[Herpetological data and management of ophidian envenomation at university hospitals in Abidjan, Côte d'Ivoire]. / Données herpétologiques et prise en charge des envenimations ophidiennes dans les CHU d'Abidjan (Côte d'Ivoire).

This study was carried in the intensive care units of Abidjan university hospitals and in the herpetology department of Pasteur Institute between January 2001 and April 2003. The purpose was to identify ophidian species that were dangerous for man and to document cases of snakebite in Abidjan. The study was carried out in two phases, i.e., collection and identification of snake species followed by review of case records involving snake envenomation at Cocody and Treichville university hospitals. A total of 5 snake families, 14 genera and 17 species including some that were dangerous for man were identified. All species except Naja nigricollis live in forest areas. Most snakebites led to simple clinical signs that regressed within 72 hours with only symptomatic treatment. However, a few cases required immunotherapy. Traditional methods of snakebite treatment were used for first line treatment in 50% of cases.

Effets de la Nicardipine intraveineuse dans les crises hypertensives severes

32 patients d'age moyen 38;56+/- 12;44 ans presentant une poussee hypertensive d'en moyenne 221;31+/- 34;64 mm Hg/134;94 +/- 20;93mm Hg associee a des complications viscerales : accidents vasculaires cerebraux (39 pour cent); encephalopathie hypertensive (22 pour cent); oedeme aigu du poumon (22 pour cent); oligo-anurie (17 pour cent) ont beneficie d'un traitement anti-hypertenseur par la Nicardipine intraveineuse.

[Value of selective prescription of preanesthetic laboratory tests]. / Intérêts de la prescription sélective des examens complémentaires préanesthésiques.

The aim of this study was to determine the comparative value of routine or selective ordering of preoperative tests. 400 ASA I, II, III patients were enrolled in the study. Two periods were considered: a retrospective period where the patients (n = 200) underwent routine preoperative tests and a prospective period where the patients (n = 200) had only preoperative tests according to the results of questioning and clinical examination. During the retrospective period 1.408 tests were effected with 44 abnormal results. During the prospective period, the abnormal results among 855 prescribed tests were: 0.8% in ASA I patients, 7.5% in ASA II and 5.9% in ASA III patients. The ASA I patients had an average of 3.47 +/- 1.28 tests each, ASA II patients 4.50 +/- 1.21 and ASA III 7.50 +/- 1.50. No complication inducing sequelae or death could be linked to lacking tests. The mean cost of tests was reduced by 50 percent.

Seroprevalence de l'infection a VIH dans le service de reanimation du CHR de Bouake

"Dans cette etude prospective; sur 100 patients hospitalises dans le service de reanimation du CHR de Bouake; menee sur une periode de 45 jours (1er juillet 1994 au 15 aout 1994); 18 patients ont une serologie a VIH positive soit un taux de seroprevalence hospitaliere de 18 pour cent. La prevalence par serotype est de 83;3 pour cent de patients a VIH 1 positifs; 5;6 pour cent de patients a VIH positifs et 11;1 pour cent de patients doublement positifs a VIH 1 et VIH 2. Les maries sont les plus touches et representent 61;1 pour cent de seropositifs; tandis que le taux des celibataires est de 27;8 pour cent. Les ""sans profession"" representent 33;36 pour cent. Les patients qui n'ont aucun niveau d'etude ont un taux de 56 pour cent. La notion de transfusion se retrouve chez 11 pour cent de patients seropositifs. On note 3 deces (VIH 1 positifs) parmi les patients seropositifs soit un taux de 17 pour cent et on observe egalement 17 pour cent de deces dans l'echantillon global. On ne note pas une difference significative entre le taux de deces dans l'echantillon global et celui du groupe des patients seropositifs. Ces resultats interpellent les auteurs sur la necessite d'observer des mesures preventives visant a lutter contre ce fleau"

Approche de la dose utile de Diprivan au cours de l'intervention cesarienne

Le but de ce travail est de determiner la dose de Diprivan necessaire a utiliser lors de l'operation cesarienne chez 28 femmes en considerant le poids en fin de grossesse. Le Diprivan a ete utilise a l'induction a la dose de 2;5 mg/kg (poids en fin de grossesse) suivie de l'injection de la celocurine pour l'intubation tracheale. Apres la delivrance artificielle; l'anesthesie a ete approfondie par l'injection de Pavulon ou de Norcuron (0;1 mg/kg) du Fantanyl 50 mcg toutes les 20 mn; du N20/02 (50 pour cent) et des reinjections de 50 mg de Diprivan au moindre signe de reveil. 190;44 6;80 mg de Diprivan a l'induction et 127;02+-1;67 mg lors des reinjections; ont ete utilisees soit au total 317;46+-29;92 mg. La dose moyenne par kg est egale a 4;3 mg/kg soit celle retrouvee dans l'etude de CORTAMBERT et coll

[Comparative study of intravenous midazolam and diazepam used as sedative agents in upper digestive endoscopy]. / Etude comparative du midazolam et du diazépam intraveineux comme agents de sédation en endoscopie haute.

This study compares the effects of midazolam and diazepam used for sedation during upper gastrointestinal endoscopy. One hundred unpremedicated patients who were to undergo gastroscopy were enrolled in a prospective controlled study. They were randomly allocated to two groups. The patients of group I and group II were given respectively midazolam and diazepam. 0.07 mg.kg-1 midazolam were given to patients less than 65 years old, and 0.06 mg.kg-1 after that age. Diazepam doses were 0.15 mg.kg-1 and 0.11 mg.kg-1 respectively. The effect and duration of both drugs were similar. The main differences between them were as follows: the intravenous injection of midazolam was not painful (p < 0.01); sedation (p < 0.05), amnesia (p < 0.01) and patient contentedness were most frequent with midazolam. Neither drug had clinically significant cardiovascular effects.

Morsures de serpents : aspects epidemiologiques et protocole therapeutique

En 12 mois; 53 cas de morsures de serpents ont ete colliges. Le sexe masculin est le plus touche. Le tableau clinique est celui d'un syndrome inflammatoire localise au niveau des membres inferieurs; il est plus sensible a l'heparinate de sodium intraveineux qu'aux anti-flammatoires non steroidiens. La duree moyenne d'hospitalisation a ete de 2;87 jours. Le traitement a ete uniquement symptomatique et l'evolution favorable dans 100 pour cent des cas

Bloc crural associe a la rachianesthesie pour chirurgie de la hanche chez des sujets ages A.S.A. III

Le bloc crural avec 6 ml Bupivacaine a 0;5 et 6 ml de Lidocaine a 2 pour cent a precede la rachianesthesie realisee avec 2 ml de Bupivacaine a 0;5 pour cent; 1ml de G 10 pour cent et 2 ml de Fentanyl. L'indication de cette rachianesthesie etait posee devant une chirurgie de la hanche chez des sujets du grand age (64 a 85 ans) et tares (ASA III). L'analgesie obtenue grace a cette association a ete precoce (6 min.); suffisante pour la chirurgie; et d'une duree prolongee jusque dans le post-operatoire (6h30). Ces auteurs conseillent donc un large usage de ce protocole simple; pas cher et interferant sur les tares preexistantes; surtout dans cette indication particuliere

[The effect of the local anesthetic temperature on spinal anesthesia using 0.5% bupivacaine]. / Influence de la température de l'anesthésique local sur la rachianesthésie à la bupivacaïne à 0.5%.

The aim of this study was to compare spinal anaesthesia with 0.5% bupivacaine at 20 degrees C and 5 degrees C. One hundred two patients ASA I-II were randomized into two groups. After atropine and IV fluid administration, patients of group I received intrathecally at L3-L4 level 0.02 ml.cm-1 of plain 0.5% bupivacaine at 20 degrees C, while patients of group II received the same solution and the same doses but at 5 degrees C. No significant difference was found between the times for installation of sensory and motor blocks nor between the durations of motor block in the two groups. On the other hand significant differences were found between the durations of sensory block in group I (283.33 min +/- 9.40 min) and group II (314.35 +/- 8.80 min) (P < 0.001) and all the more (P < 10(-9)) between the cephalad block extensions in group I (D 7.45 +/- 0.14) and group II (D 4.82 +/- 0.20). Therefore plain bupivacaine 0.5%, isobaric at 20 degrees C, seems to get the properties of an hyperbaric solution when cooled at 5 degrees C.

[Factors changing the length of analgesia in spinal anesthesia]. / Facteurs modifiant la durée de l'analgésie au cours de la rachianesthésie.

So as to determine the effects of some factors on the duration of bupivacaine spinal anaesthesia, a prospective controlled study was carried out on 152 ASA I or II patients. They were randomly allocated to six groups. The patients of group I were given 4 ml of 0.5% bupivacaine at 27 degrees C. The patients of group II were given 4 ml of a mixture including 3 ml of 0.5% bupivacaine, 1 ml fentanyl in 1 ml of 10% dextrose solution. The group III was given 4 ml of a mixture including 3 ml of 0.5% bupivacaine, 0.20 mg adrenaline. The group IV was given 4 ml of a mixture including 3 ml of 0.5% bupivacaine, 0.15 mg clonidine. The patients of group V were given 4 ml of 0.5% bupivacaine at 20 degrees C and those of group VI were given 4 ml of 0.5% bupivacaine at 5 degrees C. There is significant difference between regression times of sensory analgesia of group II and group I, group IV and group III, group VI and group V. The choice of product to lengthen analgesia in spinal anaesthesia depends on the use of each anaesthesist, the characteristic of patients and the duration of surgery.

Utilisation du glycerol buvable dans le traitement preventif de l'hypertension intracranienne

Se proposant de tester l'effet osmotique anti-oedemateux cerebral du glycerol oral; les auteurs de cette communication ont selectionne 53 patients; 25 de sexe masculin et 28 de sexe feminin : 14 accidents vasculaires cerebraux; 30 traumatismes craniens et 9 craniectomies. Tous ces malades avaient a l'admission un score de Glasgow compris entre 13 et 8 et un oedeme papillaire au fond de l'oeil. Les cas d'H.E.D. et d'H.S.D. sont exclus de ce travail. Le glycerol buvable a ete utilise comme element principal de traitement anti-oedemateux cerebral. La resorption de l'oedeme papillaire a ete effective chez 32 pour cent des sujets au bout de 4 jours et chez 47 pour cent des sujets au bout de 7 jours de prise du glycerol et l'evolution finale a ete favorable dans 71;7 pour cent des cas au prix de complications mineures

[Comparison of adrenaline and clonidine to extend the analgesic effect of bupivacaine without glucose in spinal anesthesia]. / Comparaison de l'adrénaline et de la clonidine pour prolonger l'effet analgésique de la bupivacaïne sans glucose au cours de la rachianesthésie.

So as to determine the effects of adrenaline and clonidine on the duration of isobaric bupivacaine spinal anaesthesia, a prospective controlled study was carried out on 20 ASA I or II patients. They were randomly allocated to two groups. The patients of group I were given 4 ml of a mixture including 3 ml of 0.5% bupivacaine, 0.2 mg adrenaline. The patients of group II were given 4 ml of a mixture including 3 ml of 0.5% bupivacaine, 0.15 mg clonidine. The segmental level of sensory loss was tested using forceps. The time course required for maximal spread on the sensory blockade did not differ in the two groups: 4.00 +/- 1.01 min. for group I and 3.60 +/- 0.90 min. for group II. No difference was observed between median highest levels of sensory analgesia. Regression times were 520.70 +/- 79.52 min for group II and 360.40 +/- 51.47 min. for group I. Significant prolongation of motor block was also associated with the addition of vasoconstrictors. It is concluded that addition of 0.15 mg clonidine may be useful to increase duration of isobaric bupivacaine spinal anaesthesia.

[Results of resuscitation in injured elderly patients]. / Résultats de la réanimation chez le sujet âgé traumatisé.

This study assessed the results of intensive care in elderly trauma patients and quantified the different factors involved in the final outcome. It included 116 patients, aged 65 years or more, and covered a two year period. The following parameters were obtained for each patient: age, severity of trauma (ISS and SAPS), head injury (GCS), prehospital health status (ESA), survival after three months and quality of survival. Three months after trauma, overall mortality was 45.7%. Survivors were 72.8 +/- 4.9 year old, while those that died were 75.3 +/- 7.5 year old (p = 0.01). Mean ISS was 19.7 +/- 8 and mean SAPS was 9.4 +/- 3.2. The risk of death was 3.6 (1.6 to 8.1) times greater if ISS was over 15. The same risk was 4.7 (2.1 to 11.1) times greater if SAPS was over 9. GCS was 8.8 +/- 4.4 in dead patients and 12.5 +/- 2.4 in survivors (p = 0.001). The risk of death was 10.4 (4.2 to 26.2) times greater if GCS was under 8. The final prognosis could be assessed with the following exponential model: Survival = 1/(1 + exp - (8.7 - 0.07 X age - 0.07 X ISS - 2.9 X GCS*), where GCS is equal to 0 if the real GCS was under 8, and equal to 1 otherwise. The ESA did not affect mortality. Three months after trauma, the degree of independence was the same as before in 87% of survivors. It was concluded that age and the severity of trauma were the most important factors in determining prognosis in geriatric trauma patients.(ABSTRACT TRUNCATED AT 250 WORDS)