This clinical experience demonstrates that young, otherwise healthy people can survive accidental deep hypothermia with no or minimal cerebral impairment, even with prolonged circulatory arrest. Cardiopulmonary bypass appears to be an efficacious rewarming technique.

No abstract

We report a case involving a young adult who had life-threatening bilateral pneumonitis in the course of an acute Epstein-Barr virus (EBV) infection. Because of severe hypoxemia, the patient required mechanical ventilation and additional oxygenation by an intravascular oxygenator. The patient was treated with corticosteroids and survived without sequelae. Severe pulmonary involvement associated with EBV infection is a rare but potentially fatal complication of infectious mononucleosis. Similar cases reported in the literature are reviewed, and the therapeutic options for this particular complication are discussed.Infectious mononucleosis is a worldwide, highly prevalent herpesvirus infection caused by Epstein-Barr virus (EBV). The disease is the result of a primary infection that occurs mostly early in life. During childhood, nonspecific symptoms or even a subclinical course prevail, whereas in adolescents the disease often leads to considerable morbidity [I]. Typically, the patients present with the triad of fever, pharyngitis, and lymphadenopathy, and splenomegaly is usually found on physical examination. Secondary immunologic responses are thought to play an important role in complicated courses, which may affect the heart, brain, and other organs [2,3]. Severe clinical courses with complications requiring hospital treatment occur in merely 5% of the cases; however, only 100 fatal outcomes have been registered in the United States during a period of 10 years [4][5][6]. Case fatalities occur mainly in association with fulminant hepatitis, encephalitis, hemophagocytic syndrome, and splenic rupture [7][8][9][10].Recently, we took care of a young, otherwise healthy adult who had life-threatening pneumonitis with severe hypoxemia in the course of an acute EBV infection. By exclusion of other causative agents, the pulmonary involvement was considered to be an EBV-related complication. Just a few similar cases have been reported in the literature; these are reviewed. Case ReportIn January 1994 a 30-year-old student at a police academy presented because of a lO-day history of fever, sore throat, swelling of the cervical lymph nodes, myalgias, and fatigue. He was seen by a physician, who prescribed a macrolide antibi- otic that produced no improvement in the patient's condition. Cough and progressive dyspnea developed, and he was admitted to another hospital, where bilateral pneumonia with marked partial respiratory insufficiency (arterial partial pressure of oxygen [Pao-], 5.32 kPa; arterial partial pressure of CO 2 , 3.8 kPa; and arterial blood saturation with oxygen [Sao-], 78%) was diagnosed. Therapy with amoxicillin/clavulanic acid was begun. Because of progressive respiratory failure, the patient was intubated and mechanically ventilated. Hypoxemia persisted (Pao-, 7.0 kPa, despite an FI02 of 1.0), and the patient was transferred to our hospital.On admission, the patient was noted to have well-developed muscles. He was orally intubated. The pulse rate was 100; blood pressure, 140/80 mm Hg; and temperature, 37°C....

The objective of this study was to assess the efficiency of spiral CT (SCT) aortography for diagnosing acute aortic lesions in blunt thoracic trauma patients. Between October 1992 and June 1997, 487 SCT scans of the chest were performed on blunt thoracic trauma patients. To assess aortic injury, the following SCT criteria were considered: hemomediastinum, peri-aortic hematoma, irregular aspect of the aortic wall, aortic pseudodiverticulum, intimal flap and traumatic dissection. Aortic injury was diagnosed on 14 SCT examinations (2.9 %), five of the patients having had an additional digital aortography that confirmed the aortic trauma. Twelve subjects underwent surgical repair of the thoracic aorta, which in all but one case confirmed the aortic injury. Two patients died before surgery from severe brain lesions. The aortic blunt lesions were confirmed at autopsy. According to the follow-up of the other 473 patients, we are aware of no false-negative SCT examination. Our limited series shows a sensitivity of 100 % and specificity of 99.8 % of SCT aortography in the diagnosis of aortic injury. It is concluded that SCT aortagraphy is an accurate diagnostic method for the assessment of aortic injury in blunt thoracic trauma patients.