The recurrent laryngeal nerve (RLN): application to transhiatal oesophagectomy.

To emphasize the risks of recurrent laryngeal nerve lesions during transhiatal oesophagectomy an anatomical study of the course of the recurrent laryngeal nerve (RLN) was performed. Twenty RLN were dissected in their thoracic portion. This work showed the constancy of the low origin of the nerve in the adult under the aortic arch, and its course in the tracheal angle.

Post-operative intravenous continuous analgesia: comparison of buprenorphine, fentanyl and nalbuphine.

Continuous intravenous infusions of fentanyl, buprenorphine or nalbuphine were investigated to provide pain relief for patients after major abdominal surgery. Buprenorphine (n = 23) was given as a loading dose of 5 micrograms kg-1 and infused at 0.8 micrograms kg-1 h-1.

[Prolonged apnea after suxamethonium administration during staphylococcal toxic shock].

A toxic shock syndrome occurred after a femoral nail removal requiring revision surgery. After administration of suxamethonium (1 mg.kg-1), an apnoea prolonged over 45 minutes was observed.

[Invasive aspergillosis in surgical intensive care patients].

Aspergillosis is a rare event in intensive care patients. Three cases of invasive aspergillosis due to Aspergillus fumigatus were diagnosed in a surgical critical care unit. Risk factors for aspergillosis were found in two liver transplanted patients.

[Value of Tissucol in cervical anastomosis of esophagoplasty].

There is an important fistula rate associated with the cervical anastomosis of oesophagoplasties. The authors report their experience with reinforcement of these anastomoses by adhesion using a fibrinogen based biological tissue glue. They propose that this technique be used in all high risk anastomoses, in particular, for those affecting a non peritonealized section of the digestive tract.

Cerebral blood flow and cerebral oxygen consumption during nitroprusside-induced hypotension to less than 50 mmHg.

The authors determined the effect of profound induced hypotension (i.e., mean arterial blood pressure less than 50 mmHg) during craniotomy for cerebral aneurysm on cerebral blood flow and cerebral metabolic rate for oxygen before, during, and after (20 min and 40 min after) the hypotensive period.

[Postoperative thyrotoxic crisis during beta blockade: an atypical picture of generalized muscle deficiency].

The case is reported of a 42 year old female patient with Graves disease who presented with an atypical thyroid storm after subtotal thyroidectomy. Surgery was indicated because of poor patient compliance with the medical treatment, and its partial failure. High doses of propranolol (240 mg a day) were given for 5 days preoperatively.

[Lung infection and acute adult respiratory distress syndrome during surgical resuscitation].

Non cardiogenic pulmonary edema (PE) is frequently observed during the postoperative period. 56 patients with postoperative PE were divided into two groups: ARDS, acute respiratory distress syndrom and NHPE, non hemodynamic PE. The incidence of primary pulmonary infection and pulmonary superinfection were investigated.

[Hemodynamic study during the postoperative period in coronary patients undergoing non-cardiac surgery. The role of mechanical ventilation and sedation].

The initial period of postoperative rewarming is frequently marked by rapid increases in metabolic rate and myocardial work leading to haemodynamic instability. In order to test the beneficial effect of mechanical respiratory support with sedation in the postoperative period, 18 patients with coronary artery disease operated upon for abdominal or orthopedic surgery were submitted to a hemodynamic study. The patients were divided in two groups.

[Acute renal failure after extracorporeal circulation with aortic counterpulsation in surgically treated patients].

In a series of 604 adults operated on for cardiac surgery with cardiopulmonary bypass (CPB), 21 (3.5%) underwent circulatory assistance by intra-aortic balloon pump (IABP); in 5 of them (24%), acute renal failure (ARF) was observed. ARF occurred in only 26 (4.

[Viral hepatitis B. Risk for the anesthetist].

The risk of hepatitis B, previously reported in other countries, has never been investigated in French anaesthetic medical staff. The prevalence of hepatitis B viral markers has been calculated among the medical staff of the Department of Anaesthesiology, the hospital health care personnel, patients before surgical procedure and renal transplantation patients. The frequency in anaesthesiologists (18.

[Infections in surgery under extracorporeal circulation. Results of 3 years of antibioprophylaxis].

The present study was designed to evaluate perioperative antibio-therapy with cefamandol for the prevention of post-operative infections after surgery under cardiopulmonary bypass. 1 300 patients were studied. The incidence for wound infections was 1.

[Incidence and prognosis of acute renal failure after cardiac surgery with extracorporeal circulation].

Acute renal failure occurred in 21 patients after 311 cardiac operations with cardiopulmonary bypass in adults (6,75%). It was non oliguric in 20 cases. It is related to per and postoperative hemodynamic depression.

[Prophylactic antibiotic therapy with cefamandole in total hip surgery replacement using Charnley's tent. A randomized study].

A randomized study of one-day prophylactic antibiotic therapy in total hip arthroplasty was performed in 93 procedures in 84 patients. All patients were operated by the same surgeons with use of a clean air system. They were divided into two groups: K- without antibiotic, and K+ with intravenous cefamandole, 1.

[Heart surgery with extracorporeal circulation in hemodialyzed patients with renal insufficiency].

The authors report 4 valvular replacements under cardiopulmonary bypass in chronic hemodialysis-dependent patients. The peri-operative management was the same in every case. The recent improvements of intensive care medicine amend this protocol.

[Postoperative respiratory complications of myotonia dystrophica (Steinert's disease)].

Respiratory difficulties have long been recognized to be a major risk in patients with myotonia dystrophica, but postoperative pulmonary complications have only rarely been considered. Two cases of postoperative pulmonary complications which led to the patients's death stressed the severity and difficulty of treatment of these complications. A third case of postoperative respiratory failure revealed the underlying disease.

[Peroperative circulatory arrest caused by a tumoral pulmonary embolism following hepatectomy for tumor. Apropos of a case].

The authors report a case of pulmonary tumor embolism during a hepatectomy for hepatoma, leading to a fatal cardiac arrest. This cause of cardiac arrest during operation has never been reported in the literature, but systematic autopsies of patients dying from liver cancer, especially primary or metastatic tumors, shows that the incidence of these embolisms is frequently underestimated. Any anomaly of the hepatic vein appearing in the X-rays implies a danger of intra- or post-operative embolism.

[Acute respiratory distress syndrome after accidental inhalation of a hydrosoluble contrast medium].

Acute respiratory distress syndrome after accidental aspiration of hydrosoluble contrast medium is reported. In spite of pulmonary superinfection, the outcome was favorable after mechanical ventilation with permanent positive pressure. This case confirms previous reports and invites to extreme caution when such agents are used in patients with swallowing disorders and preexisting pulmonary disease.

Intraoperative pulmonary tumor embolism after hepatectomy for liver carcinoma.

Intraoperative pulmonary tumor embolism occurred during right hepatectomy for primary hepatic carcinoma. The tumor embolus produced abrupt arterial hypotension, tachycardia, an increased central venous pressure, intense cyanosis, followed by cardiac arrest. Pulmonary tumor embolism resulting from hepatic tumors is rare and has not been reported to have occurred intraoperatively.