[Practice and complications of spinal anesthesia in African tropical countries]. / Pratique et complications de la rachianesthésie en milieu tropical africain.

OBJECTIVE: To evaluate the risk of the practice of spinal anaesthesia (SA) in African tropics. STUDY DESIGN: Prospective study in multiple centres over a two years period. PERSONS: Twenty-one anaesthesiologists and anaesthetist nurses covering ten African countries. METHODS: Two anonymous questionnaires; the first, filled in each anaesthetic problem occurred, to define the type of incident or accident, and its circumstances; the second was designed to define the position occupied, to quantify the global anaesthetic activity, the number of SA, and to value the number of complications or deaths linked to SA. RESULTS: Six anaesthesiologists and one anaesthetist nurse replied to the study, covering six sites in five different countries (Senegal, Chad, Central African Republic, Niger and Madagascar). On the 18,432 anaesthetic acts collected, 2,703 (14.7%) were SA. In the well-equipped centres, general anaesthesia was predominant with a frequency of over 75%. However in the not so well equipped centres or those which supplies were more problematical, SA technique was used with a frequency varying from 48.9 to 68.7%. Forty incidents and accidents were reported (1.5%), five led to the death of the patient (0.2%). Among the seven cardiac arrests (0.3%), four were fatal (0.1%). Eight of the ten accidents and all of the deaths occurred in the least equipped centres. Eight of ten accidents happened during emergency caesarean sections. All cardiac arrests were preceded by a severe hypovolemia. For the four deaths after cardiac arrest, an anaesthetist nurse with isobaric bupivacaine 0.5% carried out SA. CONCLUSIONS: This study showed that the practice of SA in African tropics was performing in different practice conditions and people qualification than they were in France. The frequency of cardiac arrests and deaths was respectively five and 20 times more important, in those conditions. The first conclusion that can be drawn from this study is that it is questionable to use SA for emergency Caesarean section under hypovolemic condition. The second is the necessity for specific training on the local anaesthesia for anaesthetist nurses but also training to choose the anaesthesia best adapted to the surgery, the condition of the patient and the means available.

Adrenomedullin and myocardial contractility in the rat.

The effects of adrenomedullin in the regulation of myocardial contractility were investigated in the rat. In papillary muscles (n=6), adrenomedullin (0.1 to 10 nM) failed to show contractile effects. NO (nitric oxide) synthase inhibition with N(G)-nitro-L-arginine (L-NOARG) did not unmask any inotropic effect of adrenomedullin. The positive inotropic effect of isoprenaline (0. 01 nM to 10 microM) was identical after adrenomedullin, after L-NOARG, and after L-NOARG plus adrenomedullin (n=6 each). In field-stimulated rat ventricular myocytes, adrenomedullin (1, 10, and 100 nM; n=4 each) had impact neither on cell shortening nor on Ca(2+) transients. In isolated constant-flow perfused hearts (7.3+/-0.3 ml/min), adrenomedullin (1 nM, n=9; 10 nM, n=7) induced significant coronary vasodilation (-28%, -50%). In conclusion, adrenomedullin is a potent coronary vasodilator, but has no significant effects on myocardial contractility in the rat.

[Mc Kee total hip arthroplasty. A review of 1,000 cases (author's transl)]. / Prothèses totales de hanche de Mac Kee. 1 000 cas opérés de 1967 à 1977.

The authors have inserted Mc Kee prostheses in 1,000 hips between 1967 and 1977. 616 were reviewed with a follow-up of more than three years. There was an overall infection rate of 2.4 p. cent and of 4.3 p. cent in cases which had previously had operations. The results were satisfactory with 84.7 p. cent giving no pain, using no sticks and with good mobility. 83 cases were reviewed with more than ten years follow-up. 3 out of 4 still have a satisfactory result. Only 14 cases had to be operated on for a second time for loosening with 11 satisfactory results. It is concluded that this type of prosthesis is valuable when compared with other types. Very little wear and no fracture of the stem was seen.