[Diaphragm paralysis and facial diplegia with albumin-cell count dissociation in acute ethylene glycol poisoning].
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Biomedical subjects
Publications and source records attributed to P Auzépy.
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The clinical picture of alcohol withdrawal syndrome lies somewhere on a continuum that ranges from slight morning tremor to genuine delirium tremens. The diagnosis, usually easy, may be beset with several traps: alcoholism may be unrecognized, or a diagnosis other than withdrawal syndrome may be wrongly made, or again a complication may be either overlooked or erroneously suspected. An acute withdrawal syndrome normally regresses in less than one week, but a subacute withdrawal syndrome, which presents as signs of residual hyperexcitability of the central nervous system, must be recognized, as it may persist for several months. Beside delirium tremens, with its mandatory and well-established treatment, prevention of alcohol withdrawal syndrome and treatment of its initial stages raise no problems, as it consists above all of psychotherapy combined by such tranquillizers as febarbamate or a benzodiazepine taken in well-specified dosage.
The onset of heart failure is associated with complex neurohumoral, cardiac, and vascular changes. These disorders partly explain that, in this situation, regional distribution of blood flows is hardly modified with stability or increase in heart and brain flows and impairement of limb, renal, and splanchnic blood flows. Using the bidimensional Doppler technique to measure brachial blood flow and diameter and standard clearance techniques to determine renal and hepatic blood flows, we studied the effects of perindopril, a long-lasting angiotensin-converting enzyme inhibitor, on regional hemodynamics. We demonstrated that perindopril produces a very marked increase in forearm and kidney flows but a very minor increase in the hepatosplanchnic territory, resulting in a regional distribution of cardiac output that favors the renal and musculocutaneous territories. This mechanism of action might be an important contribution to clinical improvement observed with perindopril.
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The authors report the fortuitous diagnosis of a true and a false left ventricular aneurysm in a 77 year old man with severe ischaemic heart disease and calcific aortic stenosis, admitted for cardiogenic shock. The association of these two forms of aneurysm is very rare. Clinical and paraclinical diagnosis is difficult. Conventional left ventriculography is the investigation of reference but the diagnosis has been facilitated by Technetium 99 cardiac scintigraphy and color Doppler echocardiography. Surgery may be considered in cases of true aneurysm especially in patients with left ventricular failure, but the indication is formal in cases of false aneurysm.
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Self-inflicted acute drug overdose in suicidal elderly patients appears to be a growing challenge to public health. To the best of our knowledge, little has been published on this topic. Thus we undertook a retrospective study, from January 1969 to October 1989, in a medical ICU. Ninety-two suicidal, elderly patients (54 women, 38 men) with a mean age of 77 years were included. The mean length of the hospital stay was 7 days (range: 1-45 days). Seventy-six percent of them were intubated and subjected to mechanical ventilation for a mean duration of 3 days. Overdosing on one drug occurred in 46 cases (50%). Toxicological analyses implicated the following medications: benzodiazepines, 50 cases; meprobamate, 26 cases; barbiturates, 24 cases; tricyclic anti-depressants, 17 cases; trichloroethylene, 1 case; insulin, 1 case. Psychiatric history, recorded for 47 patients, revealed previous suicide attempts by 20 of them. Complications were reported in 40 cases (43.5%): respiratory complications, 25 cases; shock, 13 cases; postanoxic coma, 2 cases. The incidence of mortality (13 cases) was 14%. Thirty-three patients were transferred to psychiatric units after release from ICU. During the same period, our ICU admitted 2,762 patients for acute drug poisoning and observed a 1% mortality rate. Thus, morbidity and mortality are higher in the elderly than in younger patients.
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A case of rhombencephalitis due to Listeria monocytogenes in a non immunocompromised patient, with initially normal cerebrospinal fluid, was marked by potentially fatal neurovegetative disorders and severe neurological sequelae partly due to delay in diagnosis and treatment. The possibility of Listeria infection should be considered in patients with fever and cranial nerves deficits, in order to initiate an appropriate antibiotic therapy and to keep the subject under close monitoring in an intensive care unit.
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