Agressologie: revue internationale de physio-biologie et de pharmacologie appliquees aux effets de l'agression最新文献

This study assesses theoreticals indications of cardiovascular monitoring in adult non cardiac surgery. These purposes are depending on patient's preoperative evaluation, operative and anesthetic risk, like current technical possibilities.

Atypical Mycobacteria were demonstrated in tap water. Mycobacteria are generally more resistant to chemical disinfection than other bacteria and grow and survive in water. In an effort to clarify the role of water in the transmission of Mycobacteria, water from various sites in the hospital was analysed. Atypical Mycobacteria were isolated from 58 of 60 samples of cold water distributor. Species more frequent are M.Kansasii, M.Gordonae, M.Fortuitum. 3 of 10 samples of hot water were positives M.Xenopi was isolated once. 1 of 10 samples of mineral waters was contaminated with M.Gordonae. The atypical Mycobacteria in normal patient are relatively less virulent, in a host with an impaired cellular immunity they caused active diseases. The number of published cases is low. The incidence in transplant patients ranges from 0.5 to 1%. Infections with atypical Mycobacteria differ in several clinical features. Person to person does not occur. Water is a source of infection induce direct inoculation inhalation and ingestion.

Polyurethane (PU) and polyethylene (PE) central venous catheters were compared for their respective responsabilities in catheter related sepsis (CRS). From may 1988 to may 1989, 300 central venous catheters were inserted. Insertion sites were freely chosen by physicians. The polymer type was randomized. Catheters were removed after 10 days in place. Microbial loads were assessed on insertion sites, catheter hubs and tips, and blood drawn through the catheters lumen. One hundred eighty three catheters were available for complete evaluation (101 PE, 82 PE). Eleven were responsible for CRS, 4 were colonized (BB3 according to Brun-Buisson's classification), 19 were contaminated (BB2), and 149 were sterile (BB1). When comparing the "infected" group (CRS+BB3) and the "noninfected" (BB2 + BB1), no difference appeared between the tested polymers. CRS were significantly associated with insertion into the internal jugular vein. It seems useless to exclude from clinical practice any of the biomaterials tested.

Bony substitutes are in fashion in maxillofacial surgery. They are used to fill bony cavities, in bony reconstruction to give shape-lines and re-create area of support or to fill bony defects. Then their use is frequently crowned by success in general surgery, it is not the same thing in maxillofacial surgery because of the usual impossibility to fulfil a requirement to biomaterial utilisation: the watertight. Furthermore, they don't have yet, for the most part, an essential quality: malleability. In our experience, their use are frequently disappointing because of postoperative infections and we stay faithful to the autograft bone. However it is highly probable that these biomaterials will take an importance more and more considerable when these problems will be overcame.

Fifty seven cases of invasive aspergillosis have been analyzed. Most patients were severely neutropenic. The main underlying diseases were acute leukemia, malignant lymphoma and bone marrow transplantation. The clinical and radiological manifestations and the mycological data rare presented. A dramatic increase of the annual incidence has been observed since 1986. The main causes appear to be the increase in intensity of chemotherapy regimen for acute leukemia and the progressive colonisation of a part the department. Overall mortality is especially high (74%) but the mortality rate appears to decrease since 1989.

Prolonged continuous stellate ganglion blockade has been found useful in treatment of post-traumatic reflex sympathetic dystrophy under the following circumstances: 1) When conservative treatment with outpatient physical therapy, tranquilizers and mild analgesics has failed. 2) When conservative therapy plus intermittent stellate blocks (q.l to 4 weeks) has failed. A three-year average follow-up of a group of 26 unselected patients has shown 25% relapse rate and 75% marked to complete improvement.

The evaluation of a drug used in neuroanesthesia is based upon controlled trials. The main principles of such trials are not different from trials of other drugs but some characteristics should be emphasized. The first phase of the development of a drug is an evaluation in healthy volunteers of its tolerance and kinetics, which must combine rapid and short action without residual effect. The second phase is a study of the tolerance and kinetics but also of its efficacy because only patients are involved. Action upon cerebral circulation is of great importance. During the third phase, trials have to prove that the new drug has "something more" than the drug usually prescribed for the same indication to obtain approval for marketing. The next phase is the best period for the evaluation of safety by recording the adverse effects observed when many patients are exposed to the new drug. The french system of post marketing surveillance is based upon spontaneous reports of adverse effects by prescribers To be correctly performed a trial needs the collaboration of a neuroanesthetist, a pharmacologist and a statistician. The trial needs to be controlled which means a comparison of two groups of patients, one with the drug and the other one without the drug. The treatment has to be randomized and blind to be sure that any difference between the two groups is in fact due to the drug. The clinician has to define the evaluation criteria and the tool of measurement to calculate the number of patients needed for the purpose of the trial.

Recording brainstem auditory evoked potential (BAEP) in post operative period after neurosurgery is easy. The presence of abnormal BAEP predicts unfavorable outcome in both cases with or without sedation. But in case of normal recording it is impossible to predict surely a favorable outcome.