[Catheter rupture at the site of implantation: a rare accident? Apropos of 2 observations]. / Rupture de cathéter sur site implantable: un accident rare? A propos de deux observations.

Seventy three venous access ports of the same type have been implanted recently in our hospital. We have observed two cases of catheter's rupture. Both accidents show a lot of similarities: material of the same trade mark; same way of implantation: right subclavian vein; rupture before one year; rupture at the point of entry of the subclavian vein; migration of the distal part of catheter; withdrawal of this part by right femoral vein's catheterism. Both broken catheters and another not broken (implanted during more than one year) were tested. It appears that those catheters were weakened, especially around the rupture. The reason is the long-standing compression of the catheter at the narrow space between clavicle and first rib. Then, the rupture of this weakened catheter could have been produced by the high pressure due to injection with small syringes.

[Interactions between naltrexone, an opioid antagonist, and opioids administered during general anesthesia]. / Interférences entre la naltrexone, un antagoniste des morphiniques, et les morphiniques administrés pendant une anesthésie générale.

We report a case of a probable interaction between sufentanil and naltrexone, an oral long acting opioid antagonist, prescribed for maintenance of abstinence in alcoholics and opioid addicts. The interaction resulted in an antagonisation of the effects of sufentanil and the necessity to increase the dosage. Anaesthetists should be aware of this potential drug interaction.

[Sheehan's syndrome: a recurrent obstetrical complication]. / Le syndrome de Sheehan: une complication obstétricale toujours d'actualité.

Case report of a 25-year-old primigravida who sustained a necrosis of the anterior pituitary gland after a haemorrhagic Caesarean section. The diagnosis was delayed, as the early symptoms (apathy, anorexia, nausea, orthostatic hypotension and hypoglycaemia) were imputed to more usual causes.

[Intracranial subdural hematoma after obstetric dural puncture]. / Hématome sous-dural intracrânien après brèche dure-mérienne en obstétrique.

The authors report a case of subdural haematoma (HSD), which occurred following epidural analgesia for labour, complicated by post dural puncture headache (PDPH). A 26-year-old woman displayed a typical PDPH following epidural anaesthesia. On the sixth day, she was given a blood patch (BP), which was partially efficacious. Because of worsening of the headache, of disappearance of the postural characteristics, and of vomiting without focal neurological signs on the 9th day, a CT-scan was done. The CT-scan showed a small hemispheric subdural haematoma. The recovery was complete with only medical treatment. HSD is a rare serious complication of dural puncture. When the characteristics of PDPH change, HSD should be evoked even without focal neurological signs. An early diagnosis and the small size of the haematoma may allow HSD to be treated medically and avoid surgical evacuation.