Traumatic blunt carotid injury: clinical experience and review of the literature

To evaluate the symptoms, the associated lesions, the treatment and the outcome of patients with blunt carotid injury (BCI), we reviewed the records of all patients admitted to our intensive care unit with head trauma between May 1991 and May 1995. A patient's assessment included the commonly used severity scores and cranial computed tomography (CT). Other diagnostic investigations were performed according to the clinical setting. Four patients (2 males, 2 females, age 29 +/- 13 years) out of 145 were diagnosed to have BCI. At admission, the Glasgow Coma Scale (GCS) was > or = 12 in all patients, and was associated with hemiparesis in three of them; the fourth became paretic 48 hours later. No pathological elements were demonstrated at the initial CT scan, whilst subsequent examinations showed signs of ischaemia after a variable interval from admission. In every patient the radiologic investigations demonstrated a thrombotic obstruction of the internal carotid artery (ICA), associated with an intimal dissection in two cases. Three patients were discharged with only minor neurologic symptoms. The fourth patient was referred to our ICU after the development of a massive hemispheric infarction, and died 3 days after admission.

Drug-induced hyperthermia in a patient with persistent vegetative state. Case report and review of the literature

The case of posttraumatic patient with persistent vegetative state and severe and prolonged hyperthermia (T = 39-40 degrees C for more than 20 days), in absence of infection, is described. Diffuse muscular rigidity, treated with L-dopa, slightly preceded the onset of hyperthermia, which was treated with several antipyretics, including phenotiazines. The withdrawal of these drugs and the administration of dantrolene and bromocriptine was followed by the restoration of the normal body temperature.

[Botulinum poisoning in adults: a case report and differential diagnosis]

The authors reports the case of a patient with quadriplegia associated with respiratory failure. A few days before, a paralysis of the oculomotor nerves appeared, which rapidly spreads in cranio-caudal fashion. The occurrence of a similar symptomatology in a patients' relative addressed the diagnosis toward a possible Clostridium botulinum intoxication. Other possible differential diagnoses are reviewed and discussed.

[Occurrence of acute refractory hypotension during laparoscopic cholecystectomy. Report of a case and review of the literature]

The authors report the case of a patient who developed irreversible cardiovascular collapse during a laparoscopic cholecystectomy. The abrupt onset of shock and the rapid deterioration of the hemodynamic conditions prevented a thorough diagnostic workup. Possible differential diagnoses of hypotension occurring during laparoscopic procedures are reviewed and discussed.

Treatment of cryptococcosis with liposomal amphotericin B (AmBisome) in 23 patients with AIDS

OBJECTIVE

To determine the safety and efficacy of liposomal amphotericin B (AmBisome) in the primary treatment of AIDS-associated cryptococcosis.

DESIGN

A Phase II, multicentre, European, non-comparative, open study to assess the use of AmBisome in 23 patients (26 enrolments) with cryptococcosis. Dose requirements, mycological response and toxicity were documented.

SETTING

Hospital-based HIV units.

PATIENTS

Twenty-three HIV-1-seropositive patients.

RESULTS

Drug toxicity, assessed in 25 enrolments, was well-tolerated with little renal, hepatic or haematological toxicity. Eighteen out of 23 (78%) enrolments responded clinically. Nineteen enrolments had cryptococcal meningitis: sterilization of spinal fluid was achieved in 12 out of the 18 (67%) who were mycologically evaluable. Fourteen out of the 19 (74%) responded clinically.

CONCLUSION

AmBisome is well-tolerated and may be an effective formulation in the treatment of cryptococcosis.