Incidental findings in a series of 2500 gene panel tests for a genetic predisposition to cancer: Results and impact on patients.

With next generation sequencing, physicians are faced with more complex and uncertain data, particularly incidental findings (IF). Guidelines for the return of IF have been published by learned societies. However, little is known about how patients are affected by these results in a context of oncogenetic testing. Over 4 years, 2500 patients with an indication for genetic testing underwent a gene cancer panel. If an IF was detected, patients were contacted by a physician/genetic counsellor and invited to take part in a semi-structured interview to assess their understanding of the result, the change in medical care, the psychological impact, and the transmission of results to the family. Fourteen patients (0.56%) were delivered an IF in a cancer predisposition gene (RAD51C, PMS2, SDHC, RET, BRCA2, CHEK2, CDKN2A, CDH1, SUFU). Two patients did not collect the results and another two died before the return of results. Within the 10 patients recontacted, most of them reported surprise at the delivery of IF, but not anxiety. The majority felt they had chosen to obtain the result and enough information to understand it. They all initiated the recommended follow-up and did not regret the procedure. Information regarding the IF was transmitted to their offspring but siblings or second-degree relatives were not consistently informed. No major adverse psychological events were found in our experience. IF will be inherent to the development of sequencing, even for restricted gene panels, so it is important to increase our knowledge on the impact of such results in different contexts.

Risk factors of postoperative vomiting in children receiving continuous intravenous morphine.

BACKGROUND: Risk factors of postoperative vomiting (POV) have been less extensively explored in children compared to adults. We analyzed the risk factors of POV in children receiving continuous intravenous (i.v.) morphine in a standardized manner without POV prophylaxis after major surgery. METHODS: This observational retrospective study included 235 children aged from 2 to 216 months (91 F:144 M, 11.5% <6 months, 31.5% 6-11 months). The primary end point was the occurrence of at least one episode of POV recorded on the nursing chart. The independent predictors of POV were determined by univariate analysis followed by a multivariate analysis by logistic regression. The data are presented as either medians (25th-75th percentile) or as values with a 95% confidence interval. RESULTS: Continuous i.v. morphine was administered over 42 (22-60) h with an initial infusion rate of 20 µg x kg(-1) x h(-1) in 63% of cases, which was increased in 31.5% of cases and was accompanied by an additional bolus in 39.2% of children. At least one episode of POV occurred in 22.6% of children. The following three independent factors were associated with POV: female gender (OR 3.324 [1.695-6.519], P=0.0005), urological surgery (OR 5.605 [1.291-24.340], P=0.0214) and age (OR 1.012 [1.006-1.018], P<0.0001). The discriminating characteristics of the model were good with an ROC curve AUC of 0.778, sensitivity of 71.7% and specificity of 71.4% for a 0.22 cut-off value of POV incidence. The positive predictive value was 42.2%, and the negative predictive value was 89.6%. CONCLUSION: Female gender, which is usually considered a risk factor after puberty, should be taken into account independent of age to guide the POV prophylaxis in children receiving a postoperative continuous i.v. morphine infusion.

[Halogenated inhalation anesthesia with a semiclosed circle system]. / Anesthésie halogénée utilisant un respirateur muni d'un circuit-filtre.

Thirty-six patients were anaesthetized for a maxillofacial surgical procedure. Ventilation was controlled by a ventilator (Kontron ABT 4100) with a semi-closed circle system. The flow of fresh gases was 1,200 ml.min-1. The vaporizer for the halogenated anaesthetic agent was placed out of the circle before the ventilator. Halothane was used for maintenance of anaesthesia and isoflurane for induced hypotension in orthognathic surgery. The inspired concentration of the halogenated agent was monitored by an analyser. A linear correlation between the delivered and the inhaled concentration of halogenated agent was established, the latter never reaching the delivered concentration. Monitoring the inspired oxygen concentration was required, so as to maintain a constant value. Carbon dioxide absorption by soda lime was also studied. The known advantages were: substantial economies in nitrous oxide and halogenated agents, prevention of contamination of the operating theatre, humidification and warning of the inspired gases. The use of such a system with the vaporizer out of the circle was safe, all the more so as the concentration of inhaled halogenated agents could be predicted.

[Anesthetic aspects of the primary treatment of labio-maxillo-palatal clefts]. / Aspects anesthésiques du traitement primaire des fentes labio-maxillo-palatines.

This study of 97 operations discusses our anaesthetic experience for labio-maxillary clefts and the problems which arise for the anaesthetist during pre-inter and post surgical periods. This type of functional surgery is carried out on children between 4 and 23 months old, of which 22% presented with associated malformations. Paediatric anaesthetic characteristics in a maxillo-facial context are discussed in detail. We indicate the importance of installing the different surveillance elements before placement of the surgical fields. We treat the problems of drug interactions between the halogenic anaesthetics and vasoconstrictor used for local haemostasis, the limits of spontaneous ventilation and the secondary metabolic consequences of prolonged fasting.

[Use of ventilation by oxygen injection in laryngeal microsurgery]. / Utilisation de la ventilation par injection d'oxygène au cours de la microchirurgie laryngée

Thirty patients with a laryngeal polyp or other tumour, were operated on under the microscope. During the operation, which lasted from 10 to 30 minutes, ventilation was ensured by injection of oxygen at 3 to 4 atmospheric pressures through a naso-tracheal catheter. Anaesthesia was obtained by an association of propanidide, small doses of analgesic and succinycholine, constant rate syringes were used for maintenance of narcosis and curarisation. In 23 patients, blood gases were analysed at various stages of the operation permitting one to assess the quality of the ventilation carried out. In a few patients, it was also possible to record pressure curves in the trachea. The results were excellent, both concerning the quality of the ventilation and that of the anaesthesia together with the operative conditions. After recalling the main characteristics of this mode of ventilation which uses Venturi's principle, the authors expose the other methods which are variants compared with their technique of use of this procedure for laryngeal micro-surgery.