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Objective: We investigated patients who died in our institution during the August 2003 heat wave, to determine whether some in hospital patients actually died of heat stroke., Methods: Records of all patients who died in our tertiary care hospital between 6-15 August 2003 were analyzed retrospectively. Heat stroke was considered the cause of death when the following criteria were met: body temperature higher than 40.5 degrees C, except if there was documented evidence of cooling before the first temperature measurement, central nervous system abnormalities, and a reliable history of exposure to high temperatures in a hospital ward. The number of patients who died in the hospital during the heat wave was compared with data from the previous year., Results: Seventeen patients died from hospital-acquired heat stroke (19% of all hospital deaths). This condition accounted for a 25% increase in hospital mortality over the same period during 2002., Comment: Hospital-acquired heat stroke appears to be a nosocomial disease that was responsible for an overall increase in hospital mortality during the 2003 heat wave.

The in vivo relevance of the paradoxical bactericidal effect (the Eagle effect) is not evident. We found in vitro a paradoxical bactericidal effect of amoxicillin on 2 strains of nontoxigenic Corynebacterium diphtheriae. Then, using an experimental rabbit model of endocarditis, we evaluated the in vivo relevance of this phenomenon. Rabbits were assigned to the following groups: no treatment (control group), continuous amoxicillin infusion simulating a dosage of 200 mg/kg/day in humans, and continuous amoxicillin infusion simulating a dosage of 20 mg/kg/day in humans. The low dosage (20 mg/kg/day) was significantly more effective than the high dosage (200 mg/kg/day) against both strains (P<.025), confirming the paradoxical bactericidal effect observed in vitro.

Objective: The number of visits to emergency units in public hospital settings in France increases every year. The adequation between admission to an SAU--Service d'accueil d'urgence (emergency unit) and the clinical status of the patient must be checked to improve handling upstream of the SAU., Method: A prospective study was conducted in the SAU of the University Hospital in Nantes to assess the proportion of patients who would benefit from direct hospitalisation, scheduled in a department of specialised or polyvalent medicine., Results: This proportion was of 10%. Seventy-three percent of the patients were aged over 60. They were referred in 77% of cases by their treating physician and in 10.4% of cases by the physician on duty. Thirty-three percent of cases were non-specified organ diseases, 20% were dermatological affections, 12% broncho-pulmonary infections and in the same proportion rheumatological pathologies; other affections were rare., Comments: The results of this study must be confirmed in a pilot study in which the general practitioner would refer any patient, that he would have sent to an SAU, directly to a medical department without passing through the SAU. To do so, using a cell phone, the practitioner would contact the hospital physician who would find a hospital bed. The impact of this new modality of hospitalisation on the SAU could be assessed in terms of the number of admissions avoided to the SAU.

The decision of an antibiotic treatment depends first on clinical and bacteriological data. Then PK/PD (pharmacodynamics/pharmacokinetics) of antibiotics must be taken into account in order to optimise the dosing regimen, and to reach the targeted serum concentrations. The good oral bioavailability of some drugs allows the use of the oral route, at the beginning of the treatment, or shortly after an initial successful i.v. administration, even in severe infections.