[Human fibronectin in the treatment of septic states. Tolerance and course of plasma levels]. / Fibronectine humaine dans le traitement des états septiques. Tolérance et évolution des taux plasmatiques.

A purified freeze-dried fibronectin concentrate prepared by the Centre National de Transfusion Sanguine from blood donors' plasma pools was tested for safety and effects on recipients' plasma fibronectin levels. The product was administered on 17 occasions to 10 patients with severe sepsis, either as bolus intravenous injection (group B) or as bolus injection of one-half of the dose followed by continuous infusion of the remaining half-dose over a 6-hour period (group B + P). The drug was well tolerated both clinically and biochemically. Following a 1 mg/kg dose of fibronectin, the maximum increase in mean plasma fibronectin levels was 17 +/- 5 mg/l in group B patients and 20 +/- 5 mg/l in group B + P patients. Mean times to peak were 188 +/- 53 min and 282 +/- 106 min respectively in the two groups. A cooperative randomized double-blind trial is currently in progress to evaluate the clinical effectiveness of the product.

[Compressive hematoma complicating percutaneous catheterization of the axillary vein]. / Hématome compressif compliquant le cathétérisme percutané de la veine axillaire.

A 41-year-old woman was admitted in the intensive care unit with ruptured oesophageal varices. She had already had two similar events, six and four months previously. She had a haemoglobin concentration of 56 g.l-1, 20% prothrombin, 228 s activated cephalin time for a control time of 60 s, 0.9 g.l-1 of fibrinogen and a platelet count of 53 G.l-1. Because of the poor condition of her peripheral veins, it was decided to insert a central venous catheter. The axillary vein was chosen because of the coagulopathy. The axillary artery was accidentally punctured during the second attempt. Despite manual compression for 15 min, a small haematoma arose. The catheter was inserted in the right internal jugular vein. At the same time, a very large oedema of the left arm was noticed. The axillary haematoma had spread to the breast and lumbar fossa. The humeral and radial pulse amplitudes were decreased, and the patient complained of paraesthesiae. At phlebography, a vast haematoma was seen to compress the axillary vein. The patient's condition rapidly worsened, and she died 19 hours after admission with a probable cerebral haemorrhage. Although complications of axillary venous catheterization are rare, this case demonstrates that, in patient with very abnormal coagulation tests, central venous access should be obtained via a peripheral vein.

[The use of buprenorphine for peroperative analgesia]. / Utilisation de la buprénorphine pour l'analgésie peropératoire.

In an open study, buprenorphine was used as the sole analgesic agent in sixty patients undergoing orthopedic or abdominal surgery. The average dose used was 5 micrograms.kg-1. The level of peroperative analgesia was of good quality and was maintained during the recovery period in the majority of cases. The occurrence of side effects such as nausea, vomiting, respiratory depression was low.

[Comparison of 2 anesthetic protocols in colonoscopy on a series of 100 patients]. / Comparaison de deux protocoles anesthésiques pour coloscopies sur une série de 100 patients.

The quality of the anaesthesia and of the recovery (appreciated by Newman's test) of two anesthetic technics for colonoscopies are compared on two homogeneous groups from 50 patients each: propofol alone versus midazolam-alfentanyl association. The differences registered during anaesthesia, particularly concerning the breathing depression might be attributed to alfentanyl which has been used often at important doses. The recovery is delayed in the midazolam + alfentanyl's group in comparison with the propofol's group. The difference is very significant at 15 and 60 minutes. The use's safety and the fast recovery with propofol incite to advocate it as an unique+ anaesthetic agent for colonoscopies.