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

A retrospective study was carried out on anaesthetic records concerning spinal anaesthesia with hyperbaric bupivacaine 0.5% in urologic surgery. Three doses were utilised: slight (< 0.19 mg.kg-1), mean (0.19-0.21 mg.kg-1) or important (> 0.21 mg.kg-1) for two different levels: T12 or T10. Important doses may be involved excessive extension. Failures are perhaps more frequent with slight doses. Mean doses, 0.20 mg.kg1, seems to be recommended.

Non invasive blood pressure (NBP) measures are currently used in anesthesiology. The accuracy of this oscillometric technic has been tested with healthy patients, but not often with a wide pattern of pathology. The aim of this study is to point out the reliability of NBP during vascular surgery with patients suffering from arterial disease and atherosclerosis. It compares outcome with simultaneous catheter arterial blood pressure measurement (template technic). In this conditions, oscillometric method underestimates the systolic pressure value, and overestimates the diastolic one. The higher the level of arterial pressure is, the larger is the difference between this methods. It is clear that the automatic oscillometric technic is not so reliable if hypertension or atherosclerosis disease occurs. In order to improve this technic, automatic measures must take in account the degrees of arterial rigidity in its outcome.

The HSV (1 or 2) is the cause of serious pulmonary infections among patients who have had a transplantation. This study in retrospect is based on the analysis of 145 patients who underwent a cardiothoracic transplant at the CHU. in Nancy. Confronted with clinical signs calling to mind breathing difficulties, the analysis of the broncho alveolar lavage (or of the bronchial brushing) revealed the viral aetiological agent. The answer from the laboratory is quickly available by immunofluorescence or by immunoperoxidase with viral anti-protein monoclonal antibodies and by the multiplication in vitro of the virus into cell cultures. The HSV 1 was responsible for 8 herpetic lung infections. The specific Acyclovir treatment was used 6 times successfully. When such a direction of treatment was impossible (in 2 cases) the outcome was fatal. The carry HSV is highly frequent and recurrences under immuno-suppressor treatment require an Acyclovir prophylaxis among patients admittedly carrying the virus in a pre-transplanted serum assessment.

This study concerning bacteriological controls of food for immuno-suppressive patients have shown that food sterilized in sterilizer or with pressure-cooker contains sporulated bacteria after treatment. Unit packaging or freeze-drying commercial foods offer no bacteriological quality guarantees. Clinicians have to define acceptable contamination rate according to their patients' condition.

The investigation was carried on 122 waiting renal transplantation hospitalized patients. Detection of HCV antibodies was done before transplantation and after renal transplantation. HCV antibodies were detected by immunosorbent assay (ELISA) for C 100-3 protein of HC virus (Lab. ORTHO). Positive results were checked by a second test (immunoblot RIBA II) to detect antibodies against C100-3, 5-1-1, C33, C22 proteins of HCV genome. Before transplantation, 112 patients were negative and 10 positive. After transplantation, 104 were checked: 103 had identical serology (93- and 10+); only one patient has shown a seroconversion six months after the transplantation, demonstrating the late apparition of HCV antibodies, but immunological status of donor was unknown. Renal transplantation does not seem a risk factor of HCV contamination: only 1 seroconversion on 122 patients or 0.8%: near percentage of French blood donors (0.68%). The percentage of positivity HCV before transplantation (9%) answered with that of European hemophils (5 to 20%). Second generation tests demonstrate a better sensibility and specificity than the first.

This retrospective clinical study was made to help determine the signs of infectious or healing problems in candidates for prosthetic breast surgery. It concerns 80 patients with 108 breast implants (44 breast reconstructions, 21 cases of hypoplasia, 8 breast asymmetric, 20 secondary procedures, 15 of them being changes of expansion implants by definitive implants). Thirty one infectious complications (28.7%) were noted. In 22 cases it consisted of a resolutive hyperthermia. Nine cases of local complications were noted, with four implant exposures (3%). Bacteriological samples were analyzed and were positive in four out of nine (Staphylococcus aureus). In 8 out of the 9 cases the initial procedure consisted in a breast reconstruction. All 8 patients underwent postoperative radiotherapy after the initial mastectomy (Patey). The implant type (implantable, pre-filled, expansion prosthesis), its location (retromuscular), the type of surgery (asymmetrical breast musculocutaneous or fasciocutaneous flap) don't seem to be responsible in the genesis of the complications. This retrospective study could not help determine which protocol of antistaphylococcal antibiotherapy suits lest. Infectious problems arose with or without antibiotics.

Sedation for patients during surgery under local or regional anaesthesia may induce ventilatory depression. All sedated patients must be monitored with a pulse oximeter. Routine administration of supplementary oxygen is necessary. General anaesthesia must be rapidly performed when regional anaesthesia is unsuccessful.

Candidiasis, aspergillosis and cryptococcosis are the most common fungal infections in transplant recipients. However other fungal infections have been reported. Mucormycosis, Scedosporium infections, fusariosis and trichosporonosis represent the largest part of these rare mycosis. The clinical and mycological features are described here. In addition, cases of very uncommon mycosis, most of them only once reported, have been reviewed. Overall the diagnosis is difficult as mycological examinations are often negative till the disease is disseminated. Amphotericin B remains the reference treatment except in Scedosporium infections which respond more likely to azole antifungal agents. Despite the treatment the outcome is usually fatal.

Disturbances of the oxygenation of a patient during the early postoperative period occur frequently. Their mechanisms are complex. Alveolar related hypoxemia can be distinguished from pulmonary or nonrespiratory related hypoxemias. Those of alveolar origin are characterized by a drop in the alveolar oxygen pressure. Those of pulmonary origin arise mainly due to ventilation perfusion distribution problems or an increase in the intrapulmonary shunt. Those of nonrespiratory origin are mainly caused by a drop in cardiac output or by an increase in the tissular oxygen consumption. Patients showing signs of postoperative oxygenation trouble usually recover rapidly. Severe cases require intensive care treatment.