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T Gros

Publications and source records attributed to T Gros.

10 recordsLinked to original sources

[Orbital haemorrhage after medial canthus episclera (sub-Tenon's) anaesthesia].

Medial canthus episclera (sub-Tenon's) anaesthesia is a technique proposed as a suitable alternative to the more classical peribulbar block because of the greater reliability and more constancy in effectiveness. We report two cases of retrobulbar haematoma after sub-Tenon's anaesthesia, one with central retina artery compression needed anterior room punction. Sub-Tenon's anaesthesia, like peribulbar anaesthesia, can give also retrobulbar haemorrhage if the insertion of the needle is not limited to the anterior orbit.

Aged↗

[Multitruncular block at the elbow for a major hand trauma for prehospital care].

Upper limb peripheral nerve blocks offer many advantages but they are not widely used in prehospital care. We report the case of a multitroncular block at the elbow made by the emergency department team out of the hospital after a major hand trauma. A successful axillary brachial plexus block was done two hours later, without any problem. This case report allows us to discuss about different analgesia techniques useful in prehospital care.

Amputation, Traumatic↗

Preoperative nutritional evaluation of elderly patients: the Mini Nutritional Assessment as a practical tool.

BACKGROUND AND GOAL: Age and malnutrition are each surgical risk factors. Because the Mini Nutritional Assessment (MNA) has been specifically designed for assessing the nutritional status of elderly patients, it can be used for preoperative nutritional evaluation. Therefore, the MNA was included in the preoperative clinical evaluation of patients over 60 years of age to describe their nutritional status. METHODS: Every patient over 60 years of age, scheduled for elective surgery, was seen in anaesthesiology consultation and was submitted to the MNA. The MNA is a clinical score consisting of four additive items: 'Anthropometric assessment' based on BMI, mid-arm and calf circumferences, weight loss; global evaluation; dietetic assessment, and subjective assessment - these last three items being obtained through a specific questionnaire. It requires no biological marker. Awarding to the obtained score, the MNA stratifies patients in the following categories: well-nourished (24 </= MNA </= 30), at risk of malnutrition (17 </= MNA < 23.5), and undernutrition (MNA < 17). Also recorded were: age, gender, type of scheduled operation, and the American Society of Anesthesiologists (ASA) physical status score. Results are given as median (extremes). RESULTS: Four hundred and nineteen patients (50.4% women) were seen between January and October 1996. The mean age was 72 years (range, 60-98 years); BMI: 25.2 (12.8-40.4) kg m(-2). The MNA score was recorded in 408 patients, ranging from 1.5 to 30 (median: 26). According to the score, the patients were stratified in: well-nourished, 276 patients (67.6%), at risk, 104 patients (25. 5%) and suffering from overt malnutrition, 28 patients (6.9%). According to the ASA score, 290 patients were found to be at low or mild risk for anaesthesia and surgery (ASA 1 and 2), and 72 patients (24.8%) were stratified as being at least at risk of malnutrition. One hundred and eighteen other patients were found to be at a higher risk (ASA 3 and 4), and 58 (49.2%) were not well-nourished (MNA < 24). CONCLUSION: The MNA was found to be well-suited for the preoperative assessment during anaesthesia consultation because it required no biological marker. It showed that approximately one-third of all the examined patients, and half of the ASA 3-4 patients, were not well-nourished. The ASA score could not predict poor nutritional status. The results suggested that nutritional assessment should be routinely performed in ASA 3-4 patients over 60 years of age.

Aged↗

[Control of arterial hypertension: analysis of visit and time factors].

OBJECTIVE: To analyse the frequency of attendance and the time elapsed between the diagnosis of Arterial Hypertension (AHT) and the control of Arterial Pressure (AP); and to analyse the different ways of presenting the level of control of AHT. DESIGN: Retrospective study. SETTING: Teaching Health Centre. PATIENTS: 103 hypertense patients diagnosed since 1986: 44 men (42.7%) and 59 women (57.3%), with an average age of 52.6 +/- 1. Their initial AP was 164.4 +/- 17.1/102.1 +/- 7.4 mmHg. The criterion of AHT control was Diastolic Arterial Pressure (DAP) < 90 mmHg. MEASUREMENTS AND MAIN RESULTS: AP at the end of the first year was 150.1 +/- 20.6/90.7 +/- 9.6 mmHg (p < 0.001 in comparison with the initial AP). The average attendances for AHT and per patient in the first year was 8.7 +/- 5 (1-26). Patients with more severe forms of AHT and/or with associated risk factors visited more often (p < 0.05). During the first year 76 patients (73.7%) presented on at least one attendance a controlled DAP. At the end of the first year 46 patients (44.6%) were under control. The average time per patient until AP was controlled was 28.6 +/- 31.6 weeks (1-168). Males and under-65s took more time to control their AP (p < 0.05). CONCLUSIONS: There are gender and age differences in the time required to bring AP under control. Frequency of attendance is related to the severity of AHT and the presence of other pathologies and risk factors. The level of control of AHT, expressed in different ways, is not constant.

Adult↗

[Analysis of direct costs of controlling arterial hypertension].

OBJECTIVE: To analyse the number of attendances and the direct cost of pharmaceutical prescription arising from a year-long monitoring of hypertense patients. SETTING: Health Centre. DESIGN: A prospective observation study. PATIENTS: 220 hypertense patients, undergoing arterial pressure (AP) monitoring, were chosen by means of systematic random sampling. MEASUREMENTS AND MAIN RESULTS: The variables of age, gender, cardiovascular risk factors, AP, monitoring level (criterion AP < 160-90 mmHg), attendances and treatment used were analysed. The pharmaceutical cost was calculated in line with the dosages and according to the 1990 Vademecum. The monitoring level was 43.6%. The total number of attendances per patient were 12.8 +/- 6.43 and those for hypertension, 7.9 +/- 3.5. Diabetics attended more for hypertension (8.8 vs 7.5, p < 0.05). Pharmaceutical treatment was prescribed for 183 people (83.2%). The number of drugs was correlated with the severity of the hypertension and the number of attendances. Overall drug cost was 429,571 pesetas per month. Average monthly cost per patient was 2,348.69 +/- 2,318.92 pesetas (range 90.5-12,856.5). Angiotensin enzyme conversion inhibitors (AECI) made for the greatest monthly mean cost per patient (4,352.9 pesetas) and diuretics, the least (322.2 pesetas). CONCLUSION: Frequency of attendance is related to the presence of diabetes and the number of drugs prescribed. The introduction of AECI and Calcium antagonists into first-line treatment represents an important increase in the cost of controlling Hypertension.

Adult↗

[Multifocal tubercular osteitis in a female patient infected with the human immunodeficiency virus].

We discuss the case of a 22-year-old female, carrying of antibodies to against human immunodeficiency virus (HIV), who developed several tumors on different bone localizations, which corresponded to plurifocal bone tuberculosis. We reviewed multifocal bone tuberculosis reports in the literature. The exceptionally of this case in underlined and the relationship between this atypical clinical presentation and immunodeficiency in discussed.

Adult↗