[Deep cerebral venous system thrombosis: report of two cases]. / Thrombose veineuse cerebrale profonde: à propos de deux observations.

We report two cases of cerebral deep venous thrombosis in female adults. The first patient presented with headaches and confusion 20 days postpartum. Deep cerebral internal venous thrombosis was suspected based on the CT scan showing bilateral hypodensity in the thalamus and internal capsules. The diagnosis was confirmed on cerebral angiography. The patient was treated but died within 3 weeks of the onset of symptoms. The second patient had no obvious predisposing factors. She presented with confusion and fever. The diagnosis was strongly suggested by the CT scan, which showed spontaneous high density in the deep venous system associated with bilateral hypodensities in the thalamus and internal capsules. Venous MR angiography revealed obliteration of internal cerebral veins and the great vein of Galen. Ten days after appropriate therapy, the patient recovered completely.

[Clonidine and anesthesia]. / Les indications de la clonidine en anesthésie.

The alpha2-adrenoceptor agonists have several beneficial actions during the perioperative period. They exert a central sympatholytic action, improving haemodynamic stability in response to endotracheal intubation and surgical stress, reducing the anesthetic and opioid requirements and causing sedation, anxiolysis and analgesia. Furthermore, alpha2-adrenoceptor agonists may offer benefits in the prophylaxis and treatment of perioperative myocardial ischaemia. Recent alpha2-adrenoceptor agonists with short duration of action (dexmedetomidine and mivazerol) are adapted for the administration to patients at high risk for coronary artery disease during surgery. The alpha2-adrenoceptor agonists have an analgesic action at several sites of the peripheral and central nervous system as well as the prolongation of epidurally or intrathecally administered local anesthetics and opioids.

[Autologous versus homologous transfusion in cervico-fascial oncologic and ENT surgery]. / Transfusion autologue versus. Transfusion homologue en chirurgie oncologique cervico-faciale et ORL.

The objective was to evaluate the interest of the normovolemic hemodilution (NVH) in cervico-facial oncologic and ENT surgery. It was a prospective, randomised and simple blind study having included A(n = 17) having benefitted before induction of a blood withdrawal of 6-8 ml.kg-1, substituted by an intravenous drip of colloid. B group (n = 21). The transfusional objective having been to assure for the two groups, during operative and in postoperative periods, a rate of Hb > or = 10 g.dl-1 and a rate of Ht > or = 30%. The two groups were comparable for the demographic and anesthetic characteristics, and the blood losses during operative period. A variation significantly more important between before and postoperative hemoglobin has been objectified in the group A. The infectious morbidity was significantly more elevated in the group A (23.5% versus 4%). The cost was distinctly more elevated in the hemodiluted group. The NVH doesn't seem to be an indication of choice in the cervico-facial and ENT oncologic surgery.

[Control of hemodynamic variations secondary to suspension microlaryngoscopy]. / Controle des variations hemodynamiques secondaires a la microlaryngoscopie en suspension.

The objective was to evaluate the clinic interest of the esmolol in the attenuation of the hemodynamic response to suspension microlaryngoscopy (mls). It was a prospective, randomized and double blind study, having included 29 patient ASA II and III, distributed in two groups, having received respectively before laryngoscopy: group A (n = 15), esmolol in intravenous (i.v.) at the dose of 150 micrograms.kg-1 and DS group (n = 14), 10 ml of normal saline at 0.9%. Has been achieved a general anaesthesia i.v. based on propofol, fentanyl and atracurium. After tracheal intubation, it has been assured an artificial ventilation. The two groups were comparable for the demographic and anesthetic characteristics. A significant decrease of the mean arterial pressure (-11%) and of the prp (product systolic arterial pressure heart rate) have been raised during the mls, in the group esmolol, whereas the variations of the cardiac frequency were comparable. In order to assure a better hemodynamic control during the mls, it seems important, in addition to the adjustment of the recommended dose of esmolol, to cover the whole duration of the endoscopic act by a continuous drip.