[Generalized seizure induced by methohexital]. / Convulsion généralisée induite par le méthohexital.

Seizures induced by methohexitone have been reported in epileptic patients. An alcoholic patient without any previous history of epilepsy had grand mal-like seizures after being given an intravenous injection of 4 mg X kg-1 methohexitone. The respective parts played by high doses of methohexitone and chronic alcoholism in the induction of seizures are discussed.

[Control of the ratio of the flow rate of the substitution fluid to the blood removal rate during preoperative normovolemic hemodilution]. / Asservissement du débit d'administration du soluté de substitution à celui du prélèvement sanguin au cours de l'hémodilution normovolémique préopératoire.

Twenty-one patients (mean age 46 +/- 13 years) due to undergo abdominal or ENT surgery, presumed to give rise to an important blood loss were included in this study. None had any contra-indication to the use of normovolaemic haemodilution (NH). Mean initial haematocrit was 40.3 +/- 1.8%. Their estimated total blood volume was 4,867 +/- 857 ml. The patients were anaesthetized with thiopentone, fentanyl, vecuronium or atracurium. Maintenance was carried out with isoflurane (0.5% during NH). Usual haemodynamic monitoring was used throughout. The required haematocrit was decided on before starting NH. The amount of blood to be removed was calculated with usual mathematical formulae. A radial artery cannula (n = 7), or a subclavian or femoral venous cannula (n = 14) was used to remove blood, which was collected within a bag containing CPC-adenine. Six % hydroxyethyl starch (Elohes) was given through a short venous cannula some distance from the first one. An antiparallel double line set in a roller pump was used to carry out the NH. A mean 1,341 +/- 405 ml of blood were withdrawn so as to reach a mean haematocrit of 30.6 +/- 2.4%. NH was completed within 17 +/- 6 min. No major haemodynamic changes occurred during the procedure. No significant differences were observed between expected and observed final haematocrits. There was no effect of the volume of blood withdrawn on the error of haematocrit prediction (0.5 +/- 0.3%). However, a higher rate of blood removal could increase this error. This easy-to-use device seems to provide fast and identical rates of blood removal and replacement. The expected haematocrit may thus be reached reliably, even if this must be checked for the sake of safety.

[Evaluation and treatment of chronic pain after cervicofacial cancer surgery]. / Evaluation et traitement des douleurs chroniques après chirurgie carcinologique cervico-faciale.

When lasting pain occurs after surgery of head and neck cancer, tumoral recurrence should be considered. In addition to curative treatment, relief of pain is often provided by opioid analgesics. Doses vary according to tolerance and patient. Other than digestive routes of administration may be required. Here are two clinical reports: the first case with cervical epidural analgesia by ambulatory autoadministration device (Patient control analgesia), the other one with intrathecal in C7-T1 catheter with port access in which morphine was injected every 24 hours resulting in efficient analgesia, in metastatic Pancoast's syndrome. Surgical or radiotherapy sequelae sometimes bring about pain; bilateral cervicalgy described as burns associated with pain-related depression, 18 months after glotto-subglottic partial laryngectomy, requires psychological support and carbamazepine for desafferation pain removed within 6 months. When the only treatment left appears to be analgesia after surgery of head and neck cancer, follow-up in a multidisciplinary pain treatment centre allows a therapeutical management with optimum tolerance and efficiency.

[The effect of alfentanil on pain caused by the injection of propofol during anesthesia induction in children]. / Influence de l'alfentanil sur la douleur à l'injection de propofol, lors de l'induction anesthésique pédiatrique.

Three modes of administration of alfentanil were assessed in order to reduce pain on injection with propofol. Forty healthy children scheduled for ENT surgery were included in this double-blind randomized study. All patients received intrarectal premedication with midazolam and atropine. Pain was scored with a behavioral scale. The children experience pain when alfentanil was administered a few seconds before or just after propofol. An bolus injection reduced significantly discomfort in patients. Dosages of alfentanil in plasma might determine the right moment of propofol injection to obtain analgesia.

[Effects of anesthesia induction with propofol on plasma renin activity and atrial natriuretic factor secretion. A preliminary study]. / Effets de l'induction anesthésique au propofol sur l'activité rénine plasmatique (ARP) et la sécrétion de facteur natriurétique auriculaire (ANF). Etude préliminaire.

The authors have noted a substantial increase in plasma renin activity, when the patients were induced with propofol (2.5 mg.kg-1). Although a direct or an indirect effect of propofol may be suggested, the design of this study is not helpful in pointing out the responsibility of the drug in the observed effects. Further studies including peripheral vascular resistance measurements should be undertaken.

[Current status of Clostridium difficile: recent advances in diagnostic materials and treatment of colitis and diarrheas associated with antibiotic therapy]. / Mise à jour sur Clostridium difficile: progrès récents en matière de diagnostic et de traitement des colites et diarrhées associées à l'antibiothérapie.

Clostridium difficile infection covers several clinical pictures which have been identified only recently. The majority are based upon imbalance in the intestinal ecosystem. Major advances in recent years concerning this type of infection have involved: a) better knowledge of pathophysiological mechanisms, in particular the demonstration of a 2nd toxin, essential to the understanding of C. difficile infections; b) better codification of the management of these disorders. This is aimed today at treating the infection while maintaining the balance of the intestinal ecosystem.

Quantitative model demonstrating that recombinant adeno-associated virus and green fluorescent protein are non-toxic to the rat retina.

BACKGROUND: Recombinant adeno-associated virus (rAAV) is one of the most promising recombinant viral vectors for delivering therapeutic agents to the retina. The present study aims to quantify any effect that an rAAV construct may have on the retina. To be able to use rAAV for therapeutic purposes, the potentially toxic effect of the vector and an associated green fluorescent protein (gfp) marker has to be investigated. METHODS: By combining histological analysis with computer scanning techniques, the local toxicity of rAAV and gfp can be measured. This will have obvious implications for its role as a carrier in the rapidly developing world of gene therapy. RESULTS: It is shown that a construct consisting of rAAV and gfp, delivered subretinally to rat eyes, causes no more histological damage than injection with saline alone. Furthermore, via fluorescent fundus photography and computer scanning techniques it is seen that the area exposed to the rAAV-gfp construct is significantly greater than the area of histological change. CONCLUSIONS: It is thus concluded that the rAAV-gfp construct has no significant toxic effect, at an anatomical level, on the retina 12 months after injection.