[Comparison of propanidid with propofol for dental surgery of short or medium duration]. / Comparaison propanidide-propofol en chirurgie stomatologique de courte ou moyenne durée.

The properties of propofol in emulsion given by continuous intravenous infusion to spontaneously breathing patients have been well studied. Thirty randomized voluntary premedicated patients undergoing dental extraction were anaesthetized with propofol (2.5 mg X kg-1 IVD, and 9 mg X kg-1 X h-1) or with propanidid (9 mg X kg-1 IVD, and 60 mg X kg-1 X h-1), supplemented with nitrous oxide in oxygen and fentanyl. Induction, maintenance and recovery times had the same characteristics. Highly significant differences occurred between the two groups regarding the increase in heart rate, apnoea and recovery time. This study showed that propofol was an eminently suitable agent for continuous intravenous anaesthesia in spontaneously breathing patients for dental surgery.

[Retrospective diagnosis of a coma in an infant]. / Diagnostic rétrospectif d'un coma chez un nourrisson.

A four month old baby presented one morning a quiet, hypotonic, areflexive coma without any signs of localization, which vanished without any sequelae. Hepatic cytolysis and an isolated proteinuria with a maximum at about three days after the initial neurological problems completed the picture. A new interview with the parents looking for a toxic cause revealed without any doubt poisoning by tetrachloro-ethylene. Following this particular case, the main signs of poisoning by halogenated aliphatic hydrocarbons are recalled. One should always have in mind the possibility of poisoning at all ages, even with young babies.

[Effects of injectable flunitrazepam on hepatic and cardiac output in man]. / Effets du flunitrazépam injectable sur les débits hépatique et cardiaque chez l'homme.

The effects of intravenous flunitrazepam (0.03 mg X kg-1) on the estimated hepatic plasma output (DPHE), compared with the cardiac output (Q), were studied before its injection and 1 min afterwards. The question asked was whether the decrease in venous return led to a fall in hepatic perfusion. This study was made on patients in neurological coma without any organic lesion. The DPHE was measured by applying Fick's principle, using a continuous infusion of indocyanine green (ICG). The DPHE was given by the amount of ICG perfused in mg X min-1 divided by the arterial concentration of ICG less the concentration of ICG in the hepatic vein (in mg X 1(-1)). Cardiac output was measured by thermodilution. Flunitrazepam did not significantly modify either DPHE or Q; they fell by 5.6% and 3.4% respectively. None of the seven cardiovascular parameters changed during the time of the study. Thus, in unconscious patients with satisfactory haemodynamic conditions prior to the intravenous injection, flunitrazepam did not significantly modify hepatic perfusion.

[2 cases of anaphylaxis from droperidol]. / Deux cas d'anaphylaxie au dropéridol.

Following two cases of anaphylactoid reactions during anaesthesia, immunoallergological investigations showed up the responsibility of droperidol, which probably acted by way of an anaphylactic mechanism. In both cases, there were no cardiovascular signs, the main clinical symptom being bronchospasm. The exceptional nature of allergic accidents due to neuroleptic drugs, as opposed to extrapyramidal phenomena, must be underlined. However, these reactions should cast doubts on the safety and usefulness of neuroleptanalgesia.

[Adsorption of insulin directly added to infusion bottles]. / Adsorption de l'insuline introduite directement dans les flacons de perfusion.

A study of insulin adsorption to infusion system was undertaken in the situation of direct addition of insulin alone in the infusion bottles, with use of 125I-labelled insulin and non labelled insulin. The infusion solutions tested were glucose solutions (5, 10, 15 and 30%). There is an important adsorption of insulin (75%) to the infusion system when the insulin concentration in the solution is low. The effluent insulin is not degraded. The glucose content of the solution does not influence the phenomenon. Adsorption of insulin decreases when the insulin concentration in the solution is increased and a plateau is reached starting from an insulin concentration in the solution of about 400 ng/ml; at higher concentrations, 80 to 90% of insulin that has been initially put in the bottle is recovered. Since the insulin concentrations in the solutions used in clinical practice are higher than 400 ng/ml, this adsorption phenomenon can be neglected and therefore can explain the efficiency of this mode of insulin-therapy. Kinetics of effluent insulin is a plateau, stable all along the infusion. Thus, direct addition of insulin alone into infusion bottles is an efficient and controlled mode of insulin-therapy if a minimal insulin concentration in the infused solution has been reached.

[Adsorption of insulin introduced directly into perfusion bottles]. / Adsorption de l'insuline introduite directement dans les flacons de perfusion.

A study of insulin adsorption to infusion system was undertaken in the situation of direct addition of insulin alone in the infusion bottles, with use of 125I-labelled insulin and non labelled insulin. The infusion solutions tested were glucose solutions (5, 10, 15 and 30%). There is an important adsorption of insulin (75%) to the infusion system when the insulin concentration in the solution is low. The effluent insulin is not degraded. The glucose content of the solution does not influence the phenomenon. Adsorption of insulin decreases when the insulin concentration in the solution is increased and a plateau is reached starting from an insulin concentration in the solution of about 400 ng/ml; at higher concentrations, 80 to 90% of insulin that has been initially put in the bottle is recovered. Since the insulin concentrations in the solutions used in clinical practice are higher than 400 ng/ml, this adsorption phenomenon can be neglected and therefore can explain the efficiency of this mode of insulin-therapy. Kinetics of effluent insulin is a plateau, stable all along the infusion. Thus, direct addition of insulin alone into infusion bottles is an efficient and controlled mode of insulin-therapy if a minimal insulin concentration in the infused solution has been reached.

[Fulminant infectious syndrome after post-traumatic splenectomy]. / Syndrome infectieux foudroyant après splénectomie post-traumatique.

A 49 year old woman presented a very serious infectious state with respiratory failure, on the third postoperative day following splenectomy for a traumatic ruptured spleen. Despite massive antibiotic treatment and treatment of the respiratory failure, the patient died. The responsibility of the splenectomy in this infection with many different organisms and the failure of antibiotics is discussed.

[Severe anaphylactoid accidents occurring during general anesthesia]. / Accidents anaphylactoïdes graves survenus au cours d'une anesthésie générale.

Four patients were studied following an anaphylactoid accident occurring during general anaesthesia. Histamine release was assessed on clinical signs, basophil degranulation and, in one case, an early serum histamine peak. Past medical history revealed previous allergies in all cases. An immunological study showed that IgE, CH50, C3 and C4 serum levels were within the normal range. Skin reactivity to histamine was normal in all but one case. In every case, one of the drugs used during the anaesthetic gave a positive skin test and was considered as the causative agent. There were discrepancies between the in vitro and in vivo tests of basophil degranulation, a second drug being positive in one case, and several drugs inducing abnormal degranulation reactions in the other cases. The drugs considered as involved in these accidents are noteworthy: suxamethonium (two cases), fluid gelatin (Plasmion) and droperidol. The results are discussed by the authors.

[Doppler velocimetric evaluation of the reliability of Allen's test for radial artery catheterization]. / Contrôle par la vélocimétrie Doppler de la fiabilité du test d'Allen pour le cathétérisme de l'artère radiale.

The result of Allen's test was compared with the variations in the Doppler flow recording of the thumb artery after compression of the radial artery in 76 volunteers. In five cases, manual compression let to a disappearance systolic flow, showing an absence of collateral ulnar circulation. In fifteen cases, the systolic flow was greatly reduced in the thumb. It is interesting to find that 14.6 per cent of the subjects have their two hands in a different classification (asymmetric subjects). In 99.34 per cent of the cases the results of these two methods was the same. The routine use of Allen's test before radial artery catheterization is fully justified by these results.

[Technic of continuous axillary plexus block]. / Technique du bloc plexique prolongé par voie axillaire.

A technique of continuous axillary brachial plexus block, using an epidural Tuohy needle and an epidural catheter, is described. Studies were carried out in ten patients using this technique with bupivacaine as a local anesthetic drug. The catheter remained indwelling during a mean period of five days. Good analgesia was obtained in nine out of the ten patients. Thus this technique allows pain-free postoperative period in hand surgery.

[Effects of dopamine on cardiac and hepatic index in man (author's transl)]. / Effets de la dopamine sur les index hépatique et cardiaque chez l'homme.

Dopamine is known to increase cardiac output and, to a greater extent, renal blood flow. The purpose of this study was to find out whether renal blood flow is increased partly at the expense of splanchnic blood flow. The splanchnic blood flow was evaluated by measuring, according to Fick's principle, the estimated liver blood flow during a continuous infusion of indocyanine green. Each determination was coupled with a measurement of the cardiac output, using a thermodilution method. The results were corrected to body surface, thus providing a cardiac index (Cl) and a hepatic index (Hl). The study involved 10 subjects free from hepatic, haemodynamic or haemorrhagic disease and was carried out in 3 stages: determination of initial values, then of values under dopamine (10-12 micrograms. kg. min) and finally, control of return to initial levels. The results showed that dopamine produced a significant (p less than 0,01) increase in Cl (mean 44%) and an equally significant (p less than 0,01) increase in Hl (mean 66%), the difference between the two increases being also significant (p less than 0.05). There was a strong correlation between Cl and Hl during dopamine fusion.

[Hypovolaemic shock due to increased capillary permeability (author's transl)]. / Choc hypovolémique par augmentation de la perméabilité capillaire. Une observation.

In a 69-year-old man admitted to hospital for shock with symptoms suggesting acute cor pulmonale, laboratory tests showed low proteinaemia associated with haemoconcentration. Vascular filling led to recovery, but the condition relapsed 6 months later, heralded by weight increase, swelling of the face and profuse swelling; the patient again recovered. On this last occasion, a monoclonal peak of IgG kappa thought to have antibody activity was discovered. These attacks of hypovolaemic shock seem to be due to sudden increases in capillary permeability.

[Discriminant factors of risk of infection in routine digestive surgery. Trial apropos of 308 cases]. / Facteurs discriminants du risque infectieux en chirurgie digestive réglée. Essai à propos de 308 cas.

Postoperative infection in routine digestive surgery is a common complication, its prevalence being variously assessed between 10 and 30%. Study of criteria of infectious risk, whether inherent to the subject or his environment, has not been the subject of overall evaluation. The present study involved 308 subjects in two departments of surgery with different geographical and architectural features. A comparison was first made between the two departments in terms of the surgical population and the reaction rate. The presence was then sought of a relationship between infection, whether general or local (urinary tract, pulmonary, septicaemia) and factors concerning the bacteriological environment and factors indicative of the resistance of the subject. The statistical technique of discriminant analysis was used to determine the preponderance of certain factors which might be indicative of at risk subjects.

Increase in hepatic blood flow and cardiac output during dopamine infusion in man.

The object of this paper was to evaluate the effect of a continuous dopamine infusion (10--12 micrograms/kg . min) on the estimated hepatic blood flow (EHBF) and cardiac output (CO) in man. Measurements were made in 3 periods: the initial control state, during dopamine infusion, and after the infusion. The CO (by thermodilution) and EHBF (by hepatic vein sampling after continuous indocyanine green (ICG) infusion) were measured during each phase. Ten subjects, with inapparent hepatic disease, hemorrhage, or hemodynamic anomalies, were studied. The results showed a 64% increase in the EHBF and a 49% increase in the CO. All subjects showed a return to the original baseline state after infusion. The EHBF/CO was 14% in the control period, 17.3% during infusion, and 13.4% after dopamine infusion. These changes were not statistically significant. Dopamine, therefore, increased both EHBF and CO, but the existence of intrahepatic dopaminergic receptors could not be established.

[Physiopathology of continuous enteral feeding. Application to several major digestive system disease syndromes]. / Physiopathologie de l'alimentation entérale a débit continu. Application a quelques grands syndromes de pathologie digestive.

The first chapter looks at the advantages of continuous oral feeding (COF) over conventional oral feeding, from a physiological and physiopathological point of view. From this discussion the indications and contraindications for this type of feeding are drawn. Then a few major diseases of the digestive tract are examined: diseases of the bile salts, intra-luminal bacterial proliferation, acute bacterial diarrhoea, isufficiency of exocrine pancreatic secretion. In each case the use off continuous oral feeding is suggested.