Primary Invasive Aspergillosis of the Digestive Tract: Report of Two Cases and Review of the Literature

Abstract : Background: : Disseminated aspergillosis is thought to occur as a result of vascular invasion from the lungs with subsequent bloodstream dissemination, and portals of entry other than sinuses and/or the respiratory tract remain speculative. Methods: : We report two cases of primary aspergillosis in the digestive tract and present a detailed review of eight of the 23 previously-published cases for which detailed data are available. Results and Conclusion: : These ten cases presented with symptoms suggestive of typhlitis, with further peritonitis requiring laparotomy and small bowel segmental resection. All cases were characterized by the absence of pulmonary disease at the time of histologically-confirmed gastrointestinal involvement with vascular invasion by branched Aspergillus hyphae. These cases suggest that the digestive tract may represent a portal of entry for Aspergillus species in immunocompromised patient

Primary Invasive Aspergillosis of the Digestive Tract: Report of Two Cases and Review of the Literature

BACKGROUND: Disseminated aspergillosis is thought to occur as a result of vascular invasion from the lungs with subsequent bloodstream dissemination, and portals of entry other than sinuses and/or the respiratory tract remain speculative. METHODS: We report two cases of primary aspergillosis in the digestive tract and present a detailed review of eight of the 23 previously-published cases for which detailed data are available. RESULTS AND CONCLUSION: These ten cases presented with symptoms suggestive of typhlitis, with further peritonitis requiring laparotomy and small bowel segmental resection. All cases were characterized by the absence of pulmonary disease at the time of histologically-confirmed gastrointestinal involvement with vascular invasion by branched Aspergillus hyphae. These cases suggest that the digestive tract may represent a portal of entry for Aspergillus species in immunocompromised patients

Dopamine, dobutamine, dopéxamine : des différences significatives ?

Les catécholamines (dopamine, adrénaline et noradrénaline) sont des substances naturellement sécrétées dans le corps humain. Elles agissent soit à distance comme des hormones, soit dans la fente synaptique, comme neurotransmetteurs. De plus, l'industrie a permis la synthèse de deux autres produits largement utilisés dans les soins intensifs, la dobutamine et la dopéxamine. Dans cet article, nous discutons quelques éléments de base des mécanismes d'action des catécholamines et nous proposons une stratégie d'emploi de ces molécules, particulièrement de la dopamine, de la dobutamine et de la dopexamine, chez les malades aigus

Effects of helium-oxygen on intrinsic positive end-expiratory pressure in intubated and mechanically ventilated patients with severe chronic obstructive pulmonary disease

Objective: To test the hypothesis that replacing 70:30 nitrogen: oxygen (Air-O-2) with 70:30 helium:oxygen (He-O-2) can decrease dynamic hyperinflation ("Intrinsic" positive end-expiratory pressure) in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD), and to document the consequences of such an effect on arterial blood gases and hemodynamics. Design: Prospective, interventional study. Setting: Medical intensive care unit, university tertiary care center. Patients: Twenty-three intubated, sedated, paralyzed, and mechanically ventilated patients with COPD enrolled within 36 hrs after intubation. Interventions: Measurements were taken at the following time points, all with the same ventilator settings: a) baseline; b) after 45 mins with He-O-2; c) 45 mins after return to Air-O-2. The results were then compared to those obtained in a test lung model using the same ventilator settings. Main Results (mean +/- so):Trapped lung volume and intrinsic positive end-expiratory pressure decreased during He-O-2 ventilation (215 +/- 125 mL vs. 99 +/- 15 mL and 9 +/- 2.5 cm H2O vs. 5 +/- 2.7 cm H2O, respectively; p < .05). Likewise, peak and mean airway pressures declined with He-O-2 (30 +/- 5 cm H2O vs. 25 +/- 6 cm H2O and 8 +/- 2 cm H2O vs. 7 +/- 2 cm H2O, respectively; p < .05). These parameters all rose to their baseline values on return to Air-O-2 (p < .05 vs, values during He-O-2). These results were in accordance with those obtained in the test lung model. There was no modification of arterial blood gases, heart rate, or mean systemic arterial blood pressure. In 12/23 patients, a pulmonary artery catheter was in place, allowing hemodynamic measurements and venous admixture calculations. Switching to He-O-2 and back to Air-O-2 had no effect on pulmonary artery pressures, right and left ventricular filling pressures, cardiac output, pulmonary and systemic vascular resistance, or venous admixture. Conclusion: In mechanically ventilated COPD patients with intrinsic positive end-expiratory pressure, the use of He-O-2 can markedly reduce trapped lung volume, intrinsic positive end-expiratory pressure, and peak and mean airway pressures. No effect was noted on hemodynamics or arterial blood gases. He-O-2 might prove beneficial in this setting to reduce the risk of barotrauma, as well as to improve hemodynamics and gas exchange in patients with very high levels of intrinsic positive end-expiratory pressure. (Crit Care Med 2000; 28:2721-2728)

Programme latin de don d'organes: les intensivistes se mettent en réseau [Latin program for organ donation: the intensivists are networking]

The new Swiss federal law on organ and transplantation strengthens the responsibilities of the intensive care units. In Italian and French speaking parts of Switzerland, the Programme Latin pour le Don d'Organe (PLDO) has been launched to foster a wider collaboration between intensivists and donation coordinators. The PLDO aims at optimising knowledge and expertise in organ donation through improvements in identification, notification and management of organ donors and their next of kin. The PLDO dispenses education to all professionals involved. Such organisation should allow increasing the number of organs available, while improving healthcare professionals experience and next of kin emotion throughout the donation process