[Severe paralysis of the upper limb after axillary brachial plexus block]. / Paralysie grave du membre supérieur après bloc plexique axillaire.

A case is reported of a severe neurological deficit occurring after axillary blockade. The 37-year-old ASA I patient underwent an axillary block for hand surgery using 20 ml of lignocaine 1% with adrenaline and 20 ml of lignocaine 2%. In order to elicit paraesthesia, several attempts were required. Injection of the local anaesthetic was not painful. The tourniquet remained at 250 mmHg for only 35 min. The following day, the patient's arm remained numb. As there was no improvement, epineurotomy was carried out on day 19, to liberate the median nerve which was severely stenosed at the axilla. The patient then started to improve slowly, so that he was able to return to part-time work 6 months later. Prevention of such an accident relies on avoiding intraneural injection and repeated punctures when searching for paraesthesia. When using axillary blockade in day-care surgery, the patient's must be informed upon the possibility of persistent paraesthesia. Should such a rare incident occur, rapid consultation with the anaesthesiologist is essential.

[Esophagopulmonary fistulas. Description of a case and review of the literature]. / Les fistules oesophago-pulmonaires. Description d'un cas et revue de la littérature.

We report the case of a 30-year old male patient who presented with chronic right lung purulence of 10 years' duration and of undetermined origin. At pneumonectomy a fistula joining the oesophagus to the cavities in the right lower lobe was discovered. Non tumoral oesophago-bronchial or oesophago-tracheal fistulae are rare, but oesophago-pulmonary fistulae are truly exceptional, since only 3 cases were found in the literature. The possible causes of this pathology in our patient are discussed.

[Surgery of abdominal aortic aneurysm infra-renal. Hemodynamic changes induced by aortic clamping and declamping. Eight cases (author's transl)]. / La chirurgie de l'anévrysme de l'aorte abdominale sous-rénale. Perturbations hémodynamiques induites par le clampage et le déclampage de l'aorte. Huit observations.

Hemodynamic data of 8 patients undergoing planned resection of abdominal aortic aneurysm are statistically analyzed by variance analysis ("patient" factor and "time" factor). The results are: 1. "Patient" factor exists for all the variables studied. 2. "Time" factor is present for some of them. After aortic clamping, there is a significant decrease of the systolic index (p less than 0.05) and of the left ventricular systolic work index (p less than 0.01). After aorting declamping, a high significant increase of the mean right auricular pressure (p less than 0.001) and of mean capillary wedge pressure (p less than 0.001) are seen. Similar results are observed at the end of surgery. The results are commented with regard of the literature.

[Comparison between hypo- and hyperglucidic diets on protein sparing in major visceral surgery (author's transl)]. / Comparaison de deux régimes hypo- et hyperglucidiques sur l'épargne azotée post-opératoire en chirurgie viscérale majeure. Répercussions sur l'aminogramme plasmatique et urinaire.

The authors compare the protein sparing effect of two diets, exclusively intravenous, including the same protein intake, but a different caloric intake, 21 calories/gm nitrogen for diet "A" (20 cases); 138 calories/gm nitrogen for diet "B" (20 cases). This has been observed during the six post-operative days of major visceral surgery: oesophagectomy, total gastrectomy, colic or rectocolic exeresis, sequestrectomy for acute pancreatitis, lots having been drawn for the diets. Daily nitrogen balances have been made and plasmatic and urinary levels of amino-acids have been measured before surgery and on the third and fifth post-operative days. Statistical exploitation is done by variance analysis (linear model of three factors) with a 99% confidence ratio: 1) Patient factor has no influence whatsoever on cumulative nitrogen balance. 2) Time factor arises only on the fourth post-operative day and only in the hypocaloric diet, leading to catabolism. 3) Metabolic condition is determinant. On no cancerous disease, superiority of hypercaloric diet is well demonstrated. On cancerous disease, nitrogen loss is only significantly different on 4th and 5th post-operative day: hypercaloric diet gives a better nitrogen balance.