Biomedical subjects
Publications and source records attributed to A Harti.
The authors report a case of pheochromocytoma recognized during surgery, at the manipulation of the tumor resulting in severe arterial hypertension, arrhythmia and a final unresponsive ventricular fibrillation. The anatomopathological examination confirmed the diagnosis of the pheochromocytoma in ectopic localization.
Many brain complications occur during eclampsia with various degree of gravity. The pathogenesis of these lesions continues to be a source of considerable controversy. Five cases of eclampsia with severe neurologic manifestations were treated in our surgical intensive care unit. The CT image appeared to be related to haemorrhagic lesions (3 cases) and ischaemic lesions (2 cases). The clinical course was favourable, often reversible, in cases with oedema and ischaemia maternal prognosis was poor in the case with haemorrhage.
Nosocomial urinary tract infection is the most frequent nosocomial infection in many care units. Its main risk factor is the presence of a bladder catheter. Prevention is based upon the enforcement of hygiene recommendations which are not always carefully applied everywhere. We report a prospective study concerning 328 patients divided into two gropus. Group I patients (n = 161) had an indwelling bladder catheter. Group II patients (n = 167) had an external urinary drainage by Penilex. The incidence of nosocomial urinary infection was 2.4% in group II versus 26.7% in group I. Thus preventive efficacy of Penilex use appears to be well demonstrated.
A case of polyradiculoneuritis, resembling Guillain-Barre syndrome, was reported during the sixth month of a first gestation. The patient was seventeen years old and also had toxaemia of pregnancy. The interaction between polyradiculoneuritis and pregnancy is slight and carries little risk of prematurity. Plasma exchange procedures can be used in pregnant women and the results of this treatment are similar to those in patients presenting with polyradiculoneuritis alone.
This study analyses 25 cases of spermatic cord blockade for scrotal surgery (hydrocele, spermatocele, tumor of epididymis). The spermatic cord was infiltrated, after identification of the pubic tubercle, with a mean total dose of 17 +/- 3 ml of a 2% lidocaine solution not containing adrenaline. The scrotal skin was infiltrated separately at the site of incision. Analgesia was excellent in 22 patients. The duration of analgesia was 82 +/- 33 min. No adverse effects occurred. It is concluded that the blockade of the spermatic cord is a convenient anaesthesia technique for testicular surgery.
The prevention of blood pressure fall during a conventional spinal anaesthesia effected with 20 mg (4 ml) of isobaric 0.5 p. 100 bupivacaine relies on the use of vascular filling and/or a vasoconstrictor. A randomized prospective study was performed to evaluate the comparative efficacy of these two treatments. 148 patients were included and divided into three groups. Group I (n = 50): 2.5 mg IV bolus of etilefrine followed by continuous infusion (0.35 mg.kg-1.h-1). Group II (n = 50): 30 ml.kg-1 infusion of saline isotonic solution for 90 min, with infusion rate according to blood pressure. Group III (n = 48) did not receive any preventive treatment. A blood pressure fall of more than 30% of the initial value was observed in 59 patients: 18% of the etilefrine group, 28% of the saline infusion group, 54% of the control group. This peculiar frequency of hypotension in the control group emphasizes the need of a preventive treatment. Haemodynamic changes were fewer and less important in the etilefrine group compared with the saline infusion group. No failure and a better tolerance in the vasoconstrictor group were also to be noticed. These clinical data suggest that etilefrine could meet satisfactorily the therapeutic requirements.
Acute pancreatitis during pregnancy is a serious condition and diagnosis is often difficult. The authors report the case of a 32-year-old woman in the 32nd week of her fifth pregnancy, in which the outcome was fatal for both mother and child. The cause of pancreatitis during pregnancy has been attributed to many factors, chiefly cholelithiasis. A number of recent studies have shown the relationship existing between the role played by pregnancy in predisposing to gallbladder disease with lithiasis. Many diagnosis errors are made in this condition. Thus modern treatment methods have improved the prognosis in acute pancreatitis but, when it occurs during pregnancy, diagnostic delays often lead to a gloomy outlook.
A man 55 years old reached of chronic bronchopneumopathy was underwent a subumbilical surgery under an epidural anesthesia. The puncture has been realized at the level of the space L3-L4, with the location of an epidural catheter after negative aspiration test. The local anesthetic with lidocaine 2% (12 ml) Ten minutes later, the patient presented cardiac arrest that evaluated favourably under the cardiocirculatory intensive care. Blood and LCR analysis exclude the eventuality of a toxic accident, an anaphylaxia or spinal anesthesia.
Cervical peridural anesthesia was associated to a general anesthesia with controlled ventilation in ten patients undergoing laryngectomy for cancer. All the patients (middle age 57 years) suffered chronic bronchopneumopathy. The cervical peridural approach is realized by puncture at the level C6-C7 with setting of a peridural catheter. After a test dose, a total volume of 18 ml of bupivacaïne at 0.33% is injected. Reinjections of nine ml of the anesthetic solution are realized after a mean delay 200 min. After induction with thiopental and pancuronium bromide, narcosis is maintained by N2O/O2, 0.5/0.5 associated to 0.5% halothane. The mean operating time was four hours and ten minutes. The anesthetic block obtained stretches from C2 to D4, after a mean delay 22 +/- 7 min. Analgesia is satisfying. Little changes occurs in hemodynamic state, except an almost constant bradycardia. Bleeding stay in range of laryngectomies. The awakening is immediate; the post-operative evolution is simple. No complication tied to the anesthesia has been observed.
The authors report a case of severe hematobilia originating in the gall bladder itself ans associated with a cholecysto-colic fistula. They review the different etiologies of hematobilia and stress the major value of selective arteriography of the coeliac trunk and possible pitfalls in this condition. This case highlights the rare complications of cholelithiasis (hematobilia and cholecyto-colic fistula) and the severity of blood spoliation. Therapy is reviewed as a function of the lesion causing hematobilia.
The authors report three cases of subcapsular liver hematomas occurring after delivery and diagnosed by ultrasonography (1 case), and exploratory laparotomy (2 cases). These three cases compared with the data from the literature, illustrate the conditions of occurrence and the clinical signs of subcapsular liver hematomas during pregnancy or in the post-partum period. The frequency of this complication is most likely underestimated, since benign forms remain latent and the severe forms, responsible for sudden death, eludes the diagnosis in the absence of anatomical confirmation.
The anesthesia for sismotherapy is characterized by its briefness and repetitiveness, resulting in several imperatives: anesthesia of short duration, deep narcosis with muscular relaxation and ambulatory character. Thus anesthesic drugs should have a fast onset of action, in order to obtain a rapid and as alert as possible post anesthesia awakening. The objective of this study is to compare two anesthesic drugs: propofol versus thiopentone. We included in this study patients referred to our unit by the psychiatric service for sismotherapy, which was carried on under general anesthesia in the awakening room of the anesthesia department of Ibn Rochd University hospital. 7 of our patients received sismotherapy for schizophrenia, 2 for acute mania and 1 for suicidal depression. A total of 40 sessions of sismotherapy were analyzed, distributed in two groups: group I (n = 20): benefitted of a general anesthesia by thiopentone, the dose was 2 to 3 mg/kg; group II (n = 20): benefitted of general anesthesia by propofol, the dose was 1 to 1.5 mg/kg. Sismotherapy was carried out only once narcosis was considered as deep. To monitor our patients we used electrocardioscope and pulpe oxymeter. We evaluated the quality and especially the time of onset of anesthesia, its duration, the quality of narcosis, the degree of muscular relaxation, respiratory and cardiovascular parameters as well as side effect linked to anesthesia drugs and sismotherapy. Analysis of the results showed that the quality of anesthesia was excellent for both groups. The necessary dose for narcosis was 202 mg for thiopentone and 167 mg for propofol, time of onset of narcosis was 30 seconds for propofol and 45 seconds for thiopentone, anesthesia and the quality of muscular relaxation were considered deep for the two groups. Many authors showed that propofol is the most efficient agent in anesthesia for sismotherapy due to its brief delay of action and faster reversibility. As for thiopentone despite its convulsive properties and poor hemodynamic tolerance, it still is a good hypnotic in anesthesia for sismotherapy when administered at appropriate dose by slow injection. This is due on the one hand to easy administration, lesser incidence of side effects and on the other hand to brief duration of action and low cost. We conclude that thiopentone can be recommended in anesthesia for sismotherapy owing to good properties: deepness of anesthesia, good awakening, tolerance and lower cost.
Sixty cases of severe eclampsia were treated in an intensive care unit between January 1989 and September 1993. Mean age was 26, and 70% of patients were primipara. The pregnancy has been unsupervised in almost all cases. All had visceral lesions and/or hematologic problems and there was impaired conscious level in 9 cases out of 10. Medical treatment involved the control of seizures and of hypertension. Cesarean section was performed in 34 cases. The maternal death rate was 23.3%. Our experience indicates that mortality depends upon visceral lesions (cerebral, disseminated intravascular coagulation, acute pulmonary edema, Hellp syndrome). Better awareness of severity factors in preeclampsia improves both maternal and fetal prognosis by precisely indicating the best time for fetal extraction.