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In intensive care, urinary tract infections are usually the first to the third cause of nosocomial infection. There are almost exclusively related to a urinary catheter often present during most of the stay. They are usually asymptomatic and without severe complications. In some cases, they can give sepsis syndrome, often due to an extension of infection to the renal parenchyma. Clinical signs are often difficult to interpret because of the patient’s severe state. The biologic diagnostic is made on criteria defined for the interpretation of urinalysis and quantitative culture. Micro-organisms are often very resistant. Today, Candida spp. are very frequently identified but their pathogenic role is difficult to determine. Asymptomatic Utis are usually not treated. Nevertheless the treatment must be administrated quickly in case of severe sepsis. Initially, it may be either empiric with a large spectrum antibiotic or determined by data from a previously reported colonization. It is later reviewed according to microbiological data. Most antibiotics reach high concentrations in urine. There is no argument in favour of a specific antimicrobial class. Antibiotic combinations are not required unless bacteria are little susceptible, or in case of abscess. Furthermore there are useful only in the first days of treatment. It is necessary to rule out a urologic cause. There are no specific recommandations concerning the interest of changing the indwelling catheter. Indications for vesical lavage with antibiotics or antiseptics are rare. [Copyright &y& Elsevier]

Objectives: To assess the respective value of ultrasonography (US) and morphine cholescintigraphy (MC) in the diagnosis of acute acalculous cholecystitis (AAC).Design and Setting: Prospective study in an intensive care unit of a university hospital.Patients and Intervention: Twenty-eight patients with clinically and biologically suspected of AAC. US was performed at the bedside and less than 12 h later MC. US was considered positive if three major criteria were present: wall thickness greater than 4 mm, hydrops, sludge; MC results were regarded as positive if the gallbladder could not be visualized. These latter patients underwent cholecystectomy and the diagnosis of AAC was confirmed through histopathological study.Measurements and Main Results: Sensitivity of US and MC, respectively, was 50% and 67%, specificity 94% and 100%, positive predictive value 86% and 100%, negative predictive value 71% and 80%, and accuracy 75% and 86%. The correlation between US and MC findings was 71%, with chi = 0.31. By Bayesian analysis the probability of disease if the MC finding was positive was 100% regardless of US results. A positive US finding was associated with a 86% probability of disease, but with a probability of only 66% in case of negative MC results. MC is thus superior to US for confirming AAC in selected critically ill patients. Nevertheless, US is an easy, noninvasive, and effective method of bedside screening. The combination of the two imaging tests improves diagnostic accuracy and reduces false-positive and false-negative rates. Poor agreement between the two tests leads to better diagnostic complementarity. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about the suitable alternative of regional anesthesia to local infiltration anesthesia for facial soft-tissue surgery.

Abstract: Objective: The practice of anaesthesiology has the potential for transmitting a number of infectious agents to the patient. In France, several recent cases have been identified, so that a wide survey on anaesthesiology practice has been enhanced. Methods: An anonymous questionnaire, based on the recommendations of the French Society of Anaesthesiology and Intensive Care (Sfar), was send to 8,771 anaesthesiologists and intensive care practitioners and to 2,070 nurses practicing anaesthesiology. Results: A total of 1,343 questionnaires were analyzed (response rate of 12.4%). The study shows that some recommendations were routinely applied, such as: availability of alcohol-based hand hygiene solution in operating rooms (94%), use of antimicrobial filters for respiratory circuits (99%), use of single-use laryngoscope blades (77%), aseptic technique for central venous catheterization (99%), hand hygiene after contact with body fluids (96%). In contrast, the study showed that some recommendations were partially applied: hand hygiene practice (52%), wear of gloves when a risk of blood exposure exists (23%), cleaning of reusable laryngoscope blades (19%), and incorrect wear of masks (71%). The reuse of the same syringe for several patients was described in 2% of the responses. Conclusion: This results, similar to those previously described in the literature, must be followed by appropriate training and education of anaesthesia personnel, implementation of the recommendations, and evaluation of practices. Reuse of the same syringe for several patients have to be eradicated because of the high risk of viral transmission. [Copyright &y& Elsevier]

We report a case of severe pulmonary embolism diagnosed using spiral CT-scan in a patient admitted for shock associated with acute abdominal symptoms. Intraluminal clots images were visualized associated with an infiltration of mediastinal fat. Abdominal CT showed infiltration of the hepatobiliary hilum. After thrombolysis, the clinical thoracic and abdominal symptoms improved. A CT-scan at the 48th hour showed that the thoracic and abdominal features had disappeared. We emphasize the misleading aspect of the CT-scan images and we speculated that this infiltration could reflect the abdominal and mediastinal lymphoedema. [Copyright &y& Elsevier]