Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Sep 2013
Case Reports[Multiple organ failure complicating a severe acute necrotising pancreatitis secondary of a severe hypertriglyceridemia: A case report.]
We report the case of a 42-year-old man admitted for a multi-organ failure with a coma, a hemodynamic instability, a respiratory distress syndrome, an acute renal failure and a thrombocytopenia. The blood samples highlighted a milky serum and allowed to diagnose an acute pancreatitis associated with a major dyslipidemia: hypertriglyceridemia 11,800 mg/dL and hypercholesterolemia 1195 mg/dL. The CT-scans do not reveal any cerebral abnormalities but highlighted pancreatic lesions without biliary obstruction. ⋯ The clinical and biological course was good in parallel of the normalization of lipid abnormalities. The patient was discharged at day 17 with a lipid-lowering therapy. We discuss the various treatments available for the management of acute pancreatitis complicating a severe hypertriglyceridemia and their actual relevance in the absence of clear recommendations.
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Ann Fr Anesth Reanim · Sep 2013
[Implementation of morbidity and mortality conferences in French intensive care units: A survey.]
A national survey was conducted by the "Collège français d'anesthésie et de réanimation (CFAR)" and the "Collège des bonnes pratiques en réanimation (CBPR)", to analyze the implementation of morbidity and mortality conferences (MMCs) in French intensive care units (ICUs). ⋯ This survey showed that the practice of MMR is common in French ICUs, allowing the identification of organizational problems, but also of training needs, joining one of the initial concerns that have led to their implementation. Expanding the participation to non-physician members of the units should be encouraged, without underestimating the difficulties particularly in the organizational domains that represent an obstacle to development of MMCs.
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Ann Fr Anesth Reanim · Sep 2013
Observational Study[Predictive factors of organ failure in patients admitted in intensive care unit for acute gastrointestinal bleeding.]
Gastrointestinal hemorrhage is an emergency requiring usually an admission in intensive care unit (ICU), which may prove abusive secondarily. The aim of this study was to identify predictive risk factors of organ failure in patients admitted for GH in our ICU. ⋯ Our results confirmed that a large proportion of patients admitted in ICU for the primary diagnosis of gastrointestinal hemorrhage developed any organ failure. The history of cirrhosis and the systemic consequences of the hemorrhagic syndrome as myocardial damage represents important risk factors of morbidity and mortality and thus should be considered during the management.
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Tuberculosis disease, in its extra pulmonary form, remains a difficult diagnosis because of its atypical symptoms and evolution. We have observed a case of acute tuberculosis neuromeningitis, without being able to make a definite diagnosis prior to the patient's death because of the negativity of the initial bacteriological samples. ⋯ This case allows us to challenge diagnostic methods and resulting treatments in emergency cases where tuberculosis is suspected. Moreover, it seems essential to do everything possible to find the bacterium when confronted with a patient with risk factors and clinical and radiological symptoms compatible with tubercular disease, before the disease becomes acute.