Postoperative analgesia and early rehabilitation after total knee replacement: a comparison of continuous low-dose intravenous ketamine versus nefopam.

The effects of nefopam and ketamine on pain control and rehabilitation after total knee replacement were compared in a prospective, double blinded study. Seventy-five patients were randomly assigned to receive a 0.2mg kg(-1) bolus of nefopam or ketamine, followed by a 120microg kg(-1) h(-1) continuous infusion until the end of surgery, and 60microg kg(-1) h(-1) until the second postoperative day, or an equal volume of saline considered as placebo.

[Practical advice for exercise-induced asthma in children: experience of the exercise training centre of Necker-Enfants malades hospital].

Now, to care exercise-induced asthma is not only to prescribe drugs. It is a global and interdisciplinary approach: the pulmonary rehabilitation, matching a therapeutic education and a physical training, with the goal of promoting a regular physical activity in the asthmatic child, achieving physiological benefits and improvement of quality of life. Getting from the experience of Necker-Enfants Malades Hospital's Training Centre, a few advises encourage the physical practice of the asthmatic child, and decrease risks of exercise-induced asthma: optimisation of treatments;progressive beginning and end of exercises; use of the diaphragmatic breathing, keeping up with the exercise; use of the ventilatory threshold (or dysponea threshold) as intensity of the aerobic training; practice of different activities promoting play and conviviality in sports and allowing the integration of sports in the daily life of the asthmatic child.

Comparison of mechanical behaviour of normal and scoliotic vertebral segment: a preliminary numerical approach.

Specific behaviour of the scoliotic spine has already been proven. The aim of this preliminary study is to evaluate if this behaviour is mainly due to geometrical deformities or to mechanical characteristics of soft tissues. We use a kriging technique to obtain a personalized finite element model of scoliotic spine from 3D reconstructions and from an existing detailed model of normal spine.

Validation of the non-stereo corresponding points stereoradiographic 3D reconstruction technique.

Several 3D reconstruction techniques deriving from stereoradiographic DLT have been presented during the last 15 years, but these techniques have usually been limited in accuracy because of the small number of corresponding anatomical landmarks identified on both radiographs. A new technique has recently been proposed to perform 3D reconstruction of the spine using not only the stereo-corresponding anatomical landmarks (seen on both frontal and sagittal X-ray films) but also some non-stereo-corresponding ones. This technique (called non-stereo-corresponding points or NSCP) has already been used for cervical dry vertebrae.

[An outbreak of Shigella dysenteriae type 1 dysentery in a refugee camp in Rwanda].

As a consequence of the civil war that devastated Burundi in October 1993, more than 300,000 refugees settled in the neighboring country of Rwanda. We describe the outbreak of dysentery due to Shigella dysenteriae type 1 (Sd1) that developed in Nzangwa, a camp hosting some 20,000 Burundese refugees. Between November 17, 1993 and March 10, 1994, 6,122 cases of bloody diarrhea were notified by the health information system of the camp.

[Right atrial thrombosis and severe pulmonary embolism].

Two cases of severe pulmonary embolism associated with right atrial thrombosis are reported. In the first case, fibrinolytic therapy was administered and was thought to be a causative factor in the death of the patient due to massive pulmonary embolism. In the second case, the patient was referred for surgery and two enormous thrombi were extracted.

[Myocardial infarction in young women: apropos of 22 cases. Pathogenic and prognostic approach].

The authors report 22 cases of myocardial infarction documented by selective left ventriculography and coronary angiography in women under 45 years of age. The average age in this series was 36 +/- 6.8 years.

Systolic intra-cavitary gradients following aortic valve replacement: an echo-Doppler study.

Systolic left ventricular flow was studied by pulsed and continuous wave Doppler in 41 patients following aortic valve replacement for severe stenosis (mean valvular area: 0.58 cm2; range 0.3-0.

[Diagnosis of coronary artery disease by thallium 201 myocardial scintigraphy during atrial pacing].

Rapid atrial pacing may reveal myocardial ischemia but the sensitivity for the diagnosis of coronary artery disease is not high enough for routine use. Therefore, the value of atrial pacing coupled with Thallium 201 scintigraphy was evaluated. Sixty-two patients (53 men and 9 women) referred for investigation of angina or chest pain were divided into two groups: a control group of 13 patients (9 men and 4 women, average age: 57.

[Evaluation of aortocoronary bypass using exercise myocardial thallium 201 scintigraphy].

The surveillance of aortocoronary bypass grafts is a difficult problem. Clinical examination and exercise testing are unable to give a complete evaluation of the operative results and cardiac catheterisation with radiological opacification of the grafts are not without risk and cannot be repeated periodically. Therefore, radioisotopic methods have been proposed as a means of assessing aortocoronary bypass grafts.

[Idiopathic ventricular arrhythmia in children. Apropos of 24 cases].

The severity and prognosis of idiopathic ventricular arrhythmias in childhood were studied in 24 patients (12 boys, 12 girls) with an average age of 8 years at the time of diagnosis of the arrhythmia. Investigations included clinical assessment and analysis of basal ECG (morphology of the arrhythmias) and dynamic recordings (Holter and exercise stress testing). The clinical course was followed for an average of 3.

[Accelerated idioventricular rhythm. 2 new cases in children].

Two new cases of idiopathic accelerated idioventricular rhythm are reported in children aged 12 and 16. This is a very rare arrhythmia in childhood with only 12 previously published cases in the medical literature. The prognosis seems to be excellent in all cases which underlines the importance of distinguishing this rhythm from other ventricular arrhythmias observed in childhood.

[Comparison of data from exercise tests and continuous electrocardiographic recording in patients with ventricular extrasystole. Apropos of 131 cases].

A series of 131 patients aged from 4 to 70 years old with significant ventricular arrhythmias corresponding to at least Grade 2 of Lown's classification underwent exercise stress testing and continuous 24 hour electrocardiography. There were two objectives: to compare exercise electrocardiography and Holter monitoring in the detection and assessment of the seriousness of the arrhythmia, and to assess the arrhythmia's modifications on exercise. The patients were divided into 4 types: "chronic coronary insufficiency", "mitral valve prolapse", "other cardiac disease" and "idiopathic" arrhythmias.

[Evaluation of cardiovascular disturbances in patients with erythrodermic skin diseases by echocardiography (author's transl)].

Echocardiography was performed in seventeen patients with acute or chronic erythrodermic skin disease, to assess the cardiovascular disturbances. Fundamental difference is between the acute erythrodermic skin diseases, in which the cardiac output is low and the chronic erythrodermic skin diseases in which the cardiac output is very high, during the attacks. The reasons of this difference are studied.

[Ventricular arrhythmias in mitral valve prolapse (author's transl)].

Ventricular arrhythmias were looked for in 35 patients with mitral valve prolapse. Their frequency is estimated to 35% in the 31 cases studied prospectively. Ventricular tachycardia is observed in 23% of them.

[Horseshoe kidney and hypertension (author's transl)].

The authors report a case of horseshoe kidney responsible for hypertension through a one-sided renal dysplasia. The part of the renal malformation in the development of the hypertension is attested by the activities of renin from renal veins, by the isotopic nephrogram and by the disappearance of the hypertension following the heminephrectomy. The hypertension seems an exceptionnal complication of the horseshoe kidney, which can be surprising given the frequency of this malformation and associated urologic anomalies.

[Williams-Beuren syndrome and renovascular arterial hypertension].

The Williams and Beuren's syndrome associates a particuliar facies, a mental debility, a supravalvular aortic stenosis, and frequent vascular anomalies of pulmonary artery as well as aorta and its branches. Relations between this syndrome and congenital idiopathic hypercalcemia seem now determined; the hypertension which has been frequently observed in this last case, seems more unusual in the case of Williams and Beuren's syndrome. The authors report a case about this syndrome in which the hypertension seemed linked to a stenosis of the left renal artery and which has been treated surgically.

[Hyperthyroidism and atrioventricular heart block (author's transl)].

Two cases of thyrotoxicosis including a first-degree heart block are reported; a study of action potentials of the bundle of His was achieved in the second case. The association atrioventricular block-hyperthyroidism is unusual but does not seem to be a pure coincidence. The direct effect of thyroid hormon on the myocardium is supposed to be responsible for the conduction disturbance; its disappearance with the cure of the thyrotoxicosis is a favourable argument for a relation of causality.

[Complete atrio-ventricular block caused by a metastatic tumor of the heart. Apropos of a case].

Metastatic tumors of the heart are often asymptomatic but they may dominate the clinical picture. The location in the interventricular septum can account for conduction disturbances. The authors report a case of esophagus neoplasm with septal metastasis responsible for a complete atrioventricular block.