P. Trunet

Decreased plasma epinephrine concentrations after glucose ingestion in humans

Plasma levels of norepinephrine (NE), epinephrine (E), immunoreactive insulin (IRI), and glucose were measured in six healthy volunteers after glucose consumption and in six volunteers after a water solution. Ingestion of the glucose (100 g) solution significantly decreased E levels from 46.7 +/- 8.0 to 20.8 +/- 1.9 pg/mL (P less than 0.01). Three hours after the glucose ingestion, plasma E levels nearly returned to basal values. Plasma IRI and glucose levels peaked at 45 minutes after glucose consumption (P less than 0.01), then declined toward basal values. Plasma NE levels were unaffected by glucose consumption. There were no changes in glucose, IRI, NE, or E levels in the control group. These results suggest that E behaves as a counter-regulatory hormone to insulin under stimulation by glucose.

The role of drug-induced illness in admissions to an intensive care unit

All patients admitted during a 33-month period to a multidisciplinary intensive care unit were prospectively studied in order to determine the incidence and severity of drug-induced illness leading to the admission. The role of underlying diseases was assessed and the avoidability of drug-induced illness considered. Out of 1651 patients, 97 (5.88%) were admitted because of drug-induced illness; 74 of these had serious underlying diseases. 13 (13.4%) of the 97 patients died, but underlying diseases accounted for 4 of the 13 fatalities. In nearly half of the cases, the drug-induced illness appeared potentially avoidable.

Computed tomography and post-laparotomy intra-abdominal abscesses

Thirty-one patients were prospectively studied and had abdominal computed tomography for post laparotomy sepsis. Computed tomography is of particular interest in seriously ill post-operative patients, 15 of our patients were on ventilators, and it enabled diagnosis and localization of abscesses in 15 patients. Drainage could therefore be achieved via a limited surgical approach, and extensive laparotomy was avoided. Of 16 patients without abscess, the abdominal computed tomogram was negative in 14 cases and there were two false positives. The overall accuracy was 0.94 with a sensitivity of 1 and a specificity of 0.88. The ability to screen the whole abdomen and exactly localize the lesion are the advantages of this non-invasive method.

Syndrome de détresse respiratoire aiguë de l'adulte après lymphographie

Pulmonary complications of lymphography are usually described as radiological infiltrates without clinical symptoms. However, a case is here reported of an adult respiratory distress syndrome occurring after lymphography in a 60 year old female lymphoma patient. Pulmonary oedema developed within 48 h; haemodynamic study showed a normal capillary wedge pressure. The patient died from intractable low cardiac output within 24 h. Post-mortem examination showed pulmonary lymphocytic infiltration and multiple fat emboli. The lack of lymphatic drainage was probably responsible for the intravascular passage of lipid-soluble contrast medium, this giving endothelial lesions. In such patients with preexisting lung disease or pulmonary involvement in haematological disease, lymphography has to be considered carefully.Pulmonary complications of lymphography are usually described as radiological infiltrates without clinical symptoms. However, a case is here reported of an adult respiratory distress syndrome occurring after lymphography in a 60 year old female lymphoma patient. Pulmonary oedema developed within 48 h; haemodynamic study showed a normal capillary wedge pressure. The patient died from intractable low cardiac output within 24 h. Post-mortem examination showed pulmonary lymphocytic infiltration and multiple fat emboli. The lack of lymphatic drainage was probably responsible for the intravascular passage of lipid-soluble contrast medium, this giving endothelial lesions. In such patients with preexisting lung disease or pulmonary involvement in haematological disease, lymphography has to be considered carefully.

Hospitalisations dues a la Pathologie Iatrogene Dans un Service de Reanimation Multidisciplinaire

We prospectively studied all admissions to a multidisciplinary intensive care unit in order to determine how many were due to iatrogenic diseases and of these, what number were potentially avoidable. Iatrogenic disease was defined as a disease induced by either drug treatment, medical or surgical actions. We used precise criteria to determine the cause and effect relationship between the medical action, the patient’s reaction and the severity. Of 325 patients admitted in the course of one year 41 patients (12.6%) were hospitalized because of the iatrogenic disease. Many of these patients had concomitant serious illnesses. Nevertheless nearly half (19 patients or 46.3%) of iatrogenic admissions were admitted with iatrogenic disease due to therapeutic or technical errors that were potentially avoidable. Iatrogenic disease was fatal in 8 cases, life threatening in 13, moderate in 20.

Evaluation de l’Etat de Sante Avant et Apres Hospitalisation en Reanimation

To evaluate the results of a multidisciplinary intensive care unit (ICU) 228 patients (group I) have been prospectively studied and compared to a control group of 98 patients (group II) treated only in an intermediate unit. The health status (HS) was estimated A : good health, B : chronic and minor health problem with limited activity, C : chronic and major health problem with very decreased activity, D : institutionalized patient. Three months before ICU, then 1, 3 and 12 months after discharge, the HS was measured by physical examination or phone interview. Patients of group I had multiple organ failures and a level of therapy 4 times higher than in group II. Immediate survival rate was 67 per cent and 49 per cent after one year. Twenty per cent of surviving patients were still hospitalized three months after discharge. One year later 33 per cent of the 228 entering patients had a A or B health status level. All these results are significantly different from those of the control group.