[Difficulty of regional anaesthesia catheter withdrawing due to a knot: three case reports]. / Echec de retrait de cathéters nerveux périphériques : les noeuds, une complication à connaître.

We observed three cases of knots after peripheral nerve catheterism. Catheter removal was impossible and required the intervention of an anaesthetist. This complication should be known and included in the training of nurses. The analgesic technique by peripheral nerve catheter is currently used for the treatment of acute postoperative pain and starts to be used for the treatment of chronic pain. The catheter removal should be included in a protocol. One solution might be the use of a network to meet all the complications that happen in continuous peripheral nerve blocks, particularly at home.

[Method of radiotherapy planning for head and neck tumors using simulated CT images and radiographic data, developed at the Gustave Roussy Institute]. / Méthode utilisée à l'institut Gustave Roussy pour l'établissement des plans de traitement des cancers ORL à partir des images de simulateur-scanneur et du film radiographique de profil.

The paper deals with the recent improvements introduced in the most usual method applied in the Institut Gustave Roussy radiotherapy department for obtaining the anatomical data of patients treated for head and neck tumors. For each of these patients, five to seven transverses slices and a lateral radiographic film are taken from a Mecaserto simulator-CT. The anatomical representation of the patient sagittal plane is carried out from the digitalisation of the radiographic film on a Vidar Vxr-12 Plus film scanner and integrated into the Dosigray dose calculation programme in order to be used as a support for the laying out of the dose distribution in reference to the treatment. The sagittal anatomical representation obtained from the radiographic film digitalisation is compared with the one resulting from the interpolation between a limited number of irregularly-spaced transverse slices taken on the simulator-CT. The method using the simulator-scanner transverse slices and the radiographic film digitalisation represents an interesting alternative for obtaining an anatomy simulation representative of the patient in hospitals where a scanner is not available full-time for the needs of the radiotherapy process.

Haemobilia causing acute pancreatitis after percutaneous liver biopsy: diagnosis by magnetic resonance cholangiopancreatography.

Magnetic resonance cholangiopancreatography (MRCP) has received much attention as a non-invasive alternative to endoscopic retrograde cholangiopancreatography, primarily for investigation of choledocholithiasis, but also for evaluation of less common biliary anomalies. We present a case of haemobilia causing acute pancreatitis after percutaneous liver biopsy in which the diagnosis could be made clearly by MRCP, thus avoiding endoscopic retrograde cholangiopancreatography and sphincterotomy.

Segmental reversal of the small bowel as an alternative to intestinal transplantation in patients with short bowel syndrome.

OBJECTIVE: This article reports the results of segmental reversal of the small bowel on parenteral nutrition dependency in patients with very short bowel syndrome. SUMMARY BACKGROUND DATA: Segmental reversal of the small bowel could be seen as an acceptable alternative to intestinal transplantation in patients with very short bowel syndrome deemed to be dependent on home parenteral nutrition. METHODS: Eight patients with short bowel syndrome underwent, at the time of intestinal continuity restoration, a segmental reversal of the distal (n = 7) or proximal (n = 1) small bowel. The median length of the remnant small bowel was 40 cm (range, 25 to 70 cm), including a median length of reversed segment of 12 cm (range, 8 to 15 cm). Five patients presented with jejunotransverse anastomosis, and one each with jejunorectal, jejuno left colonic, or jejunocaecal anastomosis with left colostomy. RESULTS: There were no postoperative deaths. Three patients were reoperated early for wound dehiscence, acute cholecystitis, and sepsis of unknown origin. Three patients experienced transient intestinal obstruction, which was treated conservatively. Median follow-up was 35 months (range, 2 to 108 months). One patient died of pulmonary embolism 7 months postoperatively. By the end of follow-up, three patients were on 100% oral nutrition, one had fluid and electrolyte infusions only, and, in the four other patients, parenteral nutrition regimen was reduced to four (range of 3 to 5) cyclic nocturnal infusions per week. Parenteral nutrition cessation was obtained in 3 of 5 patients at 1 years and in 3 of 3 patients at 4 years. CONCLUSION: Segmental reversal of the small bowel could be proposed as an alternative to intestinal transplantation in patients with short bowel syndrome before the possible occurrence of parenteral nutrition-related complications, because weaning for parenteral nutrition (four patients) or reduction of the frequency of infusions (four patients) was observed in the current study.

Proton NMR studies of tissue water phases during chemical carcinogenesis in rats.

The water content, relative ratio of bound water, mean 1H NMR spin-lattice relaxation time T1, and T1 of bound water fraction were studied on rat liver during the course of cancer induction by diethylnitrosamine. Using the FETS model proposed by Fung, the results were discussed according to histology. Liver T1 increase was correlated with water content and a regular decrease of T1b was observed during the course of hepatocarcinogenesis, associated with a shift of the position of the minimum of T1b toward the negative temperatures. A biphasic decay of T1b was also noticed in the presence of hepatocarcinoma nodules.

Pheochromocytoma in a long-term hemodialysis patient.

A right adrenal tumor was found incidentally by renal echography in a 25-year-old man, who had been on hemodialysis for 4 years. Inquiry and clinical examination suggested pheochromocytoma, which was confirmed by plasma catecholamine measurements. Subsequent adrenalectomy was uneventful. Although hypertension, headache, and diaphoresis are common symptoms in a dialyzed patient, pheochromocytoma has to be eliminated in the presence of this clinical triad.

[Use of grafts for the olecranial crest in rhinoplasty]. / Utilisation des greffons de crête oléocrânienne dans la rhinoplastie.

On the basis of 30 cases of rhinoplasty utilizing an ulnar crest graft performed over the past few years, the authors review the various types of grafts used for rhinoplasty and describe the technique for sampling the ulnar crest graft in detail. They stress the merits of this procedure: --superficial, easily accessible donor site; --simple postoperative period; --minimal scars; --good-quality graft requiring minimum modeling.

1H- and 2H-NMR study of bovine serum albumin solutions.

Frozen, native and denatured bovine serum albumin solutions have been studied with a wide-band NMR pulse spectrometer. Both macromolecular and water protons spin-spin and spin-lattice relaxation times--t2m, t1m, t2w, t1w--have been measured between 170 and 360 K. In the native sample, the t2m process is the tumbling rate of the bovine serum albumin molecules. It gives to the spin-lattice relaxation an omega 0(-2) frequency dependence at room temperature in the studied frequency range, 6-90 MHz. An additional process contributes to t1m-1; it arises from internal backbone or segmental motions and provides a lower frequency behaviour. On denaturation, bovine serum albumin molecules lose their tumbling motion and form a rigid network, while internal backbone motions seem unaffected. Calorimetric Cp measurement confirms the occurrence of a phase transition upon denaturation. 1H and 2H spin-lattice relaxation times of water protons depend mainly on bound water mobility. 1H and 2H t2w depend also on the tertiary structure of bovine serum albumin and on its mobility, because of a fast exchange process between water and some protein protons (or deutons), while a cross-relaxation process between protein and water protons contributes to 1H t1w. Denaturation has no influence on bound water motional properties and bound water population.

Proton nuclear magnetic resonance of regenerating rat liver after partial hepatectomy.

Spin-lattice (T1) and spin-spin (T2) proton nuclear magnetic resonance relaxation times were measured over a 48-hours period of experimental liver regeneration in Wistar rats. T2 showed an early significant increase reaching a plateau 30% above baseline from the 10th hrs onwards. Laparotomized control animals showed no change in T2 values. The increase in T1 occurred at a later stage but was no different from that in laparotomized controls. T1 reached a peak, 20% above baseline, around the 30th hr. The changes observed were far less marked than those previously described for cancer tissue, which showed about a 60% increase in T1. Liver T1 fluctuations followed a circadian pattern, with a minimum at night's end and a maximum around mid-day. No circadian rhythm was seen for T2. The observed T1 and T2 changes were discussed with respect o mitotic and metabolic events known to occur during regeneration of the liver.

Nuclear magnetic resonance study of cancer: systemic effect on the proton relaxation times (T1 and T2) of human serum.

Increased spin-lattice T1 and spin-spin T2 proton relaxation times of malignant tissues are by now well documented phenomena. A "systemic effect" of cancer, evidenced by NMR, has been demonstrated in different experimental models. The present study was undertaken to examine systemic effect in man by measuring serum relaxation times and related biochemical variables in 224 healthy control individuals and 311 patients with solid tumors at different stages of growth. The increase in T1 values is statistically significant in the advanced cancer group but not in the nonevolutive disease group, compared to healthy control group. Variations of T2 values are not significant in this study. There is no correlation of T1 increase with serum ions, total proteins or protein fractions.

[Continuous monitoring of temperature in anesthesia and intensive care]. / La surveillance continue des températures en anesthésie-réanimation.

Continuous surveillance of both regional and general temperatures is of great interest in anaesthesia and intensive care. After a brief review of temperature regulation and the value of temperature control, the authors suggest a simple and reliable method of surveillance. This uses Chromel/Alumel thermocouples connected to a central device used to store the information. An experimental clinical study involved the assessment of 3 different anaesthetic protocols: Taractan-Palfium; Droleptan-Phenoperidine, Fentanyl only. These measurements were made in 30 young subjects undergoing a maxillofacial surgical procedure under identical conditions. The parameters studied were central temperature (rectal) and skin temperature of the index finger. With regard to peripheral temperature curves the results showed a first phase consisting of fall followed by a second phase characterised by a sudden increase up to a plateau. This plateau (3rd phase) persisted as long as the subject slept. The 4th phase, when peripheral temperature fell suddenly to a level sometimes lower than the initial temperature represented one of the first signs of awakening. As far as central temperature was concerned it fell in a linear fashion for all curves. Comparing the different curves obtained, the authors conclude by noting that the more vasoplegic the anaesthetic protocol, the higher the induction peak of the second phase of peripheral temperature pattern, but also that the fall in central temperature was marked. The authors feel that an anaesthetic which is biologically satisfactory and at the same time produces an overall fall in the production of heat without causing chills avoids the development of vasoconstrictor reactions between the care and the surface which are reflected by a decrease in the gradient between central and peripheral temperatures.

[The Cerebral Function Monitor. Description, functioning and interpretation principles]. / Le Moniteur de Fonction Cérébrale. Description - principe de fonctionnement et d'interprétation.

The Monitor of Cerebral Function enables continuous monitoring of the cerebral electrical activity and this over long periods due to the slow recording speeds. The cerebral electrical signals picked up by the electrodes attached to the scalp are registered in the form of a curve which fluctuates to a greater or lesser extent depending on the recording speed. The examination of the height of the curve with respect to zero and its amplitude indicates the voltage of the cerebral activity and yields information regarding polymorphism. It is thus possible to monitor variations in cerebral activity over a prolonged period during anaesthesia as well as during the revival phase with the Monitor of Cerebral Function, the electroencephalogram being reserved as an aid to precise diagnosis and for localization and close scruting of the anomalies.

[Cerebral Function Monitor (CFM) and electroencephalography (EEG). Experimental study]. / Moniteur de Fonction Cérébrale (MFC) et électro-encéphalogramme (EEG). Etude expérimentale.

This work is an attempt to connect the electro-encephalogram (EEG) and monitor of cerebral function (MCF) recordings during the experimental stimulation of the rabbit brain whether this is in the from of direct central stimulation, by stereotaxic location, or in the form of indirect stimulation via a peripheral nerve. These stimulations, performed under alfadione anaesthesia or under the neuroleptanalgesic sedative effect of chlorprothixine, are compared for every animal with the results of the control stimulations. The cardiovascular responses are recorded simultaneously. It has been found that, in simple narcosis induced by alfadione, there is much variation in the EEG recording and even more so in the MCF recording according to the quantity used and the block of responses to stimuli does not appear until there is deep anaesthesia. However, when chlorprothixine is used, the MCF trace is found to be very closely related to the trace of mild anaesthesia with accompanying block to all of the nociceptive stimulations. It would seem, therefore, if we accept the concept of levels of cerebral activity, that the use of the MCF could well open the way to a better understanding of the pure narcotic phenomena and of the neurovegetative response block to aggression.

[Cerebral Function Monitor and anesthesia]. / Moniteur de Fonction Cérébrale et anesthésie.

The Monitor of Cerebral Function was employed in anaesthesia for a double purpose: as a monitor of anaesthesia, of possible complications and of overdosage that might lead to cerebral damage; a bringing up to date of the comparative data on the various anaesthetic protocols. In this manner, we were able to demonstrate the during anaesthesia application of a cerebral monitor that is well designed and easy to handle. A comparative study of hypnotic anaesthetics and those that induce neuroleptanalgesia demonstrated that, in certain cases, the same anaesthetic stability is achieved when there is an early appearance of the electric silences as when the cerebral electrical activity is only slightly modified.

Purification and specificity of bacteriolytic enzyme I from Hartmannella glebae.

A soil amoeba (Hartmannella glebae), when grown in conjunction with Enterobacter aerogenes and Alcaligenes faecalis, produced two enzymes. Enzyme I was purified by gel filtration on Sephadex G-100 and chromatography on diethylaminoethyl-cellulose. It is a basic protein. The analysis of the enzymic digest of the cell walls of Micrococcus lysodeikticus after reduction and acid hydrolysis showed that the enzyme cleaved the glycosidic bond between acetylmuramic acid and acetylglucosamine of the peptidoglycan moiety of the cell walls. The enzyme is identified as endo-beta-N-acetylmuramidase.