Proximal paraparesis following spinal anesthesia.

A 70-year-old man with prostatic cancer extending to the urinary bladder underwent transurethral resection of the bladder neck under spinal anesthesia and developed weakness of the proximal lower limbs a few hours after the procedure. The weakness persisted for several months. Because there were no local surgical complications (hematoma, infectious epiduritis, abscess) or bone metastases responsible for nerve root or spinal cord compression, a causal relation between the neurologic deficit and the spinal anesthesia was considered likely. Neurologic deficits are uncommon after spinal anesthesia and can be produced by complications of the surgical procedure (direct nerve injury, hematoma, abscess), arachnoiditis, neurotoxicity of disinfectants or of preservatives added to solutions of anesthetic drugs, or spinal cord ischemia. Precipitating factors for spinal cord ischemia include faulty patient position during the procedure, intraoperative arterial hypotension and injection of vasoconstricting agents.

[Cholestatic hepatitis induced by the amoxicillin-clavulanic acid combination. A case and review of the literature]. / Hépatite cholestatique due à l'association amoxicilline-acide clavulanique. Un cas et revue de la littérature.

We report the case of a patient who developed jaundice after receiving amoxicillin-clavulanic acid for 7 days. Laboratory features were consistent with acute cholestatic hepatitis. Histopathological examination of a liver specimen showed cholestasis. Complete recovery occurred within 2 months after withdrawal of the drug. Analysis of the 24 reported cases of amoxicillin-clavulanic acid induced hepatitis revealed a predominantly cholestatic syndrome occurring soon after drug administration. In all cases, hepatic dysfunction disappeared within 1 to 3 months after discontinuation of the drug. Because of the small number of cases in contrast with the widespread use of this drug, associated with blood hypereosinophilia or eosinophilic infiltration of portal triads in some cases, a hypersensitivity phenomenon is suggested.

[The adaptation of the Bennett PR2 to intermittent mandatory ventilation (author's transl)]. / Adaptation du Bennett PR2 à la ventilation intermittente commandée.

This adaptation presents the following advantages over and above those already acknowledged for continuous IPP ventilation: conservation of respiratory muscle functions, autoregulation of ventilatory frequence, reduction of mean endothoracic pressure, thus dispensing with the necessity for negative-end-expiratory pressure. In addition: easy, effortless assembly, abolishes the defects of the Bennett PR2, gives the machine a good volumetric performance.