Delirium tremens : étude rétrospective de 39 observations

Introduction

Alcohol withdrawal delirium (AWD) is one of the most serious complications of alcohol withdrawal. The daily practice of linking activity in addiction shows that this condition is not uncommon.

Patients and methods

We extracted from the hospital database patients’ admissions for which a diagnosis of AWD (F104) was registered between 2004 and 2009. The review of discharge reports allowed to select the patients for which the medical records were analyzed.

Results

Thirty-nine patients admitted for DT were selected. Mean age was 48 years (male 89.7%). A majority of patients (89.7%) were admitted through the emergency department. In about a half of cases (51.3%), blood alcohol concentration was null at admission. The main reasons for the admission were alcohol withdrawal syndrome (17.9%), fall/malaise (15.4%), and generalized seizures (12.8%). Approximately one-third of the patients had a medical history of seizures and 23.1% of AWD. No patient had severe liver failure. Six patients (15.4%) were transferred to intensive care. Two patients developed AWD after surgery. No deaths have been observed.

Conclusion

Improving medical knowledge of AWD is a way to make this complication even more uncommon.     

Letter to the Editor: Comparison of Outcomes with Semi-mechanical and Circular Stapled Intrathoracic Esophagogastric Anastomosis Following Esophagectomy

World Journal of Surgery -     

Changes in psychopathological symptoms in sleep apnea patients after treatment with nasal continuous positive airway pressure.

To evaluate the psychological disturbances associated with obstructive sleep apnea (OSA) and the effect of nasal continuous positive airway pressure (NCPAP) treatment on these alterations, personality patterns and psychosocial adjustment were assessed in patients hypnopolygraphically diagnosed with OSA before and after different periods of NCPAP therapy. Prior to treatment, MMPI results for 23 patients showed significant elevations (p < .01) on five clinical scales compared to those of 17 normal controls. Apneics' personality patterns were predominantly of a "neurotic-mixed" type, indicating an anxiety reaction with paranoid features. Depression, schizophrenia, and hypochondriasis were the highest scales. Most patients had severe psychosocial maladjustment. In the follow-up study during the NCPAP treatment, there was a progressive reduction of the psychopathological signs along with a generalized improvement in psychosocial adaptation. These changes were remarkably significant after about a year's treatment, in particular for depression (p < .01) and total adjustment degree (p < .01). It was concluded that severe OSA is associated with serious psychosocial alterations that improve gradually with NCPAP.     

Use of Ultrasonography for Lung Transplant Recipients on Postoperative Care

The authors report their findings regarding lung ultrasound profiles in a population of transplant recipients. Twenty‐two patients were studied once each in multiple different ultrasound windows focusing on pleural, lung, and diaphragmatic signatures. All studies were performed in presumably otherwise healthy recipients at an outpatient follow‐up visit at least 3 months after transplantation. Those with recent pulmonary infections or decline in lung function were excluded from enrollment. The majority of scans revealed otherwise normal lungs with lung sliding, but there were more abnormalities than one would expect in a healthy control group. Lung ultrasonography will likely never replace other cross‐sectional imaging given its inherent visual limitations but adds another modality to interrogate the lung/pleural interface and diaphragmatic function.