Postoperative lymphopaenia as a risk factor for postoperative infections in cancer surgery: A prospective multicentre cohort study (the EVALYMPH study).

Background: Stress due to surgical trauma decreases postoperative lymphocyte counts (LCs), potentially favouring the occurrence of postoperative infections (PIs).

Objectives: We aimed to determine whether postoperative lymphopaenia following thoracic or gastrointestinal cancer surgery is an independent risk factor for PIs and to identify modifiable factors related to anaesthesia and surgical procedures that might affect its occurrence.

Study Design: The EVALYMPH study was a prospective, multicentre cohort study with a 30-day patient follow-up.

Association Between Short-, Intermediate-, and Long-term Mortality and Myocardial Injury After Noncardiac Surgery After Hip Fracture Surgery: A Retrospective Cohort.

Background: For more than 20 years, hip fracture 1-year mortality has remained around 20%. An elevation of the postoperative troponin peak within 72 hours (myocardial injury after noncardiac surgery [MINS]) is associated with a greater risk of short-term mortality in the general population. However, there seem to be conflicting results in the specific population who undergo hip fracture surgery, with some studies finding an association between troponin and mortality and some not.

Early management of severe pelvic injury (first 24 hours).

Objective: Pelvic fractures represent 5% of all traumatic fractures and 30% are isolated pelvic fractures. Pelvic fractures are found in 10 to 20% of severe trauma patients and their presence is highly correlated to increasing trauma severity scores. The high mortality of pelvic trauma, about 8 to 15%, is related to actively bleeding pelvic injuries and/or associated injuries to the head, abdomen or chest.

[Use of thrombelastography to guide posttraumatic hemostatic therapy: More coagulation factor concentrates and less allogenic blood transfusion?].

Viscoelastic technics are used for 10 years and include the ROTEM and the TEG. These devices that exploit the viscoelastic properties of the clotting blood, allow a rapid and global analysis of the haemostatic process taking into account all the process interfering with haemostasis such as inflammation. It has been shown that the use of these technics in clinical situations such as trauma, postpartum haemorrhage, gastrointestinal bleeding or cardiac surgery may reduce the need for blood product, the cost and perhaps may improve the outcome of the patients.

[Pulmonary resection and ECMO: A salvage therapy for penetrating lung trauma].

The majority of chest penetrating trauma patients are successfully managed with tube thoracostomy and general supportive measures. Pulmonary resection for hemorrhagic shock is rarely required after trauma to control bleeding. Both pulmonary injury and massive blood transfusion can lead to acute respiratory distress syndrome (ARDS).

[Trap in severe trauma: the rotary atlantoaxial dislocation].

We reported the case of asymptomatic traumatic atlantoaxial dislocation in a 14-year-old woman. Clinical diagnosis of this uncommon dislocation is difficult and often made late. The early diagnosis by CT scan is necessary to avoid secondary aggravation.

[Exceptional medical circumstances: interest of an interhospital support strategy within the North Alps emergency trauma network].

The Northern French Alps Emergency Network (RENAU) has a main objective the improvement of the quality of the care in the field of the emergency medical treatment. With this French medical system, we developed a procedure allowing the detachment of a medical-surgical team of the university hospital to help general hospital team in the event of immediate vital emergency situation with untransportable patient. We reported the successful implementation of this support strategy for a 51-year-old patient arrived in a hospital of the network in extremely serious hemodynamic shock due to an important hemorrhagic pericardial effusion with tamponnade 1 day after percutaneous closure of the patent foramen ovale (PFO).

Evaluation of the effect of one large dose of erythropoietin against cardiac and cerebral ischemic injury occurring during cardiac surgery with cardiopulmonary bypass: a randomized double-blind placebo-controlled pilot study.

Cardiac surgery and cardiopulmonary bypass (CPB) induce ischemia-reperfusion and subsequent cellular injury with inflammatory reaction. Clinical and experimental studies suggest that recombinant human erythropoietin (EPO) independently of its erythropoietic effect may be used as a cytoprotective agent against ischemic injury. We tested the hypothesis that one large dose of EPO administered shortly before CPB prevents the elevation of cardiac and cerebral ischemic blood markers as well as the systemic inflammatory response induced by cardiac surgery with CBP through this randomized double-blind placebo-controlled pilot trial.

[Insertion of catheter for temporary transvenous ventricular pacing at prehospital scene after sudden malfunction of pacemaker].

A 70-year-old patient who had been fitted with a pacemaker for 27 years consulted his cardiologist to check the latest device, which had been changed in 1998. During the examination there was a sudden malfunction of the pacemaker, which became uncontrollable, resulting in an escape rhythm of 15 beats/min and circulatory insufficiency. Attempted treatment by isoprénaline and external transcutaneous systolic stimulation failed, and an intraventricular catheter was therefore positioned successfully as an emergency prehospital manoeuvre.

Prehospital use of minimally invasive direct cardiac massage (MID-CM): a pilot study.

Background: Internal cardiac compressions are more efficient than closed chest compressions (CCC) in cardiac arrest (CA).

Aim Of The Study: To evaluate the prehospital feasibility of performing a new method of minimally invasive direct cardiac massage (MID-CM TheraCardia Inc.).

Co-amoxiclav pharmacokinetics during posttraumatic hemorrhagic shock.

Objective: To determine the effects of severe trauma with hemorrhagic shock on amoxicillin and clavulanate concentrations in plasma and their pharmacokinetics.

Design: A prospective, open, descriptive study.

Setting: A 12-bed, adult surgical intensive care unit in a university-affiliated hospital in France.

Analgesic efficacy and safety of nefopam vs. propacetamol following hepatic resection.

In order to compare the morphine-sparing effect, analgesic efficacy and tolerance of nefopam and propacetamol given at their highest recommended doses, 120 patients undergoing elective hepatic resection were randomly assigned to receive postoperative intravenous patient-controlled analgesia with morphine alone, or in combination with nefopam (20 mg.4 h-1) or propacetamol (2 g.6 h-1).

Pharmacokinetics of cefpirome during the posttraumatic systemic inflammatory response syndrome.

Objective: To determine the pharmacokinetic parameters of cefpirome, a new so-called fourth-generation cephalosporin, in previously healthy trauma patients with posttraumatic systemic inflammatory response syndrome (SIRS) and to compare them to parameters obtained in matched, healthy volunteers.

Design: A prospective study.

Setting: 12-bed surgical intensive care unit in a university hospital.

[Anesthesia, analgesia and obstetrics: a high-risk association!].

The authors review the changes in obstetric anesthesia and analgesia that have contributed to a decreased maternal mortality as well as those accounting for the clinically significant improvements of maternal and neonatal morbidity.