[Scientific medicine and care relationship: From the therapeutic alliance to the therapeutic effect of the alliance].

The new paradigm of precision medicine in oncology questions today the respective place of evidence-based medicine and doctor-patient relationship. Based on the results of a randomized study comparing the efficacy of a homeopathic molecule in the prevention of nausea and vomiting induced by chemotherapy in non-metastatic breast cancer, this article extends and develops the discussion of maintaining an unresolved tension between medical art and medical science, between care and cure. This tension sets a base for the authors of the therapeutic alliance in medicine, defined as a dialectic constantly adjourned between the alliance of the doctor with the patient and his therapy, and the therapeutic effect of this alliance.

Population pharmacokinetics of fondaparinux administered at prophylactic doses after major orthopaedic surgery in everyday practice.

Fondaparinux is a synthetic antithrombotic agent with specific anti-factor Xa activity. A population pharmacokinetic model of fondaparinux, based on data obtained in patients included in phase II/III trials, has been described. However, the validity of this model in everyday practice needed to be confirmed.

Patient-controlled cervical epidural fentanyl compared with patient-controlled i.v. fentanyl for pain after pharyngolaryngeal surgery.

Background: Analgesia after pharyngolaryngeal surgery is commonly provided through the i.v. route.

Effect of pre- vs postoperative tonsillar infiltration with local anesthetics on postoperative pain after tonsillectomy.

Background: Since pre-incisional peritonsillar infiltrations of local anesthetic solutions have been suggested to reduce postoperative pain after tonsillectomy, we compared the efficacy of either pre- or postoperative local anesthetic infiltration upon post-tonsillectomy pain.

Methods: After the induction of general anesthesia, 68 consecutive healthy patients, ranging in age from 8 to 65 years, were randomly allocated to either receive peritonsillar infiltration with 0.25% bupivacaine (group 1) or normal saline (group 2) before incision.

Regional anaesthesia for outpatient nasal surgery.

Regional anaesthesia is not used widely for outpatient nasal surgery. The aim of this study was to determine the role of nasociliary and infraorbital nerve block in 24 patients undergoing nasal surgery comprising: cosmetic or reconstructive surgery of the nose and surrounding soft tissue, polypal removal, turbinectomy, reduction of fractured nasal bones, small tumour resection or emergency surgery on isolated facial lacerations. Mild sedation with midazolam 0.

[Cervical epidural anesthesia].

Cervical epidural anaesthesia (CEA) results in an effective sensory blockade of the superficial cervical (C1/C4) and brachial plexus (C5/T1-T2). It is used both intraoperatively and in the treatment of postoperative or chronic pain. The approach to the epidural space at the C7-T1 interspace is not technically difficult.

[Cerebral pneumocephalus after epidural anesthesia: a rare complication?].

A case is reported of pneumoencephalus occurring after an accidental dural puncture during a cervical epidural puncture using the loss of resistance technique. Six ml of air were injected intrathecally. The patient recovered spontaneously within five days.

[A rare cause of obstruction of the intubation tube].

A case is reported of endotracheal tube obstruction due to impaction of a turbinate. This complication occurred during a first attempt of nasotracheal intubation in an ASA 1 18-year-old patient. Once the tube had been inserted into the trachea, manual ventilation was impossible.

[Cerebral nocardiosis cured by repeated stereotaxic punctures and antibiotic therapy].

We report the case of a 58-year old man who had been on corticosteroid therapy for several months and presented with cerebral nocardiosis. Computerized tomography showed multiple brain abscesses. As the neurological status was getting worse, several stereotactic needle aspirations were performed, resulting in decompression of the brain and permitting bacteriological examination of the pus.

[Deafness surgery in adults. The growing role of improved local anesthesia].

As deafness surgery is subject to the two imperatives of safety and reduction of bleeding, local anaesthesia constitutes a very satisfactory solution. The concomitant administration of Midazolam and Buprenorphine relaxes the patient and ensures analgesia and anterograde amnesia, allowing the surgeon to operate under excellent conditions. Over the last 6 months, except in one subject under the age of 16 years and one psychologically very fragile patient, all surgical operations for deafness, regardless of their importance, have been performed under local anaesthesia improved by means of diazanalgesia.