25 research outputs found
Clinical and multifocal-electroretinographic findings of congenital tilted disc syndrome associated with choroidal neovascularization: A case report
No full textPurpose: To report a case of a tilted disc syndrome associated with choroidal neovascularization. Methods: A 55-year-old male patient presented with blurred vision and metamorphopsia of the left eye. He underwent complete ophthalmologic examination, fluorescein angiography, optical coherence tomography (OCT) and multifocal-electroretinogram (mf-ERG). Results: All features are consistent with a tilted disc syndrome complicated with a small neovascular membrane. OCT confirmed the presence of a serous retinal detachment. Mf-ERG confirmed a decrease of electrical activity of the photoreceptors in area 1 (fovea). The patient refused to be treated. Conclusion: Macular serous retinal detachment due to subretinal leakage is a rare complication of tilted disc syndrome. To the author's knowledge, this is the first time a tilted disc syndrome with choroidal neovascularization is documented by means of OCT and mf-ERG. These are the only objective tools in order to assess objectively the anatomical and functional damage accordingly. © Springer-Verlag 2007
Ventilator-associated pneumonia in patients assisted by veno-arterial extracorporeal membrane oxygenation support: Epidemiology and risk factors of treatment failure
No full textIntroductionVentilator-associated pneumonia (VAP) is frequent in Intensive Care Unit (ICU) patients. In the specific case of patients treated with Veno-Arterial Extracorporeal Membrane Oxygenation Support (VA-ECMO), VAP treatment failures (VAP-TF) have been incompletely investigated.MethodsTo investigate the risk factors of treatment failure (VAP-TF) in a large cohort of ICU patients treated with VA-ECMO, we conducted a retrospective study in a Surgical ICU about patients assisted with VA-ECMO between January 1, 2013, and December 31, 2014. Diagnosis of VAP was confirmed by a positive quantitative culture of a respiratory sample. VAP-TF was defined as composite of death attributable to pneumonia and relapse within 28 days of the first episode.ResultsIn total, 152 patients underwent ECMO support for > 48h. During the VA-ECMO support, 85 (55.9%) patients developed a VAP, for a rate of 60.6 per 1000 ECMO days. The main pathogens identified were Pseudomonas aeruginosa and Enterobacteriaceae. VAP-TF occurred in 37.2% of patients and was associated with an increased 28-day mortality (Hazard Ratio 3.05 [1.66; 5.63], PRisk factors for VAP-TF were renal replacement therapy (HR 13.05 [1.73; 98.56], P = 0.013) and documentation of Pseudomonas aeruginosa (HR 2.36 [1.04; 5.35], P = 0.04).ConclusionsVAP in patients treated with VA-ECMO is associated with an increased morbidity and mortality. RRT and infection by Pseudomonas aeruginosa appear as strong risks factors of treatment failure. Further studies seem necessary to precise the best antibiotic management in these patients.</div
RESEARCH Open Access Alteration of skin perfusion in mottling area during septic shock
No full textBackground: Mottling score has been reported to be a strong predictive factor during septic shock. However, the pathophysiology of mottling remains unclear. Methods: In patients admitted in ICU for septic shock, we measured on the same area the mean skin perfusion by laser Doppler, the mottling score, and variations of both indices between T1 (6 hours after vasopressors were started) and T2 (24 hours later). Results: Fourteen patients were included, SAPS II was 56 [37–71] and SOFA score at T1 was 10 [7–12]. The mean skin surface area analyzed was 4108 ± 740 mm2; 1184 ± 141 measurements were performed over each defined skin surface area. Skin perfusion was significantly different according to mottling score and decreased from 37 [31–42] perfusion units (PUs) for a mottling score of [0–1] to 22 [20–32] PUs for a mottling score of [2–3] and 23 [16–28] for a score of [4–5] (Kruskal-Wallis test, P = 0.05). We analyzed skin perfusion changes during resuscitation in each patient and together with mottling score variations between T1 and T2 using a Wilcoxon signed-rank test. Amon
Pathogens isolated from respiratory samplings.
No full textPathogens isolated from respiratory samplings.</p
Kaplan-Meier analysis of the probability of survival according to the presence of a VAP during ECMO support.
No full textThe 28-day survival was significantly lower in the VAP group (red line) in comparison to the no VAP group (black line) (nominal p < 0.001).</p
Pathophysiology of Escherichia coli pneumonia: Respective contribution of pathogenicity islands to virulence
No full textRisk factors for VAP treatment failure in patients assisted with ECMO.
No full textRisk factors for VAP treatment failure in patients assisted with ECMO.</p
