Woman and Anesthetist in Bir Hakeim.

Louise-Marie Lemanissier was a French physician who, after The Appeal of 18 June, joined with her husband the doctors of the Free French Forces (FFL) during World War II. The 1st Free French Division moved to Bir Hakeim on February 13, 1942, and the Lemanissier couple joined it in the Hadfield Spears Mobile Surgical Ambulance. Louise-Marie Lemanissier performed anesthesia among other duties. Anesthesia techniques seem to have been limited to the use of the Ombredanne's mask. After 17 days, the 1st Free French Division broke the siege on June 10, 1942, to join with the British troops. The couple returned to Syria until the end of war, and then returned to France. Louise-Marie Lemanissier passed her medical thesis in 1947, devoted to serotherapy in the treatment of Diphtheria. She died in 2007 in her hundredth year.

[Ludwig Wittgenstein (1889-1951) and the "wound shock"]. / Ludwig Wittgenstein (1889-1951) et le "wound shock".

Ludwig Wittgenstein was born in 1889 in Vienna. As a scholar in Cambdrige University, his philosophical achievements are still major regarding the foundations of mathematics and language. In 1939, he took a job as a porter at London Guys' Hospital then under the Blitz. Wittgenstein met Drs. Grant and Reeve who worked in a dedicated "traumatic shock" under the auspices of the Medical Research Council unit, a unit which then moved to the Royal Victoria Infirmary in Newcastle; Wittgenstein followed them as a technician and improved the preparation of fine pieces of histology fixed by paraffin. He also invented a new device to record pulse pressure and paradoxical pulse search in laboratory rats. At the end of the war, he returned to Cambridge until 1949 and died in 1951.

[Early human transplants: 60th anniversary of the first successful kidney transplants]. / L'aube des greffes humaines : 60(e) anniversaire des premières transplantations rénales réussies.

First kidney transplant attempts begin with the 20th century: improving vascular sutures, understanding the phenomena of rejection or tolerance, then progress in HLA groups enable early success in the second half of the century. Definition of brain death, use of corticosteroids, radiotherapy and prime immunosuppressors promote the development of transplants. Discover of cyclosporine in the 1980s, and legislative developments augur a new era. Many advances are arising: use of stem cells from the donor, enhancement of Maastricht 3 donor or living donation. Finally organ transplantation remains an immense human adventure, but also scientific and ethic.

The County Council of the Order of Physicians in Ille et Vilaine (France) during the Second World War.

Initially, the examination of the archives from the Ille et Vilaine Council of the College of Physicians was based solely on the findings of Dr. George from Rennes who had helped Jews during the Occupation. Gradually I perceived that the quality of available documents permitted writing this article to show a contrasting view of this dark period in our history. This work aimed to analyze the role of the County Council (CC) of Ille et Vilaine through minutes of their meetings and to compare, year by year, directives and circulars from the Supreme Council of the Order of Physicians (SCO) sent to CC at this period. We will observe see that between the institution, acting by strictly following the orders from the "French State", and the county councils, for some at least, there was a gap that men of good will knew not to cross.

Assessing the depth of the subarachnoid space by ultrasound.

BACKGROUND AND OBJECTIVES: To assess the accuracy of the ultrasound (US) to predict the depth to reach lumbar intrathecal and epidural spaces in order to decrease the number of puncture attempts. METHODS: Thirty-one patients (25 males and 6 females), ASA I or II participated in this study. The transversal ultrasound image of the lumbar spine was obtained at the level of the L3-L4 space. An anesthesiologist without prior information performed the spinal anesthesia through the predicted target area. The distance between the skin and the anterior portion of the flavum ligamentum which is supposedly the bottom limit of the intrathecal depth or an approximation of the depth of the epidural space (ED-US) was measured by ultrasound and it was compared with the distance between the skin and the anterior portion of the flavum ligamentum on the needle (ED-N). RESULTS: ED-US and ED-N were respectively 5.15±0.95cm and 5.14±0.97cm; these distances were not significantly different (p>0.0001). A significant correlation r=0.982 [95% CI 0.963-0.992, p>0.0001] was observed between the ED-US and ED-N measurements. Bland-Altman analysis showed an accuracy of 0.18cm; tolerated variations ranged from -0.14cm to -0.58cm. CONCLUSIONS: This study supports the idea that the US transversal plane allows the identification of axial anatomical structures and provides physicians with efficient information to perform spinal anesthesia.

Opioid-induced sedation in the postanesthesia care unit does not insure adequate pain relief: a case-control study.

BACKGROUND: Sedation can occur during intravenous titration of morphine for acute pain control in the postanesthesia care unit (PACU). We designed this case-control study to evaluate the relationship between opioid-induced sedation in the PACU and adequacy of early postoperative analgesia. METHODS: Intravenous morphine was titrated in 2 mg (body weight < or =60 kg) or 3 mg (body weight >60 kg) boluses every 5 min to treat moderate-to-severe pain in the PACU. Pain was assessed using a 11-point verbal rating scale (VRS) with scores > or =3 representing moderate-to-severe pain. The 6-point Ramsay score was used to assess the level of sedation with scores >3 representing clinically significant sedation. Twenty-six patients, with a Ramsay sedation score >3 and a pain VRS > or =3 at discharge from the PACU, were evaluated 24 h after surgery to assess (a) the recall of early postoperative pain in the PACU, (b) quality of sleep on the first night after surgery, (c) pain on the 24th postoperative hour, and (d) satisfaction with pain management at 24 h after surgery. Two patients discharged from the PACU with VRS pain scores <3 were matched to each of the patients with pain scores > or =3 and Ramsay score >3, as part of a 52 patient control group. RESULTS: Patients with Ramsay scores >3 and pain scores > or =3 more frequently reported moderate-to-severe pain in the PACU (severe/moderate/no pain: 18%/25%/57% vs 58%/16%/26%, P = 0006, for the control and the sedated group, respectively), poorer quality of sleep the night after surgery (well/moderate/bad: 48%/42%/10% vs 23%/23%/54%, P = 0.001, for the control and the sedated group, respectively), and higher pain scores at the 24th hour after surgery (severe/moderate/no pain: 6%/44%/50% vs 50%/42%/8%, P < 0.0001, for the control and the sedated group, respectively). In addition, their overall satisfaction with pain control during the first 24 postoperative hours was lower (satisfied/moderately satisfied/not satisfied: 96%/2%/2% vs 50%/30%/20%, P < 0.0001, for the control and the sedated group, respectively). CONCLUSION: Clinically significant opioid-induced sedation in the PACU does not insure adequate self-reported pain relief.