["Population and xenograft" investigation. Preliminary results]. / Enqu¿ete "population et x¿enogreffe". R¿esultats pr¿eliminaires.

The chronic shortage of human organs is the argument for xenotransplantation. In emergencies, acceptability is closely linked to the benefit. Little information is available on attitudes towards xenotransplantation. A poll of the attitudes was carried out, based on a questionnaire with targeted questions and background information. The goal of the study was to have a better understanding of people's attitudes towards xenotransplantation and to know the eventual changes in the answers after having been given information. For 75% of the sample, xenotransplantation would be a future biotechnology. The animal sources that would be considered for xenotransplantation were the pig and monkey. A period of ten years or more is necessary for 69% of the respondents before xenografts are performed routinely; for 19%, five years or less are needed. Human organ donation should be continued, according to 90% of the sample. Roughly, 46.4% support xenotransplantation, though in the case of a life-or-death situation acceptance reaches 65.7%. This level is higher (77%) for relatives or unknown people (71%); 74% of respondents were in favour of using normal animals and a large majority (88%) support research on xenotransplantation. A good level of confidence in medical biotechnology research and practice is suggested by this study, contrary to the results of a European survey on biotechnology.

[Which graft for which patient? and when? III. Organization schema of organ procurement and graft coordination]. / Quel greffon pour quel patient? et à quel moment? III. Schéma d'organisation de la coordination des prelèvements et des greffes.

Organ and tissue procurement strongly increased during the past decades to become a common activity among accredited hospitals. Structuring efficient regional organ procurement organisations appear as an important goal in order to offer the relevant number and quality of transplants to the patients on the national waiting list maintained by the Etablissement français des Greffes. Two structures acting together coordinate organ and tissue procurement: (i)accredited hospitals allocate some medical and non medical personal interfacing; (ii) the Etablissement français des Greffes through one of its seven regional units or its national unit. These units are in charge with the operational responsibility of multiorgan and tissue retrieval co-ordination in their geographical area, with organ allocation and with an institutional role of local and regional organ procurement development and promotion.

Pathological findings in 165 patients explored for malignant hyperthermia susceptibility.

The pathological findings in 165 patients explored for malignant hyperthermia (MH) susceptibility are reported. The first group of 120 subjects were patients investigated for MH. These patients had suffered an attack of MH under anaesthetic or were members of families in which a subject had died of MH. In vitro contracture tests revealed 25 malignant hyperthermia susceptible (MHS) subjects, with positive contracture tests for halothane and caffeine, 5 malignant hyperthermia subjects with reaction to caffeine only (MHC), 3 malignant hyperthermia subjects with reaction to halothane only (MHH) and 87 malignant hyperthermia negative (MHN) subjects with normal contracture tests. The second group of 45 subjects had exertional heat stroke. In vitro contracture tests performed at least 3 months after the exertional heat stroke revealed 11 MHS, 6 MHC, 2 MHH subjects and 26 MHN. In both groups, whatever the in vitro contracture test results, pathological findings were heterogeneous and revealed various changes: rhabdomyolysis, mitochondrial myopathy, denervation, type II atrophy, AMPase deficiency, non-specific findings or normal features. Central core myopathy was only observed in the first subgroup and was the only disease significantly associated with MH. In contrast to previous reports, this study demonstrates the absence of a specific malignant hyperthermia or exertional heat stroke myopathy. Furthermore, the discovery of MHS subjects among the EHS group of patients highlights the need for systematic exploration of all these patients.

[Analysis of parameters used for the evaluation of the Relative Complexity Index beta]. / Analyse des paramètres utilisés pour le calcul de l'ICR bêta.

The Relative Complexity Index beta (RCI beta) has been devised as an indicator of the relative complexity and cost of anaesthesia. It takes into account the type of anaesthesia, the duration, the type of surgery and the patients' ASA status. This study analyses the relative weight of each component of RCI by a multiple regression analysis. The results show the pre-eminence of the surgical procedure in the formula. The weight of surgical procedure is responsible of 80 p. cent of the model's variance. In these conditions, the RCI beta cannot be accepted as an accurate complexity index of anaesthesia.

[Organization pf the consultation for ambulatory anesthesia in university hospitals]. / Organisation de la consultation pour anesthésie ambulatoire en CHU.

The recent increase in endoscopic and radiological exploratory techniques, with the possibility of taking therapeutical action, has led to the multiplication of interventions outside the operating theatre in University Hospitals. This increase in ambulatory activity has been managed at the DAR by setting up a centralized consultation using the existing accommodation, staff and secretarial facilities. This approach has enabled us to rigourously select all patients using these facilities and to monitor their management over the last three years. The medical and paramedical staff has been rationally organized according to the posts made available. This compulsory procedure guarantees the safety of a patient who has to undergo anaesthesia.

[Ambulatory anesthesia in the elderly]. / Anesthésie ambulatoire chez le vieillard.

The aim of ambulatory anaesthesia in elderly is to reduce consequences of an interruption of their life habits. Medical and social selection criteria must be rigorous in order to obtain a great benefit comparing with short hospitalization. No previous significant study has been yet published to precise the place of this technique and its benefits for these patients.

[The "high concentration" oxygen mask: a dangerous defect]. / Masque à oxygène "haute concentration": une malfaçon dangereuse.

Three cases of unidirectional valve inversion in airtight oxygen masks are reported. These defects were discovered before use on a patient. One of the masks was tested on a healthy volunteer. It resulted in the rupture of the reservoir bag, with a oxygen leak and decrease in FiO2. Checking the valve before use is therefore mandatory, and fabrication procedures should be revised.

[Surgery of Conn's syndrome. Apropos of 16 cases]. / Chirurgie du syndrome de Conn. A propos de 16 observations.

Operation for tumors responsible for a Conn's syndrome was performed in 16 patients, 11 women and 5 men, over a period of 13 years, the average time before diagnosis being 5 1/2 years. All patients presented hypertension, permanent in 14 and paroxysmal in 2 cases while blood potassium levels were below 3 mmol/l in all patients. Diagnosis was confirmed by elevation of plasma aldosterone and of urine tetrahydroaldosterone, associated with low plasma renin activity not responding to a stimulus. The tumor was demonstrated by imaging in 15 cases before operation and its mean size was 1.7 cm. Investigatory methods for diagnosis and localization are discussed. One patient died during the immediate post-operative period from decompensated cardiac failure. Long-term review showed persistent hypertension in 5 patients but electrolyte disturbances were corrected in all cases. Lack of consistency of results of surgical reduction in case of hyperplasia suggests that only patients with hyperaldosteronism related to an adrenal cortex tumor should be operated upon.

[Comparative effect of halothane and isoflurane on peroperative cardiac arrhythmias]. / Effet comparé de l'halothane et de l'isoflurane sur les arythmies cardiaques peropératoires.

Cardiac arrhythmias were studied in twenty ASA class 1 patients under general anesthesia using halothane or isoflurane to supplement nitrous oxide in oxygen. The study began during the maintenance period, once the expiratory MAC value had reached a stable level of 1, and stopped one hour later. Both intubation and recovery periods were excluded. The end-tidal gas concentration was measured for carbon monoxide and vapours. The ECG was recorded on a magnetic tape. The incidence of arrhythmias was higher in the halothane group when compared to the isoflurane group (p less than 0.05). The main types of arrhythmias observed were supraventricular and ventricular ectopic beats. None of the arrhythmias observed were serious; in particular the ventricular beats were all unifocal and occasional. Heart rate measured at 10 min intervals tended to be more rapid in the isoflurane group.

[Differentiated thyroid cancers. Thyroid recurrence after limited surgery]. / Cancers thyroïdiens différenciés. Récidives thyroïdiennes après chirurgie limitée.

Twenty-eight patients with differentiated thyroid cancer presented with local relapse 6 months to 24 years (mean: 7 years) after limited surgery. The tumour was clinically undetectable in 7 cases. Among 22 patients reoperated upon, one died post-operatively, 17.8% had permanent recurrent nerve paralysis and 14.3%, permanent hypoparathyroidism. Metastases were discovered in 15 patients (53.8%), 4 1/2 years on average after the relapse; they resulted in death within less than 2 years in 11 (39.2%) and the survival rate was moderate (26.7%). The mean survival of the 12 patients now in remission is 7 years since the relapse and 13 years since the initial tumour.

[Our experience with autotransplantation and cryopreservation of parathyroid tissue in thyro-parathyroid surgery]. / Notre expérience de l'autotransplantation et de la cryopréservation du tissu parathyroïdien dans la chirurgie thyro-parathyroïdienne.

Results are reported of four and a half years of experience with autotransplantation and cryopreservation of parathyroid tissue in thyro-parathyroid surgery. One hundred patients with hyperparathyroidism secondary to renal insufficiency were treated by total parathyroidectomy and partial autotransplantation, immediate in 98 cases and secondarily using their frozen stored tissue in the other two cases. Results were compared with those in 13 other patients treated during the same period by subtotal parathyroidectomy. Seven of 46 patients with primary parathyroid hyperplasia underwent total parathyroidectomy with immediate partial autotransplantation. Grafts were not used in the other two previously cervicotomized patients. All parathyroid tissue removed during these operations was frozen and stored if not used for grafting. Of 116 patients treated by enlarged total thyroidectomy for cancer, 34 received parathyroid autotransplants; complementary in 19 cases and substitutive in 15. Technique and results are described, and respective indications for autotransplantation and parathyroid cryopreservation discussed with respect to primary, secondary, persisting or recurrent hyperparathyroidism, and to total thyroidectomy for cancer.