[The lung in brain death. Anatomo-biological correlations for pulmonary transplantation]. / Le poumon des sujets en état de mort cérébrale. Corrélations anatomo-biologiques en vue de la transplantation pulmonaire.

Histopathological studies of the lung conducted during multiple organ procurement from 25 subjects in a state of brain death showed that 19 of them had lung lesions pre-existent to coma, viz. alveolitis and lung invasion by dusts increasing with the subject's age. Alveolar or interstitial emphysema and subpleural bullae caused by mechanical ventilation were present in 19 cases; signs of bronchial inertia were found in 6 cases and established superinfection in 3 cases. Finally, 17 subjects showed interstitial and vascular alterations induced by oedema and shock which were related to the time spent in intensive care units, to the cause of the coma and to the quantity and quality of intravenous received while in intensive care unit. There were histological correlations between these various factors, but precise criteria concerning the functional prognosis of the transplant could not be defined. However, this study seemed to confirm the need for a new approach to the intensive care of brain-dead subjects during lung procurement: the time elapsed before procurement should be shortened, the amount of medicinal solutions administered should be reduced, Ringer lactate and packed cells should be used in preference to albumin derivatives, and arterial blood pressure, rather than diuresis, should be maintained.

[Catheterization of the jugular vein (vena jugularis interna). The advantage of Boulanger's technic]. / Katheterisierung der Drosselvene (Vena jugularis interna) Vorteil der Technik nach Boulanger.

The present study was designed to emphasize the technical accuracy of the percutaneous internal jugular vein approach in operative reanimation (Boulanger Technik). In 18 specimens with hyperextended neck, the cannulation of the internal vein was achieved from a puncture point situated 7.3 cm lateral to the sternoclavicular joint, at level of the top of the thyroid cartilage; then the catheter was pushed slanting downwards an laterally by 50 degrees with respect to the inner border of the sternomastoid muscle toward the union medial third-middle third of the clavicle. The acknowledge of the distance between the puncture point and the right auricle allows to ascertain the proper location of the catheter. The use of the internal jugular vein can be recommended in operative reanimation because its cannulation is harmless and easy to carry out and both its large size and deep situation lower the usual risks of more distal venous catheterizations.

[Course of plasma fibronectin in burn patients. Its variations during septic episodes]. / Evolution de la fibronectine plasmatique chez le brûlé. Ses variations lors d'épisodes septiques.

The time course of plasma fibronectin (FNp) was evaluated following burn injury in 62 patients during 30 days. Those patients were divided into three groups: A: 36 non septic survivors, B: 7 septic survivors, C: 19 dead patients. Those groups were statistically different if either age or total body surface area burnt (TBSA), or unit burnt standard (UBS) or the percentage or third degree burnt area were considered. The relationship between FNp, UBS or sepsis was studied. No correlation was found between FNp levels and TBSA or UBS for the first three days. After acute depletion on day 2, the FNp level returned to initial values on day 3. That depletion was probably a consequence of resuscitation since both falls in plasma FNp and haematocrit were parallel from day 1 to day 2. When the patients became septic, there was always a drop in FNp level. The depleted level of FNp remained low in the patients who finally died, whereas in those who survived that level had returned to normal. The observation of FNp level could therefore be useful in determining how serious a sepsis is.

[Pediatric head injuries. Observations in pediatric surgery. 1,019 cases (author's transl)]. / Traumatismes crâniens de l'enfant. Expérience d'un service de chirurgie infantile. A propos de 1019 cas.

For 5 years, 1,019 children with head injury have been admitted in pediatric surgery. More often the patient is a boy one to five years old. 8.9 p. cent of the children had one or more other body injury. A skull fracture was found in 23 p. cent of the cases without influence on the evolutivity but a repeated clinical examination is necessary. For all head injuries an E.E.G. study is necessary. In 93.5 p. cent of the children the clinical findings allowed to said that head injury was "benign".

[Positive blood cultures in the "Centre des Brûles du c. h. u. de Lille". Evolution of epidemiology during the last thirteen years (author's transl)]. / Hémocultures positives au Centre des Brülés de Lille. Evolution épidémiologique des treize dernières années.

An epidemiological study was made on 3,249 patients admitted in the "Centre des Brûlés du C.H.U. de Lille" from January 1965 to December 1977. This study showed that 7.1 per cent of these patients has one or more positive blood cultures. The main bacteria are staphylococcus aureus, streptococcus, pseudomonias aeruginosa in spite of antibiotic therapy. Infection is the dangerous development in these patients of which generally a burned surface is more than 25 p.cent surface body.

[Post-operative hyperaldosteronism and related endocrine perturbations (author's transl)]. / Hyper-aldostéronisme post-opératoire et perturbations endocriniennes associées.

Electrolytes disturbances during operative period are believed to be related to an hyperaldosteronism produced by anaesthetic management and surgery. Effects of ethrane anaesthesia and surgery on hydroelectrolytic metabolism and endocrin function were investigated in 11 patients submitted to an abdominal surgery. Plasma and urinary levels of aldosterone were increased (x3) significantly (p less than or equal to 0.001) during operation, then decreased gradually in post-operative period, and return to normal values when Na/K ratio is reversed in urines. Relationship between hyperaldosteronism and other changes in endocrine function are established by determination of following hormones: A.C.T.H., cortisol, plasma renin activity (P.R.A.) catecholamines in plasma and urinary levels of 17-ceto, 17-hydroxysteroids and catecholamines. Ethrane anesthesia give a good neurovegetative stability since plasma catecholamines levels are not affected significatively. Plasma aldosterone level is correlated with urinary aldosterone and plasma renin activity. Plasma A.C.T.H. is much more increased at the operative time and decreases rapidly instead of plasma cortisol which decreases more slowly. Relationship of this hyperaldosteronism with anesthetic management, surgical stress intestinal transit disturbances, other endocrine function changes is discussed.

Compatibility of enflurane and adrenaline--experiments in the dog.

Anaesthetised, intubated dogs were ventilated with 1, 2, 3, 4 and 5% enflurane and received adrenaline, 1.4 microgram/kg/min, by intravenous infusion for 5 min. No further adrenaline was given if cardiac arrhythmias occurred. Depth of anaesthesia was controlled by measurement of enflurane levels in arterial blood by an original method. No relationship was observed between the inspired enflurane concentrations and the onset of cardiac arrhythmias.

[Electroencephalographic features during enflurane anaesthesia in older children (author's transl)]. / Aspects électroencéphalographiques au cours de l'anesthésie a l'enflurane chez le grand enfant.

The authors report electroclinical changes observed during Enflurane anaesthesia, at various concentrations, in 25 children aged 4 to 14 years. EEG features are described from induction to surgical anesthesia (concentration 3-3.5%) and during overdoses (4-4.5%) with or without hyperventilation. Groups of spikes, low voltage sequences and electroclinical "seizures" (2 cases) only occur if the concentration of enflurane is not kept below 3.5%. A longitudinal study (24th hour, 3rd and 6th day) shows, by comparison with the pre-anaesthetic EEG, persistence in all cases of EEG slowing 24 hours after the anaesthesia, and in some patients EEG disturbances continue until the 6th day. These results are discussed in relation to data on the biodegradation of enflurane.