[Multidisciplinary approach to pain and institution of analgesic treatment].

Pain is a complex sensory response to tissue damage but also mental functioning. Patients with chronic pain require an interdisciplinary model of care after a careful evaluation and understanding of pathophysiology. Therapy may include medications, nerve blocks and behavioural interventions.

[Celiac plexus block: value of x-ray computed guidance].

Celiac plexus block is a good alternative of pain treatment in upper abdominal pain. Neurolysis of the celiac plexus by the percutaneous posterior route used CT guidance in 8 patients. Pain relief was obtained in 5 of 7 patients (70 per cent); no complication occurred.

[Postoperative cervicofacial subcutaneous emphysema].

Two cases of post-operative subcutaneous emphysema are reported. After excessive airway pressure, air or anaesthetic gases may spread to the neck, mediastinum, abdomen or pleural cavity. Pathogenesis and mechanisms are discussed.

Visceral revascularization by anastomosis between the left renal and Drummond's marginal artery.

Drummond's marginal artery was revascularized by anastomosis with the left renal artery in two patients with visceral ischemia due to occlusion of the celiac and superior mesenteric arteries. In this manner, the authors avoided entering an infected abdominal cavity, interposition bypass and aortic clamping. In both cases, visceral arterial supply was improved.

Catheter obstruction during prolonged parenteral alimentation. Are lipids responsible?

Catheter obstruction is a serious incident during prolonged parenteral nutrition (PN). This retrospective study was carried out in order to compare the frequencies of catheter obstruction with nutritive mixtures in bags according to whether or not lipids were mixed with the entire 24 h nutritional supply (Group I, n=33) or infused separately (Group II, n=30). Our results show that obstructions are significantly more frequent in Group I (11 13 ) than in group 2 (3 10 ), appearing within a mean interval of 29 days after inserting the catheter.

[Prevention of the thromboembolic risk during the operative period in a patient with a congenital antithrombin III deficiency].

The case of a woman with congenital antithrombin III (AT III) deficiency undergoing elective hysterectomy is reported. AT III deficient patients have high risks of thromboembolic disease, especially developing during and after surgery. It is usual practice to discontinue oral anticoagulants with antivitamin K activity and to obtain effective AT III activity by the transfusion of freeze-dried concentrates of AT III and/or fresh frozen plasma (FFP).

[Value of per-operative measurement of the blood flow in vascular surgery (author's transl)].

Post-operative thrombosis in vascular surgery results from either technical error of deficient arterial outflow and can be avoided by checking, during the operation, that the new circulatory conditions created are adequate. Among the most frequently used control methods arteriography occupies a prominent place but requires a sophisticated equipment to be truly reliable. Per-operative measurement of the blood flow is much simpler.

[Traumatic chylothorax with dorsal spinal fracture. A case report (author's transl)].

We related there a traumatic chylothorax due to a thoracic vertebral fracture. It has been recognized at the 13st day, after a lost of 11 liter of lymph and a down of albuminemia by lymphography. The direct ligature has been only partly successful leaving still a tiny lymph leak during a fortnight.

[Acute dyspnoea by acute thyroid abscess (author's transl)].

Infection is extremely rare in the pathology of the thyroid gland. One case is reported, and a review of the literature has helped to emphasize some specific points. Acute thyroiditis can be misdiagnosed in its initial phase because a fever by itself may not lead to a through examination of the neck, even if a goitre is present; the latter being the site of infection in the case reported.

When can revascularization be limited to the profunda femoris alone?

Dealing with lower limbs arteriopathies with combined aorto iliac and superficial femoral occlusive diease and when ischemia leads to operation should an extension bypass to the popliteal or tibial artery be associated every time it is possible? The authors have investigated the results of revascularizing operation above the profunda femoris on 35 limbs (27 patients). On 19 limbs only, has the revascularization been sufficient to cure the distal ischemia. On the other 16 limbs, a second operation was necessary 7 times an extension bypass to the popliteal or tibial artery, once an above knee amputation, twic a below knee amputation.