Objective To compare the quality of interpretation of chest helicoidal computed tomography (HCT) by physicians with different levels of experience and medical speciality. Design Prospective observational study. Setting Trauma critical care unit at a French university hospital (US equivalent: level 1). Patients HCT of 50 consecutive patients with blunt chest trauma were assessed by four groups of physicians [residents in anaesthesiology ( n =5), residents in radiology ( n =5), senior anaesthesiologists ( n =5), and senior radiologists ( n =5)]. Interpretation from each physician was compared with a grid obtained from an expert interpretation by a senior radiologist and a senior anaesthesiologist. Interventions None. Measurements and main results No group of observers performed better than another in their interpretation of lung and parietal injuries on HCT. In contrast, senior radiologists were better than anaesthesiologists for the diagnosis of pneumomediastin. However, residents in radiology performed better than other physicians in detecting the presence of gastric and tracheal tubes. Conclusions Compared with anaesthesiologists, senior radiologists seem more expert in the diagnosis of HCT mediastinal injuries whereas residents in radiology were better at detecting resuscitation materials in thoracic trauma patients. This article reinforces the usefulness of the interpretation of the HCT by a senior radiologist in the case of blunt chest trauma. This also reinforces the usefulness of an aspect team of radiologists and anaesthesiologists in the case of trauma. The logical usefulness of a systematic interpretation of the images should be borne in mind.

Nous décrivons un cas de cholécystite aiguë alithiasique dans les suites d’une embolisation artérielle hépatique chez une patiente polytraumatisée. De nombreux facteurs, déjà décrits, favorisant la cholécystite étaient présents dans cette observation. Néanmoins, il est probable que l’embolisation artérielle hépatique ait contribué à la genèse de la nécrose comme cela a déjà été rapporté en dehors du contexte traumatique.

We have reported a case of acute acalculous cholecystitis occurring after hepatic artery embolization in a woman sustaining multiple traumatic injuries. Although many classical factors such as shock, sepsis, transfusion or narcotic administration may be involved in the genesis of gallbladder necrosis, we have discussed the possible involvement of hepatic artery embolization in the ischaemic process, indeed, this mechanism has already been reported in non traumatic patient following hepatic tumor chemoembolization. (C) 2000 Editions scientifiques et medicales Elsevier SAS.

We have reported a case of acute acalculous cholecystitis occurring after hepatic artery embolization in a woman sustaining multiple traumatic injuries. Although many classical factors such as shock, sepsis, transfusion or narcotic administration may be involved in the genesis of gall-bladder necrosis, we have discussed the possible involvement of hepatic artery embolization in the ischaemic process. Indeed, this mechanism has already been reported in non traumatic patient following hepatic tumor chemoembolization.

II est communément admis que les veines jugulaires internes sont les principales voies de drainage du sang veineux cérébral. Peu d'attention est généralement portée sur les autres voies dites accessoires. En fait, le plexus veineux méningorachidien constitue la principale voie de drainage, quand le corps est en position debout. Ce phénomène est lié à des modifications de pression du LCR. L'importance de ce retour veineux postérieur est difficile à évaluer en physiopathologie et dépend probablement de la richesse des anastomoses existant entre les deux systèmes.It is generally assumed that the jugular veins are the only significant path for cerebral venous drainage. Little attention has been given to the possible role of other venous paths for the cerebral venous outflow. In fact, the meningorachidian venous plexus acts as the major outflow tract of cerebral circulation in the upright position. This phenomenon is linked with postural variations in cerebrospinal fluid pressure. It is difficult to assess the significance of this posterior venous plexus under physiopathologic conditions, which probably depends on the extent of the anastomoses between the two systems.

Le cefpirome (CPO) est une nouvelle céphalosporine dont le spectre est celui du céfotaxime élargi aux cocci à Gram postif, aux Acinetobacter et aux Pseudomonas. Cette étude multicentrique et ouverte avait pour but d'évaluer l'efficacité et la tolérance du CPO dans le traitement d'infections sévères à bacilles à Gram négatif résistants à l'ampicilline chez des patients de réanimation. Quatre vingt huit cas (septicémies, pneumopathies, péritonites, pyélonéphrites) ont été bactériologiquement documentés chez 86 patients. Le traitement était débuté avant les résultats bactériologiques, l'inclusion définitive n'étant effectuée que lorsque les germes isolés étaient sensibles au CPO et résistants à l'ampicilline. Ces exigences bactériologiques sont la raison essentielle du faible nombre d'observations considérées comme éligibles, soit 28 sur les 88 cas initiaux. Le CPO a été administré à raison de 2 g toutes les 12 h, en association à l'amikacine pendant les 72 premières heures, pour une durée maximale de 15 jours, avec une adaptation posologique en cas d'insuffisance rénale. La tolérance a été évaluée sur l'ensemble des observations, et l'efficacité a donc été analysée chez 28 patients. Sur 102 germes isolés dans les 88 observations, 82 ont été testés au CPO, et 71 (86,5 %) y étaient sensibles. L'efficacité du CPO a été jugée satisfaisante cliniquement dans 18 cas sur 28 (64 %) et bactériologiquement dans 20 cas sur 27 (74 %), un cas étant non interprétable. L'analyse de la tolérance a retrouvé un effet indésirable au moins chez 43 patients sur 86 soit 7 % des cas. La relation au traitement a été jugée possible pour six évènements secondaires (2 rashs cutanés, 4 anomalies biologiques). Aucun effet indésirable n'a été responsable de l'arrêt du traitement. Les résultats de cette étude confirment l'efficacité du CPO, initialement associé à l'amikacine, dans le traitement des infections graves à bacilles à Gram négatif ampicilline-résistants chez les patients de réanimation.Cefpirome (CPO) is a new broad-spectrum cephalosporin, with a better activity against Grampositive cocci, Pseudomonas spp. and Acinetobacter spp. than cefotaxime. The aim of this study was to determine the efficacy and tolerance of CPO for the treatment of severe Gram-negative infections in ICU patients. 88 observations of bacteriologically documented pneumonia, peritonitis, pyelonephritis and septicemia in 86 ICU patients were recorded. Antibiotherapy was given before microbiological results became available, and consisted of CPO 2 g and amikacin 10 mg/kg administered b.i.d. Doses were adapted when required by renal failure. Definitive inclusion was obtained when ampicillin resistance and CPO susceptibility were determined for the Gram-negative bacilli isolated. Tolerance was then analysed for all 86 patients, although efficacy was evaluated only for 28 patients. Among 102 isolated pathogens, CPO activity was determined for 82 cases and was effective against 71 (86.5 %). Clinical efficacy was obtained for 18 of 28 patients (64 %), and bacteriological results were considered effective for 20 of 27 cases (74 %), 1 case remaining undetermined. As regards tolerance at least one adverse effect was reported for 43 patients (50 %). Among the 62 reported adverse effects, only 6 (2 cutaneous rashes, 4 biological abnormalities) were considered to be possibly related to CPO. In none of these cases, was the treatment discontinued. The results of this study confirm the efficacy of CPO, initially combined with amikacin, for the treatment of severe Gram-negative resistant bacilli infections in ICU patients.

A 60-year-old man, was admitted in the emergency ward, following a motor vehicle accident. At the time of arrival his clinical state was stable. The initial investigations showed a moderate left haemopneumothorax and fractured ribs. After insertion of a thoracostomy tube into the left pleural cavity he had to undergo surgery for an open fracture of the left arm. Following induction of anaesthesia, a cardiovascular collapse occurred rapidly. An emergency thoracotomy was performed which showed a right ventricular perforation by a rib fragment. The authors discuss the role of possible changes in heart position produced by induction of general anaesthesia. Indeed the decrease in functional residual capacity following induction of anaesthesia with a cephalad diaphragmatic shift may have secondarily exposed the right ventricle to the bevel of a fractured rib.

A 60-year-old man, was admitted in the emergency ward, following a motor vehicle accident. At the time of arrival his clinical state was stable. The initial investigations showed a moderate left haemopneumothorax and fractured ribs. After insertion of a thoracostomy tube into the left pleural cavity he had to undergo surgery for an open facture of the left arm. Following induction of anaesthesia, a cardiovascular collapse occurred rapidly. An emergency thoracotomy was performed which showed a right ventricular perforation by a rib fragment. The authors discuss the role of possible changes in heart position produced by induction of general anaesthesia. Indeed the decrease in functional residual capacity following induction of anaesthesia with a cephalad diaphragmatic shift may have secondarily exposed the right ventricle to the bevel of a fractured rib.