 2004, 38 patients were admitted to our department with EBV-related IM. Two patients died. The annual incidence increased significantly (r = 0.623; P = 0.013).

Assessment of peri-extubation pain by visual analogue scale in the adult intensive care unit: a prospective observational study.

OBJECTIVE: This prospective observational study was undertaken in order to assess pain experienced by intensive care unit patients at the time of extubation and to identify factors associated with pain of at least moderate intensity. DESIGN: Prospective observational study. SETTING: Intensive care unit at a university hospital. PATIENTS: During a 1-year period the presence, severity and clinical predictors of orofacial and/or chest pain among patients undergoing removal of endotracheal tubes was assessed. MEASUREMENTS AND RESULTS: Pain was evaluated using a visual analogue scale (VAS). Of 332 extubated patients, 203 could be evaluated. During the peri-extubation period, pain was significantly associated with a SAPS II score more than 36 ( p=0.03) and duration of mechanical ventilation (MV) of 6 days or more ( p=0.002), whereas intubation in the operating room was associated with less pain ( p=0.001). Pain of at least moderate intensity (VAS score >30 mm) was reported by 73% of patients and pain of severe intensity (VAS score >50 mm) was reported by 45% of patients. MV duration of 6 days or more was the only independent risk factor for pain of at least moderate intensity (OR 2.4, 95% CI 1.03-5.4, p=0.04). We also observed that pain had resolved 1 h after extubation in the majority of patients. CONCLUSION: Our results suggest that, in intensive care unit patients, peri-extubation pain is frequent and should be considered for treatment, especially in patients with longer intubation.

Reversible spongiform leucoencephalopathy after inhalation of heated heroin.

OBJECTIVE: To describe the clinical course and imaging findings in a young man who developed a spongiform leucoencephalopathy from heroin-vapour inhalation, and to discuss the treatments which may have contributed to the unexpected favourable outcome in this case. DESIGN: Case report. SETTING: Intensive care unit of a university teaching hospital. PATIENT: A patient who developed a near fatal toxic leucoencephalopathy with impressive clinical recovery and reversible white matter changes on imaging. MEASUREMENTS AND RESULTS: Successive computed tomography scans and magnetic resonance imaging over 7 months showed evolution from bilateral extensive involvement of the cerebral white matter to almost complete resolution accompanied by the development of periventricular lesions suggestive of necrosis. Despite the fact that the patient had stretching spasms for several days, the outcome was favourable with prolonged supportive care and antioxidant therapy by ubiquinone (coenzyme Q). CONCLUSION: This case demonstrates that prolonged intensive care is of paramount importance in patients with spongiform leucoencephalopathy after inhalation of heated heroin, that abnormalities of cerebral white matter may be slowly regressive, and supports the use of coenzyme Q in severe forms of the disease.