Biomedical subjects
Publications and source records attributed to J Squali.
We report three cases of a collective tetrodotoxin poisoning, after ingestion of puffer fish eggs. This neurotoxin is the most potent membrane stabilizer, blocking the nervous conduction and resulting in death from respiratory paralysis in case of massive ingestion. The father died at admission, the mother and her daughter presented an acute respiratory failure and a flaccid tetraplegia, with favourable outcome after 24 hours.
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Presence of air within the cranial cavity has been described by several authors. Little attention has been paid to its significance. The goal of this study was to analyse the clinical characteristics and the evolution of patients with pneumocephalus. We reviewed the brain computed tomography scans of 167 consecutive head injury patients who were hospitalized between January 1992 and December 1993. This retrospective study revealed intracranial air in 33 cases (19%). The analysis of clinical characteristics showed that in the initial period the neurologic status was better in patients with pneumocephalus. However, 48 hours later, the proportion of patients presenting a deep coma increased We conclude that pneumocephalus is a significant risk factor in head injury patients.
OBJECTIVES: Surgical splanchnicectomy remains a useful means to relieve pain induced by malignant tumours of the pancreas and chronic pancreatitis. We report our experience in 37 patients. METHODS: Between 1983 and 1993, 37 patients underwent transhiatal bilateral splanchnicectomy; 32 had a non-resectable adenocarcinoma and 5 chronic pancreatitis. In all cases, morphine had been required for pain relief. RESULTS: Symptomatic pain relief was immediately achieved, with complete sedation in 84.3% of the cases. Prolonged antalgic effect continued for the survival period in 84.3%. Mean post-operative follow-up was 12.7 weeks corresponding to mean survival in 32 patients with pancreatic tumour. Post-operative mortality was 21.6% with no direct relationship with neurectomy. Specific morbidity related to pleural drainage was 10.8%. CONCLUSION: Compared with other surgical procedures, trans-hiatal bilateral splanchnicectomy is a simple technique which can be performed whatever the stage of the locoregional tumour extension. In patients without an indication for exploratory laparoscopy, percutaneous chemical neurolysis is still indicated, even if the long-term result is less effective. In case of failure or technical impossibilities, thoracoscopic splanchnicectomy should be performed.
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Peroperative echography and cholangiography provide similar information during the exploration of the biliary tree for conventional surgery for gall stones. Peroperative cholangiography is more difficult to perform via the coeolioscope with a failure rate of 10% in the most skillful teams. We investigated the technical feasibility of peroperative echography during coeliosurgery for gall stones. The technique was performed in 13 patients using a pulsed Doppler 7.5 MHz scan laparoscope. The entire biliary tree was successfully imaged in 12 patients and the three structures of the hepatic pedicle were identified in all cases. The exploration took less than 10 minutes and there was no morbidity. One gall stone was discovered and endoscopic sphincterotomy was performed immediately. None of the patients presented signs suggesting residual lithiasis with a mean follow-up of 2 months. This preliminary study suggests that the technique is very favourably feasible and may play an important role in the exploration of the bile tract during coelioscopic cholecystectomy.
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