[Disseminated strongyloidiasis, a rare cause of multiple organ failure]

INTRODUCTION

Strongyloidiasis is an parasitic intestinal disease, frequent in tropical countries and fairly rare in temperate areas under certain conditions. Disseminated forms can provoke multivisceral damage.

CASE REPORT

A 75 year-old woman, hospitalized for occlusion, developed multivisceral (cerebral, renal, cardiac pulmonary and hepatic) damage over 48 hours, attributed to strongyloidiasis. The diagnosis was confirmed by isolation of larvae in the tracheal and gastric aspiration fluids. Treatment combined ivermectin and albendazole.

COMMENTS

Disseminated stronglyloidiasis is essentially observed in immunodepressed patients, under corticosteroids or HTLV1 carriers, although an HIV status does not appear to intervene. Larvae can be found in all the organs. Death occurs by multivisceral failure in 50 to 70% of cases. Broncho-alveolar washing and examination of the gastric fluids is the key to diagnosis. Treatment relies on thiabendazole, ivermectin or albendazole, and the symptomatic management of all the visceral deficiencies.

[Campylobacter fetus ssp fetus septicemia associated with a colonic abscess]

Campylobacter is considered to be an opportunistic agent. The authors relate an unusual case with Campylobacter fetus ssp fetus (CF) septicemia and colic abscess. Human Campylobacteriosis is presumed to be a food-born disease related to contaminated animal products such as milk or meat. In some cases CF may be transmitted by drinking water or by fecal soiling via the hands. Conventional treatment uses macrolides with decrease the duration of diarrhea and reduce the fecal excretion of CF. Macrolides are ineffective in CF septicemias. In such cases aminoglycosides seem to be the drug of choice.

Non-cardiac pulmonary edema following intravenous contrast injection

Acute non-cardiogenic pulmonary edema (NCPE) following intravenous administration of contrast media is a rare but life-threatening complication of radiologic contrast material. We recently observed this complication as an idiosyncratic reaction following a coelio-mesenteric arteriography.

[The locked-in syndrome]

The locked-in syndrome is poorly understood, and may be misdiagnosed as coma. The syndrome consists of complete paralysis of all four limbs and the lower cranial nerve pairs, associated with an unaltered consciousness. Vertical eye movements and blinking remain intact, so allowing some form of communication by way of eye codes. Obstruction of the vertebral and basilar vascular system is the major cause, but the six cases reported show the aetiological diversity of this syndrome. If the vascular obstruction is diagnosed within the first few hours, fibrinolytic therapy may be considered. Although the patients usually die within a few days or after several months, some rare cases of recovery after several weeks have been reported. Intensive care is required by these patients (tracheostomy, artificial ventilation, intensive nursing care); the physicians and nursing staff looking after them should always keep in mind that these patients are conscious and able to communicate.

[Hemodynamic aspect of adiastole in oxprenolol poisoning]

Self-poisoning with beta-blockers is uncommon but often life-threatening. A 59 year old man was admitted to the ICU after having ingested an estimated dose of 2 g of oxprenolol. Circulatory collapse occurred without pre-existing cardiac failure. Right ventricular haemodynamic data showed adiastole which responded to massive doses of isoprenaline and dopamine. Subsequently the patient recovered normal haemodynamic parameters. This report suggests that right ventricular dysfunction may complicate beta-blocker overdose.

[Renal failure caused by non-steroid anti-inflammatory agents]

This review of literature about non steroidal anti-inflammatory drugs renal accidents is an analysis of acute pathology and a study of renal dysfunctions induced by these drugs. Each chapter allows a physiopathologic study. The care of anti-inflammatory drugs utilisation is specified.

[Severe respiratory complications in acute voluntary drug poisoning. Apropos of 15 cases in 824 poisoning cases]

Respiratory diseases are the most heavy complications that we can meat in self-poisoning persons. Authors report 15 cases of respiratory complications appeared in 824 self-poisoning cases by drugs. Different factors involved in respiratory diseases origin are analysed but only one appears to be significant: the time between poisoning and admission in intensive care unit. The encountered complications are: acute respiratory distress syndrome, Mendelson syndrome, heavy pulmonary infections, pulmonary embolism. Authors argue about the means of prevention. This seems the fundamental aspect, alone capable to decrease the incidence of very heavy complications responsible of a height mortality range (33%).

[Changes of blood urea in drug poisoning]

A significant fall in blood urea nitrogen (BUN) was noted before gastric lavage and before renal excretion was increased by forced diuresis in 103 patients treated in an intensive care unit for self-poisoning with psychoactive drugs. The pathogenesis of changes in BUN during acute intoxication with benzodiazepines, phenothiazines and barbiturates is obscure, but they do not seem to be associated with accelerated renal excretion, hepatic failure or enzyme induction.

[Haemoperitoneum due to ruptured hepatoma in a cirrhotic patient with porphyria cutanea tarda. Three years' survival (author's transl)]

A case of ruptured hepatocarcinoma of the left lobe in a cirrhotic patient with a 7 years' history of porphyria cutanea tarda (PCT) is reported. Emergency left lobectomy resulted in 3 years' survival with no sign of recurrence at present. Comments are made concerning the clinical association PCT-hepatoma: (1) either PCT is associated with a hypersecretory hepatoma and behaves as a neoplastic syndrome following the same course as the tumour; (2) or PCT is associated with a cirrhosis (usually alcoholic) which facilitates the development of a hepatoma. In such cases, PCT precedes the tumour and follows a separate course.

[So-called refractory hypoxemia: treatment with acexamic acid]

Acexamic acid is currently used to avoid pulmonary fibrosis in patients treated with bleomycim. It seems to be equally effective to prevent pulmonary fibrosis in adult respiratory distress syndrome. The complications of this therapy are hypercalcemia and hypernatremia.