Kopfschmerzen und passagere Aphasie bei einer 35-jährigen Patientin

Zusammenfassung: Wir schildern den Fall einer 35-jährigen Patientin, die unter einer fulminant verlaufenden Frühsommer-Meningoenzephalitis litt und verstarb. Die Besonderheit dieses Falls ist, dass die junge Frau nicht direkt aus einem Endemiegebiet stammte und die Krankheit nicht, wie eigentlich typisch, im Frühling auftrat. Weiterhin zeigen wir auf, dass auch außerhalb der klassischen Endemiegebiete mit einer Zunahme an durch Zecken übertragenen Krankheiten zu rechnen ist. So kommen Zecken, wahrscheinlich bedingt durch den Klimawandel, zunehmend auch in höheren Lagen vo

Helium in the adult critical care setting

Helium is a low-density inert gas whose physical properties are very different from those of nitrogen and oxygen. Such properties could be clinically useful in the adult critical care setting, especially in patients with upper to more distal airway obstruction requiring moderate to intermediate levels of FiO2. However, despite decades of utilization and reporting, it is still difficult to give any firm clinical recommendation in this setting. Numerous case reports are available in the context of upper airway obstruction of different origins, but there is a lack of controlled studies for this indication. One study reported a helium-induced beneficial effect on surrogates of work of breathing after extubation in non-COPD patients, possibly in relation to laryngeal consequences of tracheal intubation. Physiological benefits of helium-oxygen breathing have been demonstrated in the context of acute severe asthma, but there is a lack of large controlled studies demonstrating an effect on pertinent clinical endpoints, except for a study reported only as an abstract, which mentioned a reduction in the intubation rate in helium-treated patients. Finally, there are a number of physiological studies in the context of COLD-COPD patients demonstrating a beneficial effect, mainly by a reduction in the resistive inspiratory work of breathing but also by a reduction in hyperinflation. Reduction of hypercapnia was mainly observed in spontaneously breathing and noninvasively ventilated helium-treated patients but not in intubated patients during controlled ventilation, suggesting that the decrease in PaCO2 was mainly in relation to a diminution in CO2 production, related to the diminution in work of breathing and not an improved alveolar ventilation. Moreover, there is little evidence that helium-oxygen could improve parameters of heterogeneity in such patients. Two RCTs were unable to demonstrate a reduction in the intubation rate in such setting, but they were likely underpowered. An adequately powered international multicentric study is ongoing and will help to determinate the exact place of the helium-oxygen mixture in the future. The place of the mixture during the weaning period will deserve further evaluation

Helium-oxygen reduces the production of carbon dioxide during weaning from mechanical ventilation

<p>Abstract</p> <p>Background</p> <p>Prolonged weaning from mechanical ventilation has a major impact on ICU bed occupancy and patient outcome, and has significant cost implications.</p> <p>There is evidence in patients around the period of extubation that helium-oxygen leads to a reduction in the work of breathing. Therefore breathing helium-oxygen during weaning may be a useful adjunct to facilitate weaning. We hypothesised that breathing helium-oxygen would reduce carbon dioxide production during the weaning phase of mechanical ventilation.</p> <p>Materials/patients and methods</p> <p>We performed a prospective randomised controlled single blinded cross-over trial on 19 adult intensive care patients without significant airways disease who fulfilled criteria for weaning with CPAP. Patients were randomised to helium-oxygen and air-oxygen delivered during a 2 hour period of CPAP ventilation. Carbon dioxide production (VCO₂) was measured using a near patient main stream infrared carbon dioxide sensor and fixed orifice pneumotachograph.</p> <p>Results</p> <p>Compared to air-oxygen, helium-oxygen significantly decreased VCO₂production at the end of the 2 hour period of CPAP ventilation; there was a mean difference in CO₂production of 48.9 ml/min (95% CI 18.7-79.2 p = 0.003) between the groups. There were no significant differences in other respiratory and haemodynamic parameters.</p> <p>Conclusion</p> <p>This study shows that breathing a helium-oxygen mixture during weaning reduces carbon dioxide production. This physiological study supports the need for a clinical trial of helium-oxygen mixture during the weaning phase of mechanical ventilation with duration of weaning as the primary outcome.</p> <p>Trial registration</p> <p>ISRCTN56470948</p

Effect of various Neurally adjusted ventilatory assist (NAVA) gains on the relationship between diaphragmatic activity (Eadi max) and tidal volume (Vt)

ESICM 2011 programme is available in notes http://www.springerlink.com/content/m0xth64u3885w270/</a

Soldats gaulois dans l'armée romaine

International audienc

Aulnay-de-Saintonge, un camp augusto-tibérien en Aquitaine

Paru également dans Aquitania II (1984, 105-157)International audienc

Sur deux inscriptions d'Aulnay réputées fausses

In 1785, a certain priest called Mery announced the discovery of two lapidary inscriptions in Aulnay-de-Saintonge : a taurobolic altar and a centurion's epitaph. He was immediately accused of falsification and, later on, the inscriptions were being tidied in the Falsae of CIL XIII under the numbers 118 and 119. However, his detractors' arguments do not seem to be, to our eyes, that convincing, all the more since the relics of a Celtic tradition temple, also indicated by Mery, have just been rediscovered exactely at the same place.En 1785, un certain abbé Méry annonçait la découverte de deux inscriptions lapidaires - un autel taurobolique et une épitaphe de centurion - à Aulnay-de-Saintonge. Il fut aussitôt accusé de falsification, et les inscriptions furent par la suite rangées dans les falsae du CIL XIII sous les numéros 118* et 119*. Pourtant, les arguments de ses détracteurs ne nous semblent guère convaincants, d'autant que les vestiges d'un temple de tradition celtique, également signalés par Méry, viennent d'être redécouverts exactement au même endroit.Tassaux Danielle, Tassaux Francis. Sur deux inscriptions d'Aulnay réputées fausses. In: Revue des Études Anciennes. Tome 88, 1986, n°1-4. Hommage à Robert Etienne. pp. 149-165