Streptococcus G leading to septic abortion and multiple organ failure

The authors report a patient admitted at 12 weeks of pregnancy with an acute infectious syndrome, leading to abortion, sepsis, and multiple organ failure. Admission to intensive care unit (ICU) was needed after curettage for incomplete abortion complicated by uterine atony, hemorrhage, and septic shock. The patient had multiple organ failure and required non-invasive ventilation. Hemoculture showed streptococcus G bacteremia. She had no evidence of concurrent infection, mainly genital or urinary, except amygdalitis few days before. Hematogenous spread to the gestational sac could have possibly been the cause of her sepsis. Streptococcus G infection during pregnancy can lead to severe consequences.

[Bronchopericardial fistula treatment by a metallic stent]

INTRODUCTION

Bronchopericardial fistula is a rare condition leading to pneumopericardium. This medical condition is often related to neoplastic disease, or a complication of surgical interventions. The treatment approach depends on both the etiology and the clinical presentation. In stable patients, pericardial drain insertion and/or surgical resection of the fistula are considered options for persistent cases. We present the case of a bronchopericardial fistula treated by placement of an endobronchial stent.

CASE PRESENTATION

A 64-year-old man operated on for lung cancer had a recurrence treated with radiation and chemotherapy. A pneumopericadium was discovered when he presented with a new onset of atrial fibrillation. Bronchoscopy revealed a fistula tract. Pericardial drainage was persistent and did not improve the clinical situation. The poor health status of the patient contraindicated surgery and an alternative therapeutic approach with endobronchial stent placement was undertaken. The fistula sealed immediately, the pericardial drain could be removed removed and the patient was able to be discharged from hospital.

CONCLUSION

Endobronchial stenting should be considered as a potential treatment option in patients with pneumopericardium secondary to bronchopericadial fistula, particularly where a non-surgical is required.

[Alveolar haemorrhage associated with the primary antiphospholipid syndrome]

INTRODUCTION

Thrombotic events, particularly pulmonary embolism, are well known presentations of the antiphospholipid syndrome. Other pulmonary manifestations of the disease like alveolar haemorrhage are rare but can represent a catastrophic aspect of this disease. Alveolar haemorrhage in this context is important to recognize since it can be either a complication of anticoagulation therapy or a manifestation of the disease. The therapeutic implications are then very different.

CASE PRESENTATION

We present the case of a woman with massive pulmonary embolism treated with thrombolytic therapy. This was complicated by alveolar hemorrhage initially attributed to thrombolytics and recurrent bleeding considered to be a manifestation of the antiphospholipid syndrome. The complicated course necessitated a protracted stay in the intensive care unit, mechanical ventilation, and treatment with intravenous corticosteroids and plasmapheresis.

CONCLUSION

Alveolar haemorrhage associated with the antiphospholipid syndrome can be catastrophic and require prompt and aggressive therapy. Plasmapheresis, usually reserved for the catastrophic aspects of this condition, was felt to be useful in this case.

[Acute respiratory distress syndrome complicating Ebstein-Barr virus pneumonia]

Introduction

Chez l’adulte immunocompétent, l’Epstein Barr (EBV) entraîne une maladie autolimitée spontanément résolutive.

Observation

Un syndrome de détresse respiratoire aigu (SDRA) compliquant une pneumonie grave à EBV est rapporté avec le recours à une ventilation artificielle prolongée. Le diagnostic était confirmé par l’usage des sérologies spécifiques et la recherche de la charge d’ADN virale par PCR. À part la stratégie protectrice de la ventilation mécanique, le traitement médical a compris l’utilisation de l’Acyclovir et les immunoglobulines polyclonales dans la phase précoce ainsi que des corticoïdes systémiques dans la phase tardive. La guérison était progressive et complète.

Conclusion

La pneumonie à EBV compliquée d’un SDRA chez les immunocompétents existe. Sa prise en charge est un défi diagnostique et thérapeutique.

[Reliability and survival of arterial catheters: optimal dynamic response]

OBJECTIVES

Blood pressure is one of the most critical haemodynamic parameter in the intensive care unit (ICU). The measurement relies mainly on invasive methods (arterial lines) but also on noninvasive methods (Oscillometric and Manual). It is crucial to be instantaneous and accurate to adapt any decision making plan. The aim of this study is to evaluate the reliability of this measure given by an arterial catheter over time. This can determine the maintenance of catheter patency before clinical total occlusion.

STUDY DESIGN

Observational prospective study.

PATIENTS AND METHODS

Damping coefficient (xi) and natural frequency (Fn) of the arterial catheter system are studied in vivo each 12 hours by a fast flush test (FFT) in 61 patients. The measurements of the arterial blood pressure invasively (arterial catheter method) and non invasively (oscillometric method) are compared each 12 hours until the catheter is removed.

RESULTS

All over the study period for each catheter (till 240 hours), the mean arterial blood pressure measurements given by either the catheter method or the oscillometric method were very concordant (coefficient > 0.7). Only 3.39% of the catheters had their physical characteristics (xi and Fn) in the optimal zone at T0; reaching 66.67% at T19. The maximal inserted time was highly correlated with a good operating catheter (R = 0.739; P < 10(-4)).

CONCLUSION

The measure of the arterial blood pressure invasively can still be reliable for a long period of time (10 days), as long as the catheter is inserted, especially when the mean arterial pressure is considered. Each time the distance of the catheter insertion site moves away 1 cm from the radiocarpal joint or the groin, the risk of troubleshooting is doubled; on each blood sample from the catheter, this risk is reduced by 20%.