[Cardio respiratory arrest out of the hospital at the eldest]

The management of the older constituted a problematic that will be more attractive in the future because of the population's advanced age. To evaluate the management of the older more than 75 years that presented an arrest chest. Retrospective study during 12 months [from the first January 2004 to 31 December 2004] and interested 15 regulation's documents; we studied demographic parameters, the cause and the time of called the evolution after cardio-respiratory resuscitation. We had 9276 called cases: 320 concerned patients more than 75 years [3, 45%] among 15 [4, 68%] had a chest arrest, the ratio sex was 0, 5 and the middle age: 78, 4 years. In the most cases; the called arrived by night [40%]. The principal symptomatology was respiratory troubles [33, 33%]; the outcome was fatal in all cases. The older over than 75 years had many pathologies that is why the prognostic of the chest arrest was very bad [mortality 100%], the gravity of the chest arrest was seen on this study so we must take seriously all the pathology presented by the older, multiplied the medical consultations to detect the complications earlier and to improve the life's quality

[Anaesthetic security: evolution of ideas]

The concept of risk has not clear neither in the media nor in the medical field. It appears important to us to bring details relating some definitions in the field of anaesthesia safety. This work aims to clarify the concepts of safety, of risk in a medical activity like the Anaesthesia. A search was carried Out on Medline with the following key words: Risk anaesthetic, anaesthetic Safety, anaesthetic mortality. The definitions of risk, of acceptable risk taking account of social and economic considerations are brought in this text. The ways to evaluate safety and the methods to achieve it was developed. The indicator of quality more used to evaluate safety is anaesthetic mortality. Many difficulties exist with the interpretation of data on mortality. The standards of care are normally established according to the degree of necessary safety. Concurrently to these standards exist certainly the human error which is a phenomenon towards which must direct all the efforts of improvement of safety but more especially the errors of system which are found regularly in the analysis of accidents and incident. The identification of the failures is the mandatory step to achieve safety

Facteurs predictifs de morbidite et de mortalite de la chirurgie du vieillard

The aim of the study was to determine prognostic factors of post operative morbidity and mortality for patients aged 80 years and older. We compared two groups of patients aged 80 and over operated to determine predictive factors of morbidity and mortality group of patients who presented post operative complication within 30 days after surgery and group of patients without any complication. Comparison of the two groups for global morbidity using univariate analysis showed only one prognostic factor: surgery of diabetic foot [p = 0.034]. Predictive factors of mortality according to univariate analysis were: pre-operative shock [p = 0.001], abdominal wall pathology [p = 0.027], gastric or duodenal ulcer diseases [p= 0.011] and global morbidity [p = 0.006]. After logistic regression, only pre-operative shock was an independent predictive factor of mortality [p = 0.0023]. Risk for morbidity after surgery in the elderly 80 years and over is linked with type of surgery and not with soil. Likewise, risk for mortality is linked with advanced stage of disease that is presence of pre-operative shock and not with soil

Facterus pronostiques des splenectomies pour rate hematologique

The aim of this study was to identify the prognostic factors of intraoperative haemorrhage, perioperative blood transfusions and morbidity. We collected 120 splenectomies in Beau sejour department of surgery, charles' Nicolle Hospital, Tunis, Tunisia between 1979 and 1999. the descriptive analysis showed sex ratio 0.82 with mean age [ +/- standard deviation] 30.6 +/- 15 year. Idiopathic thrombopenic purpura was the principal disease indicating splenectomy. Morbidity was defined as occurrence of post operative peritoneal sepsis or bleeding. The mortality and morbidity rates were respectively 0.8% and 6.6%. the prognostic anlysis didn't identify predictive factors of intraoperative haemorrhage, however it identified two independent predictive actors of specific morbidity: intraoperative haemorrhage [p = 0.03] and preoperative rate of haemoglobin [p = 0.0049]