Anesthesie, analgesie, reanimation最新文献

Sixty patients were studied during non cardiac thoracic surgery. In 21,6 p. cent a culture of organism was isolated and for 53.8 p. cent of them developed a pneumonic process during postoperative period. The organism'role was confirmed by clinical correlation and an abnormal chent radiograph. The same organism was isolated in blood culture sputum or empyema. On the other side the patients with sterile cultures had always a favorable course. The results confirmed the interest of the method which would permit a prophylactic antibiotherapy.

Hemodynamic data of 8 patients undergoing planned resection of abdominal aortic aneurysm are statistically analyzed by variance analysis ("patient" factor and "time" factor). The results are: 1. "Patient" factor exists for all the variables studied. 2. "Time" factor is present for some of them. After aortic clamping, there is a significant decrease of the systolic index (p less than 0.05) and of the left ventricular systolic work index (p less than 0.01). After aorting declamping, a high significant increase of the mean right auricular pressure (p less than 0.001) and of mean capillary wedge pressure (p less than 0.001) are seen. Similar results are observed at the end of surgery. The results are commented with regard of the literature.

Circadian rhythms of cortisol were studied in 10 patients. This study was made shortly after the burn and for a short period of one or two days maximum in 9 patients. Blood level measurements of cortisone were made in 4 patients. 7 patients died. The analysis of circadian rhythm was made with a computer (méthode de régression harmonique combinée à une analyse de variance). The results are deceiving: there are qualitative and quantitative disturbances but we could not give a significance to them, each patient reacting differently. In one case, a drop of cortisol to 0 was observed and the patient died, this observation shows the development of corticosurrenal failure. So, one or several measurements do not allow the study of corticosurrenal function which differs in each case. Theoretical appreciations in handbooks on the subject must be tempered.

One hundred and one patients with terminal cancer suffering severe pains reluctant to other treatment have received morphine by mouth, in a regular regimen. The doses range between 5 and 60 mg every 4 hours. 71 p. cent of our patients have their pain alleviated without any side effect impeding the treatment.

This retrospective study shows correlations between the occurrence of pulmonary and massive blood transfusion in 50 seriously injured patients. They received massive transfusions on an average of 13 titers (minimum 51, maximum 30 l) including from 0 to 7,51 of macromolecular solutions (average 2,43 1). These seriously injured patients were divided into 4 groups: --20 thoracic injured patients with associated abdominal lesions, --15 thoracic injured patients without any abdominal lesions, --4 peripheral traumatism with abdominal lesions, --11 polytraumatic patients (considering only lesions of the limbs). There is a significant difference between seriously injured patients with associated abdominal lesions who were transfused and the other groups studied. Sixteen patients experienced pulmonary edema the diagnosis of which was reinforced on grounds of clinical, biological and radiological evidences. Significant difference (p:minor 0,05) were noted as regard the incidence of pulmonary edema when comparing the volume of fluids administrated to the different groups. New out of 16 patients died, mainly because of refractory hypoxia. When more than 25 liters of fluids are transfused, the prognosis is poor. Though pulmonary edema may be brought about by transfusion, other etiologic possibilities are to be investigated.

Seventy transtracheal aspirates (T.T.A.) have been achieved with patients having an acute pneumonia; 42 had a chronic respiratory failure; 25 had received a previous antibiotherapy; 49 presented negatives delayed hypersensitivity skin reactions. No major accident was noticed and the T.T.A. were positive in 87 p. cent of the cases. The results show the predominance of the Cocci Gram + especially pneumococcus. These cases are associated with Hemophilus influenzae in 19 p. cent of the cases. Negative skin tests show the frequency of this association. Infections with Bacilles Gram -- are found as well in this circumstance. The previous antibiotherapy alters microflora and leads to a B.G. -- as well predominance. At last, the evolution is not influenced by the discovery of an organism in the T.T.A. The authors compare the results with those found in previous work and conclude in the interest of that method which enable a quick identification of the organism and the starting of a well adapted antibiotherapy.

One of these two cases (1 h 30 and 48 hours) was permanent. The cause of the paralysis seems to be either from compression of the nerve between the endotracheal tube cuff and the cricoid, or from compression between the thyroid ala and a dislocated arytenoid cartilage from use of an unnecessarily large tube. An anatomical study has helped to confirm this hypothesis and shows the presence of an ischaemic aera overlying the nerve at the level of its entrance into the larynx due to the endotracheal cuff.