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A case of Streptococcus suis meningitis is observed in a 39-year-old and previously healthy meat factory worker. Neurological recovery was incomplete despite adequate and sustained antimicrobial therapy. Early deafness was demonstrated by brainstem auditory evoked potentials. Death due to aspiration pneumonia, cardiac arrest and subsequent cerebral anoxia occurred late in the course of the illness.

Twenty-three of 514 (4.6%) patients who underwent cardiac surgery in 1988 with cardiopulmonary bypass were later reoperated for sternal complications. Several risk factors, including pre-, intra and postoperative variables, have been investigated. A significant correlation was found with the presence of diabetes mellitus, the type of operation (bilateral internal mammary artery grafting), early reoperations, haemodynamic alterations, pulmonary infections and incidence of serious non infectious complications. The different sternal complications are analyzed from a clinical and therapeutic point of view.

A previously healthy 47-year-old woman presented to the emergency department with septic shock five days after a small dog bite on the dorsum of her hand. Capnocytophaga canimorsus was isolated from blood cultures. Despite intensive therapy, multiple organ failure developed, and the patient died 27 days after admission. Characteristics of Capnocytophaga (formerly CDC group Dysgonic Fermenter-2) infection are briefly discussed. This unusual outcome in a previously healthy patient and the need for careful management of dog bite wounds, even if initially very small, is emphasized.

Hydrocephalus developed in a 16-year-old boy with a severe Guillain-Barré syndrome and was demonstrated by computerized tomography (CT) and magnetic resonance imaging. No papilledema was observed. The spontaneous resolution of hydrocephalus was achieved in a 6-month period. Ventricular changes were followed by CT scan.

To evaluate the respiratory morbidity resulting from myocardial revascularization with internal mammary artery (IMA) graft, we reviewed 153 patients operated on between April and November 1988. There were 124 men with a mean age of 61 years. A bilateral IMA graft was used in 30 patients (20%). During the harvesting of the mammary graft, the homolateral pleura was systematically opened. Acute respiratory failure was more frequent in patients with bilateral IMA (13%) than in patients with unilateral IMA graft (3%) (p less than 0.05). Consequently, the mean duration of mechanical ventilation was longer in patients with bilateral IMA graft: 56 versus 23 hours (p less than 0.05). Lung volume measurements were altered according to a restrictive pattern. On the 9th post-operative day, forced vital capacity was reduced to 59.6% of the pre-operative value in patients with unilateral IMA and to 47.1% in patients with bilateral IMA graft (p less than 0.001). Late results were obtained in 111 patients. After a mean follow-up of 7 months, forced vital capacity was still reduced to 86.8% of the pre-operative value in patients with single IMA and to 78.1% in patients with bilateral IMA graft (p less than 0.001). In conclusion, respiratory morbidity is not negligible. Bilateral IMA grafting should generally be reserved to young patients (less than 65 years) with normal pre-operative pulmonary function tests.

About two consecutive cases of acute intoxication by trichloroethylene, the authors want to point out the possible occurrence of serious disturbances in cardiac conduction which are less frequently described in the literature than disturbances in myocardial excitability.

A particularly severe case of Guillain-Barré syndrome occurring during pregnancy is reported. The therapeutic approach including plasmapheresis, ventilation, analgesia, sedation, metabolic requirements and heparin therapy is discussed with the consequences on foetal development and the early days of life.

To avoid accidental poisoning, pesticides must be handled according to prescribed rules. Furthermore, the exact composition of the pesticide formulation should be known. Cases of acute poisoning usually occur by ingestion and less frequently by the other routes. Symptoms may appear immediately but sometimes they can appear later and/or be more prolonged giving rise to delayed death and/or delayed morbidity. Acute poisoning by raticides and by organophosphate insecticides should deserve all our attention. Poisoning by herbicides containing chlorate salts, oxidative phosphorylation uncouplers or bipyridilium derivatives may be particularly dangerous. The ingestion of Paraquat, in particular, which is a veritable lesional poison, could be beyond all therapeutic resources.

A 29-year-old woman who developed fulminant pulmonary edema several minutes after intravenous administration of radiocontrast media (RCM) is reported. The low pulmonary-capillary wedge pressure and the high protein concentration in pulmonary edema fluid indicated a noncardiogenic pulmonary edema related to increased lung vascular permeability. Laboratory studies showed a slight decrease of several complement components (C3, C4 and factor B) and a transient consumption coagulopathy. Potential pathophysiologic mechanisms involved in RCM- induced pulmonary edema are discussed.