[Incidence of biological tests requested outside of written medical prescriptions in digestive surgical intensive care unit]. / Incidence des demandes d'examens biologiques effectuées hors prescription médicale écrite en réanimation postopératoire de chirurgie viscérale lourde.

OBJECTIVES: Realization of biological tests in intensive care unit requires a written medical prescription. Requests of biological tests outside written medical prescription are sometimes observed. The aim of the survey was to evaluate their incidence and the reasons of these practices. MATERIALS AND METHODS: The study was realized on a 14 days-period in a 8 beds intensive care unit of digestive surgery, in real situation and anyone was informed of the study. Nineteen patients were enrolled during the period of the study. RESULTS: A request of biological tests outside written medical prescription was found in 78% of requests of tests (89/114). The incidence of requests of biological tests outside written medical prescription was 27%. Several reasons could explain these practices. CONCLUSION: This study confirms that there is a high frequency of requests of biological tests outside written medical prescription and that several reasons could explain these practices in intensive care unit.

[Absence of clinical and biological manifestations after massive absorption of nitulamide]. / Absence de manifestation clinique et biologique après absorption massive de nitulamide.

Nitulamide (ANANDRON (R] is an antiandrogen used as an adjuvant therapy in the treatment of advanced prostatic cancer. The effects of ingestion of high doses of nitulamide has not been so far reported. A 79 years old man was admitted 2 hours after the ingestion of 13 g of nitulamide (170 mg/kg or 43 times the therapeutic dose), in a suicide attempt. He was receiving nitulamide 300 mg/day for two weeks. On admission, he underwent immediately gastric lavage, followed by administration of oral activated charcoal and received an intravenous infusion of glucose in balanced salt solution. During the first 12 hours, the patient presented with moderate vomiting and diarrhoea. There was no change in the following parameters: blood cell count, plasma electrolytes, serum transaminases and serum bilirubin, arterial blood gases, plasma cortisol value, as compared to the pre-treatment values. Chest X ray was unchanged. Plasma concentrations were measured 2 hours, 3 hours, 12 hours, 24 hours, 48 hours and 72 hours after ingestion. The initial level reached 6 times the normal therapeutic range, then fell to 3.5 times at the 72th hour. The patient recovered rapidly and was discharged on the 4th day. Biologic parameters were controlled on 4th, 9th, 30th day and remained unchanged. Treatment was started again on the 30th day with nitulamide 150 mg/day. We did not notice any side effect previously described in daily administration of nitulamide: anemia, rise in serum transaminases, interstitial pneumopathy.