RESUMO
A 37 year-old man had headaches for 10 days, then a single tonic-clonic seizure and coma due to an extensive cerebral venous thrombosis. In spite of full-dose heparin treatment for 7 days, the clinical picture worsened along with increasing edema on CT-Scan. Direct thrombolytic treatment was then performed using transvenous catheterization and instillation of Urokinase (2.6 MU over 4 days). A near complete repermeabilization of the sinuses was obtained and the patient improved dramatically in a few days. The only adverse effect of Urokinase was hematuria. Based on our experience and review of the literature which includes 26 previous cases, direct thrombolytic therapy appears to be a relatively safe procedure. This treatment should be considered in a patient with extensive dural sinus thrombosis which fails to respond to heparin treatment.
Assuntos
Embolia e Trombose Intracraniana/tratamento farmacológico , Ativadores de Plasminogênio/administração & dosagem , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Adulto , Cateterismo Periférico , Resistência a Medicamentos , Heparina , Humanos , Injeções , Masculino , Terapia TrombolíticaRESUMO
The aim of our study was to analyse the problems caused by nosocomial infections (NI) in our intensive care unit (ICU). 239 patients admitted between January and June 1995 were included in the study. 33 episodes of nosocomial infection were diagnosed in 19 patients (7.9 percent). The overall incidence of NI was 13.9 percent. Lower respiratory tract infections were the most common (6.3 percent). Patients infected on admission to the ICU had more NI than other patients (odds ratio = 3.42, 95 percent confidence interval 3.28 - 4.52, p< 0.05). Gram negative bacteria were involved in 73.2 percent of NI. Acinetobacter baumanii and Peudomonas aeruginosa were responsible, respectively, for 22.4 percent and 25.4 percent of NI. The additional cost due to NI was 33 percent for laboratory investigations and 34 percent for antibiotics. After analysis of our results, our recommendations are a cautious use of antibiotics, more efficient diagnostic tools and particular care in preventing cross contamination of our mostly severely ill or infected patients. (AU)
Assuntos
Humanos , Infecção Hospitalar/epidemiologia , Unidades de Terapia Intensiva , Martinica/epidemiologiaRESUMO
In a retrospective study, we performed two preventive antibiotic policies in 60 severly burned patients. All patients with a Burn Surface Area (BSA) of > 40 percent received ceftazidime-amikacin in Fort de France and piperacillin-netilmicin in Lyon. In Fort de France, 20 percent of patients developed septic shock with a mortality rate of 67 percent. Gram negative bacilli were always responsible for septic shock, of which 50 percent were resistant to initial antibiotics. In Fort de France, the bacteriological ecology in the burn centre showed less methicillin-resistant Staphylococcus aureus (MRSA) than the hospital (p < 0.05) and the same sensitivity for Pseudomonas aeruginosa. In Lyon, 37 percent of burn patients had septic shock with a mortality rate of 82 percent. In 91 percent, responsible isolates were multiresistant to initial antibiotics (p < 0.05). Bacteriological ecology of the burn centre was different from the hospital with a MRSA rate of 36.6 percent (p<0.02) and 54 percent of multiresistant Pseudomonas aeruginosa ( p < 0.05). Preventive antibiotics appear to be ineffective in severely ill burned patients. (AU)
Assuntos
Humanos , Queimaduras/terapia , Antibacterianos/administração & dosagem , Unidades de Queimados , Choque Séptico , Martinica , FrançaRESUMO
Deep dermal burns are initially difficult to evaluate. They sometimes even undergo spontaneous healing. We present our own experience concerning the use of dermabrasion with sandpaper, a veritable alternative to early scar excision. Skin grafts are not always called for. The aesthetic results are excellent. Dermabrasion should be systematically considered for all deep dermal burns and particularly for scalding burn mechanisms or facial burns (AU)
Assuntos
Humanos , Queimaduras/terapia , DermabrasãoRESUMO
During general anaesthesia of burned patients, airway control raises specific problems in patients with facial burns, when anaesthesia is required every other day and when grafts are done on the scalp. We studied 20 patients who required a total of 65 insertions of the laryngeal mask. There were no observed failures of insertion of the mask by either trained or untrained staff. Insertion of the mask is therefore easy even for untrained staff. Adequate ventilation was possible in all cases. There were no serious complications. The observed adverse effects were: sore throat, gastric dilation and dislodgement of the mask. It is concluded that this type of equipment should replace endotracheal intubation or facial masks in these clinical situations (AU)