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PURPOSE: To investigate the concentration-side effect relationship in a patient with severe acyclovir-induced neurotoxicity and to summarize the information available in the literature about central nervous system side effects due to acyclovir. METHODS: Repeated blood samples were drawn in a patient with severe acyclovir overdose who developed coma and nonoliguric rena1 failure. The acyclovir levels measured by radioimmunoassay were related to the level of consciousness. RESULTS: We measured the highest acyclovir serum levels reported so far (299.9 [micro]mol/L = 51.8 mg/L). Impairment of consciousness developed with a remarkable temporal delay of 24 to 48 hours after occurrence of peak serum concentrations and resolved with a comparable delay after reaching the therapeutic range (anticlockwise hysteresis). Six days after discontinuation of the drug, central nervous system symptoms had resolved, and, 4 days later, renal function returned to pretreatment values. CONCLUSIONS: The observation that neurotoxicity developed with a delay of 24 to 48 hours after acyclovir peak serum concentrations could explain the wide range of acyclovir levels reported in similar cases. Single drug level measurements may therefore be of little diagnostic value. Since toxicity develops with a remarkable delay, early removal of the drug (by hemodialysis) could possibly prevent central nervous toxicity.

Study objective: To assess conventional, large chest tube therapy in iatrogenic pneumothorax and to determine the optimal moment when to use more invasive procedures. Design: Retrospective chart review. Setting: Medical intensive care unit of a university hospital. Patients: Forty-seven patients with needle-induced iatrogenic pneumothorax. Twenty-four patients had an underlying pleural or pulmonary disorder. Interventions: After insertion of a 20- to 24-French plastic chest tube connected to an underwater seal, suction was maintained until gas egress stopped or up to 10 days in patients with a persisting gas leak. Results: In 96 percent, a definite occlusion of the pneumothorax was achieved. In all patients without an underlying lung disorder, gas egress stopped definitely after 72 h. In the presence of an underlying lung disorder, 92 percent of the pneumothoraces were healed after 10 days of continuous suction therapy. At 72 h, only 71 percent of the latter group were healed (p, Iatrogenic pneumothorax is a common complication of a variety of diagnostic and therapeutic procedures and may cause additional costs and a prolonged in-hospital stay.[1-3] A uniform treatment for iatrogenic pneumothorax [...]

Perforation through the chest wall or the pleura (membrane) covering the lung results in pneumothorax, a condition in which air enters the pleural cavity (space between the membrane covering the lungs and the membrane lining the chest cavity). This results in collapse of the lung causing sudden sharp pain and difficulty breathing. The usual treatment involves inserting a chest tube and draining the accumulated fluid from the pleural cavity. Recurrence is common after treatment. More efficient procedures such as pleurectomy (a surgical procedure) are available, but these are invasive and the best time to perform them has not yet been determined. The goal of treatment is to quickly reexpand the lung and prevent recurrence of pneumothorax. An evaluation was undertaken of 115 patients with spontaneous pneumothorax who were treated with chest tube drainage. It was found that almost the maximum success was achieved as early as 48 hours after tube insertion. After 48 hours of treatment, a significantly lower healing rate was noted in patients with secondary spontaneous pneumothorax (due to chronic obstructive pulmonary disease), 60 percent compared with 82 percent for primary spontaneous pneumothorax. This finding doesn't recommend prolonged suction therapy. Continued suction for up to 10 days resulted in only a minor increase in the number of healed patients. Extended chest tube suction also results in a prolonged hospital stay. Rates of recurrence are about 30 percent for both primary and secondary pneumothorax. The average hospital stay was six days for primary and 15 days for secondary pneumothorax. It is suggested that early surgery is beneficial if gas leakage persists for more than 48 hours after chest tube placement. (Consumer Summary produced by Reliance Medical Information, Inc.)

A 34 year old woman, who had suffered from hypertension for 16 years, presented with systolic blood pressure up to 220 mm Hg and diastolic blood pressure up to 120 [...]