RESUMEN
OBJECTIVES: To compare three techniques of brachial plexus blockade for emergency surgery of the upper limb. STUDY DESIGN: Prospective, randomised study. PATIENTS: One hundred eleven patients admitted to an emergency surgical service, randomly assigned to three groups. METHODS: The patients were given 2% lidocaine with epinephrine 20 mL and 0.5% bupivacaine 20 mL. The three groups were as follows: brachial plexus block using a peripheral nerve stimulator (group St, n = 38); transarterial brachial plexus blockade with injection of 2/3 of the anaesthetic in back of and 1/3 in front of the artery (group TAP, n = 36); transarterial brachial plexus blockade with one single injection in back of the artery (group TP, n = 37). The success rate, time required to perform the technique, latency of analgesia, quality of motor blockade, and adverse effects were compared between the three groups. Analysis of variance was used to compare quantitative data and chi 2 test were used for qualitative data. RESULTS: Rates of success varied between 65 and 75%. Success rates, latency of analgesia and quality of motor blockade were not significantly different between groups. Time to perform the technique was longer when using a nerve stimulator. CONCLUSION: As these three techniques for brachial plexus block in emergency surgery are comparable, no one can be recommended instead of the others.
Asunto(s)
Plexo Braquial , Medicina de Emergencia/métodos , Bloqueo Nervioso/métodos , Adolescente , Adulto , Anestésicos Locales , Bupivacaína , Epinefrina , Femenino , Humanos , Lidocaína , Masculino , Estudios Prospectivos , Procedimientos Quirúrgicos OperativosRESUMEN
Startle disease or hyperreflexia is an autosomal dominant neurological disorder, with a neonatal onset, characterized by muscular hypertonia and myoclonic jerks, exaggerated by the slightest stimulus. Low concentrations of free gamma-aminobutyric acid (GABA) have been found in the cerebrospinal fluid of two affected infants. The involvement of GABA or its receptors has been raised and the use of GABA-agonist drugs has been suggested. We report a newborn with startle disease who also had a low concentration of GABA in the cerebrospinal fluid. No clinical improvement was observed with progabide, a GABA agonist. Furthermore, a high dose (100 mg/kg) of gamma-hydroxybutyrate (GHB) did not improve muscular stiffness and failed to induce general anesthesia. GHB, currently used as an effective general anaesthetic, is a structural analogue of GABA. It is present naturally at low concentrations in the brain and is regarded as an inhibitory neurotransmitter. Two specific GHB receptors, distinct from the GABA receptors, have been identified in rat brain. Failure to induce general anesthesia with a high dose of GHB suggests that one of these receptors could be involved in startle disease.
Asunto(s)
Enfermedades Neuromusculares/tratamiento farmacológico , Enfermedades Neuromusculares/fisiopatología , Receptores de Superficie Celular/fisiología , Reflejo Anormal/fisiología , Reflejo de Sobresalto/fisiología , Oxibato de Sodio/uso terapéutico , Anestésicos , Anticonvulsivantes/uso terapéutico , Agonistas del GABA/uso terapéutico , Humanos , Recién Nacido , Masculino , Reflejo Anormal/efectos de los fármacos , Reflejo de Sobresalto/efectos de los fármacos , Oxibato de Sodio/farmacología , Ácido gamma-Aminobutírico/análogos & derivados , Ácido gamma-Aminobutírico/líquido cefalorraquídeo , Ácido gamma-Aminobutírico/uso terapéuticoRESUMEN
This study reports the results of a retrospective survey of transfusion-related HIV-contamination in patients who were admitted in our neurosurgery department, between the 1st January 1980 and the 30th September 1985. In our area of France, the risk of HIV-contamination is low. During this 5-year-period the blood donors were not tested for HIV. Six hundred twenty-one patients were identified from the operating room registers. The administered blood components were always noted in these registers for each patient. Among these 621 patients, 233 died rapidly. Three hundred eighty files were taken out from the central archives' department. Eight files could not be found. These 380 files were examined for the patient's address, or the family's one, or the regular doctor's name and address. A letter was sent to the latter in order to inform him about the patient's transfusion. The doctor had to ask the patient to order a HIV-test. A recall letter was sent 8 months later as required. The patients who did not have a regular doctor were contacted directly by phone or letter, or indirectly through their family. Thirteen months after the beginning of this survey it was established that 334 patients died (53.5%) and only 151 patients were found and tested. One of them was HIV-positive. As this patient suffered from a hemophilia B, he had been medically followed and his positive serology was known since 1988. It was impossible to get any answer from 136 other patients who represent 22% of all patients and 47% of still alive patients or supposed to be so.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Anticuerpos Anti-VIH/sangre , Seropositividad para VIH , Encuestas Epidemiológicas , Reacción a la Transfusión , Francia/epidemiología , Humanos , Neurocirugia , Periodo Posoperatorio , Estudios RetrospectivosRESUMEN
A retrospective study of thromboembolic complications after lumbar disc surgery has been performed. It included 16,656 patients from fifty neurosurgical units, operated on over the year 1989. The average number of operations was 333 +/- 19.5 in each unit, their average duration 55.2 +/- 20 minutes, and the hospital care 6.2 +/- 1.7 days. Surgery was performed using the genupectoral position in 64% of the cases, the supine position in 28%, and the lateral position in 8%. Two groups of patients have been individualized: a first group of patients with no preventive antithrombic treatment (46% of the units) including 10,351 patients, a second group (54% of the units) including 6,305 patients and receiving a systematic treatment with low molecular weight heparin (4,304 patients) or calciparin (1,001 patients) or antiplatelet agents or pentosane polysulfate (1,000 patients). 0.63% of the patients (105) had a thromboembolic accident: 0.65% in the first group (68 cases) and 0.58% in the second (37 cases). No statistically significant difference was noticed between the two groups concerning pulmonary embolism and/or lower-limb thrombophlebitis. Nevertheless, a prospective randomized study would be usefull to corroborate this first data.
Asunto(s)
Discectomía , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares , Complicaciones Posoperatorias/prevención & control , Embolia Pulmonar/prevención & control , Tromboembolia/prevención & control , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Complicaciones Posoperatorias/epidemiología , Embolia Pulmonar/epidemiología , Estudios Retrospectivos , Tromboembolia/epidemiologíaAsunto(s)
Peces Venenosos , Enfermedades Transmitidas por los Alimentos , Tetrodotoxina/envenenamiento , Adulto , Animales , Guyana , Humanos , MasculinoRESUMEN
The appearance observed with CT during and following eclampsia seem to be related to edema, hemorrhagic lesions and ischemic lesions. The authors report on a reversible appearance of hypodense central grey nuclei and of the calcarine cortex fitting into this new context.
Asunto(s)
Edema Encefálico/etiología , Eclampsia/complicaciones , Ataque Isquémico Transitorio/etiología , Adulto , Edema Encefálico/diagnóstico por imagen , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/etiología , Femenino , Humanos , Ataque Isquémico Transitorio/diagnóstico por imagen , Embarazo , Tomografía Computarizada por Rayos XRESUMEN
The efficacy of intravenous Nimodipine (used at the rate of 2 mg.h-1) was investigated in the treatment of delayed ischemic deterioration or angiographic vasospasm after subarachnoid haemorrhage caused by a ruptured aneurysm in a randomized, double-blind, placebo-controlled multicenter study. A total of 127 case reports was validated: 73 patients received Nimodipine, 54 received placebo. The two groups were comparable in demographic and clinical status data. Analysis of number of deaths and of patients with severe deficit related to vasospasm alone showed a significant statistical difference (Nimodipine = 19%; Placebo = 49%; p = 0.01). The risk of mortality connected with vasospasm was reduced by 82% in the treated group. Side effects were equally frequent in the two groups. The only difference noted was the increase in heart rate in group Nimodipine. The results of this study demonstrate the efficacy of intravenous Nimodipine in the treatment of consequences of cerebral vasospasm after a subarachnoid haemorrhage caused by a ruptured aneurysm.
Asunto(s)
Aneurisma Intracraneal/tratamiento farmacológico , Ataque Isquémico Transitorio/tratamiento farmacológico , Nimodipina/uso terapéutico , Hemorragia Subaracnoidea/tratamiento farmacológico , Adulto , Método Doble Ciego , Femenino , Humanos , Infusiones Intravenosas , Aneurisma Intracraneal/complicaciones , Ataque Isquémico Transitorio/etiología , Ataque Isquémico Transitorio/mortalidad , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Estudios Prospectivos , Distribución Aleatoria , Rotura Espontánea , Hemorragia Subaracnoidea/etiologíaRESUMEN
A case is reported of an acute intracranial subdural haematoma following an accidental dural puncture during an epidural anaesthesia. A seventy-year old man, class ASA I, was operated on for prostatic adenoma under epidural anaesthesia. Dural puncture occurred during the first introduction of the needle into the L4-L5 epidural space. Epidural anaesthesia was nevertheless obtained by introducing the catheter at the L3-L4 level. The immediate peroperative and postoperative course was uneventful, apart from persisting headache. After removing the epidural catheter at 24 h postoperatively, the patient received calcium heparinate. 26 h later, he complained of worsening headache and became rapidly deeply comatose. The computer tomographic scan showed air in the ventricles and a large right-sided subdural haematoma which was immediately discharged. Although the link between subdural haematoma and dural puncture is well known, the acuteness and rapidly fatal evolution of this case were exceptional and may have been facilitated by the big size of the needle, dehydration and hypercoagulability.
Asunto(s)
Anestesia Epidural/efectos adversos , Duramadre/lesiones , Hematoma Subdural/etiología , Heridas Penetrantes/complicaciones , Anciano , Deshidratación/complicaciones , Cefalea/etiología , Hematoma Subdural/diagnóstico por imagen , Hematoma Subdural/fisiopatología , Heparina/efectos adversos , Humanos , Masculino , Hiperplasia Prostática/cirugía , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Brainstem auditory evoked responses were recorded in a neurosurgical intensive care unit in 38 patients who had all the clinical criteria for brain death. Of the brain-dead patients, 65.8% never showed a response. 3.42% showed a type I wave, which was unilateral in 26.3% and bilateral in the other 7.9%. Types II to VII waves were never seen. An increase in latency of type I waves (2.25 +/- 0.24 ms) was noted. The interest and the limits of this non invasive electrophysiologic technique for the diagnosis of brain death are discussed.
Asunto(s)
Muerte Encefálica , Tronco Encefálico/fisiopatología , Potenciales Evocados Auditivos , Adolescente , Adulto , Anciano , Niño , Electroencefalografía , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The quality of recovery from general anaesthesia for day-case surgery is assessed by the Trailmaking test in a randomized study of 100 women scheduled for termination of pregnancy on an outpatients basis. All patients are in ASA group I or II. Recovery following diazepam-ketamine based anaesthesia is compared to that following fentanyl-methohexital based anaesthesia. In group A, 5 min after intravenous injection of diazepam (0,2 mg.kg-1), anaesthesia is induced with ketamine (1 mg.kg-1). If necessary, in response to spontaneous movement, for maintenance of anaesthesia, 1 or 2 supplementary doses of ketamine (0,5 mg.kg-1) are administered. In group B, 5 min after intravenous injection of fentanyl (1 microgram.kg-1), anaesthesia is induced with methohexital (2 mg.kg-1). If necessary, in response to spontaneous movement, for maintenance of anaesthesia, 1 or 2 supplementary doses of methohexital (0,7 mg.kg-1) are administered. The quality of recovery is assessed by Trailmaking test 1/2 h and 1 h after surgery and compared with pre-anaesthetic score. The two groups are comparable with regard to age, weight, educational level and average duration of anaesthesia. In group A, the mean score for the two parts of the test is not significantly different 1 h after surgery from the pre-anaesthetic score. In group B, the mean score for the two parts of the test is not significantly different 1/2 h after surgery than the pre-anaesthetic score. This better post-anesthetic score is explained by a learning effect of the test when used several times.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Periodo de Recuperación de la Anestesia , Diazepam , Fentanilo , Ketamina , Metohexital , Periodo Posoperatorio , Aborto Legal , Anestesia General , Femenino , Humanos , Embarazo , Distribución AleatoriaRESUMEN
Thirty-two patients were included in this trial: 22 with staphylococcal meningitis (including 5 methicillin-resistant) and 10 with enterobacterial meningitis. Mean duration of treatment was 14.5 and 15.9 days respectively. The combination was synergistic in vitro against 10 of the 12 strains of Staphylococcus and 5 of the 6 strains of Enterobacteriaceae studied. Bacteriological sterilization occurred in all cases which could be evaluated, and clinical recovery was obtained in 95.2% of patients with staphylococcal meningitis (4 unrelated deaths) and 100% of patients with enterobacterial meningitis (2 deaths). Bactericidal power of the cerebro-spinal fluid, often less than 1/8, was not correlated with effectiveness against Staphylococci. Mean CSF concentrations of cefotaxime, desacetylcefotaxime and fosfomycin on the 2nd and 15th days of treatment were 4, 3.5 and 39.8 mg/l and 2.2, 2.1 and 28.0 mg/l, respectively. Clinical and biological acceptability was satisfactory. There were three cases of superinfection or colonization, by Pseudomonas and Enterobacter.
Asunto(s)
Cefotaxima/uso terapéutico , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Fosfomicina/uso terapéutico , Meningitis/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Adolescente , Adulto , Anciano , Cefotaxima/líquido cefalorraquídeo , Evaluación de Medicamentos , Quimioterapia Combinada , Enterobacteriaceae/efectos de los fármacos , Infecciones por Enterobacteriaceae/líquido cefalorraquídeo , Infecciones por Enterobacteriaceae/microbiología , Femenino , Fosfomicina/líquido cefalorraquídeo , Humanos , Masculino , Meningitis/líquido cefalorraquídeo , Meningitis/microbiología , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Prospectivos , Infecciones Estafilocócicas/líquido cefalorraquídeo , Infecciones Estafilocócicas/microbiología , Staphylococcus/efectos de los fármacosRESUMEN
A case of a surgically verified neurinoma of the oculomotor nerve is presented. The diagnostic difficulties due to the parasellar localisation are discussed. Computed tomography scan data rarely allow to distinguish the nature of the tumor and in all cases are insufficient to distinguish a trigeminal nerve neurinoma of the oculomotor nerves.
Asunto(s)
Neurilemoma/diagnóstico por imagen , Nervio Oculomotor , Angiografía Cerebral , Femenino , Humanos , Persona de Mediana Edad , Neurilemoma/cirugía , Tomografía Computarizada por Rayos XRESUMEN
A post-traumatic intramural hematoma of duodenum in a 9 year old child was detected during exploratory laparotomy but left undisturbed. Postoperative follow up during parenteral feeding included surveillance by repeated gastrografin follow through examinations, normal transit being restored by the 12th day. Intramural hematoma of duodenum is usually due to injury and often affects male children. Symptomatology is that of upper digestive occlusion. The principal investigation should be gastro-duodenal follow through examinations with gastrografin, because of the risk of an associated perforation, to reveal possible partial or total duodenal obstruction. Conservative treatment is possible, but in case of failure or in adults surgery is indicated with evacuation of the hematoma and in some cases a gastro-jejunostomy.
Asunto(s)
Traumatismos Abdominales/complicaciones , Enfermedades Duodenales/etiología , Hematoma/etiología , Niño , Enfermedades Duodenales/diagnóstico por imagen , Enfermedades Duodenales/cirugía , Hematoma/diagnóstico por imagen , Hematoma/cirugía , Humanos , Masculino , RadiografíaRESUMEN
The stability of anaesthesia and the quality of recovery obtained with low doses of enflurane were studied. Two groups of 20 patients operated for lumbar slipped disc were compared. The mean age and weight distribution of the two groups were not statistically different. Induction was the same in the two groups (diazepam, fentanyl, pancuronium and nitrous oxide). In one group, enflurane (0.4%) was added with controlled ventilation. Thiopentone was added if some spontaneous movements were observed, if arterial pressure and heart rate increased, and if the digital plethysmograph curve decreased. The quality of recovery was assessed by number-connection tests 1 and 2 h after the end of anaesthesia. Thiopentone was required five times in the group without enflurane, whilst it was never used in the group with enflurane. This difference was statistically significant (p less than 0.01) and showed a more important stability of anaesthesia when enflurane (0.4%) was used. No statistically significant difference was found in the recovery scores between the two groups 1 and 2 h after the end of anaesthesia. It was proposed that low doses of enflurane were sufficient to increase the effects of the other anaesthetic drugs without any residual effect on recovery. Low doses of enflurane could be used during anaesthesia induced with fentanyl and diazepam, giving better stability during anaesthesia without any pernicious effects on recovery.
Asunto(s)
Anestesia General/métodos , Enflurano/administración & dosificación , Adulto , Periodo de Recuperación de la Anestesia , Sinergismo Farmacológico , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Tiopental/administración & dosificaciónRESUMEN
An automatic apparatus for the measurement of arterial pressure by a non-invasive technique is compared with direct intra-arterial measurement in patients admitted to a neurosurgical intensive care unit. A good correlation is found between the results of the two methods for the systolic and diastolic pressure.
Asunto(s)
Determinación de la Presión Sanguínea/instrumentación , Monitoreo Fisiológico/instrumentación , Diástole , Humanos , Unidades de Cuidados Intensivos , SístoleAsunto(s)
Anticoagulantes/efectos adversos , Hemorragia Cerebral/inducido químicamente , Hemorragia/inducido químicamente , Enfermedades de la Columna Vertebral/inducido químicamente , Anciano , Hemorragia Cerebral/tratamiento farmacológico , Hemorragia Cerebral/cirugía , Urgencias Médicas , Femenino , Hematoma Epidural Craneal/inducido químicamente , Hematoma Epidural Craneal/tratamiento farmacológico , Hematoma Subdural/inducido químicamente , Hematoma Subdural/tratamiento farmacológico , Hemorragia/tratamiento farmacológico , Heparina/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Protaminas/uso terapéutico , Enfermedades de la Columna Vertebral/tratamiento farmacológico , Vitamina K/antagonistas & inhibidoresRESUMEN
The case is reported of an 18 year old patient who developed a peripheral neuropathy after being given 1.5 g ornidazole daily for 6 days and 2 g daily for 16 days (total dose: 41 g). Bilateral radial paralysis was noted clinically, whilst electrical investigations showed diffuse motor and sensitive anomalies. Three months after the drug had been stopped, all symptoms and signs had disappeared. The pathogenesis of this complication is discussed. The part played by ornidazole is suggested but cannot be proved because of the multiple disorders presented by the patient.
Asunto(s)
Nitroimidazoles/efectos adversos , Ornidazol/efectos adversos , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Adolescente , Cuidados Críticos , Estudios de Seguimiento , Humanos , Masculino , Metronidazol/efectos adversosRESUMEN
A case of bilateral congenital oculodermal melanocytosis is reported. Ota's naevus is characterized by benign melanosis of the skin of the face in the area supplied by the first (and second) branch of the trigeminal nerve. This is associated with ipsilateral pigmentation of the episclera++, uveal tract, conjonctiva and fundus. The condition is usually unilateral, occurring mainly in the dark races (black races and orientals). Eighty percent of patients are women. It is very rarely potentially malignant, this occurring most frequently in white races and when only ocular (and not oculodermal) melanocytosis is present.