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A case of acute copper sulfate intoxication is presented here, as an illustration of high toxic copper dose. A 38-years-old patient with a light mental deficit ingested half a glass of copper sulfate. This patient first suffered from nausea and vomiting, then an intravascular haemolysis occurred during the hospitalisation in our intensive care unit. The outcome was favourable under aetiologic and symptomatic treatment: administration of D-penicillamine as a copper antidote and packed red cell transfusion. The patient left the intensive care unit after 9 days. Acute copper intoxication is not an exceptional situation, with a potentially severe outcome.

We report a case of intrapulmonary haematoma complicating a subclavian vein catheterization, in a 52-year-old patient treated with anticoagulants. The pathophysiology, the prevention and the treatment of this complication are discussed.

Objective: To evaluate the effect of the initial antibiotic therapy associating a betalactam antibiotic (BLA) with either an aminoglycoside (AG) or a fluoroquinolone (FQ) on the development of resistance of gram-negative bacilli in an intensive care unit., Study Design: Prospective bacteriological surveillance study., Patients: The study included 51 patients experiencing a second infection with gram-negative organisms, eight days or more after a first infection., Method: The incidences of bacterial infection and the antimicrobial susceptibility have been assessed., Results: The first-choice therapy was based either on BLA + AG (51%), or on BLA + FQ in the others (46%). The causative organisms were Enterobacteriaceae (57%) and Pseudomonas aeruginosa (31%). The second infection occurred 23 +/- 11 days after the first. The main organisms involved were Pseudomonas aeruginosa (51%) and Enterobacteriaceae (41%). In the group treated initially with an AG, only the antibiotic susceptibility for amikacin decreased significantly (72 vs 36%, p < 0.05). The latter was the most prescribed antibiotic (56%). In the FQ group, there was a significant decrease of susceptibility for ciprofloxacin, pefloxacin, netilmicin and tobramycin. The decrease was not significant for gentamicin and amikacin., Conclusions: In intensive care patients, the use of FQ in association with a BLA increases the resistance to AG and FQ. Therefore it seems preferable to administer an AG in association with a BLA. Amikacine should only be prescribed when justified for a given case.

We report a case of bilateral lower extremity compartment syndrome in a 52-year-old patient complicating surgery of 8h30 duration in the lithotomy position. Two months later, a bilateral foot drop was persisting. The pathophysiology and the prevention of this complication are discussed.

A 53-year-old patient, after return from a short visit to the Ivory Coast, was admitted for suspicion of hepatic encephalopathy. An acute pernicious malaria was diagnosed with associating altered consciousness, hyperthermia, icterus, hepatomegaly, and oliguria. Blood tests showed acute renal failure, pancytopenia, disseminated intravascular coagulation, metabolic acidosis and parasitaemia at 12%. An intravenous therapy with quinine and doxycycline was started without delay. One day later, an exchange blood transfusion including a erythrapheresis and plasmapheresis was undertaken. The patient's general condition improved, and he was discharged from the ICU 22 days later. The indications for exchange blood transfusion in acute pernicious malaria are discussed.

We have studied the use of clonidine combined with low doses of sufentanil and bupivacaine in 45 parturients requiring extradural analgesia for the first stage of labour, in a double-blind, randomized study. We gave 0.0625% bupivacaine 10 ml containing 1:200,000 adrenaline and sufentanil 10 micrograms (1 ml) to which was added 0.9% saline, or clonidine 100 or 150 micrograms (1 ml). We compared the quality (VAS scores) and duration of analgesia, motor block, maternal haemodynamic state (mean arterial pressure and heart rate) and fetal and maternal side effects. Mean duration of anaesthesia was prolonged slightly: 105 (SD 21) min without clonidine, 130 (26) min with clonidine 100 micrograms (P < 0.05 vs control) and 144 (40) min with clonidine 150 micrograms (P < 0.01 vs control, ns vs 100 micrograms). There were no differences in VAS scores, onset times, heart rate, ventilatory frequency, motor block, sedation, pruritus or bradycardia between the groups. Analgesia was associated with a reduction in mean arterial pressure with clonidine. However, these adverse side effects were of minor clinical importance regardless of the extradural clonidine dose, except for a high incidence of fetal heart tracing abnormalities when clonidine 150 micrograms was used. These effects associated with a limited effect on analgesia may curtail the widespread use of clonidine as an adjunct to extradural 0.0625% bupivacaine with sufentanil 10 micrograms during labour.