Clinical signs and radiographic evidence of esophageal perforation after tetraplegia.

A diagnosis of esophageal perforation at some time after cervical spine surgery is difficult to establish since there exists no clinical picture specific to tetraplegic patients. We carried out a detailed retrospective study of revelatory clinical manifestations and conventional radiographic data in a series of 16 patients hospitalized at Hôpital Henry-Gabrielle (Lyon, France) for rehabilitation purposes between 1983 and 2010 and who presented this complication. The most frequent clinical picture associates cervical pain, fever and dysphagia. Simple front and side X-rays of the cervical spine led in 77% of the cases to a diagnosis of esophageal perforation. The most prevalent radiographic signs of the latter consist in osteosynthesis hardware or instrumentation failure, prevertebral free air next to the cervical esophagus and enlarged prevertebral space. Visualized esophageal X-rays, also known as series, highlight parenchymal opacity next to the posterior wall of the esophagus. A diagnosis of esophageal perforation needs to be carried out in order to facilitate suitable treatment and avoid the compromising of vital functions.

[Rate of alcohol abstinence in patients with chronic alcoholic pancreatitis]. / Taux d'abstinence alcoolique chez les malades ayant une pancréatite chronique alcoolique.

OBJECTIVES AND METHODS: The influence of clinical manifestations of alcoholic chronic pancreatitis on the continuation of alcohol intake is still poorly known. The aim was to study the number of patients who stop drinking alcohol and the factors favouring abstinence in 87 patients with alcoholic chronic pancreatitis and to compare them to 59 patients with alcoholic liver disease. Alcoholic abstinence was assessed by patient and relative questionnaire and by blood GGT dosage. RESULTS: The proportion of patients who became abstinent was higher in patients followed at least one year with alcoholic chronic pancreatitis (64%) than in patients with alcoholic liver disease (32%, P < 0.005). Patients mainly withdraw from alcohol in the first year after clinical onset of pancreatitis. The rate of abstinent patients was higher in patients who had presented an acute bout of alcoholic pancreatitis, in patients operated on and in patients with good social status. CONCLUSIONS: Patients with alcoholic chronic pancreatitis frequently withdraw from alcohol, mainly soon after clinical onset of the pancreatitis. This seems to be due to clinical manifestations of the pancreatitis.

Clonidine does not delay recovery from anaesthesia.

Clonidine is known to reduce anaesthetic requirements and improve haemodynamic stability when given as premedication. This study, of 46 ASA I-II patients undergoing thyroid surgery, was designed to assess if clonidine interferes with recovery from anaesthesia. Patients were allocated randomly to three groups to receive, 2 h before surgery, flunitrazepam 1 mg, clonidine 150 micrograms, or both drugs. Anaesthesia comprised thiopentone, alfentanil, isoflurane and 70% nitrous oxide in oxygen. Recovery from anaesthesia was assessed using a clinical score, electro-oculographic measurements and reaction times to auditory stimuli. Psychomotor tests were performed the day before surgery and 30, 60, 120 and 240 min after arrival of the patient in the recovery room. Psychomotor performance was decreased significantly after operation in the three groups (P less than 0.05) and returned to baseline at 240 min. There was no significant difference between the three groups. This study indicates that clonidine 150 micrograms orally before surgery does not delay recovery from anaesthesia.