Arnaud Cornil

Case of acute poisoning by mercuric oxycyanide

We report the case of a 25-year-old woman who voluntary swallowed mercuric oxycyanide and presented an anuric acute renal failure. The treatment was classically based upon the use of chelating agents and haemodialysis. Recovery of renal function was excellent. We discuss then more widely the clinical, physiopathologic and therapeutic aspects of acute intoxication with inorganic mercury salts.

ASPECTS CLINIQUES ET ELECTRO-ENCEPHALOGRAPHIQUES D'UNE INTOXICATION SEVERE A L'ALPHACHLORALOSE

SummaryThe authors report a case of acute and massive poisoning by alphachloralose in a 18 year old girl. The clinical symptoms were characterised by coma, epilepsy and myoclonic jerks.Early and repeated electroencephalograms were done in this case, Inspite of the important doses which were absorbed the recovery was complete under respiratory assistance and anticonvulsant treatment.

Étude clinique de 39 observations d'hypothermie accidentelle de l'adulte

SummaryThe authors review 39 cases of adult patients with accidental hypothermia. The frequency of this affection is presumably higher than generally thought, especially in normal but aged patients and in different pathological conditions which interfere with the mechanisms of thermoregulation. Eventhough the diagnosis of hypothermia is a simple one, it is probably often missed because the symptoms of the causal disease are frequently masking it, but also because the characteristic signs of hypothermia appear only when the temperature is really low (under 33°C).Clinical manifestations of hypothermia are quite various and are largely depending on the causal disease. Shivering, muscular hypertonia, skin modifications, hemodynamic disturbances, bradycardia and bradypnea are usually observed. The authors underline the possible absence of severe alterations of conscience, even when the central temperature reaches 26°C. Biological tests are generally slightly perturbed.The prognosis is closely related to the pr...

Clostridial Gas Gangrene: A Review Of 48 Consecutive Cases

SummaryGas gangrene (GG) is an acute necrosis of the muscle and/or subcutaneous tissue due to gas-forming microorganisms. The authors retrospectively review 48 consecutive cases of clostridial GG treated in an intensive care unit over a 17-year period (1969–1986). Surgery and trauma were the most frequent initiating factors (88 %) of clostridial GG. The diagnosis is clinical and based on a comparison of the local and systemic signs. Direct examination of the sweet-smelling discharge, revealing large Gram-positive bacilli, confirmed the clinical impression in about 75 % of the cases. The key to successful treatment of clostridial GG requires the judicious application of resuscitation measures (86 % of our eases), a correct antibiotherapy (penicillin G, 30 to 40 million units daily), surgery (fasciotomies, excisions limited to undoubtedly dead tissue) and hyperbaric oxygen (H.B.O.) therapy (83% of our patients), in order to break the vicious circle of progression of the disease. Sixteen of our 48 patients w...

FIEVRE ET PROBLEMES INFECTIEUX EN REANIMATION MEDICALE

SummaryThe authors have looked for fever and infections in a hundred consecutive cases treated in a medical intensive care unit. These patients suffered from severe intoxication, respiratory insufficiency, myocardial infarction, neurological diseases or endocrine disorders. Sixty-seven patients had fever, due to infection in at least 41 cases, 35 of which had a respiratory infection. Most of the patients with non-infectious fever had a myocardial necrosis or a cerebral affection. Twenty-seven patients acquired an infection within the unit ; these hospital-acquired infections are mainly due to fungi and to Gram-negative organisms. Many factors contribute to contaminate the patients : venous and urinary catheters, artificial ventilation, coma, spontaneous hypothermia, antibiotics, corticoids, etc. The main principles of the prevention of infections in intensive therapy units are recalled.