[Forced delivery instead of postmortem cesarean section]. / Accouchement forcé en lieu et place de l'opération césarienne post mortem.

The Lex Regia stipulated that no pregnant women shall be buried unless the child has been removed from her womb. The post mortem caesarean delivery was upheld till 1861 by the majority of obstetricians but nevertheless, anterior to the XIXth century, in 1729, Delamotte practiced delivery in the agonising patient in the absence of labour in view to bypass the cesarean section in hope of better child survival. This article describes the beginning of forced ante mortem delivery upon post mortem cesarean section, which contributed to a decrease in child mortality.

[Cadavers and mummies as therapeutic means]. / Le cadavre et la momie utilisés à des fins thérapeutiques.

Sickness befallen onto him, man found that plant and animal derivatives invigorated him. Thereafter, he found a therapeutic benefit in using man as a means of self cure and especially, dead man from violent death. The foam of the skull of cadaver was an excellent antiepileptic as well as blood coming out from a freshly decapitated man. By applying on diseased parts of his body, so as to get rid of inflammation or infection, cadaver's hands were used against tumors of all kinds. Dead human skin were processed into belts and used therein for helping delivery of parturition women. The mummy must be blackish, foul smelling and hard. Those who were whitish, odorless and powder-like, were unfit for use. Mummy powder applied to the nose would stop nose bleeding. Ambroise Paré (1510-1590) was an adversary of those practices.

[Medicinal leeches]. / Les sangsues.

Leeches are hermaphroditic and hematophagous annelids. One important medical species, Hirudo medicinalis, comes from hirudiniculture of fresh water pools. Thanks to their three mandibles with some 300 teeth on their anterior muscular sucker, they easily grab to tissues and by secreting their saliva containing numerous powerful enzymes, such as hyaluronidase, collagenase and inhibitors of platelet aggregation and coagulation, like hirudin, allow blood sucking. Once they are full of blood (up to 15 g of blood), they detach themselves from their prey. Used ever since the 18th Egyptian Dynasty, leeches became famous during the first part of the XIXth century, thanks to a French physician, François Joseph Victor Broussais, known to his adversaries as the "vampire of medicine" for treating various conditions such as phlebotomy, laryngitis, ocular problems, obesity, mental disorders, etc. Overfishing, therapeutic failures and most particularly, the emergence of hygiene, brought the decline of living leeches. In 1884, an extract of leeches was obtained--hirudin and henceforth used. Nowadays, leeches are still used in microsurgery to enhance the venous circulation in finger reimplantation or skin flap transposition. Hirudin is synthesized through recombinant DNA technology and molecules such as lepirudin and desirudin are available on the market as anticoagulant.

Cerebral arteriovenous malformation mimicking acute coronary syndrome.

We report a case of cerebral arteriovenous malformation in a 34 year-old male patient presenting with chest pain. Electrocardiographic findings showed ST elevations in the precordial leads. However, a coronary angiogram showed no coronary lesions. Laboratory tests suggested that troponin and cardiac enzymes were within normal limits. Further investigation led to the diagnosis of a cerebral arterio-venous malformation occupying the left temporal and parietal lobes. The chest pain may be explained by the occurrence of a complex partial seizure.

Evaluation of a new, rapid lactate analyzer in critical care.

OBJECTIVE: To determine the reliability, precision and clinical usefulness of a newly developed substrate-specific lactate/blood gas analyzer (Chiron M865). SETTING: A university hospital 31-bed mixed medical/surgical intensive care unit (ICU). PATIENTS: Seventeen critically ill patients with sepsis (n = 4), post-cardiac surgery (n = 8), hepatic failure (n = 2) or acute respiratory failure (n = 3). MEASUREMENTS AND RESULTS: Lactate levels were measured in 17 critically ill patients on whole blood using the new Chiron M865, and on plasma by a stat lactate/glucose analyzer (Yellow Spring Instrument, YSI mode 2300) and a reference lactate/glucose/electrolyte/enzyme analyzer (Hitachi 911). The influences of temperature and storage on blood lactate levels were then evaluated. Mean lactate values obtained were 3.73+/-2.84 mmol/l with the Chiron, 3.03+/-2.60 mmol/l with the YSI, and 3.59+/-2.92 mmol/l with the Hitachi. There was a strong correlation between the three analyzers (Chiron vs YSI r = 0.99; Chiron vs Hitachi 911 r = 0.98), and good agreement between the Chiron and the two other methods (Chiron/YSI bias was -0.65, SD 0.50 mmol/l; Chiron/Hitachi bias was 0.12, SD 0.55 mmol/l). The variability coefficients were 3.7% for the Chiron and 3.0% for the YSI. During short term storage, a continuous increase in lactate levels was observed at room temperature (2.36+/-1.68 mmol/l to 2.53+/-1.74 mmol/l, p < 0.05), but when the samples were kept on ice there was just a small statistically significant, but not clinically significant, increase after 8 min (2.37+/-1.62 mmol/l to 2.39+/-1.63 mmol/l, p < 0.05). For longer storage times, samples on ice showed a small increase in lactate levels after 15 min (3.73+/-2.90 mmol/l to 4.01+/-3.00 mmol/l, p < 0.05) but no further increase during the subsequent 45 min. CONCLUSIONS: The new Chiron lactate analyzer is reliable for serial whole blood lactate measurements in an intensive care stat laboratory. Samples should be kept on ice immediately after sampling to minimize in vitro erythrocyte production of lactate.

Does hepato-splanchnic VO2/DO2 dependency exist in critically ill septic patients?

Since the gradient between the mixed venous and hepatic vein oxygen saturation (DSO2) is often increased in septic patients, we suspected these patients may have an imbalance between oxygen supply and demand in the hepato-splanchnic area. In 42 septic patients, hepato-splanchnic blood flow was determined by the indocyanine green clearance method with hepatic vein catheterization. The relationships between hepato-splanchnic oxygen delivery (DO2spla) and consumption (VO2spla) were analyzed during an increase in blood flow induced by a dobutamine infusion at doses up to 10 microg/kg x min. In 14 patients, positive end-expiratory pressure (PEEP) was also increased up to 20 cm H2O. The patients were separated according to their DSO2 (Group I: DSO2 < 10%, n = 13; and Group II: DSO2 > 10%, n = 29). Although DO2spla increased similarly in both groups, VO2spla only increased in Group II (from 45+/-22 to 59+/-39 ml/min x M2, p < 0.01). The slope of the VO2spla/DO2spla relationship was higher in Group II than in Group I (31.2+/-16.7 versus 10.4+/-5.1%, p < 0.001) and was similar during dobutamine and PEEP (21.9+/-14.2 versus 21.9+/-14.0%, p = NS). In conclusion, VO2spla increased only in septic patients with an increased DSO2 indicating splanchnic dysoxia. The similar slope observed with dobutamine and PEEP suggests that a thermogenic effect was unlikely.