[Massive air loss after chest injury. Exclusion of 2 segmental bronchi without parenchymal sacrifice]. / Fuite aérienne massive après traumatisme thoracique. Exclusion de 2 bronches segmentaires sans sacrifice parenchymateux.

Emergency thoracotomy was performed in a case of massive air loss consecutive to a thoracic injury. Two bronchi which had ruptured were excluded by suture, which made it possible to avoid pneumonectomy. The reasons for this therapeutic attitude are detailed.

[Morbidity and mortality of acute pancreatitis. Prospective study in a French university hospital]. / Morbidité et mortalité de la pancréatite aiguë. Evaluation prospective dans un centre hospitalier universitaire français.

OBJECTIVE: According to certain learned societies, acute pancreatitis mortality should not exceed 10%. The aim of our work was to review the etiology, severity and mortality of acute pancreatitis in a prospective series of patients admitted to a regional university hospital in France, using standardised collection of data assessing the medico-surgical habits in the management of acute pancreatitis. METHODS: From February to September 1999, 86 patients (54 men and 32 women with a mean age of 58.5 years) were admitted for 88 episodes of acute pancreatitis. Data was collected from all the patients on admission and permitted measurement of the severity and prognosis scores and the study of the etiology, complications and management of the latter and the mortality with acute pancreatitis. RESULTS: Ranson's score was a mean of 2.4. Balthazar's score was superior or equal to D in 45% of cases. The respective prevalence of lithiasis, alcoholism, tumors, others or undetermined was of 41%, 37.5%, 7%, 5.5% and 9%. Acute pancreatitis was severe (multi organ failure, pseudo-cyst, systemic or necrotic infection and occlusive syndrome) in 32% of cases. Complications were: infection (22%), pseudo-cyst (14%), pleural effusion (12.5%) and occlusive syndrome (3.5%). Fever of more than 38.5 degrees C was noted in more than half of the patients. The median duration of hospitalisation was of 11 days (range: 1-86 days). Global hospital mortality was of 13.6% (12/88), and of 43% (12/28) in cases of severe acute pancreatitis. Six deaths occurred within the first 8 days of acute pancreatitis, and 6 after 8 days. Seven deaths (59%) were due to multi organ failure, 4 (33%) to infectious causes and one to another cause. CONCLUSION: The standardized collection of clinical and progressive data used in this study permitted assessment of the medico-surgical habits in a regional university hospital.

[Identification and analysis of errors in prescription, preparation and administration of drugs in intensive care, medicine and surgery at the University Hospital Center of Tours]. / Identification et analyse des erreurs de prescription, de préparation et d'administration des médicaments en réanimation, médecine et chirurgie au CHU de Tours.

OBJECTIVE: Within the framework of a project to establish "the safety of drug use and the prevention of iatrogenic risks", the pharmaceutical team conducted a review on the errors in drug prescription in order to implicate the medical professionals in its development. In collaboration with the medical teams, the pharmacy organised a series of therapeutic surveys aimed at quantifying and qualifying the errors related to the prescription, preparation and administration of medicinal products. METHODS: A prospective survey was conducted in three types of care units (Medicine, surgical intensive care and paediatric vascular surgery) over a 30-day period in each unit. A resident pharmacist studied the preparations and administration of drugs and compared them to the prescriptions and recommendations of in the literature. The investigator also conducted the pharmaceutical analysis of the prescriptions (dose, drug interactions, administration timetable...). The clinical impact of the errors on the patient were scored 0 (none) to 3 (lethal) by a duo composed of an external physician and the resident physician in charge of the study on site. RESULTS: Among the 3,023 drugs prescribed, the error rate was of 0.04 [0.033; 0.047], 44% of which scored 2. The errors in preparation or administration were of 0.134 [0.117; 0.151] among the 1,632 drug administrations observed, 19% of which scored 2. Regarding errors in prescription and administration, no significant difference was revealed between the three units [p > 0.09]. DISCUSSION: This study enhanced the awareness of the nursing and medical staff and the hospital management with regards to the reality of medical errors. Our data were comparable to the results of other studies published elsewhere.

The use of standardized assessment procedures in the evaluation of patients with multiple injuries.

The accuracy of diagnosis in multiple trauma can be greatly improved by the use of standardized assessment routines and standard documentation. In the two groups of patients reviewed the diagnostic error rate fell from 23% in the period 1979-1980 to 8% for the period 1981-1982.

[Accidental chloral hydrate poisoning]. / Intoxication involontaire à l'hydrate de chloral.

A 42-year-old woman had an accidental overdose of chloral hydrate due to repeated absorption of a therapeutic dose of chloral syrup for insomnia. The total ingestion was estimated at 8 g. Overnight slight loss of consciousness associated with severe cardiac arrhythmia (bigeminia ventricular extra-systole) needed admission to the intensive care unit and intravenous lignocaine for two days. The evolution was satisfactory.

Visualization of the thoracic duct by lymphoscintigraphy.

Imaging of the thoracic duct is usually performed by radiological lymphography. However, this procedure, which uses an oil based dye injected directly into the lymph channels, has some adverse effects. In this paper we note that lymphoscintigraphy, a physiological and non invasive method, may visualize thoracic duct abnormalities, and might be particularly useful when radiological lymphography is contraindicated.