We report a case of fulminant sepsis 10 years after posttraumatic splenectomy. The low-cardiac-output stage of the septic shock with disseminated intravascular coagulation (DIC), which was already marked on admission to the intensive care unit, could not be overcome despite appropriate shock treatment. The pathogenetic spectrum includes more than 70% pneumococci, but any pathogen can trigger an overwhelming postsplenectomy infection (OPSI) syndrome. Pathogenetically, the OPSI syndrome is primarily due to distinctly reduced bacterial clearance from loss of the reticuloendothelial tissue in the spleen. Appropriate treatment of the septic shock is of prime therapeutic importance. In summary, the following recommendations can be made: 1. Nonspecific symptoms of infection in splenectomized patients, such as fever, call for immediate clarification with respect to the onset of a septic process. Immediate admission to a hospital, close monitoring, including blood cultures, and immediate antibiotic therapy are unavoidable. 2. The aim of treatment is to prevent DIC by aggressive therapy of the septic shock with prevention of the low-output stage. 3. Splenectomized patients must be informed of the possibility of a serious, potentially fatal infection and its premonitory symptoms. An emergency passport is appropriate. 4. In view of the few side effects of the vaccine, all splenectomized patients should be immunized against pneumococci. Children under 2 years of age should furthermore receive prophylactic oral penicillin up to the age of 5.

Adult↗

PubMed1984

[Not Available].

Explore the source record for details and available documents.

France↗

PubMed1984

[A new catheter set for continuous axillary plexus anesthesia].

Explore the source record for details and available documents.

Anesthesia, Local↗

PubMed1984

[Electrical nerve localization and catheter technic. A safe method for brachial plexus anesthesia].

A technique for sub-axillary blockade of the brachial plexus by means of a special catheter set is presented. A plastic self-retaining cannula is placed within the vasomotor nerve sheath, using the advantages of electric nerve stimulation. In our opinion the decisive advantages of this procedure lie in the fact that the user is not dependent on the cooperation of the patient and anatomical orientation takes place on the basis of clear and objective criteria through the muscle contractions induced in this way. If required, a catheter can be inserted into the vasomotor nerve sheath, without any additional expenditure of time, through the small-lumen puncture cannula by the Seldinger technique. If this procedure is carried out properly there is practically no danger of neural and vascular injuries. This method makes subsequent injections into the vasomotor nerve sheath through repeated puncture unnecessary. The catheter technique makes it possible to operate on the upper extremity using regional anaesthesia, whose effects can be prolonged beyond those of long-acting anaesthetics. The possibility of incomplete blockade resulting from individual variations in the amounts of local anaesthetics needed, is excluded and the anaesthetist can, if necessary, carry out pre- and post-operative pain therapy.

Anesthesia, Conduction↗

PubMed1984

[Continuous blockade of the lumbar plexus ("3-in-1 block") in perioperative pain therapy].

This is a description of a technique for a continuous blockade of the lumbar plexus by means of a specially developed catheter set. The femoral nerve is located more or less atraumatically, on the basis of objective criteria, by the use of a nerve stimulator and a small-lumen puncture cannula. The catheter is subsequently inserted into the fascia surrounding the nerves by the Seldinger technique. The advantage of this catheter technique lies in the fact that the normal blockade period can be extended at will, without any great increase in the amount of time and material needed. Pain therapy for the patient during the operation does not involve the necessity of further punctures with the risk of neural lesion resulting from the fact that partial anaesthesia still exists. Individual dosage is possible because of the anatomical circumstances. The catheter technique we used enabled us in many cases to reduce the amount of local anaesthetic used. No disturbances in the functioning of the bladder or vasomotor system, as is the case with spinal conduction anaesthetics, were observed. In the pre-operative phase this 3-in-1 blockade procedure facilitates the treatment of patients with a fractured collum femoris in particular, and after an operation it makes it possible to mobilize the patient sooner, without the administration of additional analgetics.

Anesthesia, Spinal↗

PubMed1984

[Control of the cava-catheter position using intra-arterial ECG recording].

The intraatrial ECG recording method is represented along with the results of 3.000 cases. If the catheter is filled with electrically conducting fluid, ECG potentials may be led from the catheter-tip by using the adapter mentioned below. With the characteristic high intraatrial-p-wave one can easily determine the transitional zone of the vena cava in the right atrium. Permanent ECG control enables the cava-catheter to be localized and, if necessary, it's position may be corrected. The safety instructions of VDE 0107 must be strictly observed. This method is not only time saving and simple, it also has high information value and makes an important contribution to cost saving in hospitals. From the legal aspect, it is also recommended that the results of controlling ECG position be documented.

Catheterization↗

PubMed1983

[Initial psychiatric experiences of Philippe Pinel at the Belhomme Hospital].

The purpose of this paper is to investigate Philippe Pinel's psychiatric experience, his practice in "la maison de santé Belhomme" and his first publications which were concerned with the treatment of mental patients and appeared in "La Gazette de Santé" which he edited between 1785 and 1789. During that time, the main preoccupation of the future head doctor of "La Salpétrière" had been to ensure the application and the development of moral treatment, in its practical modalities as well as its theoretic rationalization. Meanwhile, the institutional aspect of this therapy had the upper hand over the individual cure. This evolution brought Pinel and his successors to neglect the latter. In this connection we can regret that Philippe Pinel did not continue to have more private practice for this allowed him to follow first his experience and research (individual cure) in this field of rational psychotherapy, that of moral treatment.

France↗

PubMed1983