[Preoperative normovolemic hemodilution using erythropheresis]. / Hémodilution normovolémique préopératoire par érythrophérèse.

Normovolaemic haemodilution was carried out by erythropheresis by the Blood Bank, 24 to 72 yours before surgery, using a plasmapheresis device. A special disposable haemodilution kit was used, with one plasma and three red cell collection bags and CPD as anticoagulant. Plasma was replaced by 4% albumin. One to 4 red cell packs with 75% haematocrit was obtained and stored for 10 days. This technique is indicated for surgery with an expected blood loss between 1,000 and 1,500 ml, or when the patient cannot be included in a preoperative blood donation programme. The contra-indications are the same as those of intentional normovolaemic haemodilution. This technique has been used in 101 patients due to undergo orthopaedic surgery. Compared with standard haemodilution bags, the advantages of this technique are the excellent asepsis of this product, its 10 days storage and high haematocrit, and the absence of anaesthetic drugs within the bags as well. This technique does not interfere with haemodynamic conditions during anaesthesia; it saves time for both anaesthetists and surgeons. In the authors' experience, this technique has in part replaced the more usual technique.

[Back pain after epidural anesthesia]. / Douleurs rachidiennes après anesthésie péridurale.

A 24-year-old female patient underwent a minor orthopaedic procedure under epidural anaesthesia. She had a past history of lumbar backache. The epidural anaesthetic was carried out with the patient sitting. However, she had an acute vagal reaction, with loss of consciousness and forward headfall. Thirty-six hours later, the patient complained of severe pains diffusing all over her vertebral column, together with sciatica and paravertebral muscle contraction which did not respond to drug treatment. An epidural abscess or haematoma was ruled out. The pain finally disappeared after a few days of wearing a cervical collar, taking anti-inflammatory drugs, and a few vertebral manipulations. The back pain was probably due to a posterior articular joint syndrome, worsened by the forward headfall. In view of the past history, an epidural anaesthetic should probably have been best avoided.

Bowenoid papulosis. Presence of human papillomavirus (HPV) structural antigens and of HPV 16-related DNA sequences.

This study reviews 39 cases of anogenital bowenoid papulosis lesions in 22 individuals of both sexes that were analyzed clinically, histologically, immunocytochemically, and virologically. Macroscopically, three different types of lesions were demonstrated: erythematous macules; papules (lichenoid and/or pigmented papules); and leukoplakialike lesions. Microscopically, bowenoid papulosis fulfills the criteria of a squamous cell carcinoma in situ. Much like oral precancers, three distinct growth patterns (flat, endophytic, and exophytic) could be differentiated, which did not correlate with the clinical aspect of the lesions. In only two (5.12%) of the 39 cases of bowenoid papulosis could structural antigens of papillomaviruses be detected immunocytochemically (peroxidase-antiperoxidase technique). The DNA from 12 lesions that were analyzed for the presence of papillomavirus-specific sequences hybridized stringently in all cases with the human papillomavirus 16 specific DNA probe labeled with phosphorus 32.