[Patient monitoring strategy in a hand surgery university center labeled FESUM-Integration of postgraduate students: A prospective study]. / Stratégie de suivi des patients dans un centre SOS main universitaire labellisé FESUM-Intégration des étudiants de 3e cycle : une étude prospective.

INTRODUCTION: Federation of Hand Emergency Services (FESUM) is a European network of hand emergency centers (called SOS hand centers) in France, Belgium and Luxembourg. The FESUM network includes 64 SOS Hand centers in France. In our university hospital, the FESUM-certified SOS hand has been part of the plastic surgery department since 2001. It has included, since 2016, postgraduate students ("residents") training in hand surgery who participate independently in the patient follow-up. The objective of this study was to analyze the characteristics of this population of patients with hand injuries and their satisfaction with this mode of follow-up. The secondary objective was to study the characteristics of the patient population treated by our center. MATERIAL AND METHOD: We conducted a study on the follow-up of patients undergoing emergency hand surgery, prospective, single-center, declarative, anonymized, between May and October 2021 at the SOS main center of our university hospital at the "SOS Main" intern consultation. The demographic data, the main characteristics of the pathology, the elements of initial care and follow-up of the patients as well as their satisfaction were analyzed, as well as the satisfaction of the interns. RESULTS: We included 323 patients. The population of patients treated generally corresponded to a young man, manual worker, who was initially treated in an outpatient department or in an SOS Hand consultation. The lesions most often represented were fractures (24%), tendon wounds (18%) and wounds without damage to noble tissues (16%). Follow-up consultations took place mainly 15days after the emergency intervention, lasted on average 10minutes and did not present excessive delays. Patient (91.2%) and post-graduate student (87.2%) satisfaction was high. However, postoperative physiotherapy follow-up was insufficient, as was self-rehabilitation. CONCLUSION: The integration of post-graduate student in a university plastic surgery department into the care of SOS Hand patients seems beneficial for all those involved, and for their training. The characteristics of the follow-up consultations by the intern in autonomous supervision corresponded to the high quality standards of the FESUM. The patients showed a high satisfaction rate. Better valorization of this consultation in "office surgery" should be considered.

[Transfusion requirements, morbidity and mortality in cardiac surgery and the use of antifibrinolytic agents: a comparison of aprotinin and tranexamic acid]. / Requerimientos transfusionales y morbimortalidad en cirugía cardiaca en relación al empleo de antifibrinolíticos: aprotinina comparada con ácido tranexámico.

OBJECTIVE: To evaluate transfusion requirements, morbidity and mortality when 2 antifibrinolytic agents (aprotinin and tranexamic acid) were used in patients undergoing cardiac surgery. PATIENTS AND METHODS: Comparison of the effects of 2 antifibrinolytic agents in 243 patients undergoing cardiac surgery between December 2006 and June 2008. We recorded the surgical procedures used, blood product transfusions required, complications (particularly renal), mortality, and length of hospital stay. RESULTS: The patients were distributed into 2 groups to receive tranexamic acid (n = 144) or aprotinin (n = 99). The incidence of transfusion in the tranexamic acid group (31.94%) was nonsignificantly lower than in the aprotinin group (38.38%) (PF = .31). The mean (SD) number of units of packed red blood cells transfused was 0.67 (1.18) in the tranexamic acid group and 1.01 (1.54) in the aprotinin group (P = .07). The mean preoperative hemoglobin concentration in the tranexamic acid group (11.79 [1.71] mg/dL) was significantly lower than in the aprotinin group (12.35 [1.70] mg/dL) (P < .01). Incipient postoperative renal failure tended to occur more frequently in the aprotinin group (19.6% compared to 16%; P = .47). Mortality at 1 year was 9.02% in the tranexamic acid group (compared to 14.14% in the aprotinin group; PF-.21); the trend for mortality related to postoperative renal failure was similar (7.6% in the tranexamic acid group compared to 12.4% in the aprotinin group; P = .22). No significant differences were observed in postoperative complications or length of hospital stay. However, the lack of randomization and the small sample size do not allow for definitive conclusions. CONCLUSIONS: This study, subject to the aforementioned limitations, shows that tranexamic acid is as effective as aprotinin for reducing transfusion requirements in cardiac surgery in Spain.

[Compromized postadenoidectomy respiration in a child with obstructive sleep apnea syndrome]. / Compromiso respiratorio postadenoidectomía en un niño con síndrome de apnea obstructiva del sueño.

A two-year-old boy with a history of slow growth, snoring during sleep and adenoid hypertrophy underwent adenoidectomy and transtympanic drainage under general anesthesia. Immediately after extubation, severe inspiratory stridor and shallow labored breathing began and persisted over a period of two hours, in spite of corticoid administration and oxygen therapy. The signs receded partially when the patient was seated and with a mandibular traction maneuver. As symptoms persisted, foreign body obstruction was ruled out by examination of the cavum and upper airway under general anesthesia and with orotracheal intubation. The patient was transferred to the pediatric intensive care unit, where he remained intubated for 18 hours. After extubation, stridor and shallow labored breathing reappeared but gradually receded as the residual effects of sedation disappeared. The parents mentioned symptoms suggestive of obstructive sleep apnea syndrome (OSAS) occurring since the boy was 6 months old and that had worsened in recent months. OSAS in children is characterized by intermittent obstruction of the upper airway during sleep, causing snoring and periods of apnea/hypopnea that lead to hypoxemia and hypercapnia. The most frequent cause is hypertrophy of the adenoid and tonsils, and the treatment of choice is adenotonsillectomy, although the risk of postoperative respiratory distress in such children is high. It is important to rule out OSAS in children who are candidates for adenotonsillectomy so that such patients are not scheduled for ambulatory surgery, but rather given adequate postoperative monitoring and treatment.

[Severe airway obstruction in 4 cases of postoperative obstructive hematoma]. / Obstrucción grave de la vía aérea en cuatro casos de hematomas transfixiantes posquirúrgicos.

Obstructive hematoma is a rare postoperative complication of surgery on the floor of the mouth or the anterior region of the neck and throat. The insidious development of symptoms, including agitation, which may be attributed to other causes, or their late appearance in hospital wards staffed by personnel unaccustomed to treating airway complications, means that the risk of hypoxia or respiratory failure is high. We describe four patients in whom the clinical picture began with agitation and dyspnea. Once the diagnosis was established, and after decompression of the surgical wound, tracheal intubation proved impossible in two patients, who required emergency tracheostomy. Two patients died from lack oxygen. Our review of the literature and experience have led to the following recommendations that may prevent avoidable deaths: a) the caregivers directly responsible for these patients should receive specific training; b) long-term monitoring and observation should take place in recovery units where early signs and symptoms can be detected and treated immediately; c) tracheostomy or 24-hour intubation should be considered when surgery in this anatomic region is highly invasive; d) consider that postoperative agitation in these patients is a symptom of hypoxia unless another cause is demonstrated; and e) the zone must be decompressed rapidly by opening the surgical wound and safeguarding the airway whenever obstructive hematomas present.

[Abdominal compartmental syndrome in non-injured patients]. / Síndrome compartimental abdominal en pacientes no traumáticos.

Abdominal compartment syndrome (ACS) is characterized by increased intraabdominal pressure and a set of secondary pathophysiological changes in the abdominal. ACS has reappeared in the literature recently in relation to the surgical concept to damage control, applied particularity in contexts of severe abdominal injury polytraumatized patients. We report two cases of ACS that appeared after scheduled abdominal surgery: one after repair of a large eventration and the other in the context of septic shock due to fecaloid peritonitis. Both patients died of multisystem organ failure in spite of surgical decompression. We wish to emphasize that ACS can appear in contexts other than surgery for damage control, and we stress the need to measure intravesical pressure as a reflection of intraabdominal pressure, particularly in certain high risk patients in the postoperative recovery ward. Finally, we review the pathophysiology of ACS and its management, which is based on early treatment to prevent multisystem organ failure with an associated high risk of death.

[Comparison of lidocaine and urapidil for prevention of hemodynamic response to tracheal intubation in patients in general good health]. / Comparación entre lidocaína y urapidilo en la prevención de la respuesta hemodinámica a la intubación traqueal en pacientes con buen estado general.

OBJECTIVE: To compare the efficacy of endovenous administration of 0.5 mg/kg-1 of urapidil to 1 mg/kg-1 of lidocaine for attenuating hemodynamic response to laryngoscopy and tracheal intubation. PATIENTS AND METHODS: Study of 40 ASA I and II patients with normal blood pressure undergoing elective surgery under general anesthesia with orotracheal intubation. The patients were randomly assigned to two groups to receive either 0.5 mg/kg-1 of urapidil or 1 mg/kg-1 five minutes before anesthetic induction. Anesthesia was provided with 0.04 mg/kg-1 of midazolam, 2 micrograms/kg-1 of fentanyl, 2 mg/kg-1 of propofol, 0.1 mg/kg-1 of vecuronium before proceeding to orotracheal intubation, after electromyographic determination of neuromuscular response with T1 less than 5%, and laryngoscopy. Heart rate, systolic, diastolic and mean pressures, and the product of heart rate and mean arterial pressure (HR x MAP) were recorded at the following times: baseline (before administering either lidocaine or urapidil), after induction, after laryngoscopy and intubation, and 3 minutes and 5 minutes after intubation. RESULTS: ASA classification, age, sex and weight were similar in the two groups. Heart rate immediately after intubation, and after 3 and 5 minutes was significantly lower in the lidocaine group. Likewise HR x MAP immediately after intubation and 3 minutes later was significantly lower in the patients who received lidocaine. CONCLUSIONS: In healthy ASA I and II patients with normal blood pressure, a dose of 1 mg/kg-1 of lidocaine provided better protection against the hemodynamic response to laryngoscopy and tracheal intubation than does 0.5 mg/kg-1 of urapidil.

Variations of ochratoxin A concentration in the blood of healthy populations in some Croatian cities.

The nephrotoxic mycotoxin ochratoxin A (OTA), a common contaminant of cereals, has been implicated in the etiology of endemic nephropathy. It was also frequently found in low concentrations in blood of healthy populations in countries where endemic nephropathy is not known. However, data on regional and seasonal differences in the frequency and concentration of OTA in human blood are scarce. In June, September and December 1997, and March 1998, about 50 human blood samples were collected randomly from blood donors for blood banks in the Coatian cities of Osijek, Rijeka, Split, VaraZdin and Zagreb. OTA was measured in the total of 983 samples using an HPLC technique with fluorescent detection. The daily intake of OTA was estimated from the mean concentration found in different cities and at different times of year. Samples containing OTA above the detection limit (0.2 ng/ml of plasma) were found in populations from all Croatian cities at all collecting periods. The highest frequency (59%) of samples containing OTA above the detection limit and the highest mean concentration (0.39 ng/ml) were found in June. Both the frequency and the mean concentration were lowest in all samples in December (36% and 0.19 ng OTA/ml, respectively). Osijek was the city with the highest frequency of OTA-positive samples (81%) and the highest mean OTA concentration (0.56 ng/ml). The total mean concentration of OTA in blood of healthy population in Croatia is lower (0.30 ng/ ml) than the mean concentration in European countries as a whole (0.90 ng/ml). The estimated daily intake, calculated from the mean concentration in all blood samples, is 0.40 ng OTA/kg body weight, which is much lower than that proposed by World Health Organization as the tolerable daily intake (16.0 ng/kg body weight). Healthy populations of Croatia are exposed to low, but seasonally and regionally variable amounts of OTA.