[Severe hypothermia associated with cesarean section under spinal anesthesia]. / Hypothermie sévère au décours de césariennes sous rachianesthésie.

Temperature monitoring and prevention of hypothermia are rarely used during spinal anaesthesia for caesarean section because hypothermia risk is considered very low. However, in same conditions, we observed two cases of severe hypothermia. We report these two cases and discuss the effects of spinal anaesthesia on thermoregulatory system. Hypothermia seems explained by the effects of perimedullar anaesthesia that decrease the shivering and the vasoconstriction thresholds. These effects are potentiated by morphinomimetic adjunction. At last, we recall prophylactics measures.

[Difficulties in the removal and rupture of a peridural catheter]. / Difficultés de retrait puis rupture d'un cathéter péridural.

A case of inability to remove an epidural catheter after vaginal delivery is reported. Surgical removal under general anaesthesia was attempted, but the catheter tip was sheared off inadvertently. Because the parturient was asymptomatic, it was decided to stop the operation and to leave the catheter tip into the epidural space. This complication is often related to excessive insertion of the catheter into the epidural space.

[Narcolepsy and epidural obstetrical analgesia ]. / Narcolepsie et analgésie péridurale obstétricale.

We report the case of a parturient with a history of narcolepsy that delivered under epidural anaesthesia without any complication. Patients with narcolepsy might be at risk of delayed recovery or of apneic episodes after general anaesthesia while narcolepsy-cataplexy fits might be more frequent during regional anaesthesia. Avoiding sedative premedication and continuing medical therapy on the day of surgery are recommended to avoid these complications.

[Thoraco-cervicofacial purpura caused by thoracic compression: a new Perthes syndrome?]. / Purpura thoracocervicofacial par compression thoracique: un nouveau syndrome de Perthes?

A case of a major thoracocervicofacial purpura in a 16-year-old patient following a prolonged thoracic compression by his motor car is reported. The causative mechanism, equivalent to a Valsalva manoeuvre is discussed. As the first case has been described and analyzed by Perthes, the authors suggest to call it "Perthes syndrome".

[AIDS and non Hodgkin's malignant lymphoma disclosed by massive hematemesis]. / SIDA et lymphome malin non hodgkinien révélés par une hématémèse massive.

A 40-year-old man was admitted for a major haemorrhage from the upper gastro-intestinal tract. An emergency gastrectomy was performed to control the bleeding. The histopathological study revealed a non-Hodgkinian lymphoma associated with an AIDS, which had remained unknown. The postoperative period was complicated by several infections. The patient died 2 1/2 months after the hematemesis. Such major haemorrhage from the upper gastro-intestinal tract as the presenting symptom of AIDS is very rare, although this has been described during the course of the disease. This case illustrates the importance in reminding operating theater staff (anaesthetists, surgeons, nurses) of the risk of viral contamination when treating a young patient with hematemesis and the necessity of wearing gloves, face masks and glasses.