[Multiple sclerosis: immunomodulators, education, and self-injection]. / Sclérose en plaques: immunomodulateurs, éducation et auto-injection.

One hundred and sixty four patients of the Poitou-Charentes area suffering from multiple sclerosis (MS) and treated with an immunomodulating agent for more than 3 months completed a self-administered questionnaire. More than 60p.cent of the patients performed self-injection. For both modes of injection studied (subcutaneous or intramuscular), self-injection was significantly more frequent among patients who were received training and followed via telephone assistance conducted by a nurse with specialized training in MS. Our study demonstrated that waste disposal (needles), especially among patients performing self-injections, remains an important problem. Efforts must be taken concerning this important healthcare issue.

[Autonomic nervous system involvement in chronic inflammatory demyelinating polyneuropathy]. / Polyradiculonévrite inflammatoire démyélinisante chronique et atteinte du système nerveux autonome.

INTRODUCTION: Involvement of the autonomic nervous system during Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is rare. Localised hyperhydrosis and Claude Bernard Horner (CBH) syndrome have never been reported in patients with CIDP. CASE REPORT: We report the case of a 65-year-old right handed man who presented with hyperhydrosis localised to the right hemithorax and hemiface and a left CBH syndrome. After an extensive workup, the patient was found to have CIDP as the only cause of autonomic nervous system involvement. The symptoms resolved slowly after three courses of intravenous immunoglobulins. CONCLUSION: Signs of autonomic nervous system involvement can be observed in CIDP as in Guillain-Barré syndrome. This case report shows that immunomodulatory treatment can be effective against dysautonomia in CIDP.

Altered capillary permeability in neurogenic pulmonary oedema.

Two cases of fatal neurogenic pulmonary oedema are depicted. The hemodynamic study failed to document any hypertensive crisis or pulmonary hypertension. By contrast, the low values of pulmonary capillary wedge pressures and the high protein concentration in tracheal fluid suggest a pulmonary capillary wall lesion.

[Use of benzodiazepines in anesthesia and resuscitation]. / Utilisation des benzodiazépines en anesthésie-réanimation.

Diazepam, clorazepate and flunitrazepam are used to premedicate , to anesthetize and after the intervention. Anxiolysis , sedation, hypnosis, muscle relaxation, amnesia and seizure prevention justified their employment. They have few side effects. Anesthesiologist just have to be careful of their long-acting effects as for ambulatory anaesthesia.

[Management of anesthesia for surgery of the abdominal aorta]. / Conduite de l'anesthésie pour la chirurgie de l'aorte abdominale.

Anesthesia and post operative care of patients requiring abdominal aorta surgery are frequently complicated because of associated ischemic cardiopathy or respiratory insufficiency. Pre operative evaluation indicates the optimal peri-operative strategy and the need to appropriate peri-operative monitoring. This applies to patients with a previous history of myocardial infarction or with a poorly or not controlled cardiac insufficiency. The use of Swan-Ganz catheters allows monitoring of the hemo-dynamic parameters during operation, especially at the moment of clamping or unclamping of the aorta. Vasodilators and optimal volume loading allow myocardial adaptation and reduce the incidence of myocardial infarction, the main cause of peri-operative death. To perform these operations in the best conditions requires a close medicosurgical cooperation in specialized teams.

Post-operative rigidity after fentanyl administration.

A case of thoraco-abdominal rigidity leading to respiratory failure is described in the post-operative period in an elderly patient who received a moderate dose of fentanyl. This was successfully reversed by naloxone. The mechanisms possibly implicated in this accident are discussed.

[Post-operative course in tetraplegics after urological surgers (author's transl)]. / A propos des suites opératoires des tétraplégiques en chirurgie urologique

The authors report their experience with 33 tetraplegics undergoing surgery. The operations were varied, endoscopic (resection of the bladder neck, of the prostate or striate sphincter, lithot-itiasis) or surgical (lombotomies, transintentinal cutaneous ureterostomies). The post-operative course may be dramatic or even fatal (acute hypertension with cerebral haemorrhage). Respiratory insufficiency poses no particular problem and can be controlled. Epidural anaesthesia maintained for several days makes it possible to avoid the more serious problems: -- autonomic hyperreflectivity, -- delayed resolution of ileus and digestive complication. The authors hence use epidural anaesthesia routinely and are satisfied with the technique.