Correlation between urine ketones (acetoacetate) and capillary blood ketones (3-beta-hydroxybutyrate) in hyperglycaemic patients.

AIMS: To facilitate the transition from urine ketones (acetoacetate) to capillary blood ketones (3-beta-hydroxybutyrate), we studied the correlation between these two tests. METHODS: Retrospective study of all patients with blood glucose greater than or equal to 2.5 g/l on arrival in the Emergency Department. We studied the correlation between urine ketones (Clinitek 50, Bayer) and capillary blood ketones (Optium, Abbott). We then compared the relative risks (RR) of ketoacidosis and hospitalization associated with each of these tests. RESULTS: In 33 months, 529 adult patients with both urine and blood testing for ketones were enrolled (ketoacidosis 8%, admission rate 49%). Urine ketones scored as +, ++ and +++ corresponded to median capillary blood ketone levels of 0.5 mmol/l (IQR: 0.1-0.9), 0.7 mmol/l (IQR: 0.2-1.8) and 3 mmol/l (IQR: 1.4-5.2), respectively. RRs of ketoacidosis or hospitalization associated with blood ketones greater than or equal to 3 mmol/l were higher than those associated with +++ urine ketones: 74 (95% confidence interval [CI]: 48-88) and 2.9 (95% CI: 2.5-3) versus 31 (95% CI: 18-45) and 2 (95% CI: 1.7-2.1), respectively. CONCLUSIONS: In hyperglycaemic patients in the Emergency Department, a good correlation was observed between urine ketones and capillary blood ketones for low values, but a poor correlation was observed for high values. Either test can therefore be used to exclude ketosis, but the capillary blood ketones test is more accurate to confirm ketoacidosis.

[The transfacial flap in surgery of tumors of the middle and posterior 3d of the face and base of the skull. Its use as a means of approach and reconstruction]. / Le volet transfacial dans la chirurgie des tumeurs des tiers moyen et postérieur de la face et de la base du crâne. Son utilisation comme moyen d'abord et comme moyen de reconstruction.

A transfacial approach and the use of a bone flap allows exeresis of large tumors of middle and posterior third of face and of base of skull. The procedure can be used alone or associated with a neurosurgical approach to the lesions. This wide surgical approach increases the possibility of a complete excision under conditions of strict hemostasis. Replacement of the bone flap at the end of surgery restores skeletal reliefs ad integrum with excellent esthetic results. The technique is described in detail and several examples of its use outtined.