SummaryGas gangrene (GG) is an acute necrosis of the muscle and/or subcutaneous tissue due to gas-forming microorganisms. The authors retrospectively review 48 consecutive cases of clostridial GG treated in an intensive care unit over a 17-year period (1969–1986). Surgery and trauma were the most frequent initiating factors (88 %) of clostridial GG. The diagnosis is clinical and based on a comparison of the local and systemic signs. Direct examination of the sweet-smelling discharge, revealing large Gram-positive bacilli, confirmed the clinical impression in about 75 % of the cases. The key to successful treatment of clostridial GG requires the judicious application of resuscitation measures (86 % of our eases), a correct antibiotherapy (penicillin G, 30 to 40 million units daily), surgery (fasciotomies, excisions limited to undoubtedly dead tissue) and hyperbaric oxygen (H.B.O.) therapy (83% of our patients), in order to break the vicious circle of progression of the disease. Sixteen of our 48 patients with clostridial GG died in hospital.

Impairment of hypoxic pulmonary vasoconstriction (HPV) is frequently cited as an explanation for the hypoxemia of liver cirrhosis. We investigated the pulmonary and systemic hemodynamic responses to acute inspiratory hypoxia, 12.5 percent oxygen in nitrogen during 10 minutes, in 24 patients with mildly to moderately decompensated liver cirrhosis and arterial hypoxemia. A mean increase of 50 percent in pulmonary vascular resistance (PVR) was observed, which is comparable to reported responses of normal subjects to a similar degree of hypoxia. Seven of the 24 patients showed an increase in PVR of less than 20 percent. Compared with the other patients, no difference could be found between both groups in baseline blood gas and hemodynamic determinations, physical examination, liver function tests, and laboratory tests that may be disturbed by circulating endotoxin. Five of the 24 patients had a hyperkinetic circulatory state, but only one of them failed to increase PVR in response to hypoxia. Considering the whole group of 24 patients, there was no correlation between PaO2, PVR, and PVR response to hypoxia. Impairment of HPV is probably not the right explanation for most cirrhotic patients with arterial hypoxemia.

The authors report a case of generalised Kaposi sarcoma complicated by pulmonary cryptococcosis and cerebral toxoplasmosis. Clinical features were dominated by the cerebral condition. The infectious pathogenesis could be related to disturbances in immune defences. Ultrastructural study revealed the presence of several types of tumour cells. Endothelial cells formed vascular lumens and contained Weibel-Palade granules and reticulo-tubular inclusions.

Three cases of central nervous system complications of Mycoplasma pneumoniae infections are reported. There were several atypical findings: the first patient presented with an acute disseminated encephalitis with normal cerebrospinal fluid and hypogammaglobulinaemia. The second patient presented with a left sixth nerve palsy followed six weeks later by choreoathetoid movements and an acute psychosis. The third patient presented with an acute encephalitis associated with acute renal failure secondary to rhabdomyolysis and was the only patient who did not completely recover; he was discharged akinetic and mute, but with normal renal function. The diagnosis of complications of Mycoplasma pneumoniae may be difficult. In two of the three cases a raised red blood cell volume secondary to a high titre of cold agglutinins rapidly led to the correct diagnosis.

This report describes a patient who presented with coma and acute pulmonary edema after severe carbon monoxide poisoning. Hemodynamic evaluation revealed elevated systemic and pulmonary arterial, pulmonary wedge and right atrial pressures, together with an increased cardiac output. These findings are compatible with the hypothesis that a neurogenic mechanism plays a role in the pulmonary edema of carbon monoxide poisoning.

The authors report a case of generalised Kaposi sarcoma complicated by pulmonary cryptococcosis and cerebral toxoplasmosis. Clinical features were dominated by the cerebral condition. The infectious pathogenesis could be related to disturbances in immune defences. Ultrastructural study revealed the presence of several types of tumour cells. Endothelial cells formed vascular lumens and contained Weibel-Palade granules and reticulo-tubular inclusions.