[Anesthetic management of obstetrical labor in a parturient with muscular carnitine palmitoyl transferase deficiency]. / Prise en charge anesthésique du travail obstétrical chez une parturiente atteinte d'un déficit musculaire en carnitine palmitoyl transférase.

We report a case of a patient with carnitine palmityl deficiency in active labour. We discuss the metabolic and energetic implications of obstetrical labour in regard with the mitochondrial myopathy and we propose an optimal management. Neuroaxial analgesia and glucose infusion are indicated in early labour because it is necessary to alleviate stress and pain in order to avoid rhabdomyolysis associated with CPT deficiency. Combined spinal epidural analgesia using intrathecal opioid alone then epidural naropein should be a relevant choice because of a minimal motor blockage. Monitoring of myolysis using serum creatinine phosphokinase levels must take in account CK and MB fractions releases to the circulation during obstetrical labour.

[Post-partum suppurating thrombophlebitis of the ovarian vein presenting with pleuropulmonary manifestations]. / Thrombophlébite suppurée de la veine ovarienne du post-partum révélée par des manifestations pleuropulmonaires.

Following a normal delivery, a 22-year-old primigravida experienced fever resistant to antibiotic therapy. On the tenth post partum day, thoracic pain and chest X-ray were in favour of acute pneumonitis of left inferior lobe. Considering the extension to the right lung and a normal bronchic fibrescopy, a computed tomography (CT) was performed which showed a right ovarian vein thrombophlebitis, right minor subpleural opacities and left pneumopathy. The final diagnosis was post partum ovarian vein suppurated thrombophlebitis with pulmonary septic metastases from haematogenic diffusion. Post partum thrombophlebitis is a rare event with an incidence of 1 per 2,000 deliveries. Pulmonary inaugurating symptoms result rather from pulmonary embolism than from septic metastases. Post partum persisting and unexplained fever should be explored with abdominal CT-scan.

[Obstetric analgesia: peridural analgesia versus combined spinal and peridural analgesia]. / Analgésie obstétricale: analgésie péridurale versus analgésie rachidienne et péridurale combinée.

OBJECTIVE: To compare the analgesic efficiency, side effects and obstetrical repercussions of epidural analgesia (EP) and combined spinal-epidural analgesia (CSE). STUDY DESIGN: Prospective, randomized, double or single-blind studies as required, approved by the ethical committee of the institution. PATIENTS: The study included 80 parturients, in active labour with a singleton in vertex presentation and a cervical dilatation of 3 cm or less, randomly allocated to receive either EP (n = 40) or CSE (n = 40). METHOD: In the EP group, sufentanil (20 micrograms) and 0.25% bupivacaine (6-8 mL) were injected into the epidural space. In those of the CSE group, sufentanil (10 micrograms) was first injected into the subarachnoid space, followed by an epidural injection of the same agents at the same quantities as for the EP group. Additional analgesia was obtained in both groups by top-ups of 6-8 mL of 0.25% bupivacaine at the request of the patients. Analgesia, course of labour, obstetrical outcome, and neonatal status were assessed. Statistical analysis was performed using Anova, chi 2 analysis, Yates' correction or Fisher's exact test, with a P < 0.05 considered as significant. RESULTS: Both groups had similar demographic and obstetric data. The onset of analgesia was more rapid in CSE group (8 +/- 11 min vs. 12 +/- 7 min, P < 0.05), however the duration was similar. Technical incidents were more frequent in the CSE group (30% vs. 7%, P < 0.05). The technique of analgesia did not influence the bupivacaine amounts required for its maintenance. The incidence of adverse effects were comparable with the exception of vertigo, which was more frequent in the EP group (57% vs. 28%, P < 0.05). The first stage of labour was increased by 30% in the CSE group (281 +/- 130 min vs. 216 +/- 97 min, P < 0.05), without significant prolongation of labour length. Durations of second stage and expulsion were similar in both groups, despite the administration of a lower dose of bupivacaine in the CSE group (33 +/- 17 mg vs. 46 +/- 12 mg, P < 0.05). The rates of instrumental deliveries and Caesarien sections were comparable. The Apgar scores were satisfactory at 5 min. CONCLUSION: In the early phase of labour, the CSE technique using intrathecal sufentanil has no significant benefit when compared to the EP technique using bupivacaine and sufentanil. In the CSE group, technical incidents were more frequent and the length of the first stage of labour was increased.

[Transcutaneous electric stimulation of the brain: a comparative study of the effects of its combination with peridural anesthesia using bupivacaine-fentanyl during obstetrical analgesia]. / Electrostimulation cérébrale transcutanée: étude comparative des effets de son association à l'anesthésie péridurale par bupivacaïne-fentanyl au cours de l'analgésie obstétricale.

In order to test the effectiveness of Anesthelec (transcutaneous cranial electrical stimulation with Limoge currents) during labour and delivery, a randomized study was carried out in 120 primiparous women with extradural anaesthesia during active labor. Combination of transcutaneous cranial electrical stimulation with epidural bupivacaine administration has been showed to provide a 20% pain relief prolongation of the first bupivacaine injection. Statistical studies of drug requirement during labor, of cervical dilatation duration, of mode and duration of delivery and of analgesia quality showed no beneficial additive effect of electrical stimulation for obstetrical analgesia when extradural anaesthesia is performed.

[The detection of thromboembolism in orthopedic traumatology: the value and limitations of D-dimer determination by the latex method]. / Détection thromboembolique en orthopédie traumatologie: intérêt et limite du dosage du D-dimère par la méthode au latex.

We studied the usefulness of plasma D-dimer determination by a latex agglutination test used as a deep venous thrombosis (DVT) detection method in patients undergoing recent orthopaedic or traumatologic surgery. Asymptomatic patients with a level of D-dimer up to 1.5 micrograms/ml suffered phlebographic venous thrombosis in 49.3% of the cases. Because a predictive value of negative test of 0.77 the latex assay cannot be recommended for screening in symptomatic DVT. However, post operative measurement of cross linked fibrin derivatives in plasma may play a role in the selection of asymptomatic patients for venography.

[Errors in the measurement and interpretation of pulmonary artery pressure values evaluated by the Swan-Ganz method]. / Erreurs de mesure et d'interprétation des valeurs des pressions artérielles pulmonaires évaluées selon la méthode de Swan-Ganz.

The data collected by way of the catheter has for goal to give a better therapeutic treatment and is therefore directly related to the quality of the analysis of the signal. The fidelity of the measurements depend on the performance of the material used and also to other distortions linked to their utilization. In intensive care and in perioperative resuscitation, the interpretation must also take into account the possible interference from physiopathologic mechanisms which are sometimes very complex and can modify results in a number of situations both clinical and therapeutic and in particular when they are accompanied by vascular and respiratory perturbations.

[An open study on the efficacy and tolerance of a low molecular weight heparin (CY 216) in the therapeutic treatment of deep venous thrombi in orthopedics]. / Etude ouverte de l'efficacité et de la tolérance d'une héparine de bas poids moléculaire (CY 216) dans le traitement curatif des thromboses veineuses profondes en orthopédie.

A prospective clinical trial was performed to evaluate the efficacy and safety of a low molecular weight heparin (nadroparine, CY 216) in the treatment of patients with deep venous thrombosis following recent orthopaedic surgery or trauma. Forty-three patients received nadroparine subcutaneously, 100 IU AXa.kg-1 every 12 hours for a period of 10 days. A quantitative assessment of deep vein thrombosis was made according Marder's scoring after 10 days of treatment. A substantial lysis was observed in 73 per cent and a revascularisation in 52 per cent of the patients. These results are statistically significant, although not correlated with the clinical symptoms and the size of the thrombi. Tolerance was assessed on the rate of bleeding events: a minor bleeding occurred in 6 per cent of the patients. Laboratory adjustment was performed in 8 per cent of the cases. The results of this study suggest that nadroparine administered subcutaneously at a fixed daily dose of 200 IU AXa.kg-1 is as efficient and safe as unfractionated heparin in the treatment of early venous thrombosis following orthopaedic surgery or trauma.

[Non controlled prospective study of the efficacy and tolerance of a low molecular weight heparin]. / Etude prospective non contrôlée de l'efficacité et de la tolérance d'une héparine de bas poids moléculaire (tédelparine) dans la prophylaxie thrombo-embolique en chirurgie traumatologique du col du fémur.

A prospective trial has been carried out on 50 patients to test the efficacy and tolerance of low molecular weight heparin in surgery involving a high risk of thromboembolic complications. Tedelparin shows a tendency to reduce the frequency of post-operative thromboembolic disease in post-traumatic hip surgery. The effectiveness of the different low molecular weight heparins still remains to be quantified by comparative pharmacological studies. The alternative use of these treatments, whose high tolerance level make suitable for geriatric surgery do not exempt them from the biological monitoring of platelet count as they do not exclude the risk of heparin induced thrombocytopenia syndrome.

[Prevention of thromboembolism using low molecular weight heparin and hemodilution in traumatologic geriatric surgery of the femur neck]. / Prophylaxie thrombo-embolique par héparine de bas poids moléculaire et hémodilution en chirurgie traumatologique gériatrique du col du fémur.

A routine method of prophylaxis of thromboembolic disease is evaluated on 181 elderly patients undergoing post-traumatic hip surgery. A low incidence of proximal thrombosis and fatal embolism is noted and rated as a beneficial effect of the association of low molecular weight heparin therapy and moderate hemodilution; it is also connected with a precocious diagnosis of the thrombotic complications--before the proximal extension of silent thromboses--by the measurement of specific fibrin derivatives used as a screening technique in order to select the patients who will have to undergo venographical examination.