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

A cautions analysis of the respiratory preoperative study may decrease morbidity and mortality after pulmonary surgery. To search for predictive criteria of respiratory complications following this kind of surgery, 454 patients have been studied retrospectively. Morbidity was defined as the need for postoperative ventilation. Preoperative criteria were divided in clinical (age, obesity, history of pulmonary disease, dyspnea, score of Karnofsky), laboratory (blood gases, spirometry) and surgical (kind of procedure). Three criteria were significant for morbidity (15 ventilated patients) and mortality (27 deaths): age (> 65 years), obesity, hypocapnia (pCO2 < 4.1 kPa-31 mmHg). Analysed spirometric values were no significant.

For the last 40 years transtracheal ventilation has been suggested as a means of bypassing the glottis in emergency in patients unable to be intubated or ventilated by mask. A catheter has been designed to be easily inserted into the crico-thyroid membrane. The outer part of the device, with its dual attachment system, can be connected to conventional resuscitation equipment by its 15 mm male end or to a high-pressure oxygen source by its Luer-Lock fitting. The advantages of transtracheal ventilation are: a clear vision of the operative field, a good gas exchange, an elimination of airway trauma from intubation, a reduction of the hazard of airway fires and a decreased risk of aspiration of blood and debris. Barotrauma is the main danger. However, this method of providing oxygen and/or mechanical ventilation may be extended to the postoperative period, the exit of the insufflated gas mixture being assured at all times.

Based on metals, polymers, ceramics, carbons or natural products, biomaterials represent an essential contribution to the repair or reconstruction of the hard or soft tissues of the dental and maxillofacial area. In order to avoid unsuccessful results these materials should realize a satisfactory tissue integration without bacterial colonization able to compromise the tissue-biomaterial finalized cooperation. The evolution of the science and technology of biomaterials should allow to get tissue toxicity-free materials which also inhibit microorganisms adherence, the infectability becoming a criteria as important as the biocompatibility itself.

The authors report their experience of a home bone bank of cryopreserved femoral heads on a period of 3 years. They remind the rules to observe for the harvesting, the storage and the utilization of these allografts, and also the indispensable biological tests (at the moment when the article was written). About their series, the authors remind the risks of infection in relation with the utilization of femoral head from bone bank, which justify a great rigour in the organization and the managing of these home bone bank.

A personal series of 10 patients with post surgical bacterial endophthalmitis is reviewed. Clinical signs, risk factors and diagnostic modalities are analysed and compared to other reports in literature. The role of intraocular lens is discussed. While it does not seem to be a risk factor in acute endophthalmitis, it plays a major role in chronic bacterial endophthalmitis. Endophthalmitis remains a rare but serious complication after cataract surgery and prevention modalities, especially using prophylactic antibiotherapy, have still to be evaluated.

The incidence and the predisposal factors of urinary tract infections (UTI) in the first month post-transplant were studied in 255 kidney transplantations (252 patients). UTI episodes were demonstrated in 73.7% of the grafts. The most common organisms were: Escherichia coli (35.8%), Staphylococcus (33.6%), Streptococcus D (11.2%), Klebsiella (5.3%). The infectious episodes were recurrent in 39% of the cases. The majority of the UTIs were asymptomatic but 7% of the infections led to septicaemia. Etiology of end-stage renal disease, pre-graft binephrectomy, asymptomatic vesicoureteral reflux into the patient's own kidneys, type of immunosuppressive treatment, acute tubular necrosis, rejection episodes, urological complications, coexistent other infections were not predisposal factors. Bacteriuria was more frequent in female than in male patients. The incidence of UTI was found to be statistically increased with history of UTI preoperatively (p = 0.039) and the use of ureteral catheter (p = 0.018). Occurrence of UTI was less common when the donor was treated by antibiotics before brain death (p-0.025). These results provide additional support for regular monitoring of urine cultures in the first month post-transplant. They should help to identify means of reduction of this infectious risk.

Invasive Trichosporon capitatum infections are seldom reported. We present here five cases of septicemia. All patients had an acute myeloblastic leukemia and were severely neutropenic. They have also been treated before the onset of the fungal infection with broad-spectrum antibiotherapy and also with an oral azole antifungal agent. The role of this antifungal therapy in the development of T. capitatum infection is discussed. The prognosis of T. capitatum infections is severe. Eight of the 10 published cases had a fatal outcome and one of our patients died of the fungal infection in spite of the treatment.

Plasma sterilisation of heat sensitive materials appears as an attractive substitute for ethylene oxide processing which leaves adsorbed toxic residues. In oxygen-based plasmas, the de-activation of pathogenic organisms is assumed to be due to their slow combustion with the active species which produces CO2 and H2O. In the absence of ion bombardment, the concentration of oxygen atoms is an important parameter entering the plasma sterilisation efficiency. Means for achieving high production of oxygen atoms are reviewed and discussed. In particular, an initial improvement would be to generate the plasma in the sterilisation volume itself. Uniform plasma excitation at electron cyclotron resonance (ECR) which allows resonant coupling in the whole treatment volume (no shadowing) and requires reduced electric fields to sustain the discharge (no heating of biomaterials) is particularly adapted to this purpose.

This study describes the infectious complications in 68 heart-lung transplant patients. We focused interest on early post-transplant infections so called nosocomial pulmonary infections, their exacerbating cofactors their clinical expression, and elements of diagnosis and treatment. Furthermore we describe the principal infections seen during long-term followup, which are opportunist infections caused most often by immunosuppression: Cytomegalovirus infections have a high incidence with serious clinical consequences in heart-lung transplant patients. As well as pneumocystis carinii infections and fungal infections, such as aspergillosis.

Newman's test consist in draw a line on two parts of a figure made of points. This test was achieved in four successive trials by thirteen boys and fourteen girls, all voluntary students. In two trials subjects wear Reiser screen which reduce to a slight extent distinctness of vision. Trial order was randomised. For each trial, time performance and four numeral criterions of graphic defects were compared to initial values. The test retest values are no significantly different. Reiser screen alter some criterions. So the Newman test is useful to assess awakening on condition that such criterion were used in reference to subject preanaesthetic values and with controlled conditions of environment.