[Perimenopausal discovery of endometriomas on ovarian abscess]. / Découverte périménopausique d'un endométriome sur abcès ovarien.

Ovarian abscess is a rare gynaecological diagnosis. The case reported is the one of an unexplained fever with a strong physical alteration during more than 14 days occurring around the menopause, at the age of 54. It has been discovered an ovarian tumour which was, infact, an infected endometrioma. The patient never complained from endometriosis during her reproductive life. She had no other risk factor for ovarian abscess.

A comparison of volatile and non volatile agents for cardioprotection during on-pump coronary surgery.

A randomised study of 414 patients undergoing coronary artery surgery with cardiopulmonary bypass was conducted to compare the effects of a volatile anaesthetic regimen with either deesflurane or sevoflurane, and a total intravenous anaesthesia (TIVA) regimen on postoperative troponin T release. The primary outcome variable was postoperative troponin T release, secondary outcome variables were hospital length of stay and 1-year mortality. Maximal postoperative troponin T values did not differ between groups (TIVA: 0.30 [0.00-4.79] ng x ml(-1) (median [range]), sevoflurane: 0.33 [0.02-3.68] ng x ml(-1), and desflurane: 0.39 [0.08-3.74] ng x ml(-1)). The independent predictors of hospital length of stay were the EuroSCORE (p < 0.001), female gender (p = 0.042) and the group assignment (p < 0.001). The one-year mortality was 12.3% in the TIVA group, 3.3% in the sevoflurane group, and 6.7% in the desflurane group. The EuroSCORE (p = 0.003) was the only significant independent predictor of 1-year mortality.

Prevention of postoperative hypotension following spinal anesthesia for TURP: a double-blind randomized controlled trial comparing ephedrine with placebo.

Spinal hypotension (SH) is a common side effect of spinal anesthesia and may also occur after the surgical procedure. In this double-blinded, placebo-controlled, randomised clinical trial fifty patients undergoing transurethral prostatectomy under spinal anesthesia received 10 mg of ephedrine IV before being transferred from the operating table into their bed after the procedure, whereas fifty controls received saline IV. The number of per- and postoperative hypotensive episodes and vasopressor use, time delay between the administration of the study medication and the first hypotensive episode, level of spinal blockade at the start of surgery, pre- and postoperative hemoglobine and sodium concentration, cardiovascular co-morbidity and chronic medication were registered. There was no statistically significant difference in the incidence of postoperative hypotension between the two groups, but Poisson regression of the expected number of postoperative hypotensive episodes per patient showed a protective effect of ephedrine (p < 0.05). The occurence of peroperative hypotension was a risk factor for developing postoperative hypotension (p < 0.05). There was no statistically significant relation between age, level of spinal blockade, cardiovascular co-morbidity or biochemical parameters and the risk of developing per- or postoperative hypotension, except for a correlation between preoperative alpha-receptor blocking drugs and peroperative hypotension (p < 0.05). Postoperative hypotension (recorded incidence 31%) was almost as common as peroperative hypotension (recorded incidence 37%) and occurred as late as 190 minutes after the end of surgery. Ephedrine IV at the end of surgery reduced the number of postoperative hypotensive episodes per patient but did not reduce the overall incidence of postoperative SH.

[Hematemesis disclosing hemorrhagic fever with renal syndrome]. / Hématémèse révélatrice d'une fièvre hémorragique avec syndrome rénal.

We report a case of hematemesis as the presenting sign of hemorrhagic fever with renal syndrome. Gastroscopy revealed hemorrhagic gastropathy. Such lesions are a common finding in epidemic nephropathy, the European form of the disease. The occurrence of such lesions could be induced in a direct, cytopathic effect of the virus but seems also to be related to the severity of thrombocytopenia.

Intubating conditions and neuromuscular effects of mivacurium during propofol-alfentanil anaesthesia.

In three groups of 20 patients, anaesthetized with propofol and alfentanil, tracheal intubation conditions and the onset of neuromuscular blockade after administration of three different doses of mivacurium chloride (0.11, 0.15, and 0.19 mg/kg = 1.5 x ED95, 2 x ED95, and 2.5 x ED95) were assessed. Intubation conditions were found to be clinically acceptable (good or excellent) in 83% of patients. Eighty-two per cent of patients were successfully intubated on the first attempt after 60-90 s. No difference in intubation scores or number of intubation attempts among the three dosage groups were found. We conclude that mivacurium chloride allows smooth intubation in most patients within 60-90 s, even with the lowest dose (0.11 mg/kg), after a propofol-alfentanil induction of anaesthesia. However, because there were a few patients in whom intubating conditions were inadequate at 60-90 s, we are reluctant to advocate the preference of mivacurium chloride over suxamethonium for rapid sequence induction in emergency situations.

[Association of pseudochylothorax and pleural tuberculosis. Apropos of a case]. / Association pseudochylothorax et tuberculose pleurale. A propos d'une observation.

The authors report a case of pseudochylothorax revealed by pleural tuberculosis. Classically, pseudochylothorax is a late complication of chronical and calcified pleurisy especially sequellae of tuberculosis treated by induced pneumothorax. Treatment consist on thoracentesis or aspiration with frequent remove. Surgical decortication can be useful. Specific chemotherapy is only necessary in the patients in whom tuberculosis is present or never treated with antibiotics.

[Campylobacter fetus ssp fetus septicemia associated with a colonic abscess]. / Septicémie à Campylobacter fetus ssp fetus associée à un abcés colique.

Campylobacter is considered to be an opportunistic agent. The authors relate an unusual case with Campylobacter fetus ssp fetus (CF) septicemia and colic abscess. Human Campylobacteriosis is presumed to be a food-born disease related to contaminated animal products such as milk or meat. In some cases CF may be transmitted by drinking water or by fecal soiling via the hands. Conventional treatment uses macrolides with decrease the duration of diarrhea and reduce the fecal excretion of CF. Macrolides are ineffective in CF septicemias. In such cases aminoglycosides seem to be the drug of choice.

[Duplex Doppler ultrasonography of intra-renal arteries. Normal and pathological aspects]. / Echo-Doppler pulsé des artères intra-rénales. Aspects normaux et pathologiques.

Duplex Doppler ultrasonography may explore renal perfusion in frequent diseases such as renal obstruction, reno-vascular hypertension, acute or chronic renal failure or diabetic renal complications by measuring Pourcelot's resistive index (RI) of renal parenchyma arteries for each kidney. A statistical and prospective study was performed on 574 patients. In healthy patients, the RI values, equal for each kidney were included in 0.45 and 0.7 (mean RI = 0.59). For other values, there was a renal pathology. Patients with idiopathic hypertension (mean RI = 0.59) or non obstructive dilatation (mean RI = 0.61) did not have an RI significantly different from healthy patients. In cases of renal obstruction, there was a significant increase in the RI for the pathological kidney (mean RI of 0.73). The sensitivity and the specificity was 100% for acute obstructions examined during the first 48 hours. In contrast, in case of renal artery stenosis greater than 70% there was a significant decrease in the RI for pathological kidney. So the RI increased significantly in both kidneys: when there was renal failure with active disease within the tubulo-interstitial compartment (mean RI of 0.77); in all cases of diabetic nephropathy (mean RI of 0.74) where the RI increased early before laboratory signs. Duplex Doppler ultrasonography may be an original method for renal explorations by providing not only morphological data but also physiological data with the perfusion study.