[Systemic candidiasis in intensive care: incidence?].
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Adolescent↗
Biomedical subjects
H Barrou
Publications and source records attributed to H Barrou.
[Cervical extradural hematoma revealing hemophilia].
BACKGROUND: Neurological hemorrhagic complications are unusual in hemophiliacs. Extradural hematoma is an exception, particularly at the cervical level. Less than 10 cases have been reported in the literature. We report a new case which was the inaugural sign of hemophilia A. CASE REPORT: Moderate hemophilia A was revealed by post-traumatic cervical extradural hematoma in a 12-year-old boy. Pain in the cervical spine and progressive tetraplegia led to the diagnosis, confirmed by cervical CT scan. The dissonance between the injury and the minor trauma led to hemostasis exploration which revealed factor VIII at 3%. After prompt correction of the deficiency, total laminectomy allow removal of the hematoma. The neurological course was satisfactory. CONCLUSION: We stress the specific character of this association and the previously unreported mode of hemophilia disclosure. CT scan and MRI facilitate diagnosis allowing satisfactory course after emergency decompressive laminectomy.
Child↗
[Tetraplegia following cervical stab wound].
We report two cases of tetraplegia caused by cervical stab wounds. In the first one, in a 34-year-old patient, the injury caused an immediate tetraplegia from cervical spine section and had a rapid lethal outcome. The second case occurred in a 30-year-old woman, who experienced a progressive tetraplegia associated with a Brown-Séquard syndrome from an oedema of the bulbo-spinal junction. Three months later, the motor recovery was satisfactory, however a thermo-algesic hemi-anaesthesia still persisted after the 6th month.
Adult↗
[HELLP syndrome: pregnant microangiopathy].
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Adult↗
[Neurologic manifestations of fat embolism].
Neurologic manifestations are usual and variable during post-traumatic fat embolism. The pathogenesis of these lesions continues to be a source of considerable controversy. Thirteen cases of post-traumatic fat embolism with neurologic signs were treated in a surgical intensive care unit. All patients had impaired consciousness. Focal neurologic disorders were reported in 5 cases [hemiplegia (2), tetraplegia (2), aphasia (1)]. The aspects on brain CT scan seemed to be related to ischemic lesions (1 case), appeared normal in ten cases, or revealed post-traumatic hemorrhagic lesions (2 cases). The outcome at 2-4 weeks was spontaneously good, with complete resolution, without neurologic sequellae, in 11/13 patients. Two deaths were related to brain trauma severity (one case) and nosocomial pneumonia (one case).
Adult↗
[Tetraplegia in fat embolism].
This is a report of two cases of tetraplegia complicating fat embolism after fracture of long bones. In the first case, a 26 year-old male sustained fractures of femur and tibia. One day after admission, the patient became comatose (Glasgow coma score = 6) with dyspnaea and petechiae present on the anterior chest wall. In second case, a 22 year-old man with a fracture of tibia and humerus, suffered two days after admission from similar signs of fat embolism (dyspnaea, Glasgow score coma = 6, petechiae). A tetraplegia occurred after 7 days in the first patient and 6 days in the second. No lesions were visible on brain CT scan. Magnetic resonance imaging showed relative high-intensity areas on T2 weighted views. The outcome at three weeks was favourable, without neurologic sequelae.
Adult↗
[Cerebral complication in eclampsia].
Many brain complications occur during eclampsia with various degree of gravity. The pathogenesis of these lesions continues to be a source of considerable controversy. Five cases of eclampsia with severe neurologic manifestations were treated in our surgical intensive care unit. The CT image appeared to be related to haemorrhagic lesions (3 cases) and ischaemic lesions (2 cases). The clinical course was favourable, often reversible, in cases with oedema and ischaemia maternal prognosis was poor in the case with haemorrhage.
Adolescent↗
[Severe cerebral lesions in pregnancy toxemia].
The authors report a case of pre-eclamptic toxemia, characterised by extensive cortical, sub-cortical and vertebro-basilar neurological lesions. The appearance of these lesions and their course were suggestive of the role played by toxemic vasculitis and vasospasm.
Adult↗
[Prevention of nosocomial urinary tract infection: vesical catheter versus Penilex].
Nosocomial urinary tract infection is the most frequent nosocomial infection in many care units. Its main risk factor is the presence of a bladder catheter. Prevention is based upon the enforcement of hygiene recommendations which are not always carefully applied everywhere. We report a prospective study concerning 328 patients divided into two gropus. Group I patients (n = 161) had an indwelling bladder catheter. Group II patients (n = 167) had an external urinary drainage by Penilex. The incidence of nosocomial urinary infection was 2.4% in group II versus 26.7% in group I. Thus preventive efficacy of Penilex use appears to be well demonstrated.
Critical Care↗
[Guillain-Barre syndrome and pregnancy].
A case of polyradiculoneuritis, resembling Guillain-Barre syndrome, was reported during the sixth month of a first gestation. The patient was seventeen years old and also had toxaemia of pregnancy. The interaction between polyradiculoneuritis and pregnancy is slight and carries little risk of prematurity. Plasma exchange procedures can be used in pregnant women and the results of this treatment are similar to those in patients presenting with polyradiculoneuritis alone.
Adolescent↗
[Acute pancreatitis and pregnancy].
Acute pancreatitis during pregnancy is a serious condition and diagnosis is often difficult. The authors report the case of a 32-year-old woman in the 32nd week of her fifth pregnancy, in which the outcome was fatal for both mother and child. The cause of pancreatitis during pregnancy has been attributed to many factors, chiefly cholelithiasis. A number of recent studies have shown the relationship existing between the role played by pregnancy in predisposing to gallbladder disease with lithiasis. Many diagnosis errors are made in this condition. Thus modern treatment methods have improved the prognosis in acute pancreatitis but, when it occurs during pregnancy, diagnostic delays often lead to a gloomy outlook.
Acute Disease↗
[Compensation for bleeding in a surgical milieu. Importance of normovolemic hemodilution. Apropos of 25 cases].
In order to get round blood supply difficulties, 25 patients undergoing hemorrhagic interventions (blood loss average of 1,500 ml) were subjected to the techniques of normovolemic hemodilution. Preoperatively a volume of 1,080 ml of blood was taken in every patient (a total of 271 in all patients together); the blood was simultaneously replaced by 1,300 ml of macromolecules (modified fluid gelatin polymer and/or low molecular weight dextran according to disponibility). Two thirds of the taken amount are transfused to the patients preoperatively immediately after surgical hemostasis has been achieved or when the hematocrit is about 20%; the last third is administered in the immediate postoperative period. The economy of blood realised by this technique is considerable (119 units of homologous blood). The rationale depends on two essential particularities: on one hand, the diminution of blood loss since at a hematocrit of 25% the loss is only 50% of the globular mass which would have disappeared at normal hematocrit; on the other hand, the compensation of hemorrhage by transfusion of fresh autologous blood, eliminating homotransfusion reactions. The main hematocrit obtained 24 hours after transfusion is about 34%. Thus, economy of blood and rheological advantages (amelioration of microcirculation, increase of capacity of oxygen transport, increase of tissular oxygenation) must induce physicians to reexamine their behaviour in transfusion strategy and compensation of hemorrhage because the optimal hematocrit in normovolemy is of about 30%.
Adult↗
[Maternal prognostic factors in severe eclampsia].
Sixty cases of severe eclampsia were treated in an intensive care unit between January 1989 and September 1993. Mean age was 26, and 70% of patients were primipara. The pregnancy has been unsupervised in almost all cases. All had visceral lesions and/or hematologic problems and there was impaired conscious level in 9 cases out of 10. Medical treatment involved the control of seizures and of hypertension. Cesarean section was performed in 34 cases. The maternal death rate was 23.3%. Our experience indicates that mortality depends upon visceral lesions (cerebral, disseminated intravascular coagulation, acute pulmonary edema, Hellp syndrome). Better awareness of severity factors in preeclampsia improves both maternal and fetal prognosis by precisely indicating the best time for fetal extraction.
Adult↗