[Electric short-circuit incident observed with "Upsher" laryngoscopes]. / Défaut d'isolement des laryngoscopes de marque "Upsher" série UQ1.

We observed an electrical short-circuit between a fasten screw of the printed circuit and the handle of an Upsher universal laryngoscope (serial number UQ1). The isolating Silicone layer was broken above the screw. This isolation defect was found all over our Upsher laryngoscopes of the UQ1 series. No doubt that if accumulators were used instead of batteries, emitted heat would be in largest amount and perhaps dangerous.

[Duodenal perforations by the hooks of a Kimray-Greenfield filter]. / Perforation duodénale par les crochets d'un filtre de Kimray-Greenfield.

A case is reported of a duodenal perforation by a Kimray-Greenfield filter hook in a 66-year-old female patient. This device had been inserted four years before, after a pulmonary embolism. The patient presented with epigastric pain, vomiting and extracellular dehydration with renal failure. A plain abdominal film showed the filter to be tilted 15 degrees to the left, with an opening 28 mm wide. Various investigations were carried out, none of which providing a satisfactory diagnosis. Steroid treatment (1 mg.kg-1 x day-1 of prednisone) was started before admission to intensive care. Only at that time gastroduodenoscopy showed on of the filter's hooks jutting through the duodenal wall. This perforation was located in the posterior wall of the third part of the duodenum, and was associated with an ulcer of the mucosa facing this hook. The diagnosis was confirmed by an abdominal CT scan. The hook was cut and the perforation sealed off during a first laparotomy. Twenty-six days later, the patient developed intestinal obstruction due to a haematoma of the jejunal wall. She later had a cerebrovascular accident, with status epilepticus and deep coma. She died four months after her admission. The late complications of vena caval filters are discussed. The position of these devices should be regularly checked by a plain abdominal film. Abdominal CT scanning is a useful investigation for the diagnosis of intra and extravascular complications.

[Acute diltiazem poisoning: kinetic and hemodynamics study]. / Intoxications aiguës par le diltiazem: étude cinétique et hémodynamique.

The authors report three cases of diltiazem overdose with hypotension and atrio-ventricular conduction disturbances. Hemodynamic study in 2 cases showed a hyperkinetic state with a decrease of systemic vascular resistances. Diltiazem kinetics studied in 2 cases showed a plasma half life of 5.4 and 8.3 hours, a prolonged absorption until the 28th hours in one case. Treatment included gastric lavage, oral activated charcoal (2 cases), plasma expanders and in 2 cases vasopressors with alpha effects. All three patients recovered.

When should dialysis be performed in lithium poisoning? A kinetic study in 14 cases of lithium poisoning.

Lithium kinetics were studied in 14 patients with lithium poisoning. Three patients were treated by hemodialysis. Serum lithium peak concentrations ranged between 1.4 and 9.6 mmol/L. The apparent mean serum half-life was 23.16 +/- 9 h, the mean total clearance was 26.5 +/- 13.3 mL/min and the mean renal clearance was 17.2 +/- 5.4 mL/min. The kinetic parameters were dependent on the duration of the study and on the type of the poisoning: acute, acute upon chronic or chronic. During the first 12 h after admission ten patients were in a distribution phase, three were in an elimination phase and one was in an absorption phase. The serum half-life during hemodialysis ranged from 3.6 to 5.7 h and hemodialysis clearance was 63.2 to 114.4 mL/min. The mean volume of distribution calculated in six cases was 0.63 +/- 0.09 L/kg. The evolution of the lithium pools showed a different kinetic pattern between the extra- and the intracellular pool which decreased more slowly. During hemodialysis the decrease of the extracellular pool was about twice that of the cellular pool. Among the factors which may modify lithium toxicity and kinetics, are the type of the poisoning, the presence of an underlying disease and renal impairment. No general and rigid indication for hemodialysis can be set, but the need for hemodialysis should be based on clinical and kinetic data determined during the 12 h following admission.

[Acute verapamil poisoning. 6 cases. Review of the literature]. / Les intoxications aiguës par le vérapamil. A propos de 6 cas. Revue de la littérature.

Six cases of acute verapamil poisoning are reported. The dose ingested ranged between 1.2 and 9.6 g. In all cases other drugs had also been ingested and especially betablockers in two cases. Symptomatology included a cardiogenic shock in two cases and an atrioventricular block in four cases. A hemodynamic study in one case showed a cardiogenic shock with increased systemic vascular resistances. The treatment of cardiogenic shock included artificial ventilation, several vasopressors and inotropic agents and cardiac pacing in one case. All patients recovered without sequelae. A toxicokinetic study performed in two cases showed plasma half lives of 7.9 and 13.2 hours, total body clearances of 425 and 298 ml/min. Only 2 to 4.2 per cent of the dose ingested were eliminated in urine. These results confirm the severity of verapamil overdose and the efficacy of symptomatic treatment by inotropic agents. The high rate of spontaneous elimination by hepatic metabolism does not justify drug removal by extra-corporeal methods.

Transvaginal ultrasonographic characterization of ovarian masses by means of color flow-directed Doppler measurements and a morphologic scoring system.

OBJECTIVE: The aim of the study was to test the hypothesis that a combination of a previously devised morphologic scoring system and color flow-directed Doppler measurements would afford better discrimination between benign and malignant ovarian masses. STUDY DESIGN: The scoring system and color flow-directed Doppler measurements for 115 masses were prospectively analyzed and correlated with histopathologic surgical findings. RESULTS: In 21 masses (18 patients) no flow was obtained. Seventy-eight masses in 70 patients were benign, and 16 masses in 12 patients were malignant. The mean total score for the benign masses was 6.7 and for the malignant masses 11.7. The resistance index was 0.64 for the benign lesions and 0.39 for the malignant masses (range 0.2 to 0.98). The mean pulsatility index of the benign masses was 1.17 and 0.52 for the malignancies (range 0.2 to 2.6). There were no malignancies in the group with no flow obtained. The sensitivity and specificity of score alone was 94% and 87%, respectively, with a 60% positive predictive value. By means of resistance index or pulsatility index the sensitivity was 94%, the specificity 99%, and the positive predictive value 94%. CONCLUSION: These results suggest that Doppler flow measurements alone and in conjunction with a scoring system help differentiate benign from malignant masses.